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Sample records for stroke subcortical dementia

  1. Dysphagia Post Subcortical and Supratentorial Stroke.

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    Wan, Ping; Chen, Xuhui; Zhu, Lequn; Xu, Shuangjin; Huang, Li; Li, Xiangcui; Ye, Qing; Ding, Ruiying

    2016-01-01

    Studies have recognized that the damage in the subcortical and supratentorial regions may affect voluntary and involuntary aspects of the swallowing function. The current study attempted to explore the dysphagia characteristics in patients with subcortical and supratentorial stroke. Twelve post first or second subcortical and supratentorial stroke patients were included in the study. The location of the stroke was ascertained by computed tomography and magnetic resonance imaging. The characteristics of swallowing disorder were assessed by video fluoroscopic swallowing assessment/fiberoptic endoscopic evaluation of swallowing. The following main parameters were analyzed: oral transit time, pharyngeal delay time, presence of cricopharyngeal muscle achalasia (CMA), distance of laryngeal elevation, the amounts of vallecular residue and pyriform sinus residue (PSR), and the extent of pharyngeal contraction. Eighty-three percent of the 12 patients were found suffering from pharyngeal dysphagia, with 50% having 50%-100% PSRs, 50% having pharyngeal delay, and 41.6% cases demonstrating CMA. Simple regression analysis showed PSRs were most strongly associated with CMA. Pharyngeal delay in the study can be caused by infarcts of basal ganglia/thalamus, infarcts of sensory tract, infarcts of swallowing motor pathways in the centrum semiovale, or a combination of the three. Subcortical and supratentorial stroke may result in pharyngeal dysphagia such as PSR and pharyngeal delay. PSR was mainly caused by CMA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Gait and Equilibrium in Subcortical Vascular Dementia

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    Rita Moretti

    2011-01-01

    Full Text Available Subcortical vascular dementia is a clinical entity, widespread, even challenging to diagnose and correctly treat. Patients with this diagnosis are old, frail, often with concomitant pathologies, and therefore, with many drugs in therapy. We tried to diagnose and follow up for three years more than 600 patients. Study subjects were men and women, not bedridden, aged 68–94 years, outpatients, recruited from June, 1st 2007 to June, 1st 2010. We examined them clinically, neurologically, with specific consideration on drug therapies. Our aim has been to define gait and imbalance problem, if eventually coexistent with the pathology of white matter and/or with the worsening of the deterioration. Drug intake interference has been detected and considered.

  3. Gait and apathy as relevant symptoms of subcortical vascular dementia.

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    Moretti, Rita; Cavressi, Monica; Tomietto, Paola

    2015-06-01

    Subcortical vascular dementia relates to small-vessel disease and hypoperfusion, resulting in focal and diffuse ischemic white matter lesions. The main target of the disease are the frontal subcortical neural networks. There is no clinical standard definition of the pathology, on the contrary, everyday clinical practice suggests dominant behavioral alterations and dysexecutive syndrome. The aim of this study was to investigate gait disorders, behavioral alteration, and drug intake of a subcortical population with dementia (n = 1155). A complete neuropsychological examination was conducted at baseline and every 6 months, and the results were compared. Our data suggest that there is a significant increment in apathy levels and a dramatic decrease in gait and equilibrium control in the patients examined during follow-up. Subcortical vascular dementia may be associated with gait and balance alteration and apathy per se; we suggest to implement clinical data with these major aspects. © The Author(s) 2014.

  4. High-resolution nuclear magnetic resonance imaging and single photon emission computerized tomography--cerebral blood flow in a case of pure sensory stroke and mild dementia owing to subcortical arteriosclerotic encephalopathy (Binswanger's disease)

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    De Chiara, S.; Lassen, N.A.; Andersen, A.R.; Gade, A.; Lester, J.; Thomsen, C.; Henriksen, O.

    1987-01-01

    Pure sensory stroke (PSS) is typically caused by a lacunar infarct located in the ventral-posterior (VP) thalamic nucleus contralateral to the paresthetic symptoms. The lesion is usually so small that it cannot be seen on computerized tomography (CT), as illustrated by our case. In our moderately hypertensive, 72-year-old patient with PSS, CT scanning and conventional nuclear magnetic resonance imaging (NMRI) scanning using a 7-mm-thick slice on a 1.5 Tesla instrument all failed to visualize the thalamic infarct. Using the high-resolution mode with 2-mm slice thickness it was, however, clearly seen. In addition, NMRI unexpectedly showed diffuse periventricular demyelinization as well as three other lacunar infarcts, i.e., findings characteristic of subcortical arteriosclerotic encephalopathy (SAE). This prompted psychometric testing, which revealed signs of mild (subclinical) dementia, in particular involving visiospatial apraxia; this pointed to decreased function of the right parietal cortex, which was structurally intact on CT and NMRI. Single photon emission computerized tomography by Xenon-133 injection and by hexamethyl-propyleneamine-oxim labeled with Technetium-99m showed asymmetric distribution of cerebral blood flow (CBF), with an 18% lower value in the right parietal cortex compared to the left side; this indicated asymmetric disconnection of the cortex by the SAE. Thus, the tomograms of the functional parameter, CBF, correlated better with the deficits revealed by neuropsychological testing than by CT or NMRI.

  5. Cognitive deficits of pure subcortical vascular dementia vs. Alzheimer disease: PiB-PET-based study.

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    Yoon, Cindy W; Shin, Ji Soo; Kim, Hee Jin; Cho, Hanna; Noh, Young; Kim, Geon Ha; Chin, Juhee H; Oh, Seung Jun; Kim, Jae Seung; Choe, Yearn Seong; Lee, Kyung-Han; Lee, Jae-Hong; Seo, Sang Won; Na, Duk L

    2013-02-05

    Despite many neuropsychological studies to differentiate subcortical vascular dementia (SVaD) from Alzheimer disease (AD), previous studies did not eliminate confounding effects of mixed Alzheimer and vascular pathology. We aimed to investigate neuropsychological differences between patients with Pittsburgh compound B (PiB)-negative SVaD and those with PiB-positive AD. We recruited patients who were clinically diagnosed with SVaD or AD and underwent an 11C-PiB-PET scan. All patients with SVaD fulfilled DSM-IV criteria for vascular dementia and had severe white matter hyperintensities. The diagnosis of AD was made on the basis of criteria for probable AD proposed by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. The final patient sample consisted of 44/67 (65.7%) patients with SVaD who tested negative for PiB retention [PiB- SVaD] and 61/68 (89.7%) patients with AD who tested positive for PiB retention [PiB(+) AD]. Patients with PiB- SVaD performed better than patients with PiB(+) AD on both verbal and visual memory tests including delayed recalls of the Seoul verbal learning test and Rey complex figure test. Patients with PiB- SVaD were worse than patients with PiB(+) AD on phonemic fluency of the Controlled Oral Word Association Test and Stroop color test. Patients with PiB- SVaD were better at memory but worse at frontal function than patients with PiB(+) AD. The differences in memory/frontal functions observed between the 2 groups, however, could not differentiate all individual data due to some overlap in the cutoff threshold.

  6. PET studies of brain energy metabolism in a model of subcortical dementia: progressive supranuclear Palsy

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    Blin, J.; Baron, J.C.; Cambon, H.

    1988-01-01

    In 41 patients with clinically determined Progressive Supranuclear Palsy, a model of degenerative subcortical dementia, alterations in regional brain energy metabolism with respect to control subjects have been investigated using positron computed tomography and correlated to clinical and neuropsychological scores. A generalized significant reduction in brain metabolism was found, which predominated in the prefrontal cortex in accordance with, and statistically correlated to, the frontal neuropsychological score

  7. Gray matter volume changes in chronic subcortical stroke: A cross-sectional study

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    Qingqing Diao

    2017-01-01

    Full Text Available This study aimed to investigate the effects of lesion side and degree of motor recovery on gray matter volume (GMV difference relative to healthy controls in right-handed subcortical stroke. Structural MRI data were collected in 97 patients with chronic subcortical ischemic stroke and 79 healthy controls. Voxel-wise GMV analysis was used to investigate the effects of lesion side and degree of motor recovery on GMV difference in right-handed chronic subcortical stroke patients. Compared with healthy controls, right-lesion patients demonstrated GMV increase (P < 0.05, voxel-wise false discovery rate correction in the bilateral paracentral lobule (PCL and supplementary motor area (SMA and the right middle occipital gyrus (MOG; while left-lesion patients did not exhibit GMV difference under the same threshold. Patients with complete and partial motor recovery showed similar degree of GMV increase in right-lesion patients. However, the motor recovery was correlated with the GMV increase in the bilateral SMA in right-lesion patients. These findings suggest that there exists a lesion-side effect on GMV difference relative to healthy controls in right-handed patients with chronic subcortical stroke. The GMV increase in the SMA may facilitate motor recovery in subcortical stroke patients.

  8. Apraxia for differentiating Alzheimer’s disease from subcortical vascular dementia and mild cognitive impairment

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    Ozkan S

    2013-07-01

    Full Text Available Serhat Ozkan,1 Demet Ozbabalik Adapinar,1 Nese Tuncer Elmaci,2 Didem Arslantas31Department of Neurology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey; 2Department of Neurology, Marmara University Medical Faculty, Istanbul, Turkey; 3Department of Public Health, Eskisehir Osmangazi University Medical Faculty, Eskisehir, TurkeyAbstract: Although ideomotor limb apraxia is considered to be a typical sign of cortical pathologies such as Alzheimer’s disease (AD, it has been also reported in subcortical neurodegenerative diseases and vascular lesions. We aimed to investigate the difference between AD, subcortical vascular dementia (SVaD and mild cognitive impairment (MCI patients by means of ideomotor limb apraxia frequency and severity. Ninety-six AD, 72 SVaD, and 84 MCI patients were assessed with the mini-mental status examination (MMSE, clinical dementia rating (CDR and the apraxia screening test of TULIA (AST. Apraxia was significantly more frequent in the AD patients (32.3% than in both of the SVaD (16.7% and MCI (4.8% patients. The frequency of apraxia was also significantly higher in SVaD patients than in MCI patients. AD patients had significantly lower apraxia scores than both SVaD and MCI patients. In addition, a significant difference was found between SVaD and MCI patients in terms of apraxia scores. These results suggest that the widespread belief of the association between apraxia and cortical dementias is not exactly correct. The significant difference between both of the dementia groups and the MCI patients suggests that the absence of apraxia can be an indicator for MCI diagnosis.Keywords: apraxia, Alzheimer’s disease, subcortical vascular dementia, mild cognitive impairment

  9. Impaired ideomotor limb apraxia in cortical and subcortical dementia: a comparison of Alzheimer's and Huntington's disease.

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    Holl, Anna K; Ille, Rottraut; Wilkinson, Leonora; Otti, Daniela V; Hödl, Elfriede; Herranhof, Brigitte; Reisinger, Karin M; Müller, Nicole; Painold, Annamaria; Holl, Etienne M; Letmaier, Martin; Bonelli, Raphael M

    2011-01-01

    Although ideomotor limb apraxia is often considered to occur only in dementia with cortical involvement like Alzheimer's disease (AD), it is also frequently seen in dementia with subcortical degeneration like Huntington's disease (HD). To assess the occurrence of ideomotor limb apraxia, 46 patients with HD (27 men) and 37 patients with AD (16 men), matched for cognitive performance, were assessed with an apraxia test battery containing tests of the imitation of meaningless hand and finger gestures, the performance of meaningful gestures and of pantomimic movements. There was a high frequency of ideomotor limb apraxia in both AD and HD patients. For the assessment of hands' imitation 13.5% of the AD patients and 41.3% of the HD patients were apraxic, for fingers' imitation 21.6% (AD) and 41.3% (HD) were apraxic, for gestures 27.0% (AD) and 32.6% (HD), and for the assessment of pantomimic movements 24.3% (AD) and 52.2% (HD) showed apraxia. In the AD patients, disease severity was related to the occurrence of apraxia. Ideomotor limb apraxia is a common sign in both groups of patients, occurring in a high percentage. For particular neuropsychological deficits, including ideomotor limb apraxia, a division of dementia in a subcortical and cortical subtype seems to be clinically not meaningful. Copyright © 2011 S. Karger AG, Basel.

  10. Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study.

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    Cai, Jianxin; Ji, Qiling; Xin, Ruiqiang; Zhang, Dianping; Na, Xu; Peng, Ruchen; Li, Kuncheng

    2016-01-01

    Although changes in brain gray matter after stroke have been identified in some neuroimaging studies, lesion heterogeneity and individual variability make the detection of potential neuronal reorganization difficult. This study attempted to investigate the potential structural cortical reorganization after sub-cortical stroke using a longitudinal voxel-based gray matter volume (GMV) analysis. Eleven right-handed patients with first-onset, subcortical, ischemic infarctions involving the basal ganglia regions underwent structural magnetic resonance imaging in addition to National Institutes of Health Stroke Scale (NIHSS) and Motricity Index (MI) assessments in the acute (reorganization of the CL "cognitive" cortices might contribute to motor recovery after sub-cortical stroke.

  11. Neuropsychological performance in patients with subcortical stroke Perfil neuropsicológico em pacientes com lesões vasculares subcorticais

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    Silviane Pinheiro Campos de Andrade

    2012-05-01

    Full Text Available Vascular cognitive impairment (VCI is characterized by cognitive compromise predominantly of executive dysfunction. OBJECTIVES: To assess cognitive functions in VCI, focusing on executive functions, to observe functional losses in relation to activities of daily living (ADLs and to detect early symptoms prior to the onset of dementia. METHODS: We evaluated healthy subjects matched for gender, education and age to patients with diagnosis of subcortical vascular disease who had a stroke classified into three groups: 1 vascular lesions and no impairment; 2 vascular cognitive impairment with no dementia (VCIND; 3 vascular dementia (VaD. RESULTS AND DISCUSSION: The performance on neuropsychological tests differed among groups, worsening with increased impairment level. The probable VaD group demonstrated impaired performance in memory, processing speed and verbal production, while the VCIND group showed attention deficits. CONCLUSION: Impairment in executive functions and difficulties in ADLs allow us to differentiate levels of impairment in groups of subcortical vascular disease.O comprometimento cognitivo vascular (CCV é caracterizado por comprometimento cognitivo predominantemente sob a forma de disfunção executiva. OBJETIVOS: Avaliar as funções cognitivas no CCV, enfocando as funções executivas, observar as perdas funcionais em relação às atividades cotidianas (AVDs e detectar os primeiros sintomas antes do início da demência. MÉTODOS: Foram avaliados indivíduos controles saudáveis pareados por sexo, escolaridade e idade com pacientes com diagnóstico de doença vascular subcortical que sofreram derrame classificados em três grupos: 1 lesões vasculares sem déficit; 2 comprometimento cognitivo vascular sem demência (CCVSD; 3 demência vascular (DV. RESULTADOS E DISCUSSÃO: O desempenho em testes neuropsicológicos diferiu entre os grupos, sendo o desempenho tanto pior quanto maior o comprometimento. O grupo DV prov

  12. Vascular dementia | Connor | African Journal of Psychiatry

    African Journals Online (AJOL)

    Vascular dementia (VaD) is a common but heterogeneous condition in which there is a clear temporal relationship between the dementia and vascular disease. It may result from multiple large or small vessel strokes or a single strategic stroke. Subcortical ischaemic VaD includes multiple lacunes and subcortical ...

  13. Screening for New Biomarkers for Subcortical Vascular Dementia and Alzheimer’s Disease

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    Annika Öhrfelt

    2011-01-01

    Full Text Available Background: Novel biomarkers are important for identifying as well as differentiating subcortical vascular dementia (SVD and Alzheimer’s disease (AD at an early stage in the disease process. Methods: In two independent cohorts, a multiplex immunoassay was utilized to analyze 90 proteins in cerebrospinal fluid (CSF samples from dementia patients and patients at risk of developing dementia (mild cognitive impairment. Results: The levels of several CSF proteins were increased in SVD and its incipient state, and in moderate-to-severe AD compared with the control group. In contrast, some CSF proteins were altered in AD, but not in SVD. The levels of heart-type fatty acid binding protein (H-FABP were consistently increased in all groups with dementia but only in some of their incipient states. Conclusions: In summary, these results support the notion that SVD and AD are driven by different pathophysiological mechanisms reflected in the CSF protein profile and that H-FABP in CSF is a general marker of neurodegeneration.

  14. Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction.

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    Liu, Gang; Peng, Kangqiang; Dang, Chao; Tan, Shuangquan; Chen, Hongbing; Xie, Chuanmiao; Xing, Shihui; Zeng, Jinsheng

    2018-01-01

    Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear. This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction. Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke. Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery. Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery).

  15. Seoul criteria for PiB(-) subcortical vascular dementia based on clinical and MRI variables.

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    Kim, Geon Ha; Lee, Jae Hong; Seo, Sang Won; Ye, Byoung Seok; Cho, Hanna; Kim, Hee Jin; Noh, Young; Yoon, Cindy W; Chin, Ju Hee; Oh, Seung Jun; Kim, Jae Seung; Choe, Yearn Seong; Lee, Kyung Han; Kim, Sung Tae; Jeong, Jee Hyang; Na, Duk L

    2014-04-29

    The purpose of this study was to propose new criteria for differentiating Pittsburgh compound B (PiB)-negative from PiB-positive subcortical vascular dementia (SVaD) using clinical and MRI variables. We measured brain amyloid deposition using PiB-PET in 77 patients with SVaD. All patients met DSM-IV criteria for vascular dementia and had severe white matter hyperintensities on MRI, defined as a cap or band ≥ 10 mm as well as a deep white matter lesion ≥ 25 mm. Eleven models were considered to differentiate PiB(-) from PiB(+) SVaD using 4 variables, including age, number of lacunes, medial temporal atrophy (MTA), and APOE ε4. The ideal cutoff values in each of the 11 models were selected using the highest Youden index. A total of 49 of 77 patients (63.6%) tested negative for PiB retention, while 28 (36.4%) tested positive for PiB retention. The ideal model for differentiating PiB(-) from PiB(+) SVaD was as follows: age ≤ 75 years, ≥ 5 lacunes, and MTA ≤ 3, which together yielded an accuracy of 67.5%. When patients meet the DSM-IV criteria for vascular dementia and also have severe white matter hyperintensities, younger age, greater number of lacunes, and lesser MTA, these are predictive of a PiB(-) scan in patients with SVaD. This study provides Class II evidence that the combination of younger age, greater number of lacunes, and lesser MTA identifies patients with SVaD at lower risk of Alzheimer disease pathology.

  16. Does EEG (visual and quantitative) reflect mental impairment in subcortical vascular dementia?

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    Gawel, M; Zalewska, E; Szmidt-Sałkowska, E; Kowalski, J

    2007-06-15

    The aim of this study was to determine if the results of visual and quantitative EEG (QEEG) parameters reveal a correlation with mental impairment in subcortical vascular dementia (SVD), one of the most frequent causes of cognitive impairment in the elderly. In SVD, like in Alzheimer's disease disturbances were found in cholinergic transmission. The cholinergic deficit as manifested in changes of synaptic potentials is reflected in EEG signals. 31 patients with probable SVD (according to NINCDS-AIREN and T. Erkinjuntii's criteria) and mean age 72.3 yrs;(M--43%, F--57%) and 14 healthy control subjects with mean age of 72.3 yrs (M-57%, F-43%). According to the Mini Mental Scale Examination (MMSE) the SVD group was divided into two subgroups with mild and moderate dementia, their EEGs being recorded with a Medelec and Neuroscan 4.2 system. Visual EEG findings were classified with the use of eight-degree scale of pathological changes by the presence of slow waves. Then QEEGs were made. The following parameters were calculated: alpha/slow wave power ratios, the mean wave frequency in all and in some selected derivations. A significant difference was found between QEEGs in SVD subgroups with mild and moderate dementia (pvisual EEGs. A significant correlation between QEEG parameters such as alpha/slow wave ratio or mean wave frequency and mental impairment (according to MMSE results) was found (pvisual analysis and MMSE results. Only QEEGs are correlated with mental impairment in SVD. Visual EEG technique as a less precise tool does not reflect the mental impairment in SVD due to cholinergic deficit.

  17. Influence of education on subcortical hyperintensities and global cognitive status in vascular dementia.

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    Lane, Elizabeth M; Paul, Robert H; Moser, David J; Fletcher, Thomas D; Cohen, Ronald A

    2011-05-01

    Subcortical hyperintensities (SH) on neuroimaging are a prominent feature of vascular dementia (VaD) and SH severity correlates with cognitive impairment in this population. Previous studies demonstrated that SH burden accounts for a degree of the cognitive burden among VaD patients, although it remains unclear if individual factors such as cognitive reserve influence cognitive status in VaD. To address this issue, we examined 36 individuals diagnosed with probable VaD (age = 77.56; education = 12). All individuals underwent MMSE evaluations and MRI brain scans. We predicted that individuals with higher educational attainment would exhibit less cognitive difficulty despite similar levels of SH volume, compared to individuals with less educational attainment. A regression analysis revealed that greater SH volume was associated with lower scores on the MMSE. Additionally, education moderated the relationship between SH volume and MMSE score, demonstrating that individuals with higher education had higher scores on the MMSE despite similar degrees of SH burden. These results suggest that educational attainment buffers the deleterious effects of SH burden on cognitive status among VaD patients.

  18. Cortical thinning in subcortical vascular dementia with negative 11C-PiB PET.

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    Kim, Chi Hun; Seo, Sang Won; Kim, Geon Ha; Shin, Ji Soo; Cho, Hanna; Noh, Young; Kim, Suk-Hui; Kim, Min Ji; Jeon, Seun; Yoon, Uicheul; Lee, Jong-Min; Oh, Seung Jun; Kim, Jae Seung; Kim, Sung Tae; Lee, Jae-Hong; Na, Duk L

    2012-01-01

    To determine the existence of cortical thinning in subcortical vascular dementia (SVaD) with a negative 11C-Pittsburgh compound B (PiB) positron emission tomography scan and to compare the topography of cortical thinning between PiB-negative SVaD and Alzheimer's disease (AD), we enrolled 24 patients with PiB(-) SVaD, 81 clinically probable AD individuals, and 72 normal cognitive controls. Compared with controls, cortical thinning in PiB(-) SVaD was most profound in the perisylvian area, medial prefrontal area, and posterior cingulate gyri, while the precuneus and medial temporal lobes were relatively spared. When the cortical thickness of AD and PiB(-) SVaD were directly compared, PiB(-) SVaD demonstrated significant cortical thinning in the bilateral inferior frontal, superior temporal gyri, and right medial frontal and orbitofrontal lobes, while AD showed significant cortical thinning in the right medial temporal region. SVaD without amyloid burden may lead to substantial cortical atrophy. Moreover, characteristic topography of cortical thinning in PiB(-) SVaD suggests different mechanisms of cortical thinning in PiB(-) SVaD and AD.

  19. Patient with rapidly evolving neurological disease with neuropathological lesions of Creutzfeldt-Jakob disease, Lewy body dementia, chronic subcortical vascular encephalopathy and meningothelial meningioma.

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    Vita, Maria Gabriella; Tiple, Dorina; Bizzarro, Alessandra; Ladogana, Anna; Colaizzo, Elisa; Capellari, Sabina; Rossi, Marcello; Parchi, Piero; Masullo, Carlo; Pocchiari, Maurizio

    2017-04-01

    We report a case of rapidly evolving neurological disease in a patient with neuropathological lesions of Creutzfeldt-Jakob disease (CJD), Lewy body dementia (LBD), chronic subcortical vascular encephalopathy and meningothelial meningioma. The coexistence of severe multiple pathologies in a single patient strengthens the need to perform accurate clinical differential diagnoses in rapidly progressive dementias. © 2016 Japanese Society of Neuropathology.

  20. Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial.

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    Kirton, Adam; Chen, Robert; Friefeld, Sharon; Gunraj, Carolyn; Pontigon, Anne-Marie; Deveber, Gabrielle

    2008-06-01

    Arterial ischaemic stroke (AIS) can cause disabling hemiparesis in children. We aimed to test whether contralesional, inhibitory repetitive transcranial magnetic stimulation (rTMS) could affect interhemispheric inhibition to improve hand function in chronic subcortical paediatric AIS. Patients were eligible for this parallel, randomised trial if they were in the SickKids Children's Stroke Program and had subcortical AIS more than 2 years previously, had transcallosal sparing, were more than 7 years of age, had hand motor impairment, had no seizures or dyskinesia, and were taking no drugs that alter cortical excitability. Patients were paired for age and weakness and were randomised within each pair to sham treatment or inhibitory, low-frequency rTMS over contralesional motor cortex (20 min, 1200 stimuli) once per day for 8 days. An occupational therapist did standardised tests of hand function at days 1 (baseline), 5, 10, and 17 (1 week post-treatment), and the primary outcomes were changes in grip strength and the Melbourne assessment of upper extremity function (MAUEF) between baseline and day 10. Patients, parents, and occupational therapists were blinded to treatment allocation. Analysis was per protocol. Ten patients with paediatric stroke were enrolled (median age 13.25 [IQR 10.08-16.78] years, mean time post-stroke 6.33 [SD 3.56] years): four with mild weakness, two with moderate weakness, and four with severe weakness. A repeated-measures ANOVA showed a significant interaction between time and the effect of treatment on grip strength (p=0.03). At day 10, grip strength was 2.28 (SD 1.01) kg greater than baseline in the rTMS group and 2.92 (1.20) kg less than baseline in the sham group (p=0.009). Benefits in mean grip strength persisted at day 17 (2.63 [0.56] kg greater than baseline with rTMS and 1.00 [0.70] kg less than baseline with sham treatment; p=0.01). Day 10 MAUEF score improved by more in the rTMS group than in the sham group (7.25 [3.8] vs 0.79 [1

  1. Motor and premotor cortices in subcortical stroke: proton magnetic resonance spectroscopy measures and arm motor impairment.

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    Craciunas, Sorin C; Brooks, William M; Nudo, Randolph J; Popescu, Elena A; Choi, In-Young; Lee, Phil; Yeh, Hung-Wen; Savage, Cary R; Cirstea, Carmen M

    2013-06-01

    Although functional imaging and neurophysiological approaches reveal alterations in motor and premotor areas after stroke, insights into neurobiological events underlying these alterations are limited in human studies. We tested whether cerebral metabolites related to neuronal and glial compartments are altered in the hand representation in bilateral motor and premotor areas and correlated with distal and proximal arm motor impairment in hemiparetic persons. In 20 participants at >6 months postonset of a subcortical ischemic stroke and 16 age- and sex-matched healthy controls, the concentrations of N-acetylaspartate and myo-inositol were quantified by proton magnetic resonance spectroscopy. Regions of interest identified by functional magnetic resonance imaging included primary (M1), dorsal premotor (PMd), and supplementary (SMA) motor areas. Relationships between metabolite concentrations and distal (hand) and proximal (shoulder/elbow) motor impairment using Fugl-Meyer Upper Extremity (FMUE) subscores were explored. N-Acetylaspartate was lower in M1 (P = .04) and SMA (P = .004) and myo-inositol was higher in M1 (P = .003) and PMd (P = .03) in the injured (ipsilesional) hemisphere after stroke compared with the left hemisphere in controls. N-Acetylaspartate in ipsilesional M1 was positively correlated with hand FMUE subscores (P = .04). Significant positive correlations were also found between N-acetylaspartate in ipsilesional M1, PMd, and SMA and in contralesional M1 and shoulder/elbow FMUE subscores (P = .02, .01, .02, and .02, respectively). Our preliminary results demonstrated that proton magnetic resonance spectroscopy is a sensitive method to quantify relevant neuronal changes in spared motor cortex after stroke and consequently increase our knowledge of the factors leading from these changes to arm motor impairment.

  2. Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia

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    Kandiah N

    2017-04-01

    AChE-BuChE inhibitory activity of rivastigmine as a therapeutic strategy in the treatment of neurological disorders, with a focus on the role of rivastigmine in subcortical dementias such as vascular dementia (VaD and PDD. Toward this objective, we performed a literature search in PubMed and Ovid with limits to articles published in the English language before June 2016. The available evidence from the literature suggests that the dual inhibition of AChE and BuChE may afford additional therapeutic potential of rivastigmine in subcortical dementias (subcortical VaD and PDD with benefits on cognition and behavioral symptoms. Rivastigmine was found to specifically benefit executive dysfunction frequently observed in subcortical dementias; however, large randomized clinical studies are warranted to support these observations. Keywords: acetylcholinesterase, BuChE genotype, butyrylcholinesterase, Parkinson’s disease dementia, rivastigmine, subcortical vascular dementia

  3. Dementia

    Science.gov (United States)

    ... aging. Many different diseases can cause dementia, including Alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve ...

  4. Long-Term Risk of Dementia among Survivors of Ischemic or Hemorrhagic Stroke

    DEFF Research Database (Denmark)

    Corraini, Priscila; Henderson, Victor; Ording, Anne Gulbech

    2017-01-01

    BACKGROUND AND PURPOSE: Stroke is a risk factor for dementia, but the risk of dementia after different stroke types is poorly understood. We examined the long-term risk of dementia among survivors of any first-time stroke and of first-time ischemic stroke, intracerebral hemorrhage, and subarachnoid...... 303 survivors of unspecified stroke types. Patients were aged ≥18 years and survived for at least 3 months after diagnosis. We formed a comparison cohort from the general population (1 075 588 patients without stroke, matched to stroke patients by age and sex). We computed absolute risks and hazard...... ratios of dementia up to 30 years after stroke. RESULTS: The 30-year absolute risk of dementia among stroke survivors was 11.5% (95% confidence interval, 11.2%-11.7%). Compared with the general population, the hazard ratio (95% confidence interval) for dementia among stroke survivors was 1.80 (1...

  5. Abnormal organization of white matter network in patients with no dementia after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Lin Shi

    Full Text Available Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4-14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18-30, compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26-30. Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could

  6. Subcortical vascular cognitive impairment, no dementia : EEG global power independently predicts vascular impairment and brain symmetry index reflects severity of cognitive decline

    NARCIS (Netherlands)

    Sheorajpanday, Rishi V.A.; Mariën, Peter; Nagels, Guy; Weeren, Arie J.T.M.; Saerens, Jos; Van Putten, Michel J.A.M.; de Deyn, Peter P.

    2014-01-01

    Background and Purpose: Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG

  7. Subcortical Vascular Cognitive Impairment, No Dementia : EEG Global Power Independently Predicts Vascular Impairment and Brain Symmetry Index Reflects Severity of Cognitive Decline

    NARCIS (Netherlands)

    Sheorajpanday, Rishi V. A.; Marien, Peter; Nagels, Guy; Weeren, Arie J. T. M.; Saerens, Jos; van Putten, Michel J. A. M.; De Deyn, Peter P.

    2014-01-01

    Background and Purpose:Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG

  8. Cerebral Microbleeds and the Risk of Incident Ischemic Stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy).

    Science.gov (United States)

    Puy, Laurent; De Guio, François; Godin, Ophélia; Duering, Marco; Dichgans, Martin; Chabriat, Hugues; Jouvent, Eric

    2017-10-01

    Cerebral microbleeds are associated with an increased risk of intracerebral hemorrhage. Recent data suggest that microbleeds may also predict the risk of incident ischemic stroke. However, these results were observed in elderly individuals undertaking various medications and for whom causes of microbleeds and ischemic stroke may differ. We aimed to test the relationship between the presence of microbleeds and incident stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy)-a severe monogenic small vessel disease known to be responsible for both highly prevalent microbleeds and a high incidence of ischemic stroke in young patients. We assessed microbleeds on baseline MRI in all 378 patients from the Paris-Munich cohort study. Incident ischemic strokes were recorded during 54 months. Survival analyses were used to test the relationship between microbleeds and incident ischemic stroke. Three hundred sixty-nine patients (mean age, 51.4±11.4 years) were followed-up during a median time of 39 months (interquartile range, 19 months). The risk of incident ischemic stroke was higher in patients with microbleeds than in patients without (35.8% versus 19.6%, hazard ratio, 1.87; 95% confidence interval, 1.16-3.01; P =0.009). These results persisted after adjustment for history of ischemic stroke, age, sex, vascular risk factors, and antiplatelet agents use (hazard ratio, 1.89; 95% confidence interval, 1.10-3.26; P =0.02). The presence of microbleeds is an independent risk marker of incident ischemic stroke in CADASIL, emphasizing the need to carefully interpret MRI data. © 2017 American Heart Association, Inc.

  9. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)

    2002-01-01

    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic

  10. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)

    2002-01-01

    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic origin,

  11. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

    Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  12. Differences of Tc-99m HMPAO SPECT imaging in the early stage of subcortical vascular dementia compared with Alzheimer's disease

    International Nuclear Information System (INIS)

    Park, Kyung Won; Kang, Do Young; Park, Min Jeong; Cheon, Sang Myung; Cha, Jae Kwan; Kim, Sang Ho; Kim, Jae Woo

    2007-01-01

    The aim of this study is to assess the specific patterns of regional cerebral blood flow (rCBF) in patients with the early stage of subcortical vascular dementia (SVaD) and Alzheimer's disease (AD) using Tc-99m HMPAO SPECT, and to compare the differences between the two conditions. Sixteen SVaD, 46 AD and 12 control subjects participated in this study. We included the patients with SVaD and AD according to NINCDS-ADRDA and NINDS-AIREN criteria. They were all matched for age, education and clinical dementia rating scores. Three groups were evaluated by Tc-99m HMPAO SPECT using statistical parametric mapping (SPM) for measuring rCBF. The SPECT data of patients with SVaD and AD were compared with those of normal control subjects and then compared with each other. SPM analysis of the SPECT image showed significant perfusion deficits on the right temporal region and thalamus, left insula and superior temporal gyrus, both cingulate gyri and frontal subgyri in patients with SVaD and on the left supramarginal gyrus, superior temporal gyrus, postcentral gyrus and inferior parietal lobule, right fugiform gyrus and both cingulate gyri in AD compared with control subjects (uncorrected ρ < 0.01). SVaD patients revealed significant hypoperfusion in the right parahippocampal gyrus with cingulated gyrus, left insula and both frontal subgyral regions compared with AD (uncorrected ρ < 0.01). Our study shows characteristic and different pattern of perfusion deficits in patients with SVaD and AD, and these results may be helpful to discriminate the two conditions in the early stage of illness

  13. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  14. Characteristic pattern of cerebral perfusion in patients with the early stage of subcortical vascular dementia compared with Alzheimer's disease

    International Nuclear Information System (INIS)

    Jeong, Young Jin; Kang, Do Young; Park, Kyung Won; Cheon, Sang Myung; Kim, Jong Kuk; Kim, Jae Woo

    2004-01-01

    Brain perfusion SPECT has been commonly used to evaluate several different types of dementia. The aim of this study is to assess the specific patterns of regional cerebral blood flow (rCBF) in patients with the early stage of subcortical vascular dementia (SVD) and Alzheimer's disease (AD) using Tc-99m HMPAO SPECT, and to compare the differences between the two conditions. Sixteen SVD (mean age; 68.0±7.0 years, educational period; 6.3±5.6 years, CDR; 0.80±0.26). 46 AD (mean age; 69.9±7.4 years, educational period; 5.4±4.7 years, CDR; 0.86±0.23) and 12 normal control subjects (mean age; 67.1±7.7 years, educational period; 6.2±4.2 years) participated in this study. We included the patients with SVD and AD according to NINCDS-ADRDA criteria for probable AD and NINDS-AIREN criteria for probable or possible VD. They were all matched for age, education and clinical dementia scale scores. SPM analysis of the SPECT image showed significant perfusion deficits on the right temporal region and right thalamus, left insula and superior temporal gyrus, both cingulate gyri and frontal subgyral regions in patients with SVD and on the left supramarginal gyrus, superior temporal gyrus, postcentral gyrus and inferior parietal lobule, right fugiform gyrus and both cingulate gyri in patients with AD compared with control subjects (uncorrected p<0.01). SVD patients revealed significant hypoperfusion in the right parahippocampal gyrus, right cingulated gyrus, left insula, and both frontal subgyral regions compared with AD patients (uncorrected p<0.01). SVD patients revealed significant hyperperfusion in right superior frontal gyrus, left pre- and postcentral gyri, left paracentral lobule, left precuneus and both medial frontal gyri compared with AD patients (uncorrected p<0.01). Our study shows characteristic and different pattern of perfusion deficits in patients with SVD and AD, and these results may be helpful to discriminate the two conditions in the early stage of illness

  15. [Risk factors and predictive factors of cognitive deterioration in patients of vascular cognitive impairment no dementia with subcortical ischemic vascular disease].

    Science.gov (United States)

    Tan, Cheng; Peng, Wenhong; Deng, Yan

    2014-02-11

    To explore the independent risk factors and predictive factors of cognitive deterioration in patients of vascular cognitive impairment no dementia with subcortical ischemic vascular disease (VCIND-SIVD). The clinical and neuropsychological characteristics of 96 VCIND-SIVD patients were collected and their cognitive states re-assessed after one year. The distribution of continuous and categorical variables was examined with univariate analysis. And Logistic regression in multivariate modeling was employed to identify the risk and predictive factors of cognitive deterioration. After 1-year follow-up, 8 patients dropped out, 2 died and the remainder remained. There were 48 males and 38 females with an average age of 64.3 ± 5.4 years. Among them, 17 (19.8%) deteriorated into dementia, 24 (27.9%) upgraded to normal cognition and 45 (52.3%) maintained their cognitive status. They were divided into dementia group (cognition deteriorating into dementia) and control group (elevated/sustained cognition). After univariate analysis of general information and vascular risk factors, Logistic regression demonstrated that education level (P dementia while age (P dementia. After univariate analysis of neuropsychological scores, Logistic regression demonstrated that visual reproduction-immediate recall (P dementia. VCIND-SIVD patients with low score of visual reproduction-immediate recall, digit span forward, clock drawing test and completion time of London tower should receive vigorous controls of hypertension and high homocysteine.

  16. Contribution of the resting-state functional connectivity of the contralesional primary sensorimotor cortex to motor recovery after subcortical stroke.

    Directory of Open Access Journals (Sweden)

    Huijuan Xu

    Full Text Available It remains uncertain if the contralesional primary sensorimotor cortex (CL_PSMC contributes to motor recovery after stroke. Here we investigated longitudinal changes in the resting-state functional connectivity (rsFC of the CL_PSMC and their association with motor recovery. Thirteen patients who had experienced subcortical stroke underwent a series of resting-state fMRI and clinical assessments over a period of 1 year at 5 time points, i.e., within the first week, at 2 weeks, 1 month, 3 months, and 1 year after stroke onset. Thirteen age- and gender-matched healthy subjects were recruited as controls. The CL_PSMC was defined as a region centered at the voxel that had greatest activation during hand motion task. The dynamic changes in the rsFCs of the CL_PSMC within the whole brain were evaluated and correlated with the Motricity Index (MI scores. Compared with healthy controls, the rsFCs of the CL_PSMC with the bilateral PSMC were initially decreased, then gradually increased, and finally restored to the normal level 1 year later. Moreover, the dynamic change in the inter-hemispheric rsFC between the bilateral PSMC in these patients was positively correlated with the MI scores. However, the intra-hemispheric rsFC of the CL_PSMC was not correlated with the MI scores. This study shows dynamic changes in the rsFCs of the CL_PSMC after stroke and suggests that the increased inter-hemispheric rsFC between the bilateral PSMC may facilitate motor recovery in stroke patients. However, generalization of our findings is limited by the small sample size of our study and needs to be confirmed.

  17. Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries.

    Science.gov (United States)

    Garcia-Ptacek, Sara; Contreras Escamez, Beatriz; Zupanic, Eva; Religa, Dorota; von Koch, Lena; Johnell, Kristina; von Euler, Mia; Kåreholt, Ingemar; Eriksdotter, Maria

    2018-02-01

    To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. Acute Psychosis Associated with Subcortical Stroke: Comparison between Basal Ganglia and Mid-Brain Lesions

    Directory of Open Access Journals (Sweden)

    Aaron McMurtray

    2014-01-01

    Full Text Available Acute onset of psychosis in an older or elderly individual without history of previous psychiatric disorders should prompt a thorough workup for neurologic causes of psychiatric symptoms. This report compares and contrasts clinical features of new onset of psychotic symptoms between two patients, one with an acute basal ganglia hemorrhagic stroke and another with an acute mid-brain ischemic stroke. Delusions and hallucinations due to basal ganglia lesions are theorized to develop as a result of frontal lobe dysfunction causing impairment of reality checking pathways in the brain, while visual hallucinations due to mid-brain lesions are theorized to develop due to dysregulation of inhibitory control of the ponto-geniculate-occipital system. Psychotic symptoms occurring due to stroke demonstrate varied clinical characteristics that depend on the location of the stroke within the brain. Treatment with antipsychotic medications may provide symptomatic relief.

  19. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke.

    Science.gov (United States)

    Wong, Adrian; Lau, Alexander Y L; Lo, Eugene; Tang, Michael; Wang, Zhaolu; Liu, Wenyan; Tanner, Nicole; Chau, Natalie; Law, Lorraine; Shi, Lin; Chu, Winnie C W; Yang, Jie; Xiong, Yun-Yun; Lam, Bonnie Y K; Au, Lisa; Chan, Anne Y Y; Soo, Yannie; Leung, Thomas W H; Wong, Lawrence K S; Lam, Linda C W; Mok, Vincent C T

    2016-01-01

    Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3-6 months after stroke. Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, pleisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.

  20. A post hoc evaluation of a sample size re-estimation in the Secondary Prevention of Small Subcortical Strokes study.

    Science.gov (United States)

    McClure, Leslie A; Szychowski, Jeff M; Benavente, Oscar; Hart, Robert G; Coffey, Christopher S

    2016-10-01

    The use of adaptive designs has been increasing in randomized clinical trials. Sample size re-estimation is a type of adaptation in which nuisance parameters are estimated at an interim point in the trial and the sample size re-computed based on these estimates. The Secondary Prevention of Small Subcortical Strokes study was a randomized clinical trial assessing the impact of single- versus dual-antiplatelet therapy and control of systolic blood pressure to a higher (130-149 mmHg) versus lower (size re-estimation was performed during the Secondary Prevention of Small Subcortical Strokes study resulting in an increase from the planned sample size of 2500-3020, and we sought to determine the impact of the sample size re-estimation on the study results. We assessed the results of the primary efficacy and safety analyses with the full 3020 patients and compared them to the results that would have been observed had randomization ended with 2500 patients. The primary efficacy outcome considered was recurrent stroke, and the primary safety outcomes were major bleeds and death. We computed incidence rates for the efficacy and safety outcomes and used Cox proportional hazards models to examine the hazard ratios for each of the two treatment interventions (i.e. the antiplatelet and blood pressure interventions). In the antiplatelet intervention, the hazard ratio was not materially modified by increasing the sample size, nor did the conclusions regarding the efficacy of mono versus dual-therapy change: there was no difference in the effect of dual- versus monotherapy on the risk of recurrent stroke hazard ratios (n = 3020 HR (95% confidence interval): 0.92 (0.72, 1.2), p = 0.48; n = 2500 HR (95% confidence interval): 1.0 (0.78, 1.3), p = 0.85). With respect to the blood pressure intervention, increasing the sample size resulted in less certainty in the results, as the hazard ratio for higher versus lower systolic blood pressure target approached, but did not

  1. Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA. The Rotterdam Study.

    Science.gov (United States)

    Mirza, Saira Saeed; Portegies, Marileen L P; Wolters, Frank J; Hofman, Albert; Koudstaal, Peter J; Tiemeier, Henning; Ikram, M Arfan

    2016-01-01

    Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains unknown. Within the population-based Rotterdam Study, 12,561 participants free of stroke, TIA and dementia were followed for occurrence of stroke, TIA and dementia. Across the levels of education, associations of incident stroke or TIA with subsequent development of dementia and differences in cognitive decline following stroke or TIA were investigated. During 124,862 person-years, 1,463 persons suffered a stroke or TIA, 1,158 persons developed dementia, of whom 186 developed dementia after stroke or TIA. Risk of dementia after a stroke or TIA, compared to no stroke or TIA, was highest in the low education category (hazards ratio [HR] 1.46, 95% CI 1.18-1.81) followed by intermediate education category (HR 1.36, 95% CI 1.03-1.81). No significant association was observed in the high education category (HR 0.62, 95% CI 0.25-1.54). In gender stratified analyses, decrease in risk of dementia with increasing education was significant only in men. Higher education is associated with a lower risk of dementia after stroke or TIA, particularly in men, which might be explained by a higher cognitive reserve. © 2016 S. Karger AG, Basel.

  2. Subcortical vascular cognitive impairment, no dementia: EEG global power independently predicts vascular impairment and brain symmetry index reflects severity of cognitive decline.

    Science.gov (United States)

    Sheorajpanday, Rishi V A; Mariën, Peter; Nagels, Guy; Weeren, Arie J T M; Saerens, Jos; van Putten, Michel J A M; De Deyn, Peter P

    2014-10-01

    Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG parameters in subcortical vCIND in comparison with amnestic multidomain mild cognitive impairment to determine the additional diagnostic value of quantitative EEG in this setting. Fifty-seven community-residing patients with an uneventful central neurologic history and first presentation of cognitive decline without dementia were included. Neuropsychological test results were correlated with EEG parameters. Predictive values for vCIND and amnestic multidomain mild cognitive impairment were calculated using receiver operating characteristic curves and logistic regression modeling. Vascular cognitive impairment, no dementia and amnestic multidomain mild cognitive impairment differed with regard to the EEG (delta + theta)/(alpha + beta) ratio (DTABR) and pairwise derived brain symmetry index. We found statistically significant correlations between pairwise derived brain symmetry index and immediate verbal memory, immediate global memory, verbal recognition, working memory, and mean memory score in vCIND. Verbal fluency (odds ratio: 1.54, 95% confidence interval: 1.04-2.28, P = 0.033) and (delta + theta)/(alpha + beta) ratio (odds ratio: 2.28, 95% confidence interval: 1.06-4.94, P = 0.036) emerged as independent diagnostic predictors for vCIND with an overall correct classification rate of 95.0%. Our data indicate that EEG is of additional value in the differential diagnosis and follow-up of patients presenting with cognitive decline. These findings may have an impact on memory care.

  3. Effect of the presence of brain-derived neurotrophic factor val(66)met polymorphism on the recovery in patients with acute subcortical stroke.

    Science.gov (United States)

    Kim, Won-Seok; Lim, Jong Youb; Shin, Joon Ho; Park, Hye Kyung; Tan, Samuel Arnado; Park, Kyoung Un; Paik, Nam-Jong

    2013-06-01

    To investigate the effect of brain-derived neurotrophic factor (BDNF) Val(66)Met polymorphism on the recovery after subcortical stroke, using the modified Rankin Scale (mRS). Subcortical stroke patients with copies of BDNF Val(66)Met polymorphism (n=7) were compared to their controls (n=7) without a copy of BDNF Val(66)Met polymorphism after matching for initial severity, location and type of stroke. The mRS scores at 1 and 3 months after discharge from the neurorehabilitation unit were compared between the groups. A repeated measures ANOVA for mRS revealed significant interaction between time and group (F(2, 24) =37.2, pfactor for recovery and responses to rehabilitation therapies after stroke in Korean patients. There is a need for developing different rehabilitation strategies for the population with BDNF Val(66)Met polymorphism. Further studies assessing different outcomes for various functional domains of stroke recovery are needed to clarify the role of BDNF Val(66)Met polymorphism.

  4. Effects of low-frequency repetitive transcranial magnetic stimulation of the contralesional primary motor cortex on movement kinematics and neural activity in subcortical stroke.

    Science.gov (United States)

    Nowak, Dennis A; Grefkes, Christian; Dafotakis, Manuel; Eickhoff, Simon; Küst, Jutta; Karbe, Hans; Fink, Gereon R

    2008-06-01

    Following the concept of interhemispheric competition, downregulation of the contralesional primary motor cortex (M1) may improve the dexterity of the affected hand after stroke. To determine the effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of the contralesional M1 on movement kinematics and neural activation within the motor system in the subacute phase after subcortical stroke. Crossover investigation. A university hospital. Fifteen right-handed patients with impaired dexterity due to subcortical middle cerebral artery stroke received 1-Hz rTMS for 10 minutes applied to the vertex (control stimulation) and contralesional M1. For behavioral testing, patients performed finger and grasp movements with both hands at 2 baseline conditions, separated by 1 week, and following each rTMS application. For functional magnetic resonance imaging, patients performed hand grip movements with their affected or unaffected hand before and after each rTMS application. Application of rTMS to the contralesional M1 improved the kinematics of finger and grasp movements in the affected hand. At the neural level, rTMS applied to the contralesional M1 reduced overactivity in the contralesional primary and nonprimary motor areas. There was no significant correlation between the rTMS-induced reduction in blood oxygen level-dependent responses within the contralesional M1 and the degree of behavioral improvement of the affected hand. Overactivity of the contralesional dorsal premotor cortex, contralesional parietal operculum, and ipsilesional mesial frontal cortex at baseline predicted improvement of movement kinematics with the affected hand after rTMS of the contralesional M1. The functional magnetic resonance imaging data suggest that rTMS of the contralesional M1 may normalize neural activation within the cortical motor network after subcortical stroke. Identifying patients suitable for rTMS intervention based on individual patterns of cortical activation may help

  5. Higher education is associated with a lower risk of dementia after a stroke or TIA : The Rotterdam study

    NARCIS (Netherlands)

    S.S. Mirza (Saira); M.L.P. Portegies (Marileen); F.J. Wolters (Frank J.); A. Hofman (Albert); P.J. Koudstaal (Peter Jan); H.W. Tiemeier (Henning); M.A. Ikram (Arfan)

    2016-01-01

    markdownabstract__Background:__ Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains

  6. Risk and Determinants of Dementia in Patients with Mild Cognitive Impairment and Brain Subcortical Vascular Changes: A Study of Clinical, Neuroimaging, and Biological Markers—The VMCI-Tuscany Study: Rationale, Design, and Methodology

    Directory of Open Access Journals (Sweden)

    Anna Poggesi

    2012-01-01

    Full Text Available Dementia is one of the most disabling conditions. Alzheimer’s disease and vascular dementia (VaD are the most frequent causes. Subcortical VaD is consequent to deep-brain small vessel disease (SVD and is the most frequent form of VaD. Its pathological hallmarks are ischemic white matter changes and lacunar infarcts. Degenerative and vascular changes often coexist, but mechanisms of interaction are incompletely understood. The term mild cognitive impairment defines a transitional state between normal ageing and dementia. Pre-dementia stages of VaD are also acknowledged (vascular mild cognitive impairment, VMCI. Progression relates mostly to the subcortical VaD type, but determinants of such transition are unknown. Variability of phenotypic expression is not fully explained by severity grade of lesions, as depicted by conventional MRI that is not sensitive to microstructural and metabolic alterations. Advanced neuroimaging techniques seem able to achieve this. Beside hypoperfusion, blood-brain-barrier dysfunction has been also demonstrated in subcortical VaD. The aim of the Vascular Mild Cognitive Impairment Tuscany Study is to expand knowledge about determinants of transition from mild cognitive impairment to dementia in patients with cerebral SVD. This paper summarizes the main aims and methodological aspects of this multicenter, ongoing, observational study enrolling patients affected by VMCI with SVD.

  7. Evaluation of role of brain SPECT in diagnosis of post stroke dementia

    International Nuclear Information System (INIS)

    Yousepour, G.; Alavi, M.

    2003-01-01

    Post stroke dementia is one of the most common complications of stroke that is preventable and relatively treatable too. The purpose of the study is comparison between the positive findings in the brain CT scan and brain perfusion SPECT. 15 patients who were complicated by dementia after cerebrovascular accident and also 5 patients as a control group enrolled in this study. Brain CT scan and brain SPECT were performed during at most one week after stroke. Abnormal findings in both brain CT scan and SPECT were seen in 46% of patients. Brain CT scan disclosed more abnormal findings compared to brain SPECT (33.3%). While brain SPECT findings were more information than brain CT scan (20%) this study is indicating that brain CT scan and the brain SPECT concomitantly for each other in better diagnosis of post stroke dementia. We did not find any specific diagnostic pattern in brain SPECT of patients suffering from post stroke dementia. The low quality of brain SPECT in spite of uniformity of gamma camera may be suggestive of low quality of Iran produced ECD kit that needs further evaluation

  8. Does the influence of stroke on dementia vary by different levels of prestroke cognitive functioning?: a cohort study.

    Science.gov (United States)

    Dregan, Alex; Wolfe, Charles D A; Gulliford, Martin C

    2013-12-01

    The association between stroke and subsequent dementia or Alzheimer disease is well established. What is less understood is the extent to which this association is dependent on prestroke cognitive functioning. The study estimated the occurrence in poststroke dementia as a function of prestroke cognitive status and incident stroke. Study data were derived from the English Longitudinal Study of Ageing, a 10-year long prospective cohort study of older adults living in England. Baseline data (2002/2003) were used to group participants into tertiles of cognitive, memory, and executive functioning before an incident stroke. Data from 4 follow-up surveys were used to identify new stroke and poststroke dementia events. The analyses were based on 10 809 participants aged≥50 years at baseline. High prestroke executive functioning was associated with lower relative risk (RR) of dementia (RR, 0.24; 95% confidence interval, 0.13-0.45; P<0.001). Stroke was associated with increased RR of poststroke dementia (RR, 2.63; 95% confidence interval, 1.80-3.84; P<0.001). The association of stroke with poststroke dementia was greater for participants with higher prestroke executive functioning (interaction term RR, 4.4; 95% confidence interval, 1.35-14.63; P=0.014). For participants with higher executive functioning, the probability of dementia was 0.3% without stroke and 3.1% after stroke, compared with 1.9% and 5.2% for lower executive functioning. Stroke and prestroke cognition were independently associated with increased probability of poststroke dementia. Stroke results in disproportionate increase in the risk of dementia when premorbid cognitive functioning is high.

  9. Patterns of blood pressure response during intensive BP lowering and clinical events: results from the secondary prevention of small subcortical strokes trial.

    Science.gov (United States)

    Ku, Elaine; Scherzer, Rebecca; Odden, Michelle C; Shlipak, Michael; White, Carole L; Field, Thalia S; Benavente, Oscar; Pergola, Pablo E; Peralta, Carmen A

    2018-04-01

    We applied cluster analysis to identify discrete patterns of concomitant responses of systolic (SBP), diastolic (DBP) and pulse pressure (PP) during intensive BP lowering; and to evaluate their clinical relevance and association with risk of mortality, major vascular events (MVEs), and stroke. We used an unsupervised cluster procedure to identify distinct patterns of BP change during the first 9 months of anti-hypertensive therapy intensification among 1,331 participants in the Secondary Prevention of Small Subcortical Strokes Trial who were previously randomized to lower BP target (SBP < 130 mm Hg) after lacunar stroke. The cluster procedure partitioned participants into three groups in the lower SBP target arm, persons with: 1) mildly elevated baseline SBP and minimal visit-to-visit BP variability (mild reducers); 2) moderately elevated baseline SBP and moderate visit-to-visit BP variability (moderate reducers); and 3) very elevated baseline SBP with very large visit-to-visit BP variability during intensification (large reducers). In the lower SBP target group, moderate reducers had a higher risk of death (adjusted HR 1.6 [95% CI 1.0-2.7]), MVE (adjusted HR 2.1 [95% CI 1.4-3.2]), and stroke (adjusted HR 2.6[95% CI 1.7-4.1]) compared to mild reducers. Large reducers had the highest risk of death (adjusted HR 2.3 [95% CI 1.2-4.4]), but risk of MVE (HR = 1.7 [95%CI 0.9-3.1]) and stroke (HR = 1.6 [95%CI: 0.8-3.5]) were not statistically significantly different compared to mild reducers. Among persons with prior lacunar stroke, baseline BP levels, and BP variability in the setting of intensive BP lowering can identify discrete groups of persons at higher risk of adverse outcomes.

  10. Fluent Aphasia in Telugu: A Case Comparison Study of Semantic Dementia and Stroke Aphasia

    Science.gov (United States)

    Alladi, Suvarna; Mridula, Rukmini; Mekala, Shailaja; Rupela, Vani; Kaul, Subhash

    2010-01-01

    This study presents two cases with fluent aphasia in Telugu with semantic dementia and post-stroke fluent aphasia. Comparable scores were obtained on the conventional neuropsychological and language tests that were administered on the two cases. Both cases demonstrated fluent, grammatical and well-articulated speech with little content, impaired…

  11. Ocular Fundus Photography as a Tool to Study Stroke and Dementia.

    Science.gov (United States)

    Cheung, Carol Y; Chen, Christopher; Wong, Tien Y

    2015-10-01

    Although cerebral small vessel disease has been linked to stroke and dementia, due to limitations of current neuroimaging technology, direct in vivo visualization of changes in the cerebral small vessels (e.g., cerebral arteriolar narrowing, tortuous microvessels, blood-brain barrier damage, capillary microaneurysms) is difficult to achieve. As the retina and the brain share similar embryological origin, anatomical features, and physiologic properties with the cerebral small vessels, the retinal vessels offer a unique and easily accessible "window" to study the correlates and consequences of cerebral small vessel diseases in vivo. The retinal microvasculature can be visualized, quantified and monitored noninvasively using ocular fundus photography. Recent clinic- and population-based studies have demonstrated a close link between retinal vascular changes seen on fundus photography and stroke and dementia, suggesting that ocular fundus photography may provide insights to the contribution of microvascular disease to stroke and dementia. In this review, we summarize current knowledge on retinal vascular changes, such as retinopathy and changes in retinal vascular measures with stroke and dementia as well as subclinical makers of cerebral small vessel disease, and discuss the possible clinical implications of these findings in neurology. Studying pathologic changes of retinal blood vessels may be useful for understanding the etiology of various cerebrovascular conditions; hence, ocular fundus photography can be potentially translated into clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke.

    Directory of Open Access Journals (Sweden)

    Adrian Wong

    Full Text Available Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke.Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD 3-6 months after stroke. Regular participation (≥3 times per week in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3-6 months after stroke.Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63 and stretching & toning physical exercise (0.37, 0.21-0.64 was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, p<0.01 and in intellectual (r = 0.40, p<0.01, recreational (r = 0.24, p<0.01, strenuous aerobic (r = 0.23, p<0.01 and mind-body (r = 0.10, p<0.01 activities was associated with higher poststroke Mini-mental State Examination scores in models adjusted for prestroke cognitive decline.Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in patients with and without recurrent strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance. Findings of this

  13. Pyramidal neurons of the prefrontal cortex in post-stroke, vascular and other ageing-related dementias.

    Science.gov (United States)

    Foster, Vincent; Oakley, Arthur E; Slade, Janet Y; Hall, Roslyn; Polvikoski, Tuomo M; Burke, Matthew; Thomas, Alan J; Khundakar, Ahmad; Allan, Louise M; Kalaria, Raj N

    2014-09-01

    Dementia associated with cerebrovascular disease is common. It has been reported that ∼30% of elderly patients who survive stroke develop delayed dementia (post-stroke dementia), with most cases being diagnosed as vascular dementia. The pathological substrates associated with post-stroke or vascular dementia are poorly understood, particularly those associated with executive dysfunction. Three separate yet interconnecting circuits control executive function within the frontal lobe involving the dorsolateral prefrontal cortex, anterior cingulate cortex and the orbitofrontal cortex. We used stereological methods, along with immunohistological and related cell morphometric analysis, to examine densities and volumes of pyramidal neurons of the dorsolateral prefrontal cortex, anterior cingulate cortex and orbitofrontal cortex in the frontal lobe from a total of 90 elderly subjects (age range 71-98 years). Post-mortem brain tissues from post-stroke dementia and post-stroke patients with no dementia were derived from our prospective Cognitive Function After Stroke study. We also examined, in parallel, samples from ageing controls and similar age subjects pathologically diagnosed with Alzheimer's disease, mixed Alzheimer's disease and vascular dementia, and vascular dementia. We found pyramidal cell volumes in layers III and V in the dorsolateral prefrontal cortex of post-stroke and vascular dementia and, of mixed and Alzheimer's disease subjects to be reduced by 30-40% compared to post-stroke patients with no dementia and controls. There were no significant changes in neuronal volumes in either the anterior cingulate or orbitofrontal cortices. Remarkably, pyramidal neurons within the orbitofrontal cortex were also found to be smaller in size when compared to those in the other two neocortical regions. To relate the cell changes to cognitive function, we noted significant correlations between neuronal volumes and total CAMCOG, orientation and memory scores and clinical

  14. Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

    Science.gov (United States)

    Minn, Yang-Ki; Park, Hyunyoung; Cheong, Jin-Sung; Yang, Hyunduk; Lee, Sungik; Do, Seung-Yeon; Kang, Ji-Sook

    2013-01-01

    Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 ± 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P dementia-free adults. PMID:23772160

  15. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study.

    Science.gov (United States)

    Pase, Matthew P; Himali, Jayandra J; Beiser, Alexa S; Aparicio, Hugo J; Satizabal, Claudia L; Vasan, Ramachandran S; Seshadri, Sudha; Jacques, Paul F

    2017-05-01

    Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. We examined whether sugar- or artificially sweetened beverage consumption was associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort. We studied 2888 participants aged >45 years for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged >60 years for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified using a food-frequency questionnaire at cohort examinations 5 (1991-1995), 6 (1995-1998), and 7 (1998-2001). We quantified recent consumption at examination 7 and cumulative consumption by averaging across examinations. Surveillance for incident events commenced at examination 7 and continued for 10 years. We observed 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer's disease). After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer's disease dementia. When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval, 1.26-6.97) for ischemic stroke and 2.89 (95% confidence interval, 1.18-7.07) for Alzheimer's disease. Sugar-sweetened beverages were not associated with stroke or dementia. Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia. © 2017 American Heart Association, Inc.

  16. Population-Based 5-Year Follow-Up Study in Taiwan of Dementia and Risk of Stroke

    Science.gov (United States)

    Liu, Mu-En; Tsai, Shih-Jen; Chang, Wei-Chiao; Hsu, Chun-Hung; Lu, Ti; Hung, Kuo-Sheng; Chiu, Wen-Ta; Chang, Wei-Pin

    2013-01-01

    Background This study estimates the risk of stroke within 5 years of newly diagnosed dementia among elderly persons aged 65 and above. We examined the relationship between antipsychotic usage and development of stroke in patients with dementia. Methods We conducted a nationwide 5-year population-based study using data retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan. The study cohort comprised 2243 patients with dementia aged ≥65 years who had at least one inpatient service claim or at least 2 ambulatory care claims, whereas the comparison cohort consisted of 6714 randomly selected subjects (3 for every dementia patient) and were matched with the study group according to sex, age, and index year. We further classified dementia patients into 2 groups based on their history of antipsychotic usage. A total of 1450 patients were classified into the antipsychotic usage group and the remaining 793 patients were classified into the non-antipsychotic usage group. Cox proportional-hazards regressions were performed to compute the 5-year stroke-free survival rates after adjusting for potentially confounding factors. Results The dementia patients have a 2-fold greater risk of developing stroke within 5 years of diagnosis compared to non-dementia age- and sex-matched subjects, after adjusting for other risk factors (95% confidence interval (CI) = 2.58–3.08; Pdementia increases risk of stroke 1.17-fold compared to patients without antipsychotic treatment (95% CI = 1.01–1.40; PDementia may be an independent risk factor for stroke, and the use of antipsychotics may further increase the risk of stroke in dementia patients. PMID:23626726

  17. Longitudinal Brain Functional Connectivity Changes of the Cortical Motor-Related Network in Subcortical Stroke Patients with Acupuncture Treatment

    Directory of Open Access Journals (Sweden)

    Yongxin Li

    2017-01-01

    Full Text Available In clinical practice, the effectiveness of the rehabilitation therapy such as acupuncture combining conventional Western medicine (AG on stroke people’s motor-related brain network and their behaviors has not been systematically studied. In the present study, seventeen adult ischemic patients were collected and divided into two groups: the conventional Western medicine treatment group (CG and the AG. The neurological deficit scores (NDS and resting-state functional MRI data were collected before and after treatment. Compared with the CG patients, AG patients exhibited a significant enhancement of the percent changes of NDS from pre- to posttreatment intervention. All patients showed significant changes of functional connectivity (FC between the pair of cortical motor-related regions. After treatment, both patient groups showed a recovery of brain connectivity to the nearly normal level compared with the controls in these pairs. Moreover, a significant correlation between the percent changes of NDS and the pretreatment FC values of bilateral primary motor cortex (M1 in all patients was found. In conclusion, our results showed that AG therapy can be an effective means for ischemic stroke patients to recover their motor function ability. The FC strengths between bilateral M1 of stroke patients can predict stroke patients’ treatment outcome after rehabilitation therapy.

  18. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia.

    Science.gov (United States)

    Chen, Aiqing; Akinyemi, Rufus O; Hase, Yoshiki; Firbank, Michael J; Ndung'u, Michael N; Foster, Vincent; Craggs, Lucy J L; Washida, Kazuo; Okamoto, Yoko; Thomas, Alan J; Polvikoski, Tuomo M; Allan, Louise M; Oakley, Arthur E; O'Brien, John T; Horsburgh, Karen; Ihara, Masafumi; Kalaria, Raj N

    2016-01-01

    White matter hyperintensities as seen on brain T2-weighted magnetic resonance imaging are associated with varying degrees of cognitive dysfunction in stroke, cerebral small vessel disease and dementia. The pathophysiological mechanisms within the white matter accounting for cognitive dysfunction remain unclear. With the hypothesis that gliovascular interactions are impaired in subjects with high burdens of white matter hyperintensities, we performed clinicopathological studies in post-stroke survivors, who had exhibited greater frontal white matter hyperintensities volumes that predicted shorter time to dementia onset. Histopathological methods were used to identify substrates in the white matter that would distinguish post-stroke demented from post-stroke non-demented subjects. We focused on the reactive cell marker glial fibrillary acidic protein (GFAP) to study the incidence and location of clasmatodendrosis, a morphological attribute of irreversibly injured astrocytes. In contrast to normal appearing GFAP+ astrocytes, clasmatodendrocytes were swollen and had vacuolated cell bodies. Other markers such as aldehyde dehydrogenase 1 family, member L1 (ALDH1L1) showed cytoplasmic disintegration of the astrocytes. Total GFAP+ cells in both the frontal and temporal white matter were not greater in post-stroke demented versus post-stroke non-demented subjects. However, the percentage of clasmatodendrocytes was increased by >2-fold in subjects with post-stroke demented compared to post-stroke non-demented subjects (P = 0.026) and by 11-fold in older controls versus young controls (P < 0.023) in the frontal white matter. High ratios of clasmotodendrocytes to total astrocytes in the frontal white matter were consistent with lower Mini-Mental State Examination and the revised Cambridge Cognition Examination scores in post-stroke demented subjects. Double immunofluorescent staining showed aberrant co-localization of aquaporin 4 (AQP4) in retracted GFAP+ astrocytes with

  19. Screening for Very Mild Subcortical Vascular Dementia Patients Aged 75 and Above Using the Montreal Cognitive Assessment and Mini-Mental State Examination in a Community: The Kurihara Project

    Directory of Open Access Journals (Sweden)

    Mari Kasai

    2012-11-01

    Full Text Available Aims: To examine the effectiveness of the Montreal Cognitive Assessment (MoCA to screen people with mild cognitive impairment (MCI, to associate the MoCA score with the presence of infarction, and to detect the characteristics of people with very mild subcortical vascular dementia (vmSVD. Methods: 392 out of 886 community dwellers aged 75 years and above living in Kurihara, Northern Japan, agreed to participate in our study; 164 scored a Clinical Dementia Rating (CDR of 0 (healthy, 184 scored a CDR of 0.5 (MCI and 44 scored a CDR of 1+ (dementia. The participants scoring a CDR of 0.5 were divided into 2 subtypes: 37 had vmSVD and 147 had other types of dementia. The objective variables were the total MoCA, the MoCA subscale and the Mini-Mental State Examination (MMSE. Results: There was a difference in the MoCA and MMSE scores between the 3 CDR groups. The MoCA score overlapped in participants with CDR 0 and 0.5. There were significant CDR effects, while there were no significant infarction effects for the MoCA and MMSE. vmSVD participants had lower scores on the total MoCA, the MoCA attention subscale and MMSE than healthy elderly people and participants with other types of dementia. Conclusion: Our results suggested that MMSE performed rather well and that the MoCA is not superior to MMSE in MCI and vmSVD participants aged 75 and above in a community.

  20. The value of diffusion tensor imaging in the differential diagnosis of subcortical ischemic vascular dementia and Alzheimer's disease in patients with only mild white matter alterations on T2-weighted images

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Jian-Liang; Zhang, Ting (Dept. of Neurology, Shanghai Jiaotong Univ. Affiliated Sixth People' s Hospital, Shanghai (China)); Chang, Cheng; Zhang, Yu-Zhen; Li, Wen-Bin (Inst. of Diagnostic and Interventional Radiology, Shanghai Jiaotong Univ. Affiliated Sixth People' s Hospital, Shanghai (China)), Email: liwenbin@sh163.net

    2012-04-15

    Background: Diffusion tensor imaging (DTI) is a form of functional magnetic resonance imaging (MRI) that allows examination of the microstructural integrity of white matter in the brain. Dementia is a neurodegenerative disease, and DTI can provide indirect insights of the microstructural characteristics of brains in individuals with different forms of dementia. Purpose: To evaluate the value of DTI in the diagnosis and differential diagnosis of patients with subcortical ischemic vascular dementia (SIVD) and Alzheimer's disease (AD). Material and Methods: The study included 40 patients (20 AD patients and 20 SIVD patients) and 20 normal controls (NC). After routine MRI and DTI, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured and compared in regions of interest (ROI). Results: Compared to NC and AD patients, SIVD patients had lower FA values and higher ADC values in the inferior-fronto-occipital fascicles (IFOF), genu of the corpus callosum (GCC), splenium of the corpus callosum (SCC), and superior longitudinal fasciculus (SLF). Compared to controls and SIVD patients, AD patients had lower FA values in the anterior frontal lobe, temporal lobe, hippocampus, IFOF, GCC, and CF; and higher ADC values in the temporal lobe and hippocampus. Conclusion: DTI can be used to estimate the white matter impairment in dementia patients. There were significant regional reductions of FA values and heightened ADC values in multiple regions in SIVD patients compared to AD patients. When compared with conventional MRI, DTI may provide a more objective method for the differential diagnosis of SIVD and AD disease patients who have only mild white matter alterations on T2-weighted imaging

  1. Memory Loss, Dementia, and Stroke: Implications for Rehabilitation of Older Adults with Age-Related Macular Degeneration

    Science.gov (United States)

    Warren, Mary

    2008-01-01

    Older adults with age-related macular degeneration (AMD) are not immune to the other diseases of aging. Although AMD is the leading cause of low vision in older Americans, stroke is the leading cause of disability, and dementias affect another 2.5 million older Americans. Each condition alone can significantly impair a person's ability to…

  2. Metabolic vitamin B12 deficiency: a missed opportunity to prevent dementia and stroke.

    Science.gov (United States)

    Spence, J David

    2016-02-01

    The purpose of this narrative review is to highlight insights into the importance and frequency of metabolic vitamin B12 (B12) deficiency, reasons why it is commonly missed, and reasons for the widespread but mistaken belief that treatment of B12 deficiency does not prevent stroke or improve cognitive function. Metabolic B12 deficiency is common, being present in 10%-40% of the population; is frequently missed; is easily treated; and contributes importantly to cognitive decline and stroke in older people. Measuring serum B12 alone is not sufficient for diagnosis; it is necessary to measure holotranscobalamin or functional markers of B12 adequacy such as methylmalonic acid or plasma total homocysteine. B-vitamin therapy with cyanocobalamin reduces the risk of stroke in patients with normal renal function but is harmful (perhaps because of thiocyanate accumulation from cyanide in cyanocobalamin) in patients with renal impairment. Methylcobalamin may be preferable in renal impairment. B12 therapy slowed gray matter atrophy and cognitive decline in the Homocysteine and B Vitamins in Cognitive Impairment Trial. Undiagnosed metabolic B12 deficiency may be an important missed opportunity for prevention of dementia and stroke; in patients with metabolic B12 deficiency, it would be prudent to offer inexpensive and nontoxic supplements of oral B12, preferably methylcobalamin or hydroxycobalamin. Future research is needed to distinguish the effects of thiocyanate from cyanocobalamin on hydrogen sulfide, and effects of treatment with methylcobalamin on cognitive function and stroke, particularly in patients with renal failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Mortality and institutionalization in early survivors of stroke: the effects of cognition, vascular mild cognitive impairment, and vascular dementia.

    Science.gov (United States)

    Brodaty, Henry; Altendorf, Annette; Withall, Adrienne; Sachdev, Perminder S

    2010-01-01

    We explored th effects of vascular mild cognitive impairment (VaMCI), vascular dementia (VaD), and other predictors on mortality and institutionalization in early survivors of ischemic stroke without previous dementia who had been admitted to a stroke unit. A total of 202 consecutive consenting eligible ischemic stroke survivors and a matched sample of 97 community controls were followed for up to 10 years. Data for 167 patients who underwent detailed assessment 3-6 months after stroke were analyzed to determine predictors of outcomes. Cumulative mortality rates for patients (and controls) were 27% (4%) for the first 5 years and rose to 83% (10%) by 10 years. Predictors of mortality were older age, any cognitive impairment, less independent function, and less education. Nursing home admission rates were 24% at 5 years and 32% at 10 years for patients and 0 for controls over 8.9 years. Predictors of institutionalization were less independent function and older age. Patients with ischemic stroke who survive the first week have moderate, lower-than-expected mortality rates in the first 5 years that increase thereafter. VaMCI, VaD, and functional decline are predictors of mortality, while functional decline and older age predict institutionalization. Copyright © 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Dementia

    Science.gov (United States)

    ... dementia. Dementia is not the same as normal aging. When you’re in your 20s, you begin to lose brain cells a few at a time. Your body also ... to make less of the chemicals your brain cells need to work. The older you ... less affected by aging. Your recent memory is more affected. For example, ...

  5. Dementia

    Science.gov (United States)

    ... such as HIV/ AIDS , syphilis , and Lyme disease Parkinson disease Pick disease Progressive supranuclear palsy Some causes ... dementia or making it worse. These conditions include: Anemia Brain tumor Long-term (chronic) infection Intoxication from ...

  6. Vascular dementia

    African Journals Online (AJOL)

    Adele

    2003-12-10

    Dec 10, 2003 ... ischaemic VaD includes multiple lacunes and subcortical arteriosclerotic encephalopathy (Binswanger's disease) and imaging shows multiple deep ... culitis, multiple sclerosis, acute demyelinating encephalomy- ... Table I. The NINDS-AIREN criteria for the diagnosis of Vascular Dementia. 12. Require both ...

  7. encephalo- disease) Subcortical arteriosclerotic pathy (Binswanger's

    African Journals Online (AJOL)

    chronic vascular dementia with hydrocephalus charac- terized clinically by: (i) subacute focal neurological deficit; (ii) acute strokes; (iii) dementia; (iv) motor signs and pseudobulbar palsy; (v) hydrocephalus;. (vi) persistent hypertension and systemic vascular disease; and (vii) a lengthy course. The pathogene- sis is most ...

  8. Blood pressure and risk of vascular dementia: evidence from 4.3 million adults and a cohort study of TIA and stroke

    Science.gov (United States)

    Emdin, Connor A.; Rothwell, Peter M; Salimi-Khorshidi, Gholamreza; Kiran, Amit; Conrad, Nathalie; Callender, Thomas; Mehta, Ziyah; Pendlebury, Sarah T; Anderson, Simon G.; Mohseni, Hamid; Woodward, Mark; Rahimi, Kazem

    2017-01-01

    Background and Purpose Vascular dementia is the second most common form of dementia but reliable evidence on age-specific associations between blood pressure and risk of vascular dementia is limited and some studies have reported negative associations at older ages. Methods In a cohort of 4.28 million individuals, free of known vascular disease and dementia and identified from linked electronic primary care health records in the UK (Clinical Practice Research Datalink), we related blood pressure to time to physician-diagnosed vascular dementia. We further determined associations between blood pressure and dementia in a prospective population-based cohort of incident TIA and stroke (Oxford Vascular Study). Results Over a median follow-up of 7.0 years, 11 114 initial presentations of vascular dementia were observed in the primary care cohort after exclusion of the first four years of follow-up. The association between usual systolic blood pressure (SBP) and risk of vascular dementia decreased with age (HR per 20 mm Hg higher SBP = 1.62, 95% CI 1.13-2.35 at 30-50 years; 1.26, 1.18-1.35 at 51-70 years; 0.97, 0.92-1.03 at 71-90 years; p trend = 0.006). Usual SBP remained predictive of vascular dementia after accounting for effect mediation by stroke and TIA. In the population-based cohort, prior SBP was predictive of 5-year risk of dementia with no evidence of negative association at older ages. Conclusions Blood pressure is positively associated with risk of vascular dementia, irrespective of preceding TIA or stroke. Previous reports of inverse associations in old age could not be confirmed. PMID:27165956

  9. Blood Pressure and Risk of Vascular Dementia: Evidence From a Primary Care Registry and a Cohort Study of Transient Ischemic Attack and Stroke.

    Science.gov (United States)

    Emdin, Connor A; Rothwell, Peter M; Salimi-Khorshidi, Gholamreza; Kiran, Amit; Conrad, Nathalie; Callender, Thomas; Mehta, Ziyah; Pendlebury, Sarah T; Anderson, Simon G; Mohseni, Hamid; Woodward, Mark; Rahimi, Kazem

    2016-06-01

    Vascular dementia is the second most common form of dementia but reliable evidence on age-specific associations between blood pressure (BP) and risk of vascular dementia is limited and some studies have reported negative associations at older ages. In a cohort of 4.28 million individuals, free of known vascular disease and dementia and identified from linked electronic primary care health records in the United Kingdom (Clinical Practice Research Datalink), we related BP to time to physician-diagnosed vascular dementia. We further determined associations between BP and dementia in a prospective population-based cohort of incident transient ischemic attack and stroke (Oxford Vascular Study). For a median follow-up of 7.0 years, 11 114 initial presentations of vascular dementia were observed in the primary care cohort after exclusion of the first 4 years of follow-up. The association between usual systolic BP and risk of vascular dementia decreased with age (hazard ratio per 20 mm Hg higher systolic BP, 1.62; 95% confidence interval, 1.13-2.35 at 30-50 years; 1.26, 1.18-1.35 at 51-70 years; 0.97, 0.92-1.03 at 71-90 years; P trend=0.006). Usual systolic BP remained predictive of vascular dementia after accounting for effect mediation by stroke and transient ischemic attack. In the population-based cohort, prior systolic BP was predictive of 5-year risk of dementia with no evidence of negative association at older ages. BP is positively associated with risk of vascular dementia, irrespective of preceding transient ischemic attack or stroke. Previous reports of inverse associations in old age could not be confirmed. © 2016 American Heart Association, Inc.

  10. Classification enhancement for post-stroke dementia using fuzzy neighborhood preserving analysis with QR-decomposition.

    Science.gov (United States)

    Al-Qazzaz, Noor Kamal; Ali, Sawal; Ahmad, Siti Anom; Escudero, Javier

    2017-07-01

    The aim of the present study was to discriminate the electroencephalogram (EEG) of 5 patients with vascular dementia (VaD), 15 patients with stroke-related mild cognitive impairment (MCI), and 15 control normal subjects during a working memory (WM) task. We used independent component analysis (ICA) and wavelet transform (WT) as a hybrid preprocessing approach for EEG artifact removal. Three different features were extracted from the cleaned EEG signals: spectral entropy (SpecEn), permutation entropy (PerEn) and Tsallis entropy (TsEn). Two classification schemes were applied - support vector machine (SVM) and k-nearest neighbors (kNN) - with fuzzy neighborhood preserving analysis with QR-decomposition (FNPAQR) as a dimensionality reduction technique. The FNPAQR dimensionality reduction technique increased the SVM classification accuracy from 82.22% to 90.37% and from 82.6% to 86.67% for kNN. These results suggest that FNPAQR consistently improves the discrimination of VaD, MCI patients and control normal subjects and it could be a useful feature selection to help the identification of patients with VaD and MCI.

  11. Dementia.

    Science.gov (United States)

    Nardone, Raffaele; Golaszewski, Stefan; Trinka, Eugen

    2013-01-01

    Transcranial magnetic stimulation (TMS) has been used extensively to characterize motor system pathophysiology in Alzheimer's disease (AD) and other forms of dementia, as well to monitor the effects of certain pharmacological agents. Among the studies focusing on motor cortical excitability measures, the most consistent finding is a significant reduction of short-latency afferent inhibition (SAI) in AD and other forms of dementia in which the cholinergic system is affected, such as dementia with Lewy bodies. SAI evaluation may thus provide a reliable biomarker of cortical cholinergic dysfunction in dementias. Moreover, most TMS studies have demonstrated cortical hyperexcitability and asymptomatic motor cortex functional reorganization in the early stages of the disease. Integrated approaches utilizing TMS together with high-density EEG have indicated impaired cortical plasticity and functional connectivity across different neural networks in AD. Paired associative stimulation-induced plasticity has also been found to be abnormal in patients with AD. The development of novel noninvasive methods of brain stimulation, in particular repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), has increased the interest in neuromodulatory techniques as potential therapeutic tools for cognitive rehabilitation in AD. Preliminary studies have revealed that rTMS and tDCS can induce beneficial effects on specific cognitive functions in AD. Future studies are warranted to replicate and extend the initial findings. © 2013 Elsevier B.V. All rights reserved.

  12. Dementia.

    Science.gov (United States)

    Butler, Rob; Radhakrishnan, Raghavakurup

    2012-09-10

    Dementia is characterised by chronic, global, non-reversible deterioration in memory, executive function, and personality. Speech and motor function may also be impaired. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments on cognitive symptoms of dementia (Alzheimer's, Lewy body, or vascular)? What are the effects of treatments on behavioural and psychological symptoms of dementia (Alzheimer's, Lewy body, or vascular)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine), antidepressants (clomipramine, fluoxetine, imipramine, sertraline), antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), aromatherapy, benzodiazepines (diazepam, lorazepam), cognitive behavioural therapy (CBT), cognitive stimulation, exercise, ginkgo biloba, memantine, mood stabilisers (carbamazepine, sodium valproate/valproic acid), music therapy, non-steroidal anti-inflammatory drugs (NSAIDs), omega 3 (fish oil), reminiscence therapy, and statins.

  13. Music for the ageing brain: Cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia.

    Science.gov (United States)

    Särkämö, Teppo

    2017-01-01

    Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music is a powerful tool in the care and rehabilitation of many ageing-related neurological diseases. In addition to formal music therapy, there has been a growing interest in self- or caregiver-implemented musical leisure activities or hobbies as a widely applicable means to support psychological wellbeing in ageing and in neurological rehabilitation. This article reviews the currently existing evidence on the cognitive, emotional, and neural benefits of musical leisure activities in normal ageing as well as in the rehabilitation and care of two of the most common and ageing-related neurological diseases: stroke and dementia.

  14. The Role of Executive Function in the Semantic Comprehension Deficits of Stroke Aphasia and Semantic Dementia

    Directory of Open Access Journals (Sweden)

    Curtiss Chapman

    2015-05-01

    Results from 5 SD patients and 4 SA patients in our ongoing study suggest similar patterns of impairment on both semantic and executive function tasks for both patient groups. Both showed multi-modal semantic deficits via poor performance on at least 3 out of 5 semantic tasks tapping different modalities. Also, SA and SD patients showed no difference in consistency across semantic tasks (see Fig. 1a & b. Both groups also showed consistently poor performance on trail-making and verbal Stroop tasks compared to controls (see Figs. 1c & 1d. SD patients seem to be less impaired on both span measures (word span range: 2.17 – 4.43; digit span: 3.17 – 5.5 than SA patients (word span range: 1.63 – 3.75; digit span: 1.17 – 4.17, and performance was variable for both groups on non-verbal Stroop and picture-word interference. SD patients found many executive tasks too difficult to understand, which may be the reason for limited prior data for them on EF tasks.. These findings suggest that the use of syndrome categories like semantic dementia and comprehension-impaired stroke aphasia are not useful in distinguishing between storage and access deficits. Patients classified as having SD seem as likely as SA patients to have certain kinds of executive deficits and SA patients may be as likely as SD patients to show consistency across semantic tasks. The results imply that some other behavioral or neuroanatomical basis rather than syndrome classification should be used to address the hypothesized separation of storage vs. control aspects of semantic memory.

  15. The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population.

    Science.gov (United States)

    Abdin, Edimansyah; Chong, Siow Ann; Peh, Chao Xu; Vaingankar, Janhavi Ajit; Chua, Boon Yiang; Verma, Swapna; Jeyagurunathan, Anitha; Shafie, Saleha; Subramaniam, Mythily

    2017-03-20

    Our study aimed to investigate the pathways by which socio-demographic factors, modifiable health and lifestyle risk factors influence each other, and subsequently, lead to dementia. We used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older adult population aged 60 years and above in Singapore. Dementia diagnosis was established using 10/66 dementia criteria. Structural equation modelling (SEM) without latent variable was applied to confirm the hypothesized model. The results of SEM supported the hypothesized model (χ 2 = 14.999, df = 10, p = 0.132). The final model showed that those aged 75-84 years and 85 years and over (vs. 60-74 years), having no formal education, who had completed primary or secondary education (vs. completed tertiary), who were homemakers and retired (vs. paid work), and with a history of stroke were directly associated with higher odds of having dementia, while those who had more frequent contact with friends and neighbors as well as being physically active were directly associated with lower odds of having dementia diagnosis. The study also found that physical activity, more frequent contact with friends and stroke played a significant role as mediators in these relationships. The overall pathways model explained 57.7% of the variance in dementia. Our results suggest that physical activity, social contact and stroke were potential mediators in the relationship between age, education, employment and dementia. Intervention programmes focusing on physical activity such as exercise and social contact may be useful in reducing the risk of dementia among older adults.

  16. Senile dementia of the Binswanger type: a vascular form of dementia in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Roman, G.C.

    1987-10-02

    Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnections most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.

  17. Senile dementia of the Binswanger type: a vascular form of dementia in the elderly

    International Nuclear Information System (INIS)

    Roman, G.C.

    1987-01-01

    Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnections most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia

  18. Imaging dementias

    International Nuclear Information System (INIS)

    Savoiardo, M.; Grisoli, M.

    2001-01-01

    Dementia is the progressive loss of intellectual functions due to involvement of cortical or subcortical areas. Specific involvement of certain brain areas in the different diseases leads to impairment of different functions, e. g., memory, language, visuospatial abilities, and behavior. Magnetic resonance imaging and other neuroradiological studies may indicate which structures are mainly or selectively involved in a demented patient, thus allowing clinical-radiological correlations. Clinical presentation and evolution of the disease, supported by imaging studies, may lead to a highly probable diagnosis. The most common disorders, or the most relevant from the neuroradiological point of view, such as Alzheimer's disease, frontotemporal dementia, vascular dementias, dementia associated with parkinsonism, Huntington's disease, Creutzfeldt-Jakob disease, and normal-pressure hydrocephalus, are briefly discussed. (orig.)

  19. Imaging dementias

    Energy Technology Data Exchange (ETDEWEB)

    Savoiardo, M.; Grisoli, M. [Dept. of Neuroradiology, Istituto Nazionale Neurologico, Milan (Italy)

    2001-03-01

    Dementia is the progressive loss of intellectual functions due to involvement of cortical or subcortical areas. Specific involvement of certain brain areas in the different diseases leads to impairment of different functions, e. g., memory, language, visuospatial abilities, and behavior. Magnetic resonance imaging and other neuroradiological studies may indicate which structures are mainly or selectively involved in a demented patient, thus allowing clinical-radiological correlations. Clinical presentation and evolution of the disease, supported by imaging studies, may lead to a highly probable diagnosis. The most common disorders, or the most relevant from the neuroradiological point of view, such as Alzheimer's disease, frontotemporal dementia, vascular dementias, dementia associated with parkinsonism, Huntington's disease, Creutzfeldt-Jakob disease, and normal-pressure hydrocephalus, are briefly discussed. (orig.)

  20. Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke: (III) Applicability of Cognitive Tests.

    Science.gov (United States)

    Pendlebury, Sarah T; Klaus, Stephen P; Thomson, Ross J; Mehta, Ziyah; Wharton, Rose M; Rothwell, Peter M

    2015-11-01

    Cognitive assessment is recommended after stroke but there are few data on the applicability of short cognitive tests to the full spectrum of patients. We therefore determined the rates, causes, and associates of untestability in a population-based study of all transient ischemic attack (TIA) and stroke. Patients with TIA or stroke prospectively recruited (2002-2007) into the Oxford Vascular Study had ≥1 short cognitive test (mini-mental state examination, telephone interview of cognitive status, Montreal cognitive assessment, and abbreviated mental test score) at baseline and on follow-up to 5 years. Among 1097 consecutive assessed survivors (mean: age/SD, 74.8/12.1 years; 378 TIA), numbers testable with a short cognitive test at baseline, 1, 6, 12, and 60 months were 835/1097 (76%), 778/947 (82%), 756/857 (88%), 692/792 (87%), and 472/567 (83%). Eighty-eight percent (331/378) of assessed patients with TIA were testable at baseline compared with only 46% (133/290) of major stroke (Pstroke effects at baseline (153/262 [58%]: dysphasia/anarthria/hemiparesis=84 [32%], drowsiness=58 [22%], and acute confusion=11 [4%]), whereas sensory deficits caused relatively more problems with testing at later time points (24/63 [38%] at 5 years). Substantial numbers of patients with TIA and stroke are untestable with short cognitive tests. Future studies should report data on untestable patients and those with problems with testing in whom the likelihood of dementia is high. © 2015 American Heart Association, Inc.

  1. The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?

    International Nuclear Information System (INIS)

    Bateman, Grant A.; Levi, Christopher R.; Wang, Yang; Lovett, Elizabeth C.; Schofield, Peter

    2005-01-01

    Variable results are obtained from the treatment of normal pressure hydrocephalus (NPH) by shunt insertion. There is a high correlation between NPH and the pathology of Alzheimer's disease (AD) on brain biopsy. There is an overlap between AD and vascular dementia (VaD), suggesting that a correlation exists between NPH and other forms of dementia. This study seeks to (1) understand the physiological factors behind, and (2) define the ability of, the aqueduct stroke volume to exclude dementia co-morbidity. Twenty-four patients from a dementia clinic were classified as having either early AD or VaD on the basis of clinical features, Hachinski score and neuropsychological testing. They were compared with 16 subjects with classical clinical findings of NPH and 12 aged-matched non-cognitively impaired subjects. MRI flow quantification was used to measure aqueduct stroke volume and arterial pulse volume. An arterio-cerebral compliance ratio was calculated from the two volumes in each patient. The aqueduct stroke volume was elevated in all three forms of dementia, with no significant difference noted between the groups. The arterial pulse volume was elevated by 24% in VaD and reduced by 35% in NPH, compared to normal (P=0.05 and P=0.002, respectively), and was normal in AD. There was a spectrum of relative compliance with normal compliance in VaD and reduced compliance in AD and NPH. The aqueduct stroke volume depends on the arterial pulse volume and the relative compliance between the arterial tree and brain. The aqueduct stroke volume cannot exclude significant co-morbidity in NPH. (orig.)

  2. The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?

    Energy Technology Data Exchange (ETDEWEB)

    Bateman, Grant A. [John Hunter Hospital, Department of Medical Imaging, Newcastle (Australia); Levi, Christopher R.; Wang, Yang; Lovett, Elizabeth C. [Hunter Medical Research Institute, Clinical Neurosciences Program, Newcastle (Australia); Schofield, Peter [James Fletcher Hospital, Neuropsychiatry Unit, Newcastle (Australia)

    2005-10-01

    Variable results are obtained from the treatment of normal pressure hydrocephalus (NPH) by shunt insertion. There is a high correlation between NPH and the pathology of Alzheimer's disease (AD) on brain biopsy. There is an overlap between AD and vascular dementia (VaD), suggesting that a correlation exists between NPH and other forms of dementia. This study seeks to (1) understand the physiological factors behind, and (2) define the ability of, the aqueduct stroke volume to exclude dementia co-morbidity. Twenty-four patients from a dementia clinic were classified as having either early AD or VaD on the basis of clinical features, Hachinski score and neuropsychological testing. They were compared with 16 subjects with classical clinical findings of NPH and 12 aged-matched non-cognitively impaired subjects. MRI flow quantification was used to measure aqueduct stroke volume and arterial pulse volume. An arterio-cerebral compliance ratio was calculated from the two volumes in each patient. The aqueduct stroke volume was elevated in all three forms of dementia, with no significant difference noted between the groups. The arterial pulse volume was elevated by 24% in VaD and reduced by 35% in NPH, compared to normal (P=0.05 and P=0.002, respectively), and was normal in AD. There was a spectrum of relative compliance with normal compliance in VaD and reduced compliance in AD and NPH. The aqueduct stroke volume depends on the arterial pulse volume and the relative compliance between the arterial tree and brain. The aqueduct stroke volume cannot exclude significant co-morbidity in NPH. (orig.)

  3. Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up

    Science.gov (United States)

    Custodio, Nilton; Montesinos, Rosa; Lira, David; Herrera-Perez, Eder; Bardales, Yadira; Valeriano-Lorenzo, Lucia

    2017-01-01

    ABSTRACT. There is limited evidence about the progression of cognitive performance during the post-stroke stage. Objective: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD). Methods: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). Results: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. Conclusion: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients. PMID:29354218

  4. Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up

    Directory of Open Access Journals (Sweden)

    Nilton Custodio

    Full Text Available ABSTRACT. There is limited evidence about the progression of cognitive performance during the post-stroke stage. Objective: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI, patients with vascular mild cognitive impairment (MCI, and patients with vascular dementia (VD. Methods: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation, and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR, Addenbrooke's Cognitive Examination (ACE, and INECO Frontal Screening (IFS. Results: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46, contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24. The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16. Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. Conclusion: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

  5. Higher skeletal muscle mass may protect against ischemic stroke in community-dwelling adults without stroke and dementia: The PRESENT project.

    Science.gov (United States)

    Minn, Yang-Ki; Suk, Seung-Han

    2017-02-03

    It is well known that a low skeletal muscle mass (SMM) is associated with stroke. However, it is unknown whether increasing muscle mass can prevent stroke. This community-based cross-sectional study was supported by the regional government. SMM measurements and brain computed tomography was performed in 722 stroke-free and dementia-free subjects (aged 50-75 years). Subjects were divided into quartiles (Q) by SMM, checked using the bioelectrical impedance analysis method (InBody 770, InBody, Seoul, Korea). Odds ratios (ORs) of brain white matter changes/silent infarction (WMC/SI) were calculated. The subjects were then divided into two groups by sex and evaluated. In the analysis of the four groups, the unadjusted ORs of Q2-Q4 were 0.616 (95% confidence interval [CI], 0.372-1.022; P = 0.061), 0.290 (CI, 0.159-0.530; P < 0.001), and 0.209 (CI, 0.108-0.403; P < 0.001) for the risk of WMC/SI. Adjusted ORs for age, hypertension, diabetes mellitus, education, hypercholesterolemia, and smoking were 0.994 (CI, 0.513-1.740; P = 0.085), 0.669 (CI, 0.329-1.362; P = 0.268), and 0.464 (CI, 0.219-0.984; P = 0.045). In the two-group (dichotomized) analysis, the unadjusted OR for the higher muscle mass groups (Q3 + Q4) was 0.313 (CI, 0.200-0.491; P < 0.001). The adjusted OR was 0.577 (CI, 0.340-0.979; P = 0.042). Considering sex, the adjusted OR were 0.351 (CI, 0.141-0.869; P = 0.024) in men and 0.771 (CI, 0.391-1.519; P = 0.452) in women. Our findings suggest that increased SMM may protect against WMC/SI, especially in men.

  6. Comparing moral judgments of patients with frontotemporal dementia and frontal stroke.

    Science.gov (United States)

    Baez, Sandra; Couto, Blas; Torralva, Teresa; Sposato, Luciano A; Huepe, David; Montañes, Patricia; Reyes, Pablo; Matallana, Diana; Vigliecca, Nora S; Slachevsky, Andrea; Manes, Facundo; Ibanez, Agustin

    2014-09-01

    Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions. Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

  7. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  8. Multi-Infarct Dementia

    Science.gov (United States)

    ... SEARCH Definition Treatment Prognosis Clinical Trials Organizations Publications Definition Multi-infarct dementia (MID) is a common cause of memory loss in the elderly. MID is caused by multiple strokes (disruption of ...

  9. Trichotillomania in a dementia case

    Directory of Open Access Journals (Sweden)

    Leonardo Caixeta

    Full Text Available Abstract We report an 87-year-old male case of hair pulling associated with a white-matter vascular dementia (Binswanger's disease. Trichotillomania in our case did not resolve using mirtazapine or anticholinesterasic medication. Trichotillomania seems to be related to a form of perseveration associated with dementia. The findings in this case suggest the abnormality involving white matter in the pathogenesis of trichotillomania, may constitute a defect in connectivity in the right frontal-subcortical circuit.

  10. Early AIDS dementia complex

    International Nuclear Information System (INIS)

    Mountz, J.M.; Speed, N.M.; Adams, K.; Schwartz, J.A.; Gross, M.D.; Ostrow, D.G.

    1988-01-01

    A frequent complication of the acquired immunodeficiency syndrome (AIDS) is AIDS dementia complex (ADC). The authors evaluated seven patients with AIDS (aged 28-55 years, all male) for ADC by psychiatric evaluation, neuropsychological testing, CT scanning, and IMP-SPECT. Six of seven patients exhibited cognitive or behavioral abnormalities. Neuropsychological testing showed general deficits but no cases of explicit dementia. SPECT showed marked abnormalities in two cases: posterior temporal-parietal diminution of tracer uptake in one case (posterior/anterior=0.81) and marked right/left subcortical asymmetry (1.17) in the other. In three additional cases there was asymmetric tracer uptake in the subcortical and parietal regions. CT findings were normal in all seven cases. The authors conclude that functional imaging with the use of IMP-SPECT may be a useful method to follow ADC progression and response to therapy

  11. Stroke injury, cognitive impairment and vascular dementia☆

    Science.gov (United States)

    Kalaria, Raj N.; Akinyemi, Rufus; Ihara, Masafumi

    2016-01-01

    The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700

  12. The effects of slow-stroke back massage on minutes of nighttime sleep in persons with dementia and sleep disturbances in the nursing home: a pilot study.

    Science.gov (United States)

    Harris, Melodee; Richards, Kathy Culpepper; Grando, Victoria T

    2012-12-01

    This pilot study tested the effects of a 3-minute slow-stroke back massage (SSBM) on total minutes of nighttime sleep on persons with dementia with sleep disturbances aged 65 years or older in the nursing home. Pilot randomized controlled trial. Participants were randomized to an intervention group (n = 20) who received the 3-minute SSBM or a usual care control condition group (n = 20) who received usual bedtime care. Forty-eight hours of actigraphy data was recorded and analyzed on sleep variables at baseline and postintervention. Descriptive statistics showed a 36-minute increase on minutes of nighttime sleep in the SSBM intervention group (46.1 minutes) compared with the control group (10.32 minutes). Analysis of covariance did not reveal significant differences between the intervention and control groups on minutes of nighttime sleep, F(1, 37) = 1.90, p = .18, partial η(2) = .05, or on other sleep variables. Dose-finding studies are needed to determine the duration of SSBM for sleep promotion. Findings from this pilot study suggest that SSBM may be an effective nursing intervention for sleep in persons with dementia in the nursing home, but further testing is needed to provide definitive results.

  13. Formulaic Language in Parkinson's Disease and Alzheimer's Disease: Complementary Effects of Subcortical and Cortical Dysfunction

    Science.gov (United States)

    Van Lancker Sidtis, Diana; Choi, JiHee; Alken, Amy; Sidtis, John J.

    2015-01-01

    Purpose: The production of formulaic expressions (conversational speech formulas, pause fillers, idioms, and other fixed expressions) is excessive in the left hemisphere and deficient in the right hemisphere and in subcortical stroke. Speakers with Alzheimer's disease (AD), having functional basal ganglia, reveal abnormally high proportions of…

  14. Subcortical processing in auditory communication.

    Science.gov (United States)

    Pannese, Alessia; Grandjean, Didier; Frühholz, Sascha

    2015-10-01

    The voice is a rich source of information, which the human brain has evolved to decode and interpret. Empirical observations have shown that the human auditory system is especially sensitive to the human voice, and that activity within the voice-sensitive regions of the primary and secondary auditory cortex is modulated by the emotional quality of the vocal signal, and may therefore subserve, with frontal regions, the cognitive ability to correctly identify the speaker's affective state. So far, the network involved in the processing of vocal affect has been mainly characterised at the cortical level. However, anatomical and functional evidence suggests that acoustic information relevant to the affective quality of the auditory signal might be processed prior to the auditory cortex. Here we review the animal and human literature on the main subcortical structures along the auditory pathway, and propose a model whereby the distinction between different types of vocal affect in auditory communication begins at very early stages of auditory processing, and relies on the analysis of individual acoustic features of the sound signal. We further suggest that this early feature-based decoding occurs at a subcortical level along the ascending auditory pathway, and provides a preliminary coarse (but fast) characterisation of the affective quality of the auditory signal before the more refined (but slower) cortical processing is completed. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Dementia and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Pastori, Daniele; Miyazawa, Kazuo; Lip, Gregory Y H

    2018-01-01

    The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve...... in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function...

  16. Examining the subcortical infarcts in the era of acute multimodality CT imaging

    Directory of Open Access Journals (Sweden)

    Mindy Tan

    2016-12-01

    Full Text Available Background: Lacunar infarcts have been characterized as small subcortical infarcts, resulting from in situ microatheroma or lipohyalinosis in small vessels. Based on this hypothesis, such infarcts should not be associated with large areas of perfusion deficits extending beyond subcortical regions to involve cortical regions. By contrast, selected small subcortical infarcts, as defined by MR imaging in the subacute or chronic stage, may initially have large perfusion deficits or related large vessel occlusions. These infarcts with ‘lacunar’ phenotype may also be caused by disease in the parent vessel and may have very different stroke mechanisms from small vessel disease. Our aim was to describe differences in imaging characteristics between patients with small subcortical infarction with ‘lacunar phenotype’ from those with lacunar mechanism. Methods: Patients undergoing acute CT Perfusion/angiography (CTP/CTA within 6 hours of symptom onset and follow-up magnetic resonance imaging (MRI for ischaemic stroke were included (2009-2013. A lacunar infarct was defined as a single subcortical infarct (SSI ≤20 mm on follow-up MRI. Presence of perfusion deficits, vessel occlusion and infarct dimensions were compared between lacunar infarcts and other topographical infarct types. Results: Overall, 182 patients (mean age 66.4±15.3 years, 66% male were included. SSI occurred in 31 (17% patients. Of these, 12 (39% patients had a perfusion deficit compared with those with any cortical infarction (120/142, 67%, and the smallest SSI with a perfusion deficit had a diameter of <5mm. The majority of patients with SSI (8/12, 66.7% had a relevant vessel occlusion. A quarter of SSIs had a large-artery stroke mechanism evident on acute CTP/CTA. Lacunar mechanism was present in 3/8 patients with corona radiata, 5/10 lentiform nucleus, 5/6 posterior limb of internal capsule PLIC, 3/5 thalamic infarcts and 1/2 miscellaneous locations. There was a trend toward

  17. Vascular Contributions to Cognitive Impairment and Dementia

    Science.gov (United States)

    Gorelick, Philip B.; Scuteri, Angelo; Black, Sandra E.; DeCarli, Charles; Greenberg, Steven M.; Iadecola, Costantino; Launer, Lenore J.; Laurent, Stephane; Lopez, Oscar L.; Nyenhuis, David; Petersen, Ronald C.; Schneider, Julie A.; Tzourio, Christophe; Arnett, Donna K.; Bennett, David A.; Chui, Helena C.; Higashida, Randall T.; Lindquist, Ruth; Nilsson, Peter M.; Roman, Gustavo C.; Sellke, Frank W.; Seshadri, Sudha

    2013-01-01

    dementia. Dysfunction of the neurovascular unit and mechanisms regulating cerebral blood flow are likely to be important components of the pathophysiological processes underlying VCI. Cerebral amyloid angiopathy is emerging as an important marker of risk for Alzheimer disease, microinfarction, microhemorrhage and macrohemorrhage of the brain, and VCI. The neuropathology of cognitive impairment in later life is often a mixture of Alzheimer disease and microvascular brain damage, which may overlap and synergize to heighten the risk of cognitive impairment. In this regard, magnetic resonance imaging and other neuroimaging techniques play an important role in the definition and detection of VCI and provide evidence that subcortical forms of VCI with white matter hyperintensities and small deep infarcts are common. In many cases, risk markers for VCI are the same as traditional risk factors for stroke. These risks may include but are not limited to atrial fibrillation, hypertension, diabetes mellitus, and hypercholesterolemia. Furthermore, these same vascular risk factors may be risk markers for Alzheimer disease. Carotid intimal-medial thickness and arterial stiffness are emerging as markers of arterial aging and may serve as risk markers for VCI. Currently, no specific treatments for VCI have been approved by the US Food and Drug Administration. However, detection and control of the traditional risk factors for stroke and cardiovascular disease may be effective in the prevention of VCI, even in older people. Conclusions Vascular contributions to cognitive impairment and dementia are important. Understanding of VCI has evolved substantially in recent years, based on preclinical, neuropathologic, neuroimaging, physiological, and epidemiological studies. Transdisciplinary, translational, and transactional approaches are recommended to further our understanding of this entity and to better characterize its neuropsychological profile. There is a need for prospective, quantitative

  18. High-resolution nuclear magnetic resonance imaging and single photon emission computerized tomography--cerebral blood flow in a case of pure sensory stroke and mild dementia owing to subcortical arteriosclerotic encephalopathy (Binswanger's disease)

    DEFF Research Database (Denmark)

    De Chiara, S; Lassen, N A; Andersen, A R

    1987-01-01

    hypertensive, 72-year-old patient with PSS, CT scanning and conventional nuclear magnetic resonance imaging (NMRI) scanning using a 7-mm-thick slice on a 1.5 Tesla instrument all failed to visualize the thalamic infarct. Using the high-resolution mode with 2-mm slice thickness it was, however, clearly seen...

  19. CT findings and clinical analysis of subcortical hematomas in elderly patients

    International Nuclear Information System (INIS)

    Ueno, Yasushi; Tanaka, Akira; Yoshinaga, Shinya; Kimura, Masato

    1991-01-01

    Ten elderly patients (73-87 years, 78.4 years on the average) with subcortical hematomas were divided into two groups according to the shape of the hematoma on a CT scan: a lobulated group (6 patients) and a global group (4 patients). The lobulated group had a history of hypertension in one patient. The hematomas extended widely around the parietal lobe and were accompanied by perifocal edema, brain shifts and subarachnoid hemorrhages, deep consciousness disturbances, and poor prognosis of life and function. Amyloid depositions in the arteries around the hematomas were confirmed histologically in one patient. The global group had a history of hypertension in two patients. The hematomas were localized in the parietal, temporal, or occipital lobe without perifocal edema, brain shift and subarachnoid hemorrhages, and accompanied by mild consciousness disturbances. The life prognosis was good, but the functional prognosis was poor, with a subsequent development of dementia. A lobulated subcortical hematoma is thought to be due to amyloid angiopathy, while a global subcortical hematoma is thought to be due to hypertension. A surgical evacuation is seldom indicated for either type of subcortical hematoma in elderly patients. (author)

  20. Gastritis May Boost Odds of Dementia.

    Science.gov (United States)

    Momtaz, Yadollah Abolfathi; Hamid, Tengku Aizan; Ibrahim, Rahimah

    2014-08-01

    Given the high prevalence of dementia and its devastating consequences, identifying risk factors for dementia is a public health priority. The present study aims to assess whether gastritis increases the odds of dementia. The data for this study, consisting of 2926 community-dwelling older adults, were obtained from the National survey entitled "Mental Health and Quality of Life of Older Malaysians." Dementia was diagnosed using the Geriatric Mental State-Automated Geriatric Examination for Computer-Assisted Taxonomy. Prevalence of dementia was considerably higher among older adults with gastritis (29.5%) compared to those without gastritis (13.2%). After adjusting for age, gender, marital status, educational attainment, hypertension, stroke, and diabetes, gastritis was significantly associated with more than twice odds of dementia (adjusted odds ratio = 2.42, P gastritis may increase the risk of dementia provide avenue for further inquiries into dementia. © The Author(s) 2014.

  1. A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

    OpenAIRE

    Rubin, Courtney B.; Hahn, Virginia; Kobayashi, Taisei; Litwack, Andrew

    2015-01-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was ...

  2. The value of screening instruments in the diagnosis of poststroke dementia

    NARCIS (Netherlands)

    I. de Koning (Inge)

    2004-01-01

    textabstractStroke is a major cause of morbidity in the industrialized world. It often results not only in physical disability, but also in significant cognitive impairment or dementia. Between 10 and 40% of patients with a recent stroke develop dementia.1-4 Although stroke was already recognized as

  3. Subcortical arteriosclerotic encephalo-pathy (Binswanger's disease ...

    African Journals Online (AJOL)

    ... changes include severe central nervous system disease characterized by loss of white matter with gliosis, and arterial and arteriolar sclerosis of small penetrating cerebral blood vessels. ThediHerential diagnosis includes vascular pseudobulbar palsy, multi-infarct dementia and senile dementia (Alzheimer's disease).

  4. Genetics Home Reference: cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy

    Science.gov (United States)

    ... the first signs of the disorder. About half of affected individuals have a stroke or similar episode before age 40. As the disease progresses, most people with CARASIL also develop mood and personality changes, a decline in thinking ability (dementia), memory ...

  5. Structural remodeling of white matter in the contralesional hemisphere is correlated with early motor recovery in patients with subcortical infarction.

    Science.gov (United States)

    Liu, Gang; Dang, Chao; Chen, Xinran; Xing, Shihui; Dani, Krishna; Xie, Chuanmiao; Peng, Kangqiang; Zhang, Jingna; Li, Jingjing; Zhang, Jian; Chen, Li; Pei, Zhong; Zeng, Jinsheng

    2015-01-01

    This study aimed to identify brain areas with white matter changes that contribute to motor recovery of affected limbs during acute to sub-acute phases of subcortical infarction. Diffusion tensor imaging was performed 1, 4, and 12 weeks after stroke onset in 18 patients with acute subcortical infarct, and in 18 age- and risk factor-matched controls. Fugl-Meyer scale was used to assess levels of motor impairment, and Statistical Parametric Mapping was applied to determine fractional anisotropy (FA) changes for the entire brain in order to identify areas correlated with motor recovery. Fugl-Meyer scores of patients at 4 and 12 weeks were significantly higher than those at 1 week (all p Fugl-Meyer scores (all p < 0.005) within 12 weeks following acute subcortical infarction. Remodeling of white matter in contralesional brain regions related to motor, cognition, and sensory processing may facilitate early motor recovery in patients with an acute infarct.

  6. Implications of Subcortical structures in Aphasia.

    Directory of Open Access Journals (Sweden)

    Saleh Alamri

    2015-04-01

    Taken together, the results indicate that aphasia is a common outcome after a lesion to subcortical structures. Findings show that 110 out of 394 aphasic patients with lesion in the basal ganglia exhibited comprehension deficits, while 31 participants out of 288 with thalamic aphasia. Likewise, 129 aphasics of affected basal ganglia out of 394 had impaired naming, whereas 12 participants had impaired naming out of 288 individuals with thalamic aphasia. See figure 1. Figure 1: The percentage of language impairment in two sets of aphasic patients (the thalamus and the basal ganglia. Despite contradictory results and even cases of double dissociation (for an example of absence of language deficits in the event of thalamic lesions see Cappa et al., 1986, our literature review confirms the major role of subcortical structures in language processing.

  7. Subcortical correlates of individual differences in aptitude.

    Directory of Open Access Journals (Sweden)

    Rex E Jung

    Full Text Available The study of individual differences encompasses broad constructs including intelligence, creativity, and personality. However, substantially less research is devoted to the study of specific aptitudes in spite of their importance to educational, occupational, and avocational success. We sought to determine subcortical brain structural correlates of several broad aptitudes including Math, Vocabulary, Foresight, Paper Folding, and Inductive Reasoning in a large (N = 107, healthy, young (age range  = 16-29 cohort. Subcortical volumes were measured using an automated technique (FreeSurfer across structures including bilateral caudate, putamen, globus pallidus, thalamus, nucleus accumbens, hippocampus, amygdala, and five equal regions of the corpus callosum. We found that performance on measures of each aptitude was predicted by different subcortical structures: Math--higher right nucleus accumbens volume; Vocabulary--higher left hippocampus volume; Paper Folding--higher right thalamus volume; Foresight--lower right thalamus and higher mid anterior corpus callosum volume; Inductive Reasoning--higher mid anterior corpus callosum volume. Our results support general findings, within the cognitive neurosciences, showing lateralization of structure-function relationships, as well as more specific relationships between individual structures (e.g., left hippocampus and functions relevant to particular aptitudes (e.g., Vocabulary.

  8. Subcortical correlates of individual differences in aptitude.

    Science.gov (United States)

    Jung, Rex E; Ryman, Sephira G; Vakhtin, Andrei A; Carrasco, Jessica; Wertz, Chris; Flores, Ranee A

    2014-01-01

    The study of individual differences encompasses broad constructs including intelligence, creativity, and personality. However, substantially less research is devoted to the study of specific aptitudes in spite of their importance to educational, occupational, and avocational success. We sought to determine subcortical brain structural correlates of several broad aptitudes including Math, Vocabulary, Foresight, Paper Folding, and Inductive Reasoning in a large (N = 107), healthy, young (age range  = 16-29) cohort. Subcortical volumes were measured using an automated technique (FreeSurfer) across structures including bilateral caudate, putamen, globus pallidus, thalamus, nucleus accumbens, hippocampus, amygdala, and five equal regions of the corpus callosum. We found that performance on measures of each aptitude was predicted by different subcortical structures: Math--higher right nucleus accumbens volume; Vocabulary--higher left hippocampus volume; Paper Folding--higher right thalamus volume; Foresight--lower right thalamus and higher mid anterior corpus callosum volume; Inductive Reasoning--higher mid anterior corpus callosum volume. Our results support general findings, within the cognitive neurosciences, showing lateralization of structure-function relationships, as well as more specific relationships between individual structures (e.g., left hippocampus) and functions relevant to particular aptitudes (e.g., Vocabulary).

  9. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  10. Improving motor cortico-thalamic communication after stroke using real-time fMRI connectivity-based neurofeedback

    Science.gov (United States)

    Liew, Sook-Lei; Rana, Mohit; Cornelsen, Sonja; de Barros Filho, Marcos Fortunato; Birbaumer, Niels; Sitaram, Ranganatha; Cohen, Leonardo G.; Soekadar, Surjo R.

    2015-01-01

    Background Two thirds of stroke survivors experience motor impairment resulting in long-term disability. The anatomical substrate is often the disruption of cortico-subcortical pathways. It has been proposed that reestablishment of corticosubcortical communication relates to functional recovery. Objective Here, we applied a novel training protocol to augment ipsilesional cortico-subcortical connectivity after stroke. Chronic stroke patients with severe motor impairment were provided online feedback of blood-oxygenation level dependent (BOLD) signal connectivity between cortical and subcortical regions critical for motor function using real-time functional magnetic resonance imaging (rtfMRI) neurofeedback. Results In this proof of principle study, 3 out of 4 patients learned to voluntarily modulate cortico-subcortical connectivity as intended. Conclusions Our results document for the first time the feasibility and safety for patients with chronic stroke and severe motor impairment to self-regulate and augment ipsilesional cortico-subcortical connectivity through neurofeedback using rtfMRI. PMID:26671217

  11. Increased CSF levels of total Tau in patients with subcortical cerebrovascular pathology and cognitive impairment

    Science.gov (United States)

    Radanovic, Márcia; Stella, Florindo; Silva, Lis Gomes; Talib, Leda L.; Forlenza, Orestes V.

    2017-01-01

    ABSTRACT. Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's disease (AD) and cerebrovascular-related pathologies. Objective: To investigate the profile of AD-related CSF biomarkers in a sample of cognitively impaired and unimpaired older adults with concomitant subcortical cerebrovascular burden. Methods: Seventy-eight older adults attending an outpatient psychogeriatric clinic were enrolled. Diagnoses were based on clinical, neuropsychological, laboratory, and neuroimaging data. Participants were classified into: cognitively normal (controls, n = 30), mild cognitive impairment (MCI, n = 34), and dementia (AD, n = 14). All subjects were submitted to CSF analyses for determination of amyloid-beta (Aβ1-42), total tau (t-tau), phosphorylated tau (p-tau) and Aβ1-42/p-tau ratio according to the Luminex method. MRI was performed in all individuals, and was scored independently by two experts according to Fazekas scale. Statistical analyses were conducted with the aid of general linear model procedures, and the Chi-squared test. Results: T-tau levels were significantly associated with subcortical lesion pattern when Fazekas was considered as a group factor. CSF biomarkers were not associated with MCI, AD, or controls when considered separately. There was a tendency for reduction in CSF Aβ1-42 together with increasing Fazekas scores, but without statistical significance. Comparisons of Aβ1-42 and t-tau with each clinical group or with each neuroimaging pattern did not reach statistical differences. Likewise, Fazekas scores had no impact on CAMCOG scores. Conclusion: We found a significant association between t-tau levels and subcortical lesions when all Fazekas classifications were considered as a single group; comparisons of Fazekas subgroups and CSF biomarkers did not reach significance. PMID:29354223

  12. Subcortical Local Functional Hyperconnectivity in Cannabis Dependence.

    Science.gov (United States)

    Manza, Peter; Tomasi, Dardo; Volkow, Nora D

    2018-03-01

    Cannabis abuse (CA) has been associated with psychopathology, including negative emotionality and higher risk of psychosis, particularly with early age of initiation. However, the mechanisms underlying this association are poorly understood. Because aberrant dopamine signaling is implicated in cannabis-associated psychopathology, we hypothesized that regular CA would be associated with altered resting-state functional connectivity in dopamine midbrain-striatal circuits. We examined resting-state brain activity of subcortical regions in 441 young adults from the Human Connectome Project, including 30 subjects with CA meeting DSM-IV criteria for dependence and 30 control subjects matched on age, sex, education, body mass index, anxiety, depression, and alcohol and tobacco usage. Across all subjects, local functional connectivity density hubs in subcortical regions were most prominent in ventral striatum, hippocampus, amygdala, dorsal midbrain, and posterior-ventral brainstem. As hypothesized, subjects with CA showed markedly increased local functional connectivity density relative to control subjects, not only in ventral striatum (where nucleus accumbens is located) and midbrain (where substantia nigra and ventral tegmental nuclei are located) but also in brainstem and lateral thalamus. These effects were observed in the absence of significant differences in subcortical volumes and were most pronounced in individuals who began cannabis use earliest in life and who reported high levels of negative emotionality. Together, these findings suggest that chronic CA is associated with changes in resting-state brain function, particularly in dopaminergic nuclei implicated in psychosis but that are also critical for habit formation and reward processing. These results shed light on neurobiological differences that may be relevant to psychopathology associated with cannabis use. Published by Elsevier Inc.

  13. The Association Between Specific Substances of Abuse and Subcortical Intracerebral Hemorrhage versus Ischemic Lacunar Infarction

    Directory of Open Access Journals (Sweden)

    Emma H Kaplan

    2014-09-01

    Full Text Available Background: Hypertension damages small vessels, resulting in both lacunar infarction and subcortical intracerebral hemorrhage (ICH. Substance abuse has also been linked to small vessel pathology. This study explores whether the use of specific substances (eg., cocaine, tobacco is associated with subcortical ICH over ischemia in hypertensive individuals.Methods: Patients with hypertension, admitted with lacunar infarcts (measuring 1 drink per day (women, >2 drinks per day (men. Logistic regression was performed with ICH as the dependent variable comparing those presenting with ICH to those presenting with ischemia.Results: Of the 580 patients included in analysis, 217 (37% presented with ICH. The average age was similar between the two groups (64.7 versus 66.3 years. Illicit/controlled drug use was associated with a significantly increased risk of ICH over stroke in unadjusted models (25% versus 15%, p=0.02, with the largest effect seen in users ≥65 years old (not statistically significant. Smoking was associated with ischemia over ICH in a dose-dependent manner: any history of smoking OR 1.84, CI 1.19-2.84; current use OR 2.23, CI 1.37-3.62; heavy use OR 2.48, CI 1.50-4.13. Alcohol use was not preferentially associated with either outcome (p=0.29.Conclusions: In hypertensive patients, tobacco use is associated with an increased risk of subcortical ischemia compared to ICH; while use of illicit/controlled substances appears to be predictive of hemorrhage.

  14. Intracranial stenosis in cognitive impairment and dementia.

    Science.gov (United States)

    Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

    2017-06-01

    Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

  15. The Effects of Modified Constraint-Induced Movement Therapy in Acute Subcortical Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Changshen Yu

    2017-05-01

    Full Text Available Background: Constraint-induced movement therapy (CIMT promotes upper extremity recovery post stroke, however, it is difficult to implement clinically due to its high resource demand and safety of the restraint. Therefore, we propose that modified CIMT (mCIMT be used to treat individuals with acute subcortical infarction.Objective: To evaluate the therapeutic effects of mCIMT in patients with acute subcortical infarction, and investigate the possible mechanisms underlying the effect.Methods: The role of mCIMT was investigated in 26 individuals experiencing subcortical infarction in the preceding 14 days. Patients were randomly assigned to either mCIMT or standard therapy. mCIMT group was treated daily for 3 h over 10 consecutive working days, using a mitt on the unaffected arm for up to 30% of waking hours. The control group was treated with an equal dose of occupational therapy and physical therapy. During the 3-month follow-up, the motor functions of the affected limb were assessed by the Wolf Motor Function Test (WMFT and Motor Activity Log (MAL. Altered cortical excitability was assessed via transcranial magnetic stimulation (TMS.Results: Treatment significantly improved the movement in the mCIMT group compared with the control group. The mean WMF score was significantly higher in the mCIMT group compared with the control group. Further, the appearance of motor-evoked potentials (MEPs were significantly higher in the mCIMT group compared with the baseline data. A significant change in ipsilesional silent period (SP occurred in the mCIMT group compared with the control group. However, we found no difference between two groups in motor function or electrophysiological parameters after 3 months of follow-up.Conclusions: mCIMT resulted in significant functional changes in timed movement immediately following treatment in patients with acute subcortical infarction. Further, early mCIMT improved ipsilesional cortical excitability. However, no long

  16. Characteristics of subcortical infarction due to distal MCA penetrating artery occlusion.

    Science.gov (United States)

    Suzuki, Kentaro; Aoki, Junya; Tanizaki, Yoshio; Sakamoto, Yuki; Takahashi, Satoshi; Abe, Arata; Kimura, Hiroaki; Kano, Tadashige; Suda, Satoshi; Nishiyama, Yasuhiro; Akaji, Kazunori; Mihara, Ban; Kimura, Kazumi

    2016-09-15

    Isolated deep subcortical infarcts develop as a result of occlusion of the penetrating arteries from the internal carotid artery (ICA) and the proximal (M1) and distal middle cerebral artery (MCA). However, the clinical and neuroimaging characteristics of infarcts due to the occlusion of the distal MCA penetrating artery are unclear. Consecutive patients with ischemic stroke or transient ischemic attack with magnetic resonance imaging (MRI) performed within 2days of onset were studied retrospectively. Using coronal MRI data, isolated deep subcortical infarcts were classified into two groups: 1) proximal group, described as being longer than they are wide, which were expected to be related to the occlusion of the ICA or M1 penetrating artery; and 2) distal group, described as oblong, which were expected to be associated with the occlusion of penetrating arteries from the distal MCA (M2/M3/M4). A total of 653 consecutive acute ischemic stroke patients (proximal group, 50 [7.7%]; distal group, 14 [2.1%]) were enrolled. Baseline clinical characteristics were not different between the 2 groups. Modified Rankin Scale scores were lower in the distal group than in the proximal group 3months after stroke onset (1.43±0.36 vs. 2.26±1.35, p=0.023). We measured the lengths of the infarcts in the X and Y directions using axial MRI. The X/Y ratio was larger in the distal group than in the proximal group (1.3±0.6 vs. 0.7±0.2, p<0.01), which indicated that distal MCA penetrating artery infarcts appear more oblong on axial MRI. One cause for deep subcortical infarction is the occlusion of the distal MCA penetrating arteries, which occurs in 22% of patients with deep subcortical infarctions. These patients had better clinical outcomes than those with ICA and M1 penetrating artery infarctions. Distal MCA penetrating artery infarctions appear oblong on axial MRI. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Is It Lewy Body Dementia or Something Else?

    Science.gov (United States)

    ... Caregiving topics Caregiving Briefs LEWY DIGEST multimedia LBDA tv webinars, interviews & transcripts press releases Media Kit additional ... the brain. Vascular dementia is caused by a series of small strokes that deprive the brain of ...

  18. The Spectrum of Sociopathy in Dementia

    OpenAIRE

    Mendez, Mario F.; Shapira, Jill S.; Saul, Ronald E.

    2011-01-01

    Although well-known from head trauma and acute strokes, sociopathic behavior from dementia is less known and understood. This study reviewed 33 dementia patients who had been in trouble with the law. They were divided into two groups: 22 who committed impulsive sociopathic acts and 11 who committed non-impulsive acts. The impulsive patients demonstrated nonviolent acts, such as dis-inhibited sexual behavior or pathological stealing, and had disproportionate frontal-caudate atrophy on neuroima...

  19. Abnormal Gray Matter Shape, Thickness, and Volume in the Motor Cortico-Subcortical Loop in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: Association with Clinical and Motor Features.

    Science.gov (United States)

    Rahayel, Shady; Postuma, Ronald B; Montplaisir, Jacques; Bedetti, Christophe; Brambati, Simona; Carrier, Julie; Monchi, Oury; Bourgouin, Pierre-Alexandre; Gaubert, Malo; Gagnon, Jean-François

    2018-02-01

    Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a major risk factor for Parkinson's disease and dementia with Lewy bodies. Anatomical gray matter abnormalities in the motor cortico-subcortical loop areas remain under studied in iRBD patients. We acquired T1-weighted images and administrated quantitative motor tasks in 41 patients with polysomnography-confirmed iRBD and 41 healthy subjects. Cortical thickness and voxel-based morphometry (VBM) analyses were performed to investigate local cortical thickness and gray matter volume changes, vertex-based shape analysis to investigate shape of subcortical structures, and structure-based volumetric analyses to investigate volumes of subcortical and brainstem structures. Cortical thickness analysis revealed thinning in iRBD patients in bilateral medial superior frontal, orbitofrontal, anterior cingulate cortices, and the right dorsolateral primary motor cortex. VBM results showed lower gray matter volume in iRBD patients in the frontal lobes, anterior cingulate gyri, and caudate nucleus. Shape analysis revealed extensive surface contraction in the external and internal segments of the left pallidum. Clinical and motor impaired features in iRBD were associated with anomalies of the motor cortico-subcortical loop. In summary, iRBD patients showed numerous gray matter structural abnormalities in the motor cortico-subcortical loop, which are associated with lower motor performance and clinical manifestations of iRBD. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  20. Does wine prevent dementia?

    Directory of Open Access Journals (Sweden)

    Roger M Pinder

    2009-02-01

    Full Text Available Roger M PinderPharma Consultant, York, UKAbstract: There is substantial evidence that moderate consumption of alcohol reduces significantly the risks of coronary heart disease, stroke and type 2 diabetes. Furthermore, the incidence of dementia, both of the Alzheimer’s type (AD and the vascular variety (VaD, is lower in societies which consume a Mediterranean diet of mainly fish, fruit, vegetables, olive oil, and wine. In particular, extensive evidence from both population-based cohort and case control studies in different areas of the world and across genders and racial groups suggests that regular consumption of moderate amounts of alcohol, especially in the form of wine, is associated with a lower risk of developing AD and VaD compared with abstention and heavy drinking. Carriers of the APOE ε4 allele seem to gain less benefit. Age-related cognitive decline, particularly in women, is lower in regular drinkers, while older drinkers with Mild Cognitive Impairment (MCI progress less frequently to AD than their abstaining counterparts. Plausible biological mechanisms for the neuroprotective effects of wine include its glucose-modifying, antioxidant and inflammatory properties, but it additionally seems to modify the neuropathology of AD, particularly the deposition of amyloid plaque. Indeed, some of these mechanisms are already targets for the development of new therapeutic agents for the treatment of dementia.Keywords: alcohol, Alzheimer’s disease, dementia, epidemiology, polyphenols, wine

  1. Translating current knowledge into dementia prevention.

    Science.gov (United States)

    Román, Gustavo C; Nash, David T; Fillit, Howard

    2012-01-01

    Considerable knowledge has been gained from epidemiologic studies and randomized clinical trials regarding risk factors for dementia, including Alzheimer disease (AD) and vascular dementia (VaD). Most identified risk factors for dementia are similar to vascular disease risk factors for heart disease and stroke. In 2010, the National Institutes of Health Conference concluded that there are no validated modifiable factors to reduce the incidence of AD or to change its course. This research perspective specifically concerning AD disregards the fact that in community-dwelling elderly, the most common forms of dementia involve the cerebral macrovasculature and microvasculature, manifesting as VaD and mixed dementia (the combination of VaD and AD) in autopsy-confirmed cases. Thus, prevention of dementia in clinical practice should be considered from this broader and more relevant view and not just a research perspective on "pure" AD. Practicing clinicians can reasonably state to patients that, although more definitive research is clearly needed, the management and treatment of vascular disease risk factors are likely beneficial not only to prevent heart disease and stroke, but also common forms of dementia in the community.

  2. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  3. Neurodegenerative Dementia

    International Nuclear Information System (INIS)

    Allard, Michelle

    2006-01-01

    Full text: With increasing life expectancy across the world, the number of elderly people at risk of developing dementia is growing rapidly. Thus, progressive neurodegenerative disorders such as dementia represent a growing public health concern. These diseases are characterized by a progressive loss in most of the cognitive functions. The promise, possibly in a near future, of disease-modifying therapies has made the characterization of the early stages of dementia a topic of major interest. The assessment of these early stages is a challenge for neuroimaging studies. In order to conceive prevention trials; it is of major outcome to fully understand the mechanisms of the cognitive system impairment and its evolution, with a particular reference to the symptomatic pre-dementia stage, when subjects just begin to depart from normality. In this article we review recent progress in neuroimaging, and their potentiality for increasing a diagnostic accuracy. (author)

  4. Cognitively Engaging Activity is Associated with Greater Cortical and Subcortical Volumes

    Directory of Open Access Journals (Sweden)

    Talia R. Seider

    2016-05-01

    Full Text Available As the population ages and dementia becomes a growing healthcare concern, it is increasingly important to identify targets for intervention to delay or attenuate cognitive decline. Research has shown that the most successful interventions aim at altering lifestyle factors. Thus, this study examined how involvement in physical, cognitive, and social activity is related to brain structure in older adults. Sixty-five adults (mean age = 71.4 years, standard deviation = 8.9 received the Community Healthy Activities Model Program for Seniors (CHAMPS, a questionnaire that polls everyday activities in which older adults may be involved, and also underwent structural magnetic resonance imaging. Stepwise regression with backwards selection was used to predict weekly time spent in either social, cognitive, light physical, or heavy physical activity from the volume of one of the cortical or subcortical regions of interest (corrected by intracranial volume as well as age, education, and gender as control variables. Regressions revealed that more time spent in cognitive activity was associated with greater volumes of all brain regions studied: total cortex (β = .289, p = .014, frontal (β = .276, p = .019, parietal (β = .305, p = .009, temporal (β = .275, p = .020, and occipital (β = .256, p = .030 lobes, and thalamus (β = .310, p = .010, caudate (β = .233, p = .049, hippocampus (β = .286, p = .017, and amygdala (β = .336, p = .004. These effects remained even after accounting for the positive association between cognitive activity and education. No other activity variable was associated with brain volumes. Results indicate that time spent in cognitively engaging activity is associated with greater cortical and subcortical brain volume. Findings suggest that interventions aimed at increasing levels of cognitive activity may delay cognitive consequences of aging and decrease the risk of developing dementia.

  5. Formulaic language in cortical and subcortical disease: Evidence of the dual process model.

    Directory of Open Access Journals (Sweden)

    Kelly Bridges

    2014-04-01

    Full Text Available Introduction: It is known that an intact cortical left hemisphere is crucial for language production. Recently, more credit is given to the right hemisphere and subcortical areas in the production of non-novel language, including formulaic language. John Hughlings Jackson (1874/1958, first described how propositional and non-propositional speech are differentially affected by neural impairment. Non-propositional language is often preserved following left hemisphere stroke even when aphasia is present (Code, 1982; Sidtis et al., 2009; Van Lancker Sidtis & Postman, 2006. With right hemisphere and subcortical stroke, formulaic language is reduced (Sidtis et al., 2009; Van Lancker Sidtis & Postman, 2006; Speedie et al., 1993. The dual process model of language competence states that propositional and non-propositional speech are processed differently in the brain, with novel speech controlled by the left hemisphere, and a right hemisphere/subcortical circuit modulating formulaic language (Van Lancker Sidtis, 2004; 2012. Two studies of formulaic language will be presented as further evidence of the dual process model: a study of formulaic language in Alzheimer’s disease, and a study of recited speech in Parkinson’s disease. Formulaic language includes overlearned words, phrases or longer linguistic units that are known to the native speaker, occur naturally in discourse, and are important for normal social interaction (Fillmore, 1979; Pawley & Syder, 1983; Van Lancker, 1988; Van Lancker Sidtis, 2004; Wray, 2002. Formulaic expressions include conversational speech formulas, idioms, proverbs, expletives, pause fillers, discourse elements, and sentence stems (stereotyped sentence-initials. Longer units of linguistic material, such as prayers, rhymes, and poems, termed recited speech, is another subtype of formulaic language that is learned in childhood and recited periodically throughout life. Cortical disease: Alzheimer’s disease and formulaic

  6. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL in Argentina

    Directory of Open Access Journals (Sweden)

    Maximiliano A Hawkes

    2015-09-01

    Full Text Available CADASIL is the most common cause of hereditary stroke and vascular dementia. Published information about this disease in South America is scant. We describe clinical and demographic characteristics of 13 patients (10 families with CADASIL from Argentina.Methods Medical records, diagnostic tests and family history of patients with CADASIL were reviewed.Results Thirteen patients with CADASIL (10 families were included. All patients had European ancestry. Initial presentation was stroke in most patients (n = 11. Stroke patients later developed cognitive complaints (n = 9, migraine with aura (n = 1, apathy (n = 4 and depression (n = 6. External capsule and temporal lobe involvement on MRI were characteristic imaging findings. Two patients died after intracerebral hemorrhage.Conclusion This is the first report of non-related patients with CADASIL in South America addressing ancestry. Since European ancestry is not highly prevalent in all South American countries, there may be variable incidence of CADASIL within this region.

  7. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  8. Viscoelasticity of subcortical gray matter structures.

    Science.gov (United States)

    Johnson, Curtis L; Schwarb, Hillary; D J McGarry, Matthew; Anderson, Aaron T; Huesmann, Graham R; Sutton, Bradley P; Cohen, Neal J

    2016-12-01

    Viscoelastic mechanical properties of the brain assessed with magnetic resonance elastography (MRE) are sensitive measures of microstructural tissue health in neurodegenerative conditions. Recent efforts have targeted measurements localized to specific neuroanatomical regions differentially affected in disease. In this work, we present a method for measuring the viscoelasticity in subcortical gray matter (SGM) structures, including the amygdala, hippocampus, caudate, putamen, pallidum, and thalamus. The method is based on incorporating high spatial resolution MRE imaging (1.6 mm isotropic voxels) with a mechanical inversion scheme designed to improve local measures in pre-defined regions (soft prior regularization [SPR]). We find that in 21 healthy, young volunteers SGM structures differ from each other in viscoelasticity, quantified as the shear stiffness and damping ratio, but also differ from the global viscoelasticity of the cerebrum. Through repeated examinations on a single volunteer, we estimate the uncertainty to be between 3 and 7% for each SGM measure. Furthermore, we demonstrate that the use of specific methodological considerations-higher spatial resolution and SPR-both decrease uncertainty and increase sensitivity of the SGM measures. The proposed method allows for reliable MRE measures of SGM viscoelasticity for future studies of neurodegenerative conditions. Hum Brain Mapp 37:4221-4233, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. Presenile dementia in a 41-year old male Nigerian medical doctor ...

    African Journals Online (AJOL)

    Presenile dementia reflects an underlying pathology that affects the cerebral cortex, its sub-cortical connections or both occurring in persons below 65 years of age. In this study, a case report of a 41-yr old medical doctor whose mental illness spanned 8 yrs is presented. Initially he came with paranoid psychosis of the acute ...

  10. Mitochondrial disorders, cognitive impairment and dementia.

    Science.gov (United States)

    Finsterer, Josef

    2009-08-15

    The organ most frequently affected in mitochondrial disorders, particularly respiratory chain diseases (RCDs), in addition to the skeletal muscle, is the central nervous system (CNS). CNS manifestations of RCDs comprise stroke-like episodes, epilepsy, migraine, ataxia, spasticity, movement disorders, psychiatric disorders, cognitive decline, or even dementia (mitochondrial dementia). So far mitochondrial dementia has been reported in MELAS, MERRF, LHON, CPEO, KSS, MNGIE, NARP, Leigh syndrome, and Alpers-Huttenlocher disease. Mitochondrial dementia not only results from mutations in the mitochondrial genome but also from mutations in nuclear genes, such as POLG, thymidine kinase 2, or DDP1. Often mitochondrial dementia starts with specific cognitive deficits, particularly in visual construction, attention, abstraction, or flexibility but without a general intellectual deterioration. Cognitive impairment in RCDs is diagnosed upon neuropsychological testing, imaging studies, such as MRI, PET, or MR-spectroscopy, CSF-investigations, or electroencephalography. Therapy of mitochondrial dementia relies on symptomatic measures. Only single patients profit from cholinesterase inhibitors or memantine, antioxidants, vitamins, coenzyme-Q, or other substitutes. Overall, mitochondrial dementia is an important differential of dementias and should be considered in patients with multi-system disease.

  11. Subcortical vascular lesions predict functional recovery after rehabilitation in patients with L-dopa refractory parkinsonism.

    Science.gov (United States)

    Guerini, Fabio; Frisoni, Giovanni B; Bellwald, Catherine; Rossi, Roberta; Bellelli, Giuseppe; Trabucchi, Marco

    2004-02-01

    To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Observational study. A hospital geriatric rehabilitation department ("Ancelle della Carità" hospital of Cremona). Thirty-eight subjects (mean age+/-standard deviation of 78.9+/-6.5; 66% women) with gait disturbances and L-dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta-UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini-Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Patients were divided into two groups of equal size based on the delta-UPDRS (high and low functional recovery: delta-UPDRS >8 and load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1

  12. The Association between Specific Substances of Abuse and Subcortical Intracerebral Hemorrhage Versus Ischemic Lacunar Infarction.

    Science.gov (United States)

    Kaplan, Emma H; Gottesman, Rebecca F; Llinas, Rafael H; Marsh, Elisabeth B

    2014-01-01

    Hypertension damages small vessels, resulting in both lacunar infarction and subcortical intracerebral hemorrhage (ICH). Substance abuse has also been linked to small vessel pathology. This study explores whether the use of specific substances (e.g., cocaine, tobacco) is associated with subcortical ICH over ischemia in hypertensive individuals. Patients with hypertension, admitted with lacunar infarcts (measuring tobacco) was obtained. "Current use" and "history of use" were determined from patient history or a positive toxicology screen. "Heavy use" was defined as: smoking- ≥0.5 packs per day or 10 pack-years; alcohol- average of >1 drink per day (women), >2 drinks per day (men). Logistic regression was performed with ICH as the dependent variable comparing those presenting with ICH to those presenting with ischemia. Of the 580 patients included in analysis, 217 (37%) presented with ICH. The average age was similar between the two groups (64.7 versus 66.3 years). Illicit/controlled drug use was associated with a significantly increased risk of ICH over stroke in unadjusted models (25 versus 15%, p = 0.02), with the largest effect seen in users ≥65 years old (not statistically significant). Smoking was associated with ischemia over ICH in a dose-dependent manner: any history of smoking OR 1.84, CI 1.19-2.84; current use OR 2.23, CI 1.37-3.62; heavy use OR 2.48, CI 1.50-4.13. Alcohol use was not preferentially associated with either outcome (p = 0.29). In hypertensive patients, tobacco use is associated with an increased risk of subcortical ischemia compared to ICH, while use of illicit/controlled substances appears to be predictive of hemorrhage.

  13. Subcortical volumetric abnormalities in bipolar disorder.

    Science.gov (United States)

    Hibar, D P; Westlye, L T; van Erp, T G M; Rasmussen, J; Leonardo, C D; Faskowitz, J; Haukvik, U K; Hartberg, C B; Doan, N T; Agartz, I; Dale, A M; Gruber, O; Krämer, B; Trost, S; Liberg, B; Abé, C; Ekman, C J; Ingvar, M; Landén, M; Fears, S C; Freimer, N B; Bearden, C E; Sprooten, E; Glahn, D C; Pearlson, G D; Emsell, L; Kenney, J; Scanlon, C; McDonald, C; Cannon, D M; Almeida, J; Versace, A; Caseras, X; Lawrence, N S; Phillips, M L; Dima, D; Delvecchio, G; Frangou, S; Satterthwaite, T D; Wolf, D; Houenou, J; Henry, C; Malt, U F; Bøen, E; Elvsåshagen, T; Young, A H; Lloyd, A J; Goodwin, G M; Mackay, C E; Bourne, C; Bilderbeck, A; Abramovic, L; Boks, M P; van Haren, N E M; Ophoff, R A; Kahn, R S; Bauer, M; Pfennig, A; Alda, M; Hajek, T; Mwangi, B; Soares, J C; Nickson, T; Dimitrova, R; Sussmann, J E; Hagenaars, S; Whalley, H C; McIntosh, A M; Thompson, P M; Andreassen, O A

    2016-12-01

    Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10 -7 ) and thalamus (d=-0.148; P=4.27 × 10 -3 ) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10 -5 ) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.

  14. Neurolinguistic and follow-up study of an unusual pattern of recovery from bilingual subcortical aphasia.

    Science.gov (United States)

    Aglioti, S; Beltramello, A; Girardi, F; Fabbro, F

    1996-10-01

    We report on the neuropsychological and neurolinguistic features of a bilingual patient, E.M., who presented with an uncommon pattern of aphasic deficit consequent to subcortical lesions mainly involving the left basal ganglia. Not only are reports of bilingual subcortical aphasia rare, but E.M.'s deficit is particularly uncommon for it concerns the most used mother tongue (Venetian) much more than a less practiced second language (standard Italian). In this patient, the linguistic deficit in mother tongue production has been observed in spontaneous speech and in cross language translation tasks, where an asymmetrical paradoxical performance has been revealed. Indeed, unlike neurologically intact subjects, E.M. has more difficulties when translating into her mother tongue than into her second language. Although E.M.'s mother tongue is prevalently an oral language, the asymmetrical translation pattern is similar in written and oral translation tasks, thus ruling out the possibility that the deficit simply reflects differences between written and oral language codes. Finally, another remarkable feature of E.M.'s impairment is its stability over almost 5 years from the stroke. We propose that this unusual type of recovery in E.M. is related to the higher degree of automatization of the first language with respect to the second one. This proposal fits with the role of basal ganglia in automatized motor and cognitive performance.

  15. Cortical swallowing processing in early subacute stroke

    Directory of Open Access Journals (Sweden)

    Fischer Maren

    2011-03-01

    Full Text Available Abstract Background Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. Methods We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2 +/- 4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. Results Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. Conclusion Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.

  16. Recognizing Dementia

    DEFF Research Database (Denmark)

    Gjødsbøl, Iben Mundbjerg; Svendsen, Mette Nordahl

    2018-01-01

    narratives; yet during memory testing, patients are not allowed any substitution to clearly expose cognitive shortcomings. In combining works of theorists Ian Hacking and Paul Ricoeur, we argue that the clinical identification of dementia unmakes the knowing subject, a deconstruction that threatens...

  17. MR spectroscopy in dementia

    International Nuclear Information System (INIS)

    Hauser, T.; Gerigk, L.; Giesel, F.; Schuster, L.; Essig, M.

    2010-01-01

    With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia. (orig.) [de

  18. Risk factors and hospitalization costs of Dementia patients: Examining race and gender variations

    Directory of Open Access Journals (Sweden)

    Baqar Husaini

    2015-01-01

    Full Text Available Aims: To examine the variation in risk factors and hospitalization costs among four elderly dementia cohorts by race and gender. Materials and Methods: The 2008 Tennessee Hospital Discharged database was examined. The prevalence, risk factors and cost of inpatient care of dementia were examined for individuals aged 65 years and above, across the four race gender cohorts - white males (WM, black males (BM, white females (WF, and black females (BF. Results: 3.6% of patients hospitalized in 2008 had dementia. Dementia was higher among females than males, and higher among blacks than whites. Further, BF had higher prevalence of dementia than WF; similarly, BM had a higher prevalence of dementia than WM. Overall, six risk factors were associated with dementia for the entire sample including HTN, DM, CKD, CHF, COPD, and stroke. These risk factors varied slightly in predicting dementia by race and gender. Hospital costs were 14% higher among dementia patients compared to non-dementia patients. Conclusions: There exist significant race and gender disparities in prevalence of dementia. A greater degree of co-morbidity, increased duration of hospital stay, and more frequent hospitalizations, may result in a higher cost of inpatient dementia care. Aggressive management of risk factors may subsequently reduce stroke and cost of dementia care, especially in the black population. Race and gender dependent milestones for management of these risk factors should be considered.

  19. Insular networks for emotional processing and social cognition: comparison of two case reports with either cortical or subcortical involvement.

    Science.gov (United States)

    Couto, Blas; Sedeño, Lucas; Sposato, Luciano A; Sigman, Mariano; Riccio, Patricia M; Salles, Alejo; Lopez, Vladimir; Schroeder, Johannes; Manes, Facundo; Ibanez, Agustin

    2013-05-01

    The processing of the emotion of disgust is attributed to the insular cortex (IC), which is also responsible for social emotions and higher-cognitive functions. We distinguish the role of the IC from its connections in regard to these functions through the assessment of emotions and social cognition in a double case report. These subjects were very rare cases that included a focal IC lesion and a subcortical focal stroke affecting the connections of the IC with frontotemporal areas. Both patients and a sample of 10 matched controls underwent neuropsychological and affective screening questionnaires, a battery of multimodal basic emotion recognition tests, an emotional inference disambiguation task using social contextual clues, an empathy task and a theory of mind task. The insular lesion (IL) patient showed no impairments in emotion recognition and social emotions and presented with a pattern of delayed reaction times (RTs) in a subset of both groups of tasks. The subcortical lesion (SL) patient was impaired in multimodal aversive emotion recognition, including disgust, and exhibited delayed RTs and a heterogeneous pattern of impairments in subtasks of empathy and in the contextual inference of emotions. Our results suggest that IC related networks, and not the IC itself, are related to negative emotional processing and social emotions. We discuss these results with respect to theoretical approaches of insular involvement in emotional and social processing and propose that IC connectivity with frontotemporal and subcortical regions might be relevant for contextual emotional processing and social cognition. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke

    Directory of Open Access Journals (Sweden)

    Sofia Straudi

    2016-01-01

    Full Text Available Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week over two weeks. Outcome measures were collected before and after treatment: (i Fugl-Meyer Assessment-Upper Extremity (FMA-UE, (ii Box and Block Test (BBT, and (iii Motor Activity Log (MAL. Results. Both groups reported a significant improvement in FMA-UE score after treatment (p<0.01. No significant between-groups differences were found in motor function. However, when the analysis was adjusted for stroke type and duration, a significant interaction effect (p<0.05 was detected, showing that stroke duration (acute versus chronic and type (cortical versus subcortical modify the effect of tDCS and robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.

  1. Physical fitness and shapes of subcortical brain structures in children.

    Science.gov (United States)

    Ortega, Francisco B; Campos, Daniel; Cadenas-Sanchez, Cristina; Altmäe, Signe; Martínez-Zaldívar, Cristina; Martín-Matillas, Miguel; Catena, Andrés; Campoy, Cristina

    2017-03-27

    A few studies have recently reported that higher cardiorespiratory fitness is associated with higher volumes of subcortical brain structures in children. It is, however, unknown how different fitness measures relate to shapes of subcortical brain nuclei. We aimed to examine the association of the main health-related physical fitness components with shapes of subcortical brain structures in a sample of forty-four Spanish children aged 9·7 (sd 0·2) years from the NUtraceuticals for a HEALthier life project. Cardiorespiratory fitness, muscular strength and speed agility were assessed using valid and reliable tests (ALPHA-fitness test battery). Shape of the subcortical brain structures was assessed by MRI, and its relationship with fitness was examined after controlling for a set of potential confounders using a partial correlation permutation approach. Our results showed that all physical fitness components studied were significantly related to the shapes of subcortical brain nuclei. These associations were both positive and negative, indicating that a higher level of fitness in childhood is related to both expansions and contractions in certain regions of the accumbens, amygdala, caudate, hippocampus, pallidum, putamen and thalamus. Cardiorespiratory fitness was mainly associated with expansions, whereas handgrip was mostly associated with contractions in the structures studied. Future randomised-controlled trials will confirm or contrast our findings, demonstrating whether changes in fitness modify the shapes of brain structures and the extent to which those changes influence cognitive function.

  2. Lewy Body Dementia Diagnosis

    Science.gov (United States)

    ... provide an experienced diagnostic team skilled in Lewy body dementia. A thorough dementia diagnostic evaluation includes physical ... a good way to benefit others with Lewy body dementia. Medications Medications are one of the most ...

  3. Parkinson's Disease Dementia

    Science.gov (United States)

    ... Find your local chapter Join our online community Parkinson's Disease Dementia Parkinson's disease dementia is an impairment in ... disease. About Symptoms Diagnosis Causes & risks Treatments About Parkinson's disease dementia The brain changes caused by Parkinson's disease ...

  4. Confabulations after Bilateral Consecutive Strokes of the Lenticulostriate Arteries

    Directory of Open Access Journals (Sweden)

    Antonio Carota

    2012-03-01

    Full Text Available We describe the case of a 75-year-old woman who manifested persistent confabulations after two consecutive strokes encompassing the area of the lenticulostriate arteries territory on both hemispheres. Findings reported on this rare clinical syndrome suggest that fantastic confabulations and delusional thoughts may arise after bilateral damage of subcortical nonthalamic structures.

  5. Clinical, MRI and perfusion SPECT findings in strategic infarct dementia

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Park, Kyung Won; Cha, Jae Kwan; Kim, Sang Ho; Kim, Jae Woo [Dong-A University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    Strategic infarct dementia (SID) is characterized by focal ischemic lesions involving specific sites that are critical for higher cortical functions. The mechanism of SID are not well understood. We evaluate lesion sites, neuropsychiatric symptoms, brain perfusion SPECT and neuropsychological findings in patients with SID. Eleven patients with SID according to NINDS-AIREN criteria for vascular dementia were included. All patients performed brain MR and MRA, Tc-99m HMPAO brain perfusion SPECT. Various sites were responsible for SID; thalamus(n=3), medial temporal lobe(n=3), medial frontal lobe(n=1), genu of internal capsule(n=1), caudate nucleus(n=1), angular gyrus(n=1) and temporooccipital lobe(n=1). The most common neuropsychiatric symptoms were apathy and indifference by K-NPI. Brain perfusion SPECT revealed ipsilateral cortical hypoperfusion, mainly in frontal and temporal lobe area, in patients with subcortical strategic infarct. On neuropsychological assessment, cognitive deficits on attention and frontal executive function were prominent. The thalamus and medial temporal lobe were the most common sites responsible for SID. It was suggested that strategic disruption of frontal-subcortical circuit be an important role to produce SID in patients with subcortical strategic lesions.

  6. Clinical, MRI and perfusion SPECT findings in strategic infarct dementia

    International Nuclear Information System (INIS)

    Kang, Do Young; Park, Kyung Won; Cha, Jae Kwan; Kim, Sang Ho; Kim, Jae Woo

    2002-01-01

    Strategic infarct dementia (SID) is characterized by focal ischemic lesions involving specific sites that are critical for higher cortical functions. The mechanism of SID are not well understood. We evaluate lesion sites, neuropsychiatric symptoms, brain perfusion SPECT and neuropsychological findings in patients with SID. Eleven patients with SID according to NINDS-AIREN criteria for vascular dementia were included. All patients performed brain MR and MRA, Tc-99m HMPAO brain perfusion SPECT. Various sites were responsible for SID; thalamus(n=3), medial temporal lobe(n=3), medial frontal lobe(n=1), genu of internal capsule(n=1), caudate nucleus(n=1), angular gyrus(n=1) and temporooccipital lobe(n=1). The most common neuropsychiatric symptoms were apathy and indifference by K-NPI. Brain perfusion SPECT revealed ipsilateral cortical hypoperfusion, mainly in frontal and temporal lobe area, in patients with subcortical strategic infarct. On neuropsychological assessment, cognitive deficits on attention and frontal executive function were prominent. The thalamus and medial temporal lobe were the most common sites responsible for SID. It was suggested that strategic disruption of frontal-subcortical circuit be an important role to produce SID in patients with subcortical strategic lesions

  7. Factors associated with dementia in Aboriginal Australians.

    Science.gov (United States)

    Smith, Kate; Flicker, Leon; Dwyer, Anna; Atkinson, David; Almeida, Osvaldo P; Lautenschlager, Nicola T; LoGiudice, Dina

    2010-10-01

    Although the prevalence of dementia in remote living Aboriginal Australians is one of the highest in the world, the factors associated with dementia in this population are yet to be examined. This study was designed to determine the demographic, lifestyle and clinical factors associated with dementia in Aboriginal Australians living in the Kimberley region of Western Australia. A total of 363 Aboriginal Australians aged over 45 years from the Kimberley region were selected by semi-purposeful sampling. The factors analysed for association with dementia were age, sex, education, smoking, chewing tobacco, alcohol, head injury, heart disease, hypertension, diabetes, previous stroke, epilepsy, falls, mobility, incontinence, urinary problems, vision and hearing. This exposure data was collected from participants' and informants' reports using the Kimberley Indigenous Cognitive Assessment and specialist review, and medical records. Factors associated with dementia included older age, male gender (OR 3.1, 95%CI 1.4, 6.8) and no formal education (OR 2.7, 95%CI 1.1, 6.7) and after adjusting for age, sex and education, dementia was associated with current smoking (OR 4.5, 95%CI 1.1, 18.6), previous stroke (OR 17.9, 95%CI 5.9, 49.7), epilepsy (OR 33.5, 95%CI 4.8, 232.3), head injury (OR 4.0, 95%CI 1.7, 9.4), and poor mobility, incontinence and falls. Interventions aimed at better management or prevention of the modifiable factors identified could reduce dementia risk in Aboriginal populations.

  8. Subcortical aphasia and cerebral blood flow using SPECT

    International Nuclear Information System (INIS)

    Celsis, P.; Puel, M.; Demonet, J.P.; Bonafe, A.; Cardebat, D.; Viallard, G.; Pujol, T.; Marc-Vergnes, J.P.; Rascol, A.

    1985-01-01

    Possible cerebral blood flow (CBF) alteration in subcortical aphasia was investigated by single-photon emission tomography (SPECT). The results confirm the capsulo-striatal lesions and also point to the high rate of ipsilateral thalamic and cortical dysfunction. (author). 8 refs.; 1 fig.; 1 tab

  9. Phonemic Characteristics of Apraxia of Speech Resulting from Subcortical Hemorrhage

    Science.gov (United States)

    Peach, Richard K.; Tonkovich, John D.

    2004-01-01

    Reports describing subcortical apraxia of speech (AOS) have received little consideration in the development of recent speech processing models because the speech characteristics of patients with this diagnosis have not been described precisely. We describe a case of AOS with aphasia secondary to basal ganglia hemorrhage. Speech-language symptoms…

  10. Common genetic variants influence human subcortical brain structures

    NARCIS (Netherlands)

    D.P. Hibar (Derrek); J.L. Stein; M.E. Rentería (Miguel); A. Arias-Vásquez (Alejandro); S. Desrivières (Sylvane); N. Jahanshad (Neda); R. Toro (Roberto); K. Wittfeld (Katharina); L. Abramovic (Lucija); M. Andersson (Micael); B. Aribisala (Benjamin); N.J. Armstrong (Nicola J.); M. Bernard (Manon); M.M. Bohlken (Marc M.); M.P.M. Boks (Marco); L.B.C. Bralten (Linda); A.A. Brown (Andrew); M.M. Chakravarty (M. Mallar); Q. Chen (Qiang); C.R.K. Ching (Christopher); G. Cuellar-Partida (Gabriel); A. den Braber (Anouk); S. Giddaluru (Sudheer); A.L. Goldman (Aaron L.); O. Grimm (Oliver); T. Guadalupe (Tulio); J. Hass (Johanna); G. Woldehawariat (Girma); A.J. Holmes (Avram); M. Hoogman (Martine); D. Janowitz (Deborah); T. Jia (Tianye); S. Kim (Shinseog); M. Klein (Marieke); B. Kraemer (Bernd); P.H. Lee (Phil H.); L.M. Olde Loohuis (Loes M.); M. Luciano (Michelle); C. MacAre (Christine); R. Mather; M. Mattheisen (Manuel); Y. Milaneschi (Yuri); K. Nho (Kwangsik); M. Papmeyer (Martina); A. Ramasamy (Adaikalavan); S.L. Risacher (Shannon); R. Roiz-Santiañez (Roberto); E.J. Rose (Emma); A. Salami (Alireza); P.G. Sämann (Philipp); L. Schmaal (Lianne); N.J. Schork (Nicholas); J. Shin (Jean); V.M. Strike (Vanessa); A. Teumer (Alexander); M.M.J. Van Donkelaar (Marjolein M. J.); K.R. van Eijk (Kristel); R.K. Walters (Raymond); L.T. Westlye (Lars); C.D. Whelan (Christopher); A.M. Winkler (Anderson); M.P. Zwiers (Marcel); S. Alhusaini (Saud); L. Athanasiu (Lavinia); S.M. Ehrlich (Stefan); M. Hakobjan (Marina); C.B. Hartberg (Cecilie B.); U.K. Haukvik (Unn); A.J.G.A.M. Heister (Angelien J. G. A. M.); D. Hoehn (David); D. Kasperaviciute (Dalia); D.C. Liewald (David C.); L.M. Lopez (Lorna); R.R.R. Makkinje (Remco R. R.); M. Matarin (Mar); M.A.M. Naber (Marlies A. M.); D. Reese McKay; M. Needham (Margaret); A.C. Nugent (Allison); B. Pütz (Benno); N.A. Royle (Natalie); L. Shen (Li); R. Sprooten (Roy); D. Trabzuni (Danyah); S.S.L. Van Der Marel (Saskia S. L.); K.J.E. Van Hulzen (Kimm J. E.); E. Walton (Esther); A. Björnsson (Asgeir); L. Almasy (Laura); D.J. Ames (David); S. Arepalli (Sampath); A.A. Assareh; M.E. Bastin (Mark); H. Brodaty (Henry); K. Bulayeva (Kazima); M.A. Carless (Melanie); S. Cichon (Sven); A. Corvin (Aiden); J.E. Curran (Joanne); M. Czisch (Michael); G.I. de Zubicaray (Greig); A. Dillman (Allissa); A. Duggirala (Aparna); M.D. Dyer (Matthew); S. Erk; I. Fedko (Iryna); L. Ferrucci (Luigi); T. Foroud (Tatiana); P.T. Fox (Peter); M. Fukunaga (Masaki); J. Raphael Gibbs; H.H.H. Göring (Harald H.); R.C. Green (Robert C.); S. Guelfi (Sebastian); N.K. Hansell (Narelle); C.A. Hartman (Catharina); K. Hegenscheid (Katrin); J. Heinz (Judith); D.G. Hernandez (Dena); D.J. Heslenfeld (Dirk); P.J. Hoekstra (Pieter); F. Holsboer; G. Homuth (Georg); J.J. Hottenga (Jouke Jan); M. Ikeda (Masashi); C.R. Jack Jr. (Clifford); S. Jenkinson (Sarah); R. Johnson (Robert); R. Kanai (Ryota); M. Keil (Maria); J.W. Kent (Jack W.); P. Kochunov (Peter); J.B. Kwok (John B.); S. Lawrie (Stephen); X. Liu (Xinmin); D.L. Longo (Dan L.); K.L. Mcmahon (Katie); E. Meisenzahl (Eva); I. Melle (Ingrid); S. Mohnke (Sebastian); G.W. Montgomery (Grant); J.C. Mostert (Jeanette C.); T.W. Mühleisen (Thomas); M.A. Nalls (Michael); T.E. Nichols (Thomas); L.G. Nilsson; M.M. Nöthen (Markus); K. Ohi (Kazutaka); R.L. Olvera (Rene); R. Perez-Iglesias (Rocio); G. Bruce Pike; S.G. Potkin (Steven); I. Reinvang (Ivar); S. Reppermund; M. Rietschel (Marcella); N. Seiferth (Nina); G.D. Rosen (Glenn D.); D. Rujescu (Dan); K. Schnell (Kerry); C.J. Schofield (Christopher); C. Smith (Colin); V.M. Steen (Vidar); J. Sussmann (Jessika); A. Thalamuthu (Anbupalam); A.W. Toga (Arthur W.); B. Traynor (Bryan); J.C. Troncoso (Juan); J. Turner (Jessica); M.C. Valdés Hernández (Maria); D. van 't Ent (Dennis); M.P. van der Brug (Marcel); N.J. van der Wee (Nic); M.J.D. van Tol (Marie-José); D.J. Veltman (Dick); A.M.J. Wassink (Annemarie); E. Westman (Eric); R.H. Zielke (Ronald H.); A.B. Zonderman (Alan B.); D.G. Ashbrook (David G.); R. Hager (Reinmar); L. Lu (Lu); F.J. Mcmahon (Francis J); D.W. Morris (Derek W); R.W. Williams (Robert W.); H.G. Brunner; M. Buckner; J.K. Buitelaar (Jan K.); W. Cahn (Wiepke); V.D. Calhoun Vince D. (V.); G. Cavalleri (Gianpiero); B. Crespo-Facorro (Benedicto); A.M. Dale (Anders); G.E. Davies (Gareth); N. Delanty; C. Depondt (Chantal); S. Djurovic (Srdjan); D.A. Drevets (Douglas); T. Espeseth (Thomas); R.L. Gollub (Randy); B.C. Ho (Beng ); W. Hoffmann (Wolfgang); N. Hosten (Norbert); R. Kahn (René); S. Le Hellard (Stephanie); A. Meyer-Lindenberg; B. Müller-Myhsok (B.); M. Nauck (Matthias); L. Nyberg (Lars); M. Pandolfo (Massimo); B.W.J.H. Penninx (Brenda); J.L. Roffman (Joshua); S.M. Sisodiya (Sanjay); J.W. Smoller; H. van Bokhoven (Hans); N.E.M. van Haren (Neeltje E.); H. Völzke (Henry); H.J. Walter (Henrik); M.W. Weiner (Michael); W. Wen (Wei); T.J.H. White (Tonya); I. Agartz (Ingrid); O.A. Andreassen (Ole); J. Blangero (John); D.I. Boomsma (Dorret); R.M. Brouwer (Rachel); D.M. Cannon (Dara); M.R. Cookson (Mark); E.J.C. de Geus (Eco); I.J. Deary (Ian J.); D.J. Donohoe (Dennis); G. Fernandez (Guillén); S.E. Fisher (Simon); C. Francks (Clyde); D.C. Glahn (David); H.J. Grabe (Hans Jörgen); O. Gruber (Oliver); J. Hardy (John); R. Hashimoto (Ryota); H.E. Hulshoff Pol (Hilleke); E.G. Jönsson (Erik); I. Kloszewska (Iwona); S. Lovestone (Simon); V.S. Mattay (Venkata S.); P. Mecocci (Patrizia); C. McDonald (Colm); A.M. McIntosh (Andrew); R.A. Ophoff (Roel); T. Paus (Tomas); Z. Pausova (Zdenka); M. Ryten (Mina); P.S. Sachdev (Perminder); A.J. Saykin (Andrew); A. Simmons (Andrew); A. Singleton (Andrew); H. Soininen (H.); J.M. Wardlaw (J.); M.E. Weale (Michael); D.R. Weinberger (Daniel); H.H.H. Adams (Hieab); L.J. Launer (Lenore); S. Seiler (Stephan); R. Schmidt (Reinhold); G. Chauhan (Ganesh); C.L. Satizabal (Claudia L.); J.T. Becker (James); L.R. Yanek (Lisa); S.J. van der Lee (Sven); M. Ebling (Maritza); B. Fischl (Bruce); W.T. Longstreth Jr; D. Greve (Douglas); R. Schmidt (Reinhold); P. Nyquist (Paul); L.N. Vinke (Louis N.); C.M. van Duijn (Cornelia); L. Xue (Luting); B. Mazoyer (Bernard); J.C. Bis (Joshua); V. Gudnason (Vilmundur); S. Seshadri (Sudha); M.A. Ikram (Arfan); N.G. Martin (Nicholas); M.J. Wright (Margaret); G. Schumann (Gunter); B. Franke (Barbara); P.M. Thompson (Paul); S.E. Medland (Sarah Elizabeth)

    2015-01-01

    textabstractThe highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate

  11. Common genetic variants influence human subcortical brain structures

    NARCIS (Netherlands)

    Hibar, D.P.; Stein, J.L.; Renteria, M.E.; Arias-Vasquez, A.; Desrivières, S.; Jahanshad, N.; Toro, R.; Wittfeld, K.; Abramovic, L.; Andersson, M.; Aribisala, B.S.; Armstrong, N.J.; Bernard, M.; Bohlken, M.M.; Biks, M.P.; Bralten, J.; Brown, A.A.; Chakravarty, M.M.; Chen, Q.; Ching, C.R.K.; Cuellar-Partida, G.; den Braber, A.; Giddaluru, S.; Goldman, A.L.; Grimm, O.; Guadalupe, T.; Hass, J.; Woldehawariat, G.; Holmes, A.J.; Hoogman, M.; Janowitz, D.; Jia, T.; Kim, S.; Klein, M.; Kraemer, B.; Lee, P.H.; Olde Loohuis, L.M.; Luciano, M.; Macare, C.; Mather, K.A.; Mattheisen, M.; Milaneschi, Y.; Nho, K.; Papmeyer, M.; Ramasamy, A.; Risacher, S.L.; Roiz-Santiañez, R.; Rose, E.J.; Salami, A.; Sämann, P.G.; Schmaal, L.; Schork, A.J.; Shin, J.; Strike, L.T.; Teumer, A.; Donkelaar, M.M.J.; van Eijk, K.R.; Walters, R.K.; Westlye, L.T.; Welan, C.D.; Winkler, A.M.; Zwiers, M.P.; Alhusaini, S.; Athanasiu, L.; Ehrlich, S.; Hakobjan, M.M.H.; Hartberg, C.B.; Haukvik, U.K.; Heister, A.J.G.A.M.; Hoehn, D.; Kasperaviciute, D.; Liewald, D.C.M.; Lopez, L.M.; Makkinje, R.R.; Matarin, M.; Naber, M.A.M.; Reese McKay, D.; Needham, M.; Nugent, A.C.; Pütz, B.; Royle, N.A.; Shen, L.; Sprooten, E.; Trabzuni, D.; van der Marel, S.S.L.; van Hulzen, K.J.E.; Walton, E.; Wolf, C.; Almasy, L.; Ames, D.; Arepalli, S.; Assareh, A.A.; Bastin, M.E.; Brodaty, H.; Bulayeva, K.B.; Carless, M.A.; Cichon, S.; Corvin, A.; Curran, J.E.; Czisch, M.; de Zubicaray, G.I.; Dillman, A.; Duggirala, R.; Dyer, T.D.; Erk, S.; Fedko, I.O.; Ferrucci, L.; Foroud, T.M.; Fox, P.T.; Fukunaga, M.; Gibbs, J.R.; Göring, H.H.H.; Green, R.C.; Guelfi, S.; Hansell, N.K.; Hartman, C.A.; Hegenscheid, K.; Heinz, A.; Hernandez, D.G.; Heslenfeld, D.J.; Hoekstra, P.J.; Holsboer, F.; Homuth, G.; Hottenga, J.J.; Ikeda, M.; Jack, C.R., Jr.; Jenkinson, M.; Johnson, R.; Kanai, R.; Keil, M.; Kent, J.W. Jr.; Kochunov, P.; Kwok, J.B.; Lawrie, S.M.; Liu, X.; Longo, D.L.; McMahon, K.L.; Meisenzahl, E.; Melle, I.; Mohnke, S.; Montgomery, G.W.; Mostert, J.C.; Mühleisen, T.W.; Nalls, M.A.; Nichols, T.E.; Nilsson, L.G.; Nöthen, M.M.; Ohi, K.; Olvera, R.L.; Perez-Iglesias, R.; Pike, G.B.; Potkin, S.G.; Reinvang, I.; Reppermund, S.; Rietschel, M.; Romanczuk-Seiferth, N.; Rosen, G.D.; Rujescu, D.; Schnell, K.; Schofield, P.R.; Smith, C.; Steen, V.M.; Sussmann, J.E.; Thalamuthu, A.; Toga, A.W.; Traynor, B.J.; Troncoso, J.; Turner, J.A.; Valdés Hernández, M.C.; van t Ent, D.; van der Brug, M.; van der Wee, N.J.A.; van Tol, M.J.; Veltman, D.J.; Wassink, T.H.; Westmann, E.; Zielke, R.H.; Zonderman, A.B.; Ashbrook, D.G.; Hager, R.; Lu, L.; McMahon, F.J.; Morris, D.W.; Williams, R.W.; Brunner, H.G.; Buckner, R.L.; Buitelaar, J.K.; Cahn, W.; Calhoun, V.D.; Cavalleri, G.L.; Crespo-Facorro, B.; Dale, A.M.; Davies, G.E.; Delanty, N.; Depondt, C.; Djurovic, S.; Drevets, W.C.; Espeseth, T.; Gollub, R.L.; Ho, B.C.; Hoffmann, W.; Hosten, N.; Kahn, R.S.; Le Hellard, S.; Meyer-Lindenberg, A.; Müller-Myhsok, B.; Nauck, M.; Nyberg, L.; Pandolfo, M.; Penninx, B.W.J.H.; Roffman, J.L.; Sisodiya, SM; Smoller, J.W.; van Bokhoven, H.; van Haren, N.E.M.; Völzke, H.; Walter, H.; Weiner, M.W.; Wen, W.; White, T.; Agartz, I.; Andreassen, O.A.; Blangero, J.; Boomsma, D.I.; Brouwer, R.M.; Cannon, D.M.; Cookson, M.R.; de Geus, E.J.C.; Deary, I.J.; Donohoe, G.; Fernandez, G.; Fisher, S.E.; Francks, C.; Glahn, D.C.; Grabe, H.J.; Gruber, O.; Hardy, J.; Hashimoto, R.; Hulshoff Pol, H.E.; Jönsson, E.G.; Kloszewska, I.; Lovestone, S.; Mattay, V.S.; Mecocci, P.; McDonald, C.; McIntosh, A.M.; Ophoff, R.A.; Paus, T.; Pausova, Z.; Ryten, M.; Sachdev, P.S.; Saykin, A.J.; Simmons, A.; Singleton, A.; Soininen, H.; Wardlaw, J.M.; Weale, M.E.; Weinberger, D.R.; Adams, H.H.H.; Launer, L.J.; Seiler, S.; Schmidt, R.; Chauhan, G.; Satizabal, C.L.; Becker, J.T.; Yanek, L.; van der Lee, S.J.; Ebling, M.; Fischl, B.; Longstreth, Jr. W.T.; Greve, D.; Schmidt, H.; Nyquist, P.; Vinke, L.N.; van Duijn, C.M.; Xue, L.; Mazoyer, B.; Bis, J.C.; Gudnason, V.; Seshadri, S.; Arfan Ikram, M.; Martin, N.G.; Wright, M.J.; Schumann, G.; Franke, B.; Thompson, P.M.; Medland, S.E.

    2015-01-01

    The highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate how common

  12. Common genetic variants influence human subcortical brain structures

    NARCIS (Netherlands)

    Hibar, Derrek P.; Stein, Jason L.; Renteria, Miguel E.; Arias-Vasquez, Alejandro; Desrivieres, Sylvane; Jahanshad, Neda; Toro, Roberto; Wittfeld, Katharina; Abramovic, Lucija; Andersson, Micael; Aribisala, Benjamin S.; Armstrong, Nicola J.; Bernard, Manon; Bohlken, Marc M.; Boks, Marco P.; Bralten, Janita; Brown, Andrew A.; Chakravarty, M. Mallar; Chen, Qiang; Ching, Christopher R. K.; Cuellar-Partida, Gabriel; den Braber, Anouk; Giddaluru, Sudheer; Goldman, Aaron L.; Grimm, Oliver; Guadalupe, Tulio; Hass, Johanna; Woldehawariat, Girma; Holmes, Avram J.; Hoogman, Martine; Janowitz, Deborah; Jia, Tianye; Kim, Sungeun; Klein, Marieke; Kraemer, Bernd; Lee, Phil H.; Loohuis, Loes M. Olde; Luciano, Michelle; Macare, Christine; Mather, Karen A.; Mattheisen, Manuel; Milaneschi, Yuri; Nho, Kwangsik; Papmeyer, Martina; Ramasamy, Adaikalavan; Risacher, Shannon L.; Roiz-Santianez, Roberto; Rose, Emma J.; Salami, Alireza; Saemann, Philipp G.; Schmaal, Lianne; Schork, Andrew J.; Shin, Jean; Strike, Lachlan T.; Teumer, Alexander; van Donkelaar, Marjolein M. J.; van Eijk, Kristel R.; Walters, Raymond K.; Westlye, Lars T.; Whelan, Christopher D.; Winkler, Anderson M.; Zwiers, Marcel P.; Alhusaini, Saud; Athanasiu, Lavinia; Ehrlich, Stefan; Hakobjan, Marina M. H.; Hartberg, Cecilie B.; Haukvik, Unn K.; Heister, Angelien J. G. A. M.; Hoehn, David; Kasperaviciute, Dalia; Liewald, David C. M.; Lopez, Lorna M.; Makkinje, Remco R. R.; Matarin, Mar; Naber, Marlies A. M.; McKay, D. Reese; Needham, Margaret; Nugent, Allison C.; Puetz, Benno; Royle, Natalie A.; Shen, Li; Sprooten, Emma; Trabzuni, Daniah; van der Marel, Saskia S. L.; van Hulzen, Kimm J. E.; Walton, Esther; Wolf, Christiane; Almasy, Laura; Ames, David; Arepalli, Sampath; Assareh, Amelia A.; Bastin, Mark E.; Brodaty, Henry; Bulayeva, Kazima B.; Carless, Melanie A.; Cichon, Sven; Corvin, Aiden; Curran, Joanne E.; Czisch, Michael; de Zubicaray, Greig I.; Dillman, Allissa; Duggirala, Ravi; Dyer, Thomas D.; Erk, Susanne; Fedko, Iryna O.; Ferrucci, Luigi; Foroud, Tatiana M.; Fox, Peter T.; Fukunaga, Masaki; Gibbs, J. Raphael; Goering, Harald H. H.; Green, Robert C.; Guelfi, Sebastian; Hansell, Narelle K.; Hartman, Catharina A.; Hegenscheid, Katrin; Heinz, Andreas; Hernandez, Dena G.; Heslenfeld, Dirk J.; Hoekstra, Pieter J.; Holsboer, Florian; Homuth, Georg; Hottenga, Jouke-Jan; Ikeda, Masashi; Jack, Clifford R.; Jenkinson, Mark; Johnson, Robert; Kanai, Ryota; Keil, Maria; Kent, Jack W.; Kochunov, Peter; Kwok, John B.; Lawrie, Stephen M.; Liu, Xinmin; Longo, Dan L.; McMahon, Katie L.; Meisenzah, Eva; Melle, Ingrid; Mahnke, Sebastian; Montgomery, Grant W.; Mostert, Jeanette C.; Muehleisen, Thomas W.; Nalls, Michael A.; Nichols, Thomas E.; Nilsson, Lars G.; Noethen, Markus M.; Ohi, Kazutaka; Olvera, Rene L.; Perez-Iglesias, Rocio; Pike, G. Bruce; Potkin, Steven G.; Reinvang, Ivar; Reppermund, Simone; Rietschel, Marcella; Romanczuk-Seiferth, Nina; Rosen, Glenn D.; Rujescu, Dan; Schnell, Knut; Schofield, Peter R.; Smith, Colin; Steen, Vidar M.; Sussmann, Jessika E.; Thalamuthu, Anbupalam; Toga, Arthur W.; Traynor, Bryan J.; Troncoso, Juan; Turner, Jessica A.; Valdes Hernandez, Maria C.; van't Ent, Dennis; van der Brug, Marcel; van der Wee, Nic J. A.; van Tol, Marie-Jose; Veltman, Dick J.; Wassink, Thomas H.; Westman, Eric; Zielke, Ronald H.; Zonderman, Alan B.; Ashbrook, David G.; Hager, Reinmar; Lu, Lu; McMahon, Francis J.; Morris, Derek W.; Williams, Robert W.; Brunner, Han G.; Buckner, Randy L.; Buitelaar, Jan K.; Cahn, Wiepke; Calhoun, Vince D.; Cavalleri, Gianpiero L.; Crespo-Facorro, Benedicto; Dale, Anders M.; Davies, Gareth E.; Delanty, Norman; Depondt, Chantal; Djurovic, Srdjan; Drevets, Wayne C.; Espeseth, Thomas; Gollub, Randy L.; Ho, Beng-Choon; Hoffman, Wolfgang; Hosten, Norbert; Kahn, Rene S.; Le Hellard, Stephanie; Meyer-Lindenberg, Andreas; Mueller-Myhsok, Bertram; Nauck, Matthias; Nyberg, Lars; Pandolfo, Massimo; Penninx, Brenda W. J. H.; Roffman, Joshua L.; Sisodiya, Sanjay M.; Smoller, Jordan W.; van Bokhoven, Hans; van Haren, Neeltje E. M.; Voelzke, Henry; Walter, Henrik; Weiner, Michael W.; Wen, Wei; White, Tonya; Agartz, Ingrid; Andreassen, Ole A.; Blangero, John; Boomsma, Dorret I.; Brouwer, Rachel M.; Cannon, Dara M.; Cookson, Mark R.; de Geus, Eco J. C.; Deary, Ian J.; Donohoe, Gary; Fernandez, Guillen; Fisher, Simon E.; Francks, Clyde; Glahn, David C.; Grabe, Hans J.; Gruber, Oliver; Hardy, John; Hashimoto, Ryota; Pol, Hilleke E. Hulshoff; Joensson, Erik G.; Kloszewska, Iwona; Lovestone, Simon; Mattay, Venkata S.; Mecocci, Patrizia; McDonald, Colm; McIntosh, Andrew M.; Ophoff, Roel A.; Paus, Tomas; Pausova, Zdenka; Ryten, Mina; Sachdev, Perminder S.; Saykin, Andrew J.; Simmons, Andy; Singleton, Andrew; Soininen, Hilkka; Wardlaw, Joanna M.; Weale, Michael E.; Weinberger, Daniel R.; Adams, Hieab H. H.; Launer, Lenore J.; Seiler, Stephan; Schmidt, Reinhold; Chauhan, Ganesh; Satizabal, Claudia L.; Becker, James T.; Yanek, Lisa; van der Lee, Sven J.; Ebling, Maritza; Fischl, Bruce; Longstreth, W. T.; Greve, Douglas; Schmidt, Helena; Nyquist, Paul; Vinke, Louis N.; van Duijn, Cornelia M.; Xue, Luting; Mazoyer, Bernard; Bis, Joshua C.; Gudnason, Vilmundur; Seshadri, Sudha; Ikram, M. Arfan; Martin, Nicholas G.; Wright, Margaret J.; Schumann, Gunter; Franke, Barbara; Thompson, Paul M.; Medland, Sarah E.

    2015-01-01

    The highly complex structure of the human brain is strongly shaped by genetic influences(1). Subcortical brain regions form circuits with cortical areas to coordinate movement(2), learning, memory(3) and motivation(4), and altered circuits can lead to abnormal behaviour and disease(5). To

  13. Preventing stroke

    Science.gov (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  14. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  15. Improving Motor Corticothalamic Communication After Stroke Using Real-Time fMRI Connectivity-Based Neurofeedback.

    Science.gov (United States)

    Liew, Sook-Lei; Rana, Mohit; Cornelsen, Sonja; Fortunato de Barros Filho, Marcos; Birbaumer, Niels; Sitaram, Ranganatha; Cohen, Leonardo G; Soekadar, Surjo R

    2016-08-01

    Two thirds of stroke survivors experience motor impairment resulting in long-term disability. The anatomical substrate is often the disruption of cortico-subcortical pathways. It has been proposed that reestablishment of cortico-subcortical communication relates to functional recovery. In this study, we applied a novel training protocol to augment ipsilesional cortico-subcortical connectivity after stroke. Chronic stroke patients with severe motor impairment were provided online feedback of blood-oxygenation level dependent signal connectivity between cortical and subcortical regions critical for motor function using real-time functional magnetic resonance imaging neurofeedback. In this proof of principle study, 3 out of 4 patients learned to voluntarily modulate cortico-subcortical connectivity as intended. Our results document for the first time the feasibility and safety for patients with chronic stroke and severe motor impairment to self-regulate and augment ipsilesional cortico-subcortical connectivity through neurofeedback using real-time functional magnetic resonance imaging. © The Author(s) 2015.

  16. Vascular risk factors and white matter hyperintensities as predictors of progression to dementia in patients with mild cognitive impairment.

    Science.gov (United States)

    Sevilla, Raul Romero; Naranjo, Ignacio Casado; Cuenca, Juan Carlos Portilla; de San Juan, Beatriz Duque; Rodriguez, Jose Manuel Fuentes; Espuela, Fidel Lopez

    2018-01-18

    Evidence of the effect of vascular risk factors and white matter lesions on progression of mild cognitive impairment (MCI) to dementia is not conclusive. To analyze the impact of these factors on MCI progression to dementia from a global perspective. Our study included a population of 105 patients with MCI. After a mean follow-up period of 3.09 years (range, 2-3.79), 47 patients (44.76%) progressed to dementia: 32 (30.8%) to mixed dementia, 13 (12.5%) to probable AD, and 2 (1.9%) to vascular dementia. Total cholesterol levels (OR: 1.015 [1.003-1.028]) and LDL cholesterol levels (OR: 1.018 [1.004-1.032]) increased the risk of progression to dementia. Cystatin C was a protective factor against progression to dementia (OR: 0.119 [0.015-0.944], p = 0.044). During the second year of follow-up, the presence of subcortical white matter hyperintensities increased the risk of progression to dementia (OR: 5.854 [1.008-33.846]). Subcortical and periventricular white matter hyperintensities were also associated with an increased risk of progression to dementia during the second year of follow-up (OR: 3.130 [1.098-8.922] and OR: 3.561 [1.227-10.334], respectively). The same was true for silent infarcts (OR: 4.308 [1.480-12.500]). A high percentage of patients progressed to dementia. Total cholesterol, LDL cholesterol, and white matter hyperintensities were found to be associated with MCI progression to dementia. In contrast, cystatin C was shown to be a protective factor against progression to dementia. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  17. A short screening instrument for poststroke dementia : the R-CAMCOG

    NARCIS (Netherlands)

    I. de Koning (Inge); D.W.J. Dippel (Diederik); F. van Kooten (Fop); P.J. Koudstaal (Peter Jan)

    2000-01-01

    textabstractBACKGROUND AND PURPOSE: The CAMCOG is a feasible cognitive screening instrument for dementia in patients with a recent stroke. A major disadvantage of the CAMCOG, however, is its lengthy and relatively complex administration for screening purposes. We

  18. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infacts and Leukoencephalopathy (CADASIL)

    Science.gov (United States)

    ... Asprin is used in patients who have other risk factors for stroke such as diabetes and heart disease as a ... Smoking and use of birth control pills are risk factors for stroke. We encourage patients with CADASIL to limit their ...

  19. Temporal Lobe and Frontal-Subcortical Dissociations in Non-Demented Parkinson's Disease with Verbal Memory Impairment.

    Science.gov (United States)

    Tanner, Jared J; Mareci, Thomas H; Okun, Michael S; Bowers, Dawn; Libon, David J; Price, Catherine C

    2015-01-01

    The current investigation examined verbal memory in idiopathic non-dementia Parkinson's disease and the significance of the left entorhinal cortex and left entorhinal-retrosplenial region connections (via temporal cingulum) on memory impairment in Parkinson's disease. Forty non-demented Parkinson's disease patients and forty non-Parkinson's disease controls completed two verbal memory tests--a wordlist measure (Philadelphia repeatable Verbal Memory Test) and a story measure (Logical Memory). All participants received T1-weighted and diffusion magnetic resonance imaging (3T; Siemens) sequences. Left entorhinal volume and left entorhinal-retrosplenial connectivity (temporal cingulum edge weight) were the primary imaging variables of interest with frontal lobe thickness and subcortical structure volumes as dissociating variables. Individuals with Parkinson's disease showed worse verbal memory, smaller entorhinal volumes, but did not differ in entorhinal-retrosplenial connectivity. For Parkinson's disease entorhinal-retrosplenial edge weight had the strongest associations with verbal memory. A subset of Parkinson's disease patients (23%) had deficits (z-scores frontal-subcortical gray or frontal white matter regions. These findings argue for additional investigation into medial temporal lobe gray and white matter connectivity for understanding memory in Parkinson's disease.

  20. Clinicoanatomical correlation in stroke related aphasia

    Directory of Open Access Journals (Sweden)

    Vikram Bohra

    2015-01-01

    Full Text Available Context: With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles. Aims: To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke. Settings and Design: Observational study, based in a tertiary care center. Materials and Methods: Stroke patient′s ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB. Statistical analysis was done with χ2 test with Yates correction and Kruskal-Wallis test. The level of significance was set at P < 0.05. Results: Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%, Broca′s (28.3%, transcortical motor (13.33%, transcortical sensory (10%, Wernicke′s (8.33%, anomic (5%, and conduction (1.67% aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only. Conclusions: No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.

  1. Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort.

    Science.gov (United States)

    Golub, Justin S; Luchsinger, José A; Manly, Jennifer J; Stern, Yaakov; Mayeux, Richard; Schupf, Nicole

    2017-08-01

    To determine whether observed hearing loss (OHL) is associated with incident dementia in a multiethnic population. Prospective epidemiological cohort study. Community in northern Manhattan. Participants in the Washington Heights-Inwood Columbia Aging Project, a longitudinal study on aging and dementia in an ethnically diverse community (n = 1,881). OHL was defined when the examiner observed it or according to self-reported hearing aid use. A consensus panel diagnosed dementia using standard research criteria. A Cox proportional hazards model was used to examine the relationship between OHL at baseline and risk of incident dementia (mean 7.3 ± 4.4 years of longitudinal followup, range 0.9-20 years). OHL was associated with 1.69 (95% confidence interval (CI) = 1.3-2.3, P < .010) times the risk of incident dementia, adjusting for demographic characteristics, cardiovascular risk factors, apolipoprotein E4 genotype, and stroke. When stratified according to race, the association between OHL and incident dementia was high in all groups but was statistically significant only in blacks (hazard ratio = 2.62, 95% CI = 1.5-4.5, P < .010). OHL was associated with greater risk of incident dementia in a multiethnic cohort. More study is needed to determine whether HL contributes to dementia and whether treating HL can reduce the risk of dementia. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  2. Charting cognitive and volumetric trajectories after stroke: protocol for the Cognition And Neocortical Volume After Stroke (CANVAS) study.

    Science.gov (United States)

    Brodtmann, Amy; Werden, Emilio; Pardoe, Heath; Li, Qi; Jackson, Graeme; Donnan, Geoffrey; Cowie, Tiffany; Bradshaw, Jennifer; Darby, David; Cumming, Toby

    2014-08-01

    Globally, stroke and dementia are leading causes of disability and mortality. More than one third of stroke patients will develop dementia, but mechanisms are unclear. The study aims to establish whether brain volume change is associated with poststroke dementia, and to elucidate potential causal mechanisms, including genetic markers, amyloid deposition and vascular risk factors. An understanding of whether - and in whom - stroke is neurodegenerative is critical for the strategic use of potential disease-modifying therapies. That stroke patients will exhibit greater brain volume loss than comparable cohorts of stroke-free controls; and that those who develop dementia will exhibit greater brain volume loss than those who do not. Advanced brain imaging techniques are used to longitudinally measure brain volume and cortical thickness in 135 stroke patients. Concurrent neuropsychological testing will correlate clinical profile with these measures. Primary imaging end-point is brain volume change between three-months and three-years poststroke; primary clinical outcome is the presence of dementia at three-years. We will examine the correlations with the following variables: dementia subtype; physical activity levels; behavioral dysfunction as measured by patient and caregiver-reported scales; structural and functional brain connectivity disruption; apolipoprotein E; and specific neuropsychological test scores. Magnetic resonance imaging markers of structural brain aging and performance on neuropsychological tests are powerful predictors of dementia. We need to understand the trajectory of regional brain volume change and cognitive decline in patients after stroke. This will allow future risk stratification for prognostic counseling, service planning, and early therapeutic intervention. © 2014 World Stroke Organization.

  3. Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models.

    Science.gov (United States)

    Edwardson, Matthew A; Wang, Ximing; Liu, Brent; Ding, Li; Lane, Christianne J; Park, Caron; Nelsen, Monica A; Jones, Theresa A; Wolf, Steven L; Winstein, Carolee J; Dromerick, Alexander W

    2017-06-01

    Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals. To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery. Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.

  4. Vascular dementia: Facts and controversies

    Directory of Open Access Journals (Sweden)

    Pavlović Aleksandra

    2013-01-01

    Full Text Available Vascular dementia (VaD is the second most frequent dementia after Alzheimer’s disease, and is diagnosed during lifetime in 20% of demented patients. Five­year survival rate in VaD is 39%, while it is estimated to be 75% in healthy persons of the same age. It is therefore important to make correct diagnosis of VaD early in the course of the disease. Risk factors for VaD are identical to stroke risk factors, and there are significant possibilities for the prevention of vascular cognitive decline. Cognitive decline develops acutely or step­by­step within three months after stroke, but more gradual progression of intellectual decline is also possible. Neurological examination can reveal pyramidal and extrapyramidal signs, pseudobulbar palsy, gait disturbance and urinary incontinence. Neuropsychological profile comprises the loss of cognitive set shifting, decline in word fluency, verbal learning difficulties, perseverations, difficulties in complex figure copying, and in patients with cortically located lesions also problems with speech and praxia. The basis of the diagnosis is, besides history, neurological examination and neuropsychological assessment, computed tomography and/ or magnetic resonance brain imaging. Vascular risk factors control is the most important measure in VaD prevention. Modern guidelines for the treatment of cognitive decline in VaD emphasize that donepezil can be useful in the improvement of cognitive status at the level of Class IIa recommendation at the level of evidence A, while memantine may be useful in patients with mixed VaD and Alzheimer’s disease dementia. [Projekat Ministarstva nauke Republike Srbije, br. 175022 i br. 175033

  5. White matter changes in stroke patients. Relationship with stroke subtype and outcome

    DEFF Research Database (Denmark)

    Leys, D; Englund, E; Del Ser, T

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

  6. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  7. FDG PET imaging dementia

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol [Kyungpook National University Medical School and Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2007-04-15

    Dementia is a major burden for many countries including South Korea, where life expectancy is continuously growing and the proportion of aged people is rapidly growing. Neurodegenerative disorders, such as, Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia. Parkinson disease, progressive supranuclear palsy, corticobasal degeneration, Huntington disease, can cause dementia, and cerebrovascular disease also can cause dementia. Depression or hypothyroidism also can cause cognitive deficits, but they are reversible by management of underlying cause unlike the forementioned dementias. Therefore these are called pseudodementia. We are entering an era of dementia care that will be based upon the identification of potentially modifiable risk factors and early disease markers, and the application of new drugs postpone progression of dementias or target specific proteins that cause dementia. Efficient pharmacologic treatment of dementia needs not only to distinguish underlying causes of dementia but also to be installed as soon as possible. Therefore, differential diagnosis and early diagnosis of dementia are utmost importance. F-18 FDG PET is useful for clarifying dementing diseases and is also useful for early detection of the disease. Purpose of this article is to review the current value of FDG PET for dementing diseases including differential diagnosis of dementia and prediction of evolving dementia.

  8. Genetic influences on schizophrenia and subcortical brain volumes

    DEFF Research Database (Denmark)

    Franke, Barbara; Stein, Jason L; Ripke, Stephan

    2016-01-01

    Schizophrenia is a devastating psychiatric illness with high heritability. Brain structure and function differ, on average, between people with schizophrenia and healthy individuals. As common genetic associations are emerging for both schizophrenia and brain imaging phenotypes, we can now use...... genome-wide data to investigate genetic overlap. Here we integrated results from common variant studies of schizophrenia (33,636 cases, 43,008 controls) and volumes of several (mainly subcortical) brain structures (11,840 subjects). We did not find evidence of genetic overlap between schizophrenia risk...... and subcortical volume measures either at the level of common variant genetic architecture or for single genetic markers. These results provide a proof of concept (albeit based on a limited set of structural brain measures) and define a roadmap for future studies investigating the genetic covariance between...

  9. [A Case of Amusia Following Right Temporal Subcortical Hemorrhage].

    Science.gov (United States)

    Nagayoshi, Narumi; Arai, Takao; Tanno, Maiko; Watanabe, Motoi; Suzuki, Tadashi; Akasaki, Yasuharu; Murayama, Yuichi

    2017-07-01

    A woman in her 60s presented with amusia due to a localized subcortical hemorrhage of the right temporal lobe. No other symptoms of higher brain dysfunction or body paralysis were observed. One characteristic symptom in this case was rhythm impairment. Few cases of this impairment have been previously reported, and the responsible lesion and underlying mechanisms are still a matter of speculation. However, in this case, a relationship with the right temporal lobe was indicated.

  10. Subcortical auditory structures in the Mongolian gerbil: I. Golgi architecture.

    Science.gov (United States)

    Mylius, Judith; Brosch, Michael; Scheich, Henning; Budinger, Eike

    2013-04-15

    By means of the Golgi-Cox and Nissl methods we investigated the cyto- and fiberarchitecture as well as the morphology of neurons in the subcortical auditory structures of the Mongolian gerbil (Meriones unguiculatus), a frequently used animal model in auditory neuroscience. We describe the divisions and subdivisions of the auditory thalamus including the medial geniculate body, suprageniculate nucleus, and reticular thalamic nucleus, as well as of the inferior colliculi, nuclei of the lateral lemniscus, superior olivary complex, and cochlear nuclear complex. In this study, we 1) confirm previous results about the organization of the gerbil's subcortical auditory pathway using other anatomical staining methods (e.g., Budinger et al. [2000] Eur J Neurosci 12:2452-2474); 2) add substantially to the knowledge about the laminar and cellular organization of the gerbil's subcortical auditory structures, in particular about the orientation of their fibrodendritic laminae and about the morphology of their most distinctive neuron types; and 3) demonstrate that the cellular organization of these structures, as seen by the Golgi technique, corresponds generally to that of other mammalian species, in particular to that of rodents. Copyright © 2012 Wiley Periodicals, Inc.

  11. Mapping abnormal subcortical brain morphometry in an elderly HIV+ cohort

    Directory of Open Access Journals (Sweden)

    Benjamin S.C. Wade

    2015-01-01

    Full Text Available Over 50% of HIV+ individuals exhibit neurocognitive impairment and subcortical atrophy, but the profile of brain abnormalities associated with HIV is still poorly understood. Using surface-based shape analyses, we mapped the 3D profile of subcortical morphometry in 63 elderly HIV+ participants and 31 uninfected controls. The thalamus, caudate, putamen, pallidum, hippocampus, amygdala, brainstem, accumbens, callosum and ventricles were segmented from high-resolution MRIs. To investigate shape-based morphometry, we analyzed the Jacobian determinant (JD and radial distances (RD defined on each region's surfaces. We also investigated effects of nadir CD4+ T-cell counts, viral load, time since diagnosis (TSD and cognition on subcortical morphology. Lastly, we explored whether HIV+ participants were distinguishable from unaffected controls in a machine learning context. All shape and volume features were included in a random forest (RF model. The model was validated with 2-fold cross-validation. Volumes of HIV+ participants' bilateral thalamus, left pallidum, left putamen and callosum were significantly reduced while ventricular spaces were enlarged. Significant shape variation was associated with HIV status, TSD and the Wechsler adult intelligence scale. HIV+ people had diffuse atrophy, particularly in the caudate, putamen, hippocampus and thalamus. Unexpectedly, extended TSD was associated with increased thickness of the anterior right pallidum. In the classification of HIV+ participants vs. controls, our RF model attained an area under the curve of 72%.

  12. Facts, myths, and controversies in vascular dementia.

    Science.gov (United States)

    Román, Gustavo C

    2004-11-15

    Significant progress in the field of VaD resulted from publication of the NINIDS-AIREN Diagnostic Criteria for VaD (G.C. Roman, T.K. Tatemichi, T. Erkinjuntti, et al., Vascular dementia (VaD): diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43 (1993) 250-260). Epidemiological studies confirmed the importance of VaD as the second most common cause of dementia in the elderly, representing 15-20% of all cases of dementia. In Europe and North America, Alzheimer's disease (AD) predominates over VaD in a 2:1 ratio; in contrast, in Japan and China VaD accounts for almost 50% of all dementias. Case-control studies have identified risk factors for VaD including ageing, hypertension, diabetes mellitus, hyperlipidemia, recurrent stroke, cardiac disease, smoking, sleep apnea, and more recently, hyperhomocysteinemia, among others. Hypertension treatment may prevent VaD and AD. This finding has enormous importance from the Public Health viewpoint to decrease the future number of patients with dementia in the elderly. Along with advances in the field of VaD came a number of controversies and damaging misconceptions and myths. Myth no. 1--Vascular dementia is a non-entity: The false idea that VaD does not exist is particularly destructive because it creates the perspective that VaD is unworthy of study or research. A condition that either does not exist or represents only a minute proportion of all cases of dementia in the elderly, lacks public health relevance and becomes a low priority for research by funding agencies and industry. In fact, vascular brain lesions are the commonest and most important component of dementia in the elderly. Myth no. 2--Vascular dementia is so difficult to diagnose that only experts can recognize and identify it accurately: VaD does exist and the diagnosis of post-stroke VaD, in particular is straightforward. Most cases fulfill NINDS-AIREN criteria for probable VaD; i.e., (1) there is acute onset

  13. Study of diffusion tensor imaging in subcortical ischemic vascular cognitive impairment

    Directory of Open Access Journals (Sweden)

    Hui-ying GUO

    2014-04-01

    Full Text Available Objective Using diffusion tensor imaging (DTI to explore the microstructure changes of white matter in subcortical ischemic vascular cognitive impairment (SIVCI and its correlation with cognitive function.  Methods Forty-nine patients with subcortical ischemic cerebrovascular diseases were collected. By using Clinical Dementia Rating Scale (CDR, they were classified into 10 cases of vascular dementia (VaD group, 20 cases of vascular cognitive impairment-no dementia (VCIND group and 19 cases of normal cognitive function (control group. Conventional MRI and DTI were performed in all cases. Based on the DTI data, voxel-based analysis was used to assess the whole brain region. Correlation analysis was applied to illustrate the relationship between DTI parameters and cognitive scale in VaD patients.  Results Compared with the control group, fractional anisotropy (FA values of patients in VaD group decreased in medial prefrontal cortex, anterior cingulate cortex, corpus callosum stem, bilateral parietal lobes, right temporal lobe and bilateral orbitofrontal lobes (P = 0.000, for all, and FA values of patients in VCIND group decreased in right inferior frontal gyrus, right hippocampus and bilateral precuneus (P = 0.000, for all. Compared with VCIND group, FA values of patients in VaD group decreased in medial prefrontal cortex, anterior cingulate, corpus callosum, bilateral parietal lobes and right temporal lobe (P = 0.000, for all. Compared with the control group, mean diffusivity (MD values in VaD group increased in medial prefrontal cortex, corpus callosum, bilateral parietal lobes, bilateral temporal lobes and anterior cingulate (P = 0.000, for all, while in VCIND group increased in bilateral precuneus and right hippocampus (P = 0.000, for all. Compared with VCIND group, MD values in VaD group increased in right medial prefrontal cortex, anterior cingulate cortex, corpus callosum stem, bilateral parietal lobes and bilateral temporal lobes (P = 0

  14. Stroke prevention: an update.

    Science.gov (United States)

    Bousser, Marie-Germaine

    2012-03-01

    Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.

  15. Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions.

    Science.gov (United States)

    Jankowska, Agnieszka M; Klimkiewicz, Robert; Kubsik, Anna; Klimkiewicz, Paulina; Śmigielski, Janusz; Woldańska-Okońska, Marta

    2017-08-01

    Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning. The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke. Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT). Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke. Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more

  16. Joint assessment of white matter integrity, cortical and subcortical atrophy to distinguish AD from behavioral variant FTD: A two-center study

    Directory of Open Access Journals (Sweden)

    Christiane Möller

    2015-01-01

    Full Text Available We investigated the ability of cortical and subcortical gray matter (GM atrophy in combination with white matter (WM integrity to distinguish behavioral variant frontotemporal dementia (bvFTD from Alzheimer's disease (AD and from controls using voxel-based morphometry, subcortical structure segmentation, and tract-based spatial statistics. To determine which combination of MR markers differentiated the three groups with the highest accuracy, we conducted discriminant function analyses. Adjusted for age, sex and center, both types of dementia had more GM atrophy, lower fractional anisotropy (FA and higher mean (MD, axial (L1 and radial diffusivity (L23 values than controls. BvFTD patients had more GM atrophy in orbitofrontal and inferior frontal areas than AD patients. In addition, caudate nucleus and nucleus accumbens were smaller in bvFTD than in AD. FA values were lower; MD, L1 and L23 values were higher, especially in frontal areas of the brain for bvFTD compared to AD patients. The combination of cortical GM, hippocampal volume and WM integrity measurements, classified 97–100% of controls, 81–100% of AD and 67–75% of bvFTD patients correctly. Our results suggest that WM integrity measures add complementary information to measures of GM atrophy, thereby improving the classification between AD and bvFTD.

  17. [Prevention of dementia].

    Science.gov (United States)

    Urakami, Katsuya

    2016-03-01

    The dementia prevention consists of three steps, primary prevention of dementia is to prevent from normal and mild cognitive impairment to dementia, secondary prevention is early detection and early treatment of dementia, and tertiary prevention is three stages of progress prevention of dementia. Primary prevention of dementia had been considered impossible until recently, but potential scientific evidence has been shown recently. The fact that 4.62 million people are person with dementia and 400 million people are person with mild cognitive impairment are considered to be urgent problem and we must intend to perform dementia prevention from primary to tertiary prevention thoroughly. We perform dementia screening using touch panel type computer and we recommend person with mild cognitive impairment to join dementia prevention classroom. Therefore, we can prevent progression from mild cognitive impairment to dementia (primary prevention). Early diagnosis and introduction to the specialized medical institution are needed if you find early stage of dementia and treat early (secondary prevention). To prevent progression by the appropriate drug treatment and care for dementia is required (tertiary prevention).

  18. Types of Dementia

    Science.gov (United States)

    ... of dementia cases. Learn more about frontotemporal dementia . Creutzfeldt-Jakob disease back to top CJD is the most common ... certain other mammals. A specific form called variant Creutzfeldt-Jakob disease is believed to be caused by consumption of ...

  19. Dementia: Diagnosis and Tests

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Dementia Diagnosis & Tests If you or someone you care ... To determine whether an older adult might have dementia, a healthcare professional will: Ask about the person’s ...

  20. Dementia and driving

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000028.htm Dementia and driving To use the sharing features on ... please enable JavaScript. If your loved one has dementia , deciding when they can no longer drive may ...

  1. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  2. Long-term deficits in episodic memory after ischemic stroke: evaluation and prediction of verbal and visual memory performance based on lesion characteristics

    NARCIS (Netherlands)

    Schouten, Eveline A.; Schiemanck, Sven K.; Brand, Nico; Post, Marcel W. M.

    2009-01-01

    We investigated the relationship between ischemic lesion characteristics (hemispheric side, cortical and subcortical level, volume) and memory performance, 1 year after stroke. Verbal and visual memory of 86 patients with stroke were assessed with Rey Auditory-Verbal Learning Test and the Doors

  3. [Strokes caused by infection in the tropics].

    Science.gov (United States)

    Carod-Artal, F J

    Almost three out of every four people in the world who suffer a fatal stroke live in developing countries. A number of different tropical diseases may appear in Europe in the coming years as a consequence of the demographic change that is being brought about by migratory flows. We review the main infectious causes of strokes in the tropics. There are estimated to be 500 million cases of malaria every year. Cerebral malaria can cause cerebral oedema, diffuse or focal compromise of the subcortical white matter and cortical, cerebellar and pontine infarctions. Chagas disease is an independent risk factor for stroke in South America. At least 20 million people have the chronic form of Chagas disease. The main prognostic factors for Chagas-related stroke are the presence of apical aneurysms, arrhythmia and heart failure. Vascular complications of neurocysticercosis include transient ischemic attacks, ischemic strokes due to angiitis and intracranial haemorrhages. The frequency of cerebral infarction associated with neurocysticercosis varies between 2% and 12%. Gnathostomiasis is a cause of subarachnoid haemorrhage in south-east Asia. Other less common causes of stroke are viral haemorrhagic fevers due to arenavirus and flavivirus. Several diseases that are endemic in the tropics can be responsible for up to 10% of the cases of strokes in adults.

  4. The neurologist facing pain in dementia.

    Science.gov (United States)

    Álvaro González, Luis Carlos

    2015-01-01

    Ageing, a common background in dementia, is usually associated with painful disorders. Nevertheless, the use of analgesics is limited due to poor communication. On the other hand, dementia lesions are placed in the nociceptive pathways. For this reason, the painful experience becomes different and distinctive for every lesional type. The lateral nociceptive pathway (lateral thalamic nuclei and primary parietal cortex), which is in charge of the primary pain perception, is preserved in dementia. Thereafter, the shear painful perception, including pain intensity and threshold, remains unmodified. Distinctly, the medial pain pathways are affected by dementia lesions. In this pathway are included: the intralaminar thalamic nuclei, the pons (locus ceruleus:LC), the mesencephalon (periaacueductal grey substance: PGS), the hypothalamus (paraventricular nuclei, mamilary tuberculum) and different areas of the parietal (primary, secondary, operculum), temporal (amigdala, hypoccampus) and frontal (anterior cingular: ACC). As a consequence, the features of pain executed by these areas will be compromised: the cognitive assessment, the mood and emotion inherent to pain, the pain memory or the autonomic responses are modified in dementia. Specifically, in Alzheimer's disease (AD) there is a reduction in the anticipatory and avoidance responses and also a flattening of the autonomic responses. These are essentially secondary to the degenerative changes in the medial temporal (pain memory) and ACC (cognitive and mood aspects) areas. In vascular dementias, there is a cortico-subcortical deafferentation secondary to the white matter lesions. The consequence is the presence of hyperpathy and hyperalgesia. In the frontotemporal dementias, there is a reduction in pain expressivity. It is linked to the lesions in the orbitofrontal and anterior temporal areas, which are responsible of the emotional aspects of pain. In Parkinson's disease, painful conditions are a common characteristic

  5. Clinical and imaging characteristics of the vascular dementia. Preliminary studies

    International Nuclear Information System (INIS)

    Gomez Viera, Nelson; Rivero Arias, Edmundo; Perez Nellar, Jesus; Begueria Santos, Ramon; Arias Sifontes, William; Raiteris Flores, Juan

    1997-01-01

    A descriptive prospective study was carried out in 41 patients presenting with vascular dementia from Habana Vieja municipality, Havana City, in order to know some of the clinical and imaging characteristics of this disease. The main risk factors observed were the history of cerebrovascular disease and arterial hypertension. Depression, sleeping disorders and focal and pseudo bulbar neurologic signs were the most frequent clinical findings. Folstein neuropsychological test evidenced an important disorder of attention, calculation, the evocation memory and orientation. According to this test, 29 % of the patients had a severe dementia and nearly 50 % showed a severe handicap. The most frequent imaging findings observed in the computerized axial tomography of the cranium were cerebral atrophy, and single or multiple infarctions. Multiple cerebral infarctions, the lacunar status, subcortical encephalopathy of Binswanger, and single infarction located in cerebral areas related to cognition were considered as possible psychopathological mechanisms associated with the disease

  6. Treating Hypertension to Prevent Cognitive Decline and Dementia: Re-Opening the Debate.

    Science.gov (United States)

    Iulita, M Florencia; Girouard, Hélène

    2017-01-01

    Hypertension and dementia are two of the most prevalent and damaging diseases associated with aging. Chronic hypertension, particularly during mid-life, is a strong risk factor for late-life cognitive decline and impairment. Hypertension is also the number one risk factor for stroke and a major contributor to the pathogenesis of vascular dementia and Alzheimer's disease. Despite the vast epidemiologic and mechanistic evidence linking hypertension to cognitive impairment, and the positive effects of blood pressure lowering on reducing the risk of post-stroke dementia, uncertainty remains about the benefit of antihypertensive medication on other forms of dementia. This chapter reviews the link between hypertension and cognition, and discusses the evidence for and against the use of antihypertensive medication for dementia prevention.

  7. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  8. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  9. Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories.

    Science.gov (United States)

    Lin, Robert Y; Scanlan, Brian C; Liao, William; Nguyen, Truc Phuong Thanh

    2015-09-01

    The impact of dementia on hospitalization discharge dispositions (HDDs) in the United States has not been quantified, and dementia prevalence in various hospitalization categories has not been detailed in recent years. To characterize hospitalizations prevalent with dementia, and to examine the relationship between dementia and HDDs. A retrospective cross-sectional study. 2000 to 2012 National Inpatient Sample databases. Hospitalizations in persons ≥65 years old assigned to 1 of 12 Diagnosis Related Groups (DRGs) with a high number of dementia patients. None. The databases were queried for 12 DRGs (versions 18/24). Predictor effects for dementia on HDD categories were modeled adjusting for other defined comorbidities/covariates using logistic regression. Adjusted predictor effects of dementia on HDD in the DRG groupings were determined. Dementia prevalence and trends were assessed. Increasing proportions of dementia were noted in 4 DRGs studied. Dementia was strongly associated with being discharged to a nonhome setting. The most marked dementia effects were noted in DRGs 174 (gastrointestinal hemorrhage), 88 (chronic obstructive pulmonary disease), 182 (esophagitis/gastroenteritis), 138 (cardiac arrhythmias), 127 (congestive heart failure), and 89 (simple pneumonia and pleurisy), where there was at least a 76% reduction in the adjusted odds ratio (0.18-0.24) for home discharge. In contrast, DRGs 14 (stroke), 79 (respiratory infections/ inflammations), and 320 (kidney/urinary infections) had a smaller reduction in dementia-associated adjusted odds ratio (0.41-0.46) for home discharge. DRGs 79 and 320 had the highest proportions of dementia (>10%). Dementia proportions in many hospitalization categories have increased. The variable effect of dementia on home discharge suggests that dementia has a differential influence on hospital discharge disposition depending on the DRG. These findings have implications for healthcare allocation and long-term care planning.

  10. Palliative Care in Dementia.

    Science.gov (United States)

    Aquilina, Francesca Falzon; Agius, Mark

    2015-09-01

    The Dementias are common neurodegenerative diseases which gradually deteriorate and eventually become fatal. However, hospice care is usually made available to patients suffering from Cancer, while patients who suffer from other chronic conditions such as dementia are not usually offered such care. However the lessons which have been learnt regarding hospice palliative care could be applied with some modification to the care of patients with Dementia. This article attempts to discuss the present literature about palliative care in Dementia, in order to clarify the evidence which underlies the European Association for Palliative Care 'White paper defining optimal palliative care in older people with dementia'.

  11. Lewy body dementias

    DEFF Research Database (Denmark)

    Løkkegaard, Annemette; Korbo, Lise

    2017-01-01

    Dementia with Lewy bodies and Parkinson disease dementia share the same pathophysiology. Together they are called Lewy body dementias and are the second most common type of dementia. Lewy body dementias receive little attention, and patients are often misdiagnosed, leading to less than ideal...... management. In this article, diagnostic criteria combined with imaging and other biomarkers as well as current treatment recommendations are summarized, and some of the challenges for the future are outlined. Refinement of diagnosis and clarification of the pathogenesis are required in search for disease...

  12. Children with Epilepsy and Anxiety: Subcortical and Cortical Differences

    Science.gov (United States)

    Jones, Jana E.; Jackson, Daren C.; Chambers, Karlee L.; Dabbs, Kevin; Hsu, David A.; Stafstrom, Carl E.; Seidenberg, Michael; Hermann, Bruce P.

    2014-01-01

    Summary Objective Using a hypothesis driven approach, subcortical and cortical regions implicated in anxiety disorders in the general population were examined in children with recent-onset epilepsy with versus without anxiety compared to controls. This study reports frequency of anxiety disorders while examining familial, clinical and demographic variables associated with anxiety in children with epilepsy. Method Participants included 88 children with epilepsy aged 8–18 years; 25 with a current anxiety disorder and 63 children with epilepsy no current anxiety disorder. 49 controls without anxiety disorders were included. T1 volumetric MRI scans were collected; subcortical volumes and cortical thickness were computed using the FreeSurfer image analysis suite. Analyses focused on adjusted measures of subcortical volumes and cortical thickness. Results Relative to controls, larger left amygdala volumes were found in the Epilepsy Anxiety group compared to the Epilepsy No Anxiety group (p = 0.027). In the hippocampus there were no significant differences between groups. Examination of cortical thickness demonstrated that the Epilepsy Anxiety group showed thinning in left medial orbitofrontal (p=0.001), right lateral orbitofrontal (p=0.017), and right frontal pole (p=0.009). There were no differences between groups in age, sex, IQ, age of onset, medications, or duration of epilepsy. There were more family members with a history of anxiety disorders in the Epilepsy Anxiety group compared to the Epilepsy No Anxiety group (p=0.005). Significance Anxiety is a common psychiatric comorbidity in children with recent-onset epilepsy with volumetric enlargement of the amygdala and thinner cortex in orbital and other regions of prefrontal cortex, suggesting structural abnormalities in brain regions that are part of the dysfunctional networks reported in individuals with anxiety disorders in the general population. These findings are evident early in the course of epilepsy, are

  13. Human Frontal-Subcortical Circuit and Asymmetric Belief Updating.

    Science.gov (United States)

    Moutsiana, Christina; Charpentier, Caroline J; Garrett, Neil; Cohen, Michael X; Sharot, Tali

    2015-10-21

    How humans integrate information to form beliefs about reality is a question that has engaged scientists for centuries, yet the biological system supporting this process is not well understood. One of the most salient attributes of information is valence. Whether a piece of news is good or bad is critical in determining whether it will alter our beliefs. Here, we reveal a frontal-subcortical circuit in the left hemisphere that is simultaneously associated with enhanced integration of favorable information into beliefs and impaired integration of unfavorable information. Specifically, for favorable information, stronger white matter connectivity within this system, particularly between the left inferior frontal gyrus (IFG) and left subcortical regions (including the amygdala, hippocampus, thalamus, putamen, and pallidum), as well as insular cortex, is associated with greater change in belief. However, for unfavorable information, stronger connectivity within this system, particularly between the left IFG and left pallidum, putamen, and insular cortex, is associated with reduced change in beliefs. These novel results are consistent with models suggesting that partially separable processes govern learning from favorable and unfavorable information. Beliefs of what may happen in the future are important, because they guide decisions and actions. Here, we illuminate how structural brain connectivity is related to the generation of subjective beliefs. We focus on how the valence of information is related to people's tendency to alter their beliefs. By quantifying the extent to which participants update their beliefs in response to desirable and undesirable information and relating those measures to the strength of white matter connectivity using diffusion tensor imaging, we characterize a left frontal-subcortical system that is associated simultaneously with greater belief updating in response to favorable information and reduced belief updating in response to

  14. Fractal Dimension Analysis of Subcortical Gray Matter Structures in Schizophrenia.

    Directory of Open Access Journals (Sweden)

    Guihu Zhao

    Full Text Available A failure of adaptive inference-misinterpreting available sensory information for appropriate perception and action-is at the heart of clinical manifestations of schizophrenia, implicating key subcortical structures in the brain including the hippocampus. We used high-resolution, three-dimensional (3D fractal geometry analysis to study subtle and potentially biologically relevant structural alterations (in the geometry of protrusions, gyri and indentations, sulci in subcortical gray matter (GM in patients with schizophrenia relative to healthy individuals. In particular, we focus on utilizing Fractal Dimension (FD, a compact shape descriptor that can be computed using inputs with irregular (i.e., not necessarily smooth surfaces in order to quantify complexity (of geometrical properties and configurations of structures across spatial scales of subcortical GM in this disorder. Probabilistic (entropy-based information FD was computed based on the box-counting approach for each of the seven subcortical structures, bilaterally, as well as the brainstem from high-resolution magnetic resonance (MR images in chronic patients with schizophrenia (n = 19 and age-matched healthy controls (n = 19 (age ranges: patients, 22.7-54.3 and healthy controls, 24.9-51.6 years old. We found a significant reduction of FD in the left hippocampus (median: 2.1460, range: 2.07-2.18 vs. median: 2.1730, range: 2.15-2.23, p<0.001; Cohen's effect size, U3 = 0.8158 (95% Confidence Intervals, CIs: 0.6316, 1.0, the right hippocampus (median: 2.1430, range: 2.05-2.19 vs. median: 2.1760, range: 2.12-2.21, p = 0.004; U3 = 0.8421 (CIs: 0.5263, 1, as well as left thalamus (median: 2.4230, range: 2.40-2.44, p = 0.005; U3 = 0.7895 (CIs: 0.5789, 0.9473 in schizophrenia patients, relative to healthy individuals. Our findings provide in-vivo quantitative evidence for reduced surface complexity of hippocampus, with reduced FD indicating a less complex, less regular GM surface detected in

  15. Sub-cortical brain structure segmentation using F-CNN's

    OpenAIRE

    Shakeri, Mahsa; Tsogkas, Stavros; Ferrante, Enzo; Lippe, Sarah; Kadoury, Samuel; Paragios, Nikos; Kokkinos, Iasonas

    2016-01-01

    International audience; In this paper we propose a deep learning approach for segmenting sub-cortical structures of the human brain in Magnetic Resonance (MR) image data. We draw inspiration from a state-of-the-art Fully-Convolutional Neural Network (F-CNN) architecture for semantic segmentation of objects in natural images, and adapt it to our task. Unlike previous CNN-based methods that operate on image patches, our model is applied on a full blown 2D image, without any alignment or registr...

  16. Deep subcortical infarct burden in relation to apolipoprotein B/AI ratio in patients with intracranial atherosclerotic stenosis.

    Science.gov (United States)

    Park, J-H; Hong, K-S; Lee, J; Kim, Y-J; Song, P

    2013-04-01

    Pre-existing brain infarct (PBI), frequently seen on magnetic resonance imaging and usually silent, is recognized as a risk factor for future stroke. Increased apolipoprotein B (apoB)/apoAI ratio is known to be a risk predictor of ischaemic stroke and is associated with intracranial atherosclerotic stenosis (ICAS). However, little is known about the association of apoB/apoAI ratio with PBI. A total of 522 statin-/fibrate-naïve Korean patients, who experienced acute ischaemic stroke, were categorized into three groups: ICAS (n=254), extracranial (n=51), and no cerebral atherosclerotic stenosis (n=217). We explored the association between apoB/apoAI ratio and PBI lesions according to atherosclerosis type (ICAS, ECAS, and NCAS), PBI location (deep subcortical [ds-PBI] versus hemispheric [h-PBI]), and symptomatic PBI (s-PBI) which was relevant to a prior clinical stroke event. Pre-existing brain infarct(+) patients showed a higher apoB/apoAI ratio than PBI(-) patients (0.81 ± 0.28 vs. 0.72 ± 0.23, Pratio quartiles had more PBIs, ds-PBIs, and s-PBIs (P=0.020, P=0.025, and P=0.001, respectively). With multivariable analyses, the highest apoB/apoAI ratio quartile was associated with PBI (OR, 2.56; 95% CI, 1.39-4.73), ds-PBI (2.48; 1.33-4.62), and advanced (≥ 3) ds-PBIs (2.68; 1.27-5.63) in ICAS group, but not with h-PBI. s-PBI had a dose-response relationship with apoB/apoAI ratio quartiles (6.18; 1.31-29.13 for the second; 5.34; 1.06-26.83 for the third; and 12.17; 2.50-59.19 for the fourth quartile), when referenced to the first quartile. ApoB/apoAI ratio is associated with asymptomatic deep subcortical ischaemic burden as well as with symptomatic lesion in patients with ICAS. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  17. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  18. Bipolar Disorder after Stroke in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    Raquel Calvão de Melo

    2014-01-01

    Full Text Available The onset of bipolar disorder (BD secondary to a stroke event is a rare clinical entity. Although it may be related to specific regions of the brain, several other factors have been linked to its expression such as subcortical atrophy or chronic vascular burden. While precise locations and cerebral circuits involved in the bipolarity expression after stroke still need to be determined, their investigation represents an opportunity to study brain function and BD etiopathogenesis. We present a BD secondary to multiple subcortical biparietal lacunar infarctions, a lacunar infarction in left putamen and an ischemic lesion at the cerebral trunk evolving the right median portion, in a 65-year-old male patient who experienced manic, hypomanic, and depressive episodes, after 6, 10, and 16 months, respectively, of the cerebrovascular events.

  19. Higher Risk of Vascular Dementia in Myocardial Infarction Survivors

    DEFF Research Database (Denmark)

    Sundbøll, Jens; Hováth-Puhó, Erzsébet; Adelborg, Kasper

    2018-01-01

    Background -Increased risk of dementia after myocardial infarction (MI) may be mediated by shared risk factors (e.g., atherosclerosis) and post-MI stroke. We examined risk of dementia in 1-year survivors of MI. Methods -Using Danish medical registries, we conducted a nationwide population......-based cohort study of all patients with first-time MI and a sex-, birth year-, and calendar year-matched general population comparison cohort without MI (1980-2012). Cox regression analysis was used to compute 1-35 year adjusted hazard ratios (aHRs) for dementia, controlled for matching factors and adjusted...... for comorbidities and socioeconomic status. Results -We identified 314,911 patients with MI and 1,573,193 matched comparison cohort members randomly sampled from the general population (median age 70 years, 63% male). After 35 years of follow-up, the cumulative incidence of all-cause dementia in the MI cohort was 9...

  20. ESPRIT (European/Australasian Stroke Prevention in Reversible Ischaemia Trial) and related studies

    NARCIS (Netherlands)

    Halkes, P.H.A.

    2008-01-01

    1. We compared 120 patients who had had a large subcortical infarct with 324 who had had a small deep infarct and with 211 who had had a cortical infarct from the same cohort. We found no differences in risk factor profiles between the three groups, nor a difference in stroke recurrence rate. 2. We

  1. Dementia Gateway: Sensory Loss and Dementia

    OpenAIRE

    Young, Alys; Waterman, Heather; Ferguson-Coleman, Emma

    2014-01-01

    There is a lack of prevalence studies of dementia and sensory loss, but clear evidence of an association between visual impairment and dementia, and age-related hearing loss and dementia.  Visual deficits can be the first or major manifestation that trigger people to seek help regarding Alzheimer’s disease, although people are often not aware of the link.  Recent research has demonstrated strongly that there is a relationship between age-related hearing loss and an increased risk of a...

  2. Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration.

    Science.gov (United States)

    Seiger, Rene; Hahn, Andreas; Hummer, Allan; Kranz, Georg S; Ganger, Sebastian; Woletz, Michael; Kraus, Christoph; Sladky, Ronald; Kautzky, Alexander; Kasper, Siegfried; Windischberger, Christian; Lanzenberger, Rupert

    2016-12-01

    Sex-steroid hormones are primarily involved in sexual differentiation and development and are thought to underlie processes related to cognition and emotion. However, divergent results have been reported concerning the effects of hormone administration on brain structure including side effects like brain atrophy and dementia. Cross-sex hormone therapy in transgender subjects offers a unique model for studying the effects of sex hormones on the living human brain. In this study, 25 Female-to-Male (FtM) and 14 Male-to-Female (MtF) subjects underwent MRI examinations at baseline and after a period of at least 4-months of continuous cross-sex hormone administration. While MtFs received estradiol and anti-androgens, FtM subjects underwent high-dose testosterone treatment. The longitudinal processing stream of the FreeSurfer software suite was used for the automated assessment and delineation of brain volumes to assess the structural changes over the treatment period of cross-sex hormone administration. Most prominent results were found for MtFs receiving estradiol and anti-androgens in the form of significant decreases in the hippocampal region. Further analysis revealed that these decreases were reflected by increases in the ventricles. Additionally, changes in progesterone levels correlated with changes in gray matter structures in MtF subjects. In line with prior studies, our results indicate hormonal influences on subcortical structures related to memory and emotional processing. Additionally, this study adds valuable knowledge that progesterone may play an important role in this process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Common genetic variants influence human subcortical brain structures

    Science.gov (United States)

    Hibar, Derrek P.; Stein, Jason L.; Renteria, Miguel E.; Arias-Vasquez, Alejandro; Desrivières, Sylvane; Jahanshad, Neda; Toro, Roberto; Wittfeld, Katharina; Abramovic, Lucija; Andersson, Micael; Aribisala, Benjamin S.; Armstrong, Nicola J.; Bernard, Manon; Bohlken, Marc M.; Boks, Marco P.; Bralten, Janita; Brown, Andrew A.; Chakravarty, M. Mallar; Chen, Qiang; Ching, Christopher R. K.; Cuellar-Partida, Gabriel; den Braber, Anouk; Giddaluru, Sudheer; Goldman, Aaron L.; Grimm, Oliver; Guadalupe, Tulio; Hass, Johanna; Woldehawariat, Girma; Holmes, Avram J.; Hoogman, Martine; Janowitz, Deborah; Jia, Tianye; Kim, Sungeun; Klein, Marieke; Kraemer, Bernd; Lee, Phil H.; Olde Loohuis, Loes M.; Luciano, Michelle; Macare, Christine; Mather, Karen A.; Mattheisen, Manuel; Milaneschi, Yuri; Nho, Kwangsik; Papmeyer, Martina; Ramasamy, Adaikalavan; Risacher, Shannon L.; Roiz-Santiañez, Roberto; Rose, Emma J.; Salami, Alireza; Sämann, Philipp G.; Schmaal, Lianne; Schork, Andrew J.; Shin, Jean; Strike, Lachlan T.; Teumer, Alexander; van Donkelaar, Marjolein M. J.; van Eijk, Kristel R.; Walters, Raymond K.; Westlye, Lars T.; Whelan, Christopher D.; Winkler, Anderson M.; Zwiers, Marcel P.; Alhusaini, Saud; Athanasiu, Lavinia; Ehrlich, Stefan; Hakobjan, Marina M. H.; Hartberg, Cecilie B.; Haukvik, Unn K.; Heister, Angelien J. G. A. M.; Hoehn, David; Kasperaviciute, Dalia; Liewald, David C. M.; Lopez, Lorna M.; Makkinje, Remco R. R.; Matarin, Mar; Naber, Marlies A. M.; McKay, D. Reese; Needham, Margaret; Nugent, Allison C.; Pütz, Benno; Royle, Natalie A.; Shen, Li; Sprooten, Emma; Trabzuni, Daniah; van der Marel, Saskia S. L.; van Hulzen, Kimm J. E.; Walton, Esther; Wolf, Christiane; Almasy, Laura; Ames, David; Arepalli, Sampath; Assareh, Amelia A.; Bastin, Mark E.; Brodaty, Henry; Bulayeva, Kazima B.; Carless, Melanie A.; Cichon, Sven; Corvin, Aiden; Curran, Joanne E.; Czisch, Michael; de Zubicaray, Greig I.; Dillman, Allissa; Duggirala, Ravi; Dyer, Thomas D.; Erk, Susanne; Fedko, Iryna O.; Ferrucci, Luigi; Foroud, Tatiana M.; Fox, Peter T.; Fukunaga, Masaki; Gibbs, J. Raphael; Göring, Harald H. H.; Green, Robert C.; Guelfi, Sebastian; Hansell, Narelle K.; Hartman, Catharina A.; Hegenscheid, Katrin; Heinz, Andreas; Hernandez, Dena G.; Heslenfeld, Dirk J.; Hoekstra, Pieter J.; Holsboer, Florian; Homuth, Georg; Hottenga, Jouke-Jan; Ikeda, Masashi; Jack, Clifford R.; Jenkinson, Mark; Johnson, Robert; Kanai, Ryota; Keil, Maria; Kent, Jack W.; Kochunov, Peter; Kwok, John B.; Lawrie, Stephen M.; Liu, Xinmin; Longo, Dan L.; McMahon, Katie L.; Meisenzahl, Eva; Melle, Ingrid; Mohnke, Sebastian; Montgomery, Grant W.; Mostert, Jeanette C.; Mühleisen, Thomas W.; Nalls, Michael A.; Nichols, Thomas E.; Nilsson, Lars G.; Nöthen, Markus M.; Ohi, Kazutaka; Olvera, Rene L.; Perez-Iglesias, Rocio; Pike, G. Bruce; Potkin, Steven G.; Reinvang, Ivar; Reppermund, Simone; Rietschel, Marcella; Romanczuk-Seiferth, Nina; Rosen, Glenn D.; Rujescu, Dan; Schnell, Knut; Schofield, Peter R.; Smith, Colin; Steen, Vidar M.; Sussmann, Jessika E.; Thalamuthu, Anbupalam; Toga, Arthur W.; Traynor, Bryan J.; Troncoso, Juan; Turner, Jessica A.; Valdés Hernández, Maria C.; van ’t Ent, Dennis; van der Brug, Marcel; van der Wee, Nic J. A.; van Tol, Marie-Jose; Veltman, Dick J.; Wassink, Thomas H.; Westman, Eric; Zielke, Ronald H.; Zonderman, Alan B.; Ashbrook, David G.; Hager, Reinmar; Lu, Lu; McMahon, Francis J.; Morris, Derek W.; Williams, Robert W.; Brunner, Han G.; Buckner, Randy L.; Buitelaar, Jan K.; Cahn, Wiepke; Calhoun, Vince D.; Cavalleri, Gianpiero L.; Crespo-Facorro, Benedicto; Dale, Anders M.; Davies, Gareth E.; Delanty, Norman; Depondt, Chantal; Djurovic, Srdjan; Drevets, Wayne C.; Espeseth, Thomas; Gollub, Randy L.; Ho, Beng-Choon; Hoffmann, Wolfgang; Hosten, Norbert; Kahn, René S.; Le Hellard, Stephanie; Meyer-Lindenberg, Andreas; Müller-Myhsok, Bertram; Nauck, Matthias; Nyberg, Lars; Pandolfo, Massimo; Penninx, Brenda W. J. H.; Roffman, Joshua L.; Sisodiya, Sanjay M.; Smoller, Jordan W.; van Bokhoven, Hans; van Haren, Neeltje E. M.; Völzke, Henry; Walter, Henrik; Weiner, Michael W.; Wen, Wei; White, Tonya; Agartz, Ingrid; Andreassen, Ole A.; Blangero, John; Boomsma, Dorret I.; Brouwer, Rachel M.; Cannon, Dara M.; Cookson, Mark R.; de Geus, Eco J. C.; Deary, Ian J.; Donohoe, Gary; Fernández, Guillén; Fisher, Simon E.; Francks, Clyde; Glahn, David C.; Grabe, Hans J.; Gruber, Oliver; Hardy, John; Hashimoto, Ryota; Hulshoff Pol, Hilleke E.; Jönsson, Erik G.; Kloszewska, Iwona; Lovestone, Simon; Mattay, Venkata S.; Mecocci, Patrizia; McDonald, Colm; McIntosh, Andrew M.; Ophoff, Roel A.; Paus, Tomas; Pausova, Zdenka; Ryten, Mina; Sachdev, Perminder S.; Saykin, Andrew J.; Simmons, Andy; Singleton, Andrew; Soininen, Hilkka; Wardlaw, Joanna M.; Weale, Michael E.; Weinberger, Daniel R.; Adams, Hieab H. H.; Launer, Lenore J.; Seiler, Stephan; Schmidt, Reinhold; Chauhan, Ganesh; Satizabal, Claudia L.; Becker, James T.; Yanek, Lisa; van der Lee, Sven J.; Ebling, Maritza; Fischl, Bruce; Longstreth, W. T.; Greve, Douglas; Schmidt, Helena; Nyquist, Paul; Vinke, Louis N.; van Duijn, Cornelia M.; Xue, Luting; Mazoyer, Bernard; Bis, Joshua C.; Gudnason, Vilmundur; Seshadri, Sudha; Ikram, M. Arfan; Martin, Nicholas G.; Wright, Margaret J.; Schumann, Gunter; Franke, Barbara; Thompson, Paul M.; Medland, Sarah E.

    2015-01-01

    The highly complex structure of the human brain is strongly shaped by genetic influences1. Subcortical brain regions form circuits with cortical areas to coordinate movement2, learning, memory3 and motivation4, and altered circuits can lead to abnormal behaviour and disease2. To investigate how common genetic variants affect the structure of these brain regions, here we conduct genome-wide association studies of the volumes of seven subcortical regions and the intracranial volume derived from magnetic resonance images of 30,717 individuals from 50 cohorts. We identify five novel genetic variants influencing the volumes of the putamen and caudate nucleus. We also find stronger evidence for three loci with previously established influences on hippocampal volume5 and intracranial volume6. These variants show specific volumetric effects on brain structures rather than global effects across structures. The strongest effects were found for the putamen, where a novel intergenic locus with replicable influence on volume (rs945270; P = 1.08 × 10−33; 0.52% variance explained) showed evidence of altering the expression of the KTN1 gene in both brain and blood tissue. Variants influencing putamen volume clustered near developmental genes that regulate apoptosis, axon guidance and vesicle transport. Identification of these genetic variants provides insight into the causes of variability inhuman brain development, and may help to determine mechanisms of neuropsychiatric dysfunction. PMID:25607358

  4. Common genetic variants influence human subcortical brain structures.

    Science.gov (United States)

    Hibar, Derrek P; Stein, Jason L; Renteria, Miguel E; Arias-Vasquez, Alejandro; Desrivières, Sylvane; Jahanshad, Neda; Toro, Roberto; Wittfeld, Katharina; Abramovic, Lucija; Andersson, Micael; Aribisala, Benjamin S; Armstrong, Nicola J; Bernard, Manon; Bohlken, Marc M; Boks, Marco P; Bralten, Janita; Brown, Andrew A; Chakravarty, M Mallar; Chen, Qiang; Ching, Christopher R K; Cuellar-Partida, Gabriel; den Braber, Anouk; Giddaluru, Sudheer; Goldman, Aaron L; Grimm, Oliver; Guadalupe, Tulio; Hass, Johanna; Woldehawariat, Girma; Holmes, Avram J; Hoogman, Martine; Janowitz, Deborah; Jia, Tianye; Kim, Sungeun; Klein, Marieke; Kraemer, Bernd; Lee, Phil H; Olde Loohuis, Loes M; Luciano, Michelle; Macare, Christine; Mather, Karen A; Mattheisen, Manuel; Milaneschi, Yuri; Nho, Kwangsik; Papmeyer, Martina; Ramasamy, Adaikalavan; Risacher, Shannon L; Roiz-Santiañez, Roberto; Rose, Emma J; Salami, Alireza; Sämann, Philipp G; Schmaal, Lianne; Schork, Andrew J; Shin, Jean; Strike, Lachlan T; Teumer, Alexander; van Donkelaar, Marjolein M J; van Eijk, Kristel R; Walters, Raymond K; Westlye, Lars T; Whelan, Christopher D; Winkler, Anderson M; Zwiers, Marcel P; Alhusaini, Saud; Athanasiu, Lavinia; Ehrlich, Stefan; Hakobjan, Marina M H; Hartberg, Cecilie B; Haukvik, Unn K; Heister, Angelien J G A M; Hoehn, David; Kasperaviciute, Dalia; Liewald, David C M; Lopez, Lorna M; Makkinje, Remco R R; Matarin, Mar; Naber, Marlies A M; McKay, D Reese; Needham, Margaret; Nugent, Allison C; Pütz, Benno; Royle, Natalie A; Shen, Li; Sprooten, Emma; Trabzuni, Daniah; van der Marel, Saskia S L; van Hulzen, Kimm J E; Walton, Esther; Wolf, Christiane; Almasy, Laura; Ames, David; Arepalli, Sampath; Assareh, Amelia A; Bastin, Mark E; Brodaty, Henry; Bulayeva, Kazima B; Carless, Melanie A; Cichon, Sven; Corvin, Aiden; Curran, Joanne E; Czisch, Michael; de Zubicaray, Greig I; Dillman, Allissa; Duggirala, Ravi; Dyer, Thomas D; Erk, Susanne; Fedko, Iryna O; Ferrucci, Luigi; Foroud, Tatiana M; Fox, Peter T; Fukunaga, Masaki; Gibbs, J Raphael; Göring, Harald H H; Green, Robert C; Guelfi, Sebastian; Hansell, Narelle K; Hartman, Catharina A; Hegenscheid, Katrin; Heinz, Andreas; Hernandez, Dena G; Heslenfeld, Dirk J; Hoekstra, Pieter J; Holsboer, Florian; Homuth, Georg; Hottenga, Jouke-Jan; Ikeda, Masashi; Jack, Clifford R; Jenkinson, Mark; Johnson, Robert; Kanai, Ryota; Keil, Maria; Kent, Jack W; Kochunov, Peter; Kwok, John B; Lawrie, Stephen M; Liu, Xinmin; Longo, Dan L; McMahon, Katie L; Meisenzahl, Eva; Melle, Ingrid; Mohnke, Sebastian; Montgomery, Grant W; Mostert, Jeanette C; Mühleisen, Thomas W; Nalls, Michael A; Nichols, Thomas E; Nilsson, Lars G; Nöthen, Markus M; Ohi, Kazutaka; Olvera, Rene L; Perez-Iglesias, Rocio; Pike, G Bruce; Potkin, Steven G; Reinvang, Ivar; Reppermund, Simone; Rietschel, Marcella; Romanczuk-Seiferth, Nina; Rosen, Glenn D; Rujescu, Dan; Schnell, Knut; Schofield, Peter R; Smith, Colin; Steen, Vidar M; Sussmann, Jessika E; Thalamuthu, Anbupalam; Toga, Arthur W; Traynor, Bryan J; Troncoso, Juan; Turner, Jessica A; Valdés Hernández, Maria C; van 't Ent, Dennis; van der Brug, Marcel; van der Wee, Nic J A; van Tol, Marie-Jose; Veltman, Dick J; Wassink, Thomas H; Westman, Eric; Zielke, Ronald H; Zonderman, Alan B; Ashbrook, David G; Hager, Reinmar; Lu, Lu; McMahon, Francis J; Morris, Derek W; Williams, Robert W; Brunner, Han G; Buckner, Randy L; Buitelaar, Jan K; Cahn, Wiepke; Calhoun, Vince D; Cavalleri, Gianpiero L; Crespo-Facorro, Benedicto; Dale, Anders M; Davies, Gareth E; Delanty, Norman; Depondt, Chantal; Djurovic, Srdjan; Drevets, Wayne C; Espeseth, Thomas; Gollub, Randy L; Ho, Beng-Choon; Hoffmann, Wolfgang; Hosten, Norbert; Kahn, René S; Le Hellard, Stephanie; Meyer-Lindenberg, Andreas; Müller-Myhsok, Bertram; Nauck, Matthias; Nyberg, Lars; Pandolfo, Massimo; Penninx, Brenda W J H; Roffman, Joshua L; Sisodiya, Sanjay M; Smoller, Jordan W; van Bokhoven, Hans; van Haren, Neeltje E M; Völzke, Henry; Walter, Henrik; Weiner, Michael W; Wen, Wei; White, Tonya; Agartz, Ingrid; Andreassen, Ole A; Blangero, John; Boomsma, Dorret I; Brouwer, Rachel M; Cannon, Dara M; Cookson, Mark R; de Geus, Eco J C; Deary, Ian J; Donohoe, Gary; Fernández, Guillén; Fisher, Simon E; Francks, Clyde; Glahn, David C; Grabe, Hans J; Gruber, Oliver; Hardy, John; Hashimoto, Ryota; Hulshoff Pol, Hilleke E; Jönsson, Erik G; Kloszewska, Iwona; Lovestone, Simon; Mattay, Venkata S; Mecocci, Patrizia; McDonald, Colm; McIntosh, Andrew M; Ophoff, Roel A; Paus, Tomas; Pausova, Zdenka; Ryten, Mina; Sachdev, Perminder S; Saykin, Andrew J; Simmons, Andy; Singleton, Andrew; Soininen, Hilkka; Wardlaw, Joanna M; Weale, Michael E; Weinberger, Daniel R; Adams, Hieab H H; Launer, Lenore J; Seiler, Stephan; Schmidt, Reinhold; Chauhan, Ganesh; Satizabal, Claudia L; Becker, James T; Yanek, Lisa; van der Lee, Sven J; Ebling, Maritza; Fischl, Bruce; Longstreth, W T; Greve, Douglas; Schmidt, Helena; Nyquist, Paul; Vinke, Louis N; van Duijn, Cornelia M; Xue, Luting; Mazoyer, Bernard; Bis, Joshua C; Gudnason, Vilmundur; Seshadri, Sudha; Ikram, M Arfan; Martin, Nicholas G; Wright, Margaret J; Schumann, Gunter; Franke, Barbara; Thompson, Paul M; Medland, Sarah E

    2015-04-09

    The highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate how common genetic variants affect the structure of these brain regions, here we conduct genome-wide association studies of the volumes of seven subcortical regions and the intracranial volume derived from magnetic resonance images of 30,717 individuals from 50 cohorts. We identify five novel genetic variants influencing the volumes of the putamen and caudate nucleus. We also find stronger evidence for three loci with previously established influences on hippocampal volume and intracranial volume. These variants show specific volumetric effects on brain structures rather than global effects across structures. The strongest effects were found for the putamen, where a novel intergenic locus with replicable influence on volume (rs945270; P = 1.08 × 10(-33); 0.52% variance explained) showed evidence of altering the expression of the KTN1 gene in both brain and blood tissue. Variants influencing putamen volume clustered near developmental genes that regulate apoptosis, axon guidance and vesicle transport. Identification of these genetic variants provides insight into the causes of variability in human brain development, and may help to determine mechanisms of neuropsychiatric dysfunction.

  5. Neuroradiological findings in vascular dementia

    Energy Technology Data Exchange (ETDEWEB)

    Guermazi, Ali; Miaux, Yves; Suhy, Joyce; Pauls, Jon; Lopez, Ria [Synarc, Inc., Department of Radiology Services, San Francisco, CA (United States); Rovira-Canellas, Alex [Hospital General Universitari Vall d' Hebron, Unita de Resonancia Magnetica, Barcelona (Spain); Posner, Holly [Eisai, Inc., Teaneck, NJ (United States)

    2007-01-15

    There are multiple diagnostic criteria for vascular dementia (VaD) that may define different populations. Utilizing the criteria of the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) has provided improved consistency in the diagnosis of VaD. The criteria include a table listing brain imaging lesions associated with VaD. The different neuroradiological aspects of the criteria are reviewed based on the imaging data from an ongoing large-scale clinical trial testing a new treatment for VaD. The NINDS-AIREN criteria were applied by a centralized imaging rater to determine eligibility for enrollment in 1,202 patients using brain CT or MRI. Based on the above data set, the neuroradiological features that are associated with VaD and that can result from cerebral small-vessel disease with extensive leukoencephalopathy or lacunae (basal ganglia or frontal white matter), or may be the consequence of single strategically located infarcts or multiple infarcts in large-vessel territories, are illustrated. These features may also be the consequence of global cerebral hypoperfusion, intracerebral hemorrhage, or other mechanisms such as genetically determined arteriopathies. Neuroimaging confirmation of cerebrovascular disease in VaD provides information about the topography and severity of vascular lesions. Neuroimaging may also assist with the differential diagnosis of dementia associated with normal pressure hydrocephalus, chronic subdural hematoma, arteriovenous malformation or tumoral diseases. (orig.)

  6. Acupuncture Enhances Effective Connectivity between Cerebellum and Primary Sensorimotor Cortex in Patients with Stable Recovery Stroke

    Directory of Open Access Journals (Sweden)

    Zijing Xie

    2014-01-01

    Full Text Available Recent neuroimaging studies have demonstrated that stimulation of acupuncture at motor-implicated acupoints modulates activities of brain areas relevant to the processing of motor functions. This study aims to investigate acupuncture-induced changes in effective connectivity among motor areas in hemiparetic stroke patients by using the multivariate Granger causal analysis. A total of 9 stable recovery stroke patients and 8 healthy controls were recruited and underwent three runs of fMRI scan: passive finger movements and resting state before and after manual acupuncture stimuli. Stroke patients showed significantly attenuated effective connectivity between cortical and subcortical areas during passive motor task, which indicates inefficient information transmissions between cortical and subcortical motor-related regions. Acupuncture at motor-implicated acupoints showed specific modulations of motor-related network in stroke patients relative to healthy control subjects. This specific modulation enhanced bidirectionally effective connectivity between the cerebellum and primary sensorimotor cortex in stroke patients, which may compensate for the attenuated effective connectivity between cortical and subcortical areas during passive motor task and, consequently, contribute to improvement of movement coordination and motor learning in subacute stroke patients. Our results suggested that further efficacy studies of acupuncture in motor recovery can focus on the improvement of movement coordination and motor learning during motor rehabilitation.

  7. Risk Factors for Dementia

    Directory of Open Access Journals (Sweden)

    Jen-Hau Chen

    2009-10-01

    Full Text Available Dementia is a complex human disease. The incidence of dementia among the elderly population is rising rapidly worldwide. In the United States, Alzheimer's disease (AD is the leading type of dementia and was the fifth and eighth leading cause of death in women and men aged ≥ 65 years, respectively, in 2003. In Taiwan and many other counties, dementia is a hidden health issue because of its underestimation in the elderly population. In Western countries, the prevalence of AD increases from 1–3% among people aged 60–64 years to 35% among those aged > 85 years. In Taiwan, the prevalence of dementia for people aged ≥ 65 years was 2–4% by 2000. Therefore, it is important to identify protective and risk factors for dementia to prevent this disease at an early stage. Several factors are related to dementia, e.g. age, ethnicity, sex, genetic factors, physical activity, smoking, drug use, education level, alcohol consumption, body mass index, comorbidity, and environmental factors. In this review, we focus on studies that have evaluated the association between these factors and the risk of dementia, especially AD and vascular dementia. We also suggest future research directions for researchers in dementia-related fields.

  8. Dementia: role of MRI

    International Nuclear Information System (INIS)

    Georgieva-Kozarova, G.

    2012-01-01

    Full text: This presentation will focus on the role of MRI in the diagnosis of dementia and related diseases. We will discuss the following subjects: 1. Systematic assessment of MR in dementia 2. MR protocol for dementia 3. Typical findings in the most common dementia syndrome Alzheimer's disease (AD), Vascular Dementia (VaD), Frontotemporal lobe dementia (FTLD) 4. Short overview of neurodegenerative disorders which may be associated with dementia. The role of neuroimaging in dementia nowadays extends to support the diagnosis of specific neurodegenerative disorders. It is a challenge to the early diagnosis of neurodegenerative diseases such as Alzheimer's disease. Early diagnosis includes recognition of predementia conditions, such as mild cognitive impairment (MCI). Neuroimaging may also be used to assess disease progression and is adopted in current trials investigating MCI and AD. An MR-study of a patient suspected of having dementia must be assessed in a standardized way. First of all, treatable diseases like subdural hematomas, tumors and hydrocephalus need to be excluded. Next we should look for signs of specific dementias such as: Alzheimer's disease (AD): medial temporal lobe atrophy (MTA) and parietal atrophy. Frontotemporal Lobar Degeneration (FTLD): (asymmetric) frontal lobe atrophy and atrophy of the temporal pole. Vascular Dementia (VaD): global atrophy, diffuse white matter lesions, lacunas and 'strategic infarcts' (infarcts in regions that are involved in cognitive function). Dementia with Lewy bodies (DLB): in contrast to other forms of dementia usually no specific abnormalities. So when we study the MR images we should score in a systematic way for global atrophy, focal atrophy and for vascular disease (i.e. infarcts, white matter lesions, lacunas)

  9. The Spectrum of Sociopathy in Dementia

    Science.gov (United States)

    Mendez, Mario F.; Shapira, Jill S.; Saul, Ronald E.

    2012-01-01

    Although well-known from head trauma and acute strokes, sociopathic behavior from dementia is less known and understood. This study reviewed 33 dementia patients who had been in trouble with the law. They were divided into two groups: 22 who committed impulsive sociopathic acts and 11 who committed non-impulsive acts. The impulsive patients demonstrated nonviolent acts, such as dis-inhibited sexual behavior or pathological stealing, and had disproportionate frontal-caudate atrophy on neuroimaging. The majority of non-impulsive patients demonstrated agitation-paranoia, sometimes with reactive aggression, delusional beliefs, or aphasic paranoia, and had advanced memory and other cognitive impairment. The impulsive patients tended to have frontally predominant illnesses such as frontotemporal dementia or Huntington’s disease, whereas the non-impulsive group tended to have Alzheimer’s disease or prominent aphasia. Sociopathy has different causes in dementia. Two common mechanisms are disinhibition, with frontally predominant disease, and agitation-paranoia, with greater cognitive impairment. These forms of sociopathy differ significantly from the antisocial/ psychopathic personality. PMID:21677240

  10. Incidence of Brain Infarcts, Cognitive Change, and Risk of Dementia in the General Population: The AGES-Reykjavik Study (Age Gene/Environment Susceptibility-Reykjavik Study).

    Science.gov (United States)

    Sigurdsson, Sigurdur; Aspelund, Thor; Kjartansson, Olafur; Gudmundsson, Elias F; Jonsdottir, Maria K; Eiriksdottir, Gudny; Jonsson, Palmi V; van Buchem, Mark A; Gudnason, Vilmundur; Launer, Lenore J

    2017-09-01

    The differentiation of brain infarcts by region is important because their cause and clinical implications may differ. Information on the incidence of these lesions and association with cognition and dementia from longitudinal population studies is scarce. We investigated the incidence of infarcts in cortical, subcortical, cerebellar, and overall brain regions and how prevalent and incident infarcts associate with cognitive change and incident dementia. Participants (n=2612, 41% men, mean age 74.6±4.8) underwent brain magnetic resonance imaging for the assessment of infarcts and cognitive testing at baseline and on average 5.2 years later. Incident dementia was assessed according to the international guidelines. Twenty-one percent of the study participants developed new infarcts. The risk of incident infarcts in men was higher than the risk in women (1.8; 95% confidence interval, 1.5-2.3). Persons with both incident and prevalent infarcts showed steeper cognitive decline and had almost double relative risk of incident dementia (1.7; 95% confidence interval, 1.3-2.2) compared with those without infarcts. Persons with new subcortical infarcts had the highest risk of incident dementia compared with those without infarcts (2.6; 95% confidence interval, 1.9-3.4). Men are at greater risk of developing incident brain infarcts than women. Persons with incident brain infarcts decline faster in cognition and have an increased risk of dementia compared with those free of infarcts. Incident subcortical infarcts contribute more than cortical and cerebellar infarcts to incident dementia which may indicate that infarcts of small vessel disease origin contribute more to the development of dementia than infarcts of embolic origin in larger vessels. © 2017 American Heart Association, Inc.

  11. Symptoms of Lewy Body Dementia

    Science.gov (United States)

    ... the fight against LBD! Donate Symptoms Lewy body dementia symptoms and diagnostic criteria Every person with LBD ... an umbrella term for two related clinical diagnoses, dementia with Lewy bodies and Parkinson's disease dementia. The ...

  12. Dementia in Qatar

    International Nuclear Information System (INIS)

    Hamad, Ahmad I.; Ibrahim, Mohammed A.; Sulaiti, Essa M.

    2004-01-01

    Dementia is the major public health problem among the elderly in developed countries and a growing problem in the underdeveloped countries. There are no published data on dementia in any of the Arab countries. The aim of this study was to determine the different subtypes of dementia among Qataris. A retrospective and prospective ongoing hospital based study in which all medical records of the patients with diagnosis of dementia seen at the Hamad General Hospital, Doha, Qatar, between June 1997 and June 2003, whether inpatient and outpatient were reviewed. Dementia was defined according to diagnostic and statistical manual (DSM) IV criteria. Those who had dementia were evaluated by a psychologist, psychiatrist, neurologist and a geriatrician. All had brain computerized tomography, magnetic resonance imaging or both and routine blood test. Finally, they were classified into sub-types according to the cause of dementia. One of 300 patients, 134 fulfilled the inclusion criteria, most of them were illiterate, married and non-smokers. Among those dementia sub-types were: Alzheimer disease (AD) 39 (29%), vascular dementia (VaD) 30 (22%), mixed AD and VaD 20 (15%) and Parkinson's disease with dementia due to other medical conditions. Our stidy showed that AD is more prevalent than VaD. It also showed that patients and their families seek medical help late due to to the general belief among the public that forgetfulness and other associated cognitive impairment are part of normal aging process. The emergence of new drugs and advancement in prevention of cerebrovascular diseases make early diagnosis of dementia sub-type important. A community based study to show the real prevalence and incidence of sub-types of dementia is highly indicated. These data are necessory for planning and setting up community services and health care programs for demented patients. (author)

  13. Mapping Subcortical Brain Maturation during Adolescence: Evidence of Hemisphere-and Sex-Specific Longitudinal Changes

    Science.gov (United States)

    Dennison, Meg; Whittle, Sarah; Yücel, Murat; Vijayakumar, Nandita; Kline, Alexandria; Simmons, Julian; Allen, Nicholas B.

    2013-01-01

    Early to mid-adolescence is an important developmental period for subcortical brain maturation, but longitudinal studies of these neurodevelopmental changes are lacking. The present study acquired repeated magnetic resonance images from 60 adolescent subjects (28 female) at ages 12.5 and 16.5 years to map changes in subcortical structure volumes.…

  14. 21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

    Science.gov (United States)

    2010-04-01

    ... pain relief. 882.5840 Section 882.5840 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 882.5840 Implanted intracerebral/subcortical stimulator for pain relief. (a) Identification. An implanted intracerebral/subcortical stimulator for pain relief is a device that applies electrical current...

  15. Preventing and diagnosing dementia.

    Science.gov (United States)

    Keenan, Bernie; Jenkins, Catharine; Ginesi, Laura

    While dementia is an umbrella term for a range of degenerative brain disorders, many share similar presentations. Nurses are ideally placed to identify those at risk and empower them to access treatment and plan and prepare for their future needs--as such, they need up-to-date knowledge of the signs and symptoms of the different types of dementia to identify risk factors and make an informed diagnosis. This article, the third in a four-part series on dementia, examines the risk factors, signs, symptoms and diagnosis of dementia, as well as outlining lifestyle factors such as diet and exercise that may help to prevent the development of the condition.

  16. Cerebral imaging and dementia

    International Nuclear Information System (INIS)

    Rascol, A.; Celsis, P.; Berry, I.

    1989-01-01

    Modern imaging techniques undoubtedly are of value when applied to the study of dementia. This value, however, varies with the technique utilized, and one must distinguish between acquired and potential knowledge. Morphological imaging with computerized tomography or magnetic resonance detects or confirms certain causes of dementia (tumours, lacunae, hydrocephalus with normal CSF pressure), but it is still not sensitive and specific enough to be very useful in primary dementias. Functional imaging (essentially with emission tomography) has already provided interesting data in the study of degenerative dementia (correlations with neuropsychology, subtyping), but what is most promising is its possibilities in the physiopathological approach of the disease [fr

  17. Palliative care and dementia.

    Science.gov (United States)

    Scott, Carrie

    2014-09-01

    Dementia is a highly prevalent, progressive, life-limiting illness for which there is no cure. Palliative care is a specialized area of healthcare that focuses on improving the quality of life for individuals with life-limiting diseases. Symptoms such as disorientation, tension, and anxiety occur in patients with dementia at moderate to severe levels as they approach the end of their lives, as well as other common symptoms found with cancer patients, yet the dementia population continues to be unrecognized for their need for palliative care. This article examines current literature with respect to palliative care for patients with dementia.

  18. Cerebral imaging and dementia

    Energy Technology Data Exchange (ETDEWEB)

    Rascol, A.; Celsis, P.; Berry, I.

    1989-02-01

    Modern imaging techniques undoubtedly are of value when applied to the study of dementia. This value, however, varies with the technique utilized, and one must distinguish between acquired and potential knowledge. Morphological imaging with computerized tomography or magnetic resonance detects or confirms certain causes of dementia (tumours, lacunae, hydrocephalus with normal CSF pressure), but it is still not sensitive and specific enough to be very useful in primary dementias. Functional imaging (essentially with emission tomography) has already provided interesting data in the study of degenerative dementia (correlations with neuropsychology, subtyping), but what is most promising is its possibilities in the physiopathological approach of the disease.

  19. Subcortical intelligence: caudate volume predicts IQ in healthy adults.

    Science.gov (United States)

    Grazioplene, Rachael G; G Ryman, Sephira; Gray, Jeremy R; Rustichini, Aldo; Jung, Rex E; DeYoung, Colin G

    2015-04-01

    This study examined the association between size of the caudate nuclei and intelligence. Based on the central role of the caudate in learning, as well as neuroimaging studies linking greater caudate volume to better attentional function, verbal ability, and dopamine receptor availability, we hypothesized the existence of a positive association between intelligence and caudate volume in three large independent samples of healthy adults (total N = 517). Regression of IQ onto bilateral caudate volume controlling for age, sex, and total brain volume indicated a significant positive correlation between caudate volume and intelligence, with a comparable magnitude of effect across each of the three samples. No other subcortical structures were independently associated with IQ, suggesting a specific biological link between caudate morphology and intelligence. © 2014 Wiley Periodicals, Inc.

  20. Cortical and subcortical mechanisms of brain-machine interfaces.

    Science.gov (United States)

    Marchesotti, Silvia; Martuzzi, Roberto; Schurger, Aaron; Blefari, Maria Laura; Del Millán, José R; Bleuler, Hannes; Blanke, Olaf

    2017-06-01

    Technical advances in the field of Brain-Machine Interfaces (BMIs) enable users to control a variety of external devices such as robotic arms, wheelchairs, virtual entities and communication systems through the decoding of brain signals in real time. Most BMI systems sample activity from restricted brain regions, typically the motor and premotor cortex, with limited spatial resolution. Despite the growing number of applications, the cortical and subcortical systems involved in BMI control are currently unknown at the whole-brain level. Here, we provide a comprehensive and detailed report of the areas active during on-line BMI control. We recorded functional magnetic resonance imaging (fMRI) data while participants controlled an EEG-based BMI inside the scanner. We identified the regions activated during BMI control and how they overlap with those involved in motor imagery (without any BMI control). In addition, we investigated which regions reflect the subjective sense of controlling a BMI, the sense of agency for BMI-actions. Our data revealed an extended cortical-subcortical network involved in operating a motor-imagery BMI. This includes not only sensorimotor regions but also the posterior parietal cortex, the insula and the lateral occipital cortex. Interestingly, the basal ganglia and the anterior cingulate cortex were involved in the subjective sense of controlling the BMI. These results inform basic neuroscience by showing that the mechanisms of BMI control extend beyond sensorimotor cortices. This knowledge may be useful for the development of BMIs that offer a more natural and embodied feeling of control for the user. Hum Brain Mapp 38:2971-2989, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  1. Distinct subcortical volume alterations in pediatric and adult OCD

    Science.gov (United States)

    Boedhoe, Premika S.W.; Schmaal, Lianne; Abe, Yoshinari; Ameis, Stephanie H.; Arnold, Paul D.; Batistuzzo, Marcelo C.; Benedetti, Francesco; Beucke, Jan C.; Bollettini, Irene; Bose, Anushree; Brem, Silvia; Calvo, Anna; Cheng, Yuqi; Cho, Kang Ik K.; Dallaspezia, Sara; Denys, Damiaan; Fitzgerald, Kate D.; Fouche, Jean-Paul; Giménez, Mònica; Gruner, Patricia; Hanna, Gregory L.; Hibar, Derrek P.; Hoexter, Marcelo Q.; Huyser, Chaim; Ikari, Keisuke; Jahanshad, Neda; Kathmann, Norbert; Kaufmann, Christian; Koch, Kathrin; Kwon, Jun Soo; Lazaro, Luisa; Liu, Yanni; Lochner, Christine; Marsh, Rachel; Martínez-Zalacaín, Ignacio; Mataix-Cols, David; Menchón, José M.; Minuzzii, Luciano; Nakamae, Takashi; Nakao, Tomohiro; Narayanaswamy, Janardhanan C.; Piras, Fabrizio; Piras, Federica; Pittenger, Christopher; Reddy, Y.C. Janardhan; Sato, Joao R.; Simpson, H. Blair; Soreni, Noam; Soriano-Mas, Carles; Spalletta, Gianfranco; Stevens, Michael C.; Szeszko, Philip R.; Tolin, David F.; Venkatasubramanian, Ganesan; Walitza, Susanne; Wang, Zhen; van Wingen, Guido A.; Xu, Jian; Xu, Xiufeng; Yun, Je-Yeon; Zhao, Qing; Thompson, Paul M.; Stein, Dan J.; van den Heuvel, Odile A.

    2016-01-01

    Objective Structural brain imaging studies in Obsessive-Compulsive Disorder (OCD) have produced inconsistent findings. This may be partially due to limited statistical power from relatively small samples and clinical heterogeneity related to variation in disease profile and developmental stage. Methods To address these limitations, we conducted a meta- and mega-analysis of data from OCD sites worldwide. T1 images from 1,830 OCD patients and 1,759 controls were analyzed, using coordinated and standardized processing, to identify subcortical brain volumes that differ in OCD patients and healthy controls. We additionally examined potential modulating effects of clinical characteristics on morphological differences in OCD patients. Results The meta-analysis indicated that adult patients had significantly smaller hippocampal volumes (Cohen’s d=−0.13; p=5.1x10−3, % difference −2.80) and larger pallidum volumes (d=0.16; p=1.6x10−3, % difference 3.16) compared to adult controls. Both effects were stronger in medicated patients compared to controls (d=−0.29; p=2.4x10−5, % difference −4.18 and d=0.29; p=1.2x10−5, % difference 4.38, respectively). Unmedicated pediatric patients had larger thalamic volumes (d=0.38, p=2.1x10−3) compared to pediatric controls. None of these findings were mediated by sample characteristics such as mean age or field strength. Overall the mega-analysis yielded similar results. Conclusion Our study indicates a different pattern of subcortical abnormalities in pediatric versus adult OCD patients. The pallidum and hippocampus seem to be of importance in adult OCD, whereas the thalamus seems to be key in pediatric OCD. This highlights the potential importance of neurodevelopmental alterations in OCD, and suggests that further research on neuroplasticity in OCD may be useful. PMID:27609241

  2. Dementia Friendly, Dementia Capable, and Dementia Positive: Concepts to Prepare for the Future

    OpenAIRE

    Lin, Shih-Yin; Lewis, Frances Marcus

    2015-01-01

    With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer’s Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and ...

  3. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  4. Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke.

    Science.gov (United States)

    Stahl, Stephanie M; Yaggi, H Klar; Taylor, Stanley; Qin, Li; Ivan, Cristina S; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Tobias, Lauren; Sico, Jason; Vaz Fragoso, Carlos A; Williams, Linda S; Lampert, Rachel; Miech, Edward J; Matthias, Marianne S; Kapoor, John; Bravata, Dawn M

    2015-10-01

    The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients. Published by Elsevier B.V.

  5. Dementia Apraxia Test (DATE): A Brief Tool to Differentiate Behavioral Variant Frontotemporal Dementia from Alzheimer's Dementia Based on Apraxia Profiles.

    Science.gov (United States)

    Johnen, Andreas; Frommeyer, Jana; Modes, Fenja; Wiendl, Heinz; Duning, Thomas; Lohmann, Hubertus

    2016-01-01

    Standardized praxis assessments with modern, empirically validated screening tests have substantially improved clinical evaluation of apraxia in patients with stroke. Although apraxia may contribute to early differential diagnosis of Alzheimer's dementia (AD) and behavioral variant frontotemporal dementia (bvFTD), no comparable test is readily available to clinicians for this purpose to date. To design a clinically useful apraxia test for the differentiation of AD and bvFTD. 84 test items pertaining to twelve praxis subdomains were evaluated for their efficacy to discriminate between patients with bvFTD (n = 24), AD (n = 28), and elderly healthy controls (HC; n = 35). Items were then selected based on discriminative value and psychometric properties. Items indicative of mild AD comprised spatially complex imitation of hand and finger postures and to a lesser degree, pantomime of common object-use. Buccofacial apraxia including imitation of face postures, emblematic face postures, and repetition of multisyllabic pseudowords differentiated bvFTD from HC and AD. The final test version consisting of 20 items proved highly efficient for the discrimination of biologically confirmed dementia patients from HC (sensitivity 91% , specificity 71%) but also for differential diagnosis of bvFTD and AD (sensitivity 74% , specificity 93%). Assessment of praxis profiles effectively contributes to diagnosis and differential diagnosis of AD and bvFTD. The Dementia Apraxia Test (DATE) is a brief and easy to administer cognitive tool for dementia assessment, has a high inter-rater reliability (Cohen's κ= 0.885) and demonstrates content validity.

  6. Downward finger displacement distinguishes Parkinson disease dementia from Alzheimer disease.

    Science.gov (United States)

    Lieberman, Abraham; Deep, Aman; Shi, Jiong; Dhall, Rohit; Shafer, Saulena; Moguel-Cobos, Guillermo; Dhillon, Ravneet; Frames, Christopher W; McCauley, Margaret

    2018-02-01

    Purpose/Aim of the study: To study finger displacement in patients with Parkinson disease dementia (PDD) and in patients with Alzheimer disease (AD). We examined 56 patients with PDD and 35 with AD. Patients were examined during their regular outpatient clinic visit. Finger displacement was measured by observers not actively involved in the study using a creative grid ruler for all PDD and AD patients. Finger displacement was examined by asking patients to point their index fingers toward the grid ruler with the nails facing upward. Patients were asked to maintain the pointing position for 15 s. After 15 s, patients were asked to close their eyes for another 15 s while maintaining the same position. A positive result was downward index finger displacement of ≥5 cm within the 15-second time window with eyes closed. Of the 56 PDD patients, 53 had bilateral finger displacement of >5 cm. In comparison, of the 35 AD patients, only 1 patient had minimal displacement. Results of the non-invasive finger displacement test may provide insight, on an outpatient basis, of the integrity of subcortical-cortical circuits. Downward finger displacement, especially bilateral downward displacement, may signal the extensive disruption of subcortical-cortical circuits that occurs in PDD patients. AChE: acetylcholinesterase; AD: Alzheimer disease; DLB: dementia with Lewy bodies; ET: essential tremor; MDS-UPDRS: Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale; MMSE: Mini-Mental State Examination; PD: Parkinson disease; PDD: Parkinson disease dementia.

  7. Vitamin D and the risk of dementia and Alzheimer disease.

    Science.gov (United States)

    Littlejohns, Thomas J; Henley, William E; Lang, Iain A; Annweiler, Cedric; Beauchet, Olivier; Chaves, Paulo H M; Fried, Linda; Kestenbaum, Bryan R; Kuller, Lewis H; Langa, Kenneth M; Lopez, Oscar L; Kos, Katarina; Soni, Maya; Llewellyn, David J

    2014-09-02

    To determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease. One thousand six hundred fifty-eight elderly ambulatory adults free from dementia, cardiovascular disease, and stroke who participated in the US population-based Cardiovascular Health Study between 1992-1993 and 1999 were included. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected in 1992-1993. Incident all-cause dementia and Alzheimer disease status were assessed during follow-up using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria. During a mean follow-up of 5.6 years, 171 participants developed all-cause dementia, including 102 cases of Alzheimer disease. Using Cox proportional hazards models, the multivariate adjusted hazard ratios (95% confidence interval [CI]) for incident all-cause dementia in participants who were severely 25(OH)D deficient (Alzheimer disease in participants who were severely 25(OH)D deficient and deficient compared to participants with sufficient concentrations were 2.22 (95% CI: 1.02-4.83) and 1.69 (95% CI: 1.06-2.69). In multivariate adjusted penalized smoothing spline plots, the risk of all-cause dementia and Alzheimer disease markedly increased below a threshold of 50 nmol/L. Our results confirm that vitamin D deficiency is associated with a substantially increased risk of all-cause dementia and Alzheimer disease. This adds to the ongoing debate about the role of vitamin D in nonskeletal conditions. © 2014 American Academy of Neurology.

  8. Dementia: Dementia prevention - a call for contextualized evidence.

    OpenAIRE

    Lafortune, Louise; Brayne, Carol Elspeth

    2017-01-01

    Summary: The Lancet Commission on Dementia Prevention, Intervention, and Care has evaluated current evidence on dementia management, including the measures that can be taken to reduce an individual’s risk of dementia. However, further intervention trials and evaluation in real-world settings are needed to alter dementia incidence globally.

  9. The prevention of dementia.

    Science.gov (United States)

    Peters, Ruth

    2009-05-01

    Dementia is prevalent in older adults and the population is ageing. Many factors have been associated with dementia and anything that may aid the prevention of dementia is of importance. The literature in this area was evaluated and information relating to the various factors that may impact upon the prevention of dementia is presented below. Factors that have been associated with a possible increased risk of developing dementia include high blood pressure, (at least in midlife), high body mass index, smoking and possibly diabetes although the evidence is mixed. There is currently no clear evidence with regard to cholesterol and metabolic syndrome although both may be implicated. Having education and maintaining a Mediterranean diet, including vegetable, fruit and fish intake, have been linked to a lower incidence of dementia as has low to moderate alcohol intake. Although care must be taken with the latter given the different characteristics of the studies reporting on alcohol and dementia. It may be that risk and protective factors vary with age, however, in the absence of prophylactic treatment it seems likely that the maintenance of a healthy lifestyle may represent the best option with regard to the prevention of dementia. (c) 2008 John Wiley & Sons, Ltd.

  10. Prognosis of dementia

    NARCIS (Netherlands)

    van de Vorst, IE

    2016-01-01

    Background: In this thesis, we focused on the prognosis of patients with dementia who visited a hospital (inpatient or day clinic care) in the Netherlands. So far, absolute mortality risks for dementia were lacking in the Netherlands, whereas these risks have been available for years for cancer or

  11. Emerging treatments in dementia

    NARCIS (Netherlands)

    Scheltens, P.; van Gool, W. A.

    1997-01-01

    Dementia is one of the most common organic mental syndromes, usually caused by Alzheimer's disease (AD) or vascular dementia (VD) or both. Regarding AD we review the state or the art of the cholinergic approach and discuss some future options regarding preventive and nonsymptomatic strategies.

  12. Dementia and the law

    NARCIS (Netherlands)

    Gevers, Sjef

    2006-01-01

    The care for patients with dementia raises many legal (and ethical) issues. This article explores some of the more important topics, i.e. (early) diagnosis of the disease, the availability and provision of care, treatment and non treatment decisions, and medical research with dementia patients

  13. Genetics of dementia.

    Science.gov (United States)

    Loy, Clement T; Schofield, Peter R; Turner, Anne M; Kwok, John B J

    2014-03-01

    25% of all people aged 55 years and older have a family history of dementia. For most, the family history is due to genetically complex disease, where many genetic variations of small effect interact to increase risk of dementia. The lifetime risk of dementia for these families is about 20%, compared with 10% in the general population. A small proportion of families have an autosomal dominant family history of early-onset dementia, which is often due to mendelian disease, caused by a mutation in one of the dementia genes. Each family member has a 50% chance of inheriting the mutation, which confers a lifetime dementia risk of over 95%. In this Review, we focus on the evidence for, and the approach to, genetic testing in Alzheimer's disease (APP, PSEN1, and PSEN2 genes), frontotemporal dementia (MAPT, GRN, C9ORF72, and other genes), and other familial dementias. We conclude by discussing the practical aspects of genetic counselling. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Stroke Rehabilitation

    Science.gov (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  15. Pediatric Stroke

    Science.gov (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

  16. Impact of Bilingualism on Cognitive Outcome After Stroke.

    Science.gov (United States)

    Alladi, Suvarna; Bak, Thomas H; Mekala, Shailaja; Rajan, Amulya; Chaudhuri, Jaydip Ray; Mioshi, Eneida; Krovvidi, Rajesh; Surampudi, Bapiraju; Duggirala, Vasanta; Kaul, Subhash

    2016-01-01

    Bilingualism has been associated with slower cognitive aging and a later onset of dementia. In this study, we aimed to determine whether bilingualism also influences cognitive outcome after stroke. We examined 608 patients with ischemic stroke from a large stroke registry and studied the role of bilingualism in predicting poststroke cognitive impairment in the absence of dementia. A larger proportion of bilinguals had normal cognition compared with monolinguals (40.5% versus 19.6%; Pbilinguals 49.0%; Pbilinguals 10.5%; P=0.354). Bilingualism was found to be an independent predictor of poststroke cognitive impairment. Our results suggest that bilingualism leads to a better cognitive outcome after stroke, possibly by enhancing cognitive reserve. © 2015 American Heart Association, Inc.

  17. Antidepressants and dementia

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Søndergård, Lars; Forman, Julie Lyng

    2009-01-01

    BACKGROUND: It has been suggested that antidepressants may have neuroprotective abilities but it has newer been investigated lately whether treatment with antidepressants reduces the risk of dementia. METHOD: Linkage of registers of all prescribed antidepressants and diagnoses of dementia...... the rate increased with the number of prescriptions but continued long-term antidepressants treatment was associated with a reduction in the rate of dementia, however, not to the same level as the rate for the general population. This pattern was found for all classes of antidepressants (SSRIs, newer non...... in Denmark during a period from 1995 to 2005. RESULTS: Persons who purchased antidepressants once (N=687,552) had an increased rate of dementia compared to persons unexposed to antidepressants (N=779,831). Nevertheless, the rate of dementia changed over time; thus during the initial prescription periods...

  18. Antidepressants and dementia

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Søndergaard, Lars; Forman, Julie Lyng

    2009-01-01

    BACKGROUND: It has been suggested that antidepressants may have neuroprotective abilities but it has newer been investigated lately whether treatment with antidepressants reduces the risk of dementia. METHOD: Linkage of registers of all prescribed antidepressants and diagnoses of dementia...... in Denmark during a period from 1995 to 2005. RESULTS: Persons who purchased antidepressants once (N=687,552) had an increased rate of dementia compared to persons unexposed to antidepressants (N=779,831). Nevertheless, the rate of dementia changed over time; thus during the initial prescription periods...... the rate increased with the number of prescriptions but continued long-term antidepressants treatment was associated with a reduction in the rate of dementia, however, not to the same level as the rate for the general population. This pattern was found for all classes of antidepressants (SSRIs, newer non...

  19. Early-Onset Dementia

    DEFF Research Database (Denmark)

    Konijnenberg, Elles; Fereshtehnejad, Seyed-Mohammad; Kate, Mara Ten

    2017-01-01

    BACKGROUND: Early-onset dementia (EOD) is a rare condition, with an often atypical clinical presentation, and it may therefore be challenging to diagnose. Specialized memory clinics vary in the type of patients seen, diagnostic procedures applied, and the pharmacological treatment given. The aim...... of this study was to investigate quality-of-care indicators in subjects with EOD from 3 tertiary memory clinics in 3 European countries. METHODS: We included 1325 newly diagnosed EOD patients, ages 65 years or younger, between January 1, 2007 and December 31, 2013, from the Danish Dementia Registry...... (Rigshospitalet, Copenhagen), the Swedish Dementia Registry ("SveDem", Karolinska University Hospital, Stockholm), and the Amsterdam Dementia Cohort (VU University Medical Center). RESULTS: The frequency of EOD among all dementia patients was significantly lower in Copenhagen (410, 20%) and Stockholm (284, 21...

  20. [Sleep problems in dementia].

    Science.gov (United States)

    Oka, Yasunori

    2014-01-01

    Sleep disturbance is common in patients with dementia. Circadian rhythm sleep disorders are caused by the disturbance of sleep-wake regulation in the central nervous system, disturbed input into the sensory organs, and decreased social activities. Diurnal change of serum melatonin level in Alzheimer's disease showed decreased amplitude and shifted peak secretion. Age related sleep disturbances and sleep disorders due to the neurodegeneration including REM sleep behavior disorder also increase in dementia. Identifying and treating underlying sleep disorders along with therapeutic approach to circadian mechanism is effective. Treatment of circadian abnormality in dementia require light therapy and increased daytime activity. Use of oral melatonin is also effective for the improvement of nocturnal sleep. Treatment of sleep problems in dementia also contribute to the better management of dementia.

  1. Music and dementia.

    Science.gov (United States)

    Baird, Amee; Samson, Séverine

    2015-01-01

    There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia. © 2015 Elsevier B.V. All rights reserved.

  2. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  3. Prognosis with dementia in Europe

    DEFF Research Database (Denmark)

    Jagger, C; Andersen, K; Breteler, M M

    2000-01-01

    The effect of dementia on time to death and institutionalization in elderly populations is of importance to resource planning, as well as to patients and their carers. The authors report a collaborative reanalysis of nine population-based studies conducted in Europe to compare dementia cases...... for men with dementia was consistently lower than that for women with dementia of the same age group....

  4. The impact of stroke on emotional intelligence

    Directory of Open Access Journals (Sweden)

    Hoffmann Bronwyn

    2010-10-01

    Full Text Available Abstract Background Emotional intelligence (EI is important for personal, social and career success and has been linked to the frontal anterior cingulate, insula and amygdala regions. Aim To ascertain which stroke lesion sites impair emotional intelligence and relation to current frontal assessment measurements. Methods One hundred consecutive, non aphasic, independently functioning patients post stroke were evaluated with the Bar-On emotional intelligence test, "known as the Emotional Quotient Inventory (EQ-i" and frontal tests that included the Wisconsin Card Sorting Test (WCST and Frontal Systems Behavioral Inventory (FRSBE for correlational validity. The results of a screening, bedside frontal network syndrome test (FNS and NIHSS to document neurological deficit were also recorded. Lesion location was determined by the Cerefy digital, coxial brain atlas. Results After exclusions (n = 8, patients tested (n = 92, mean age 50.1, CI: 52.9, 47.3 years revealed that EQ-i scores were correlated (negatively with all FRSBE T sub-scores (apathy, disinhibition, executive, total, with self-reported scores correlating better than family reported scores. Regression analysis revealed age and FRSBE total scores as the most influential variables. The WCST error percentage T score did not correlate with the EQ-i scores. Based on ANOVA, there were significant differences among the lesion sites with the lowest mean EQ-i scores associated with temporal (71.5 and frontal (87.3 lesions followed by subtentorial (91.7, subcortical gray (92.6 and white (95.2 matter, and the highest scores associated with parieto-occipital lesions (113.1. Conclusions 1 Stroke impairs EI and is associated with apathy, disinhibition and executive functioning. 2 EI is associated with frontal, temporal, subcortical and subtentorial stroke syndromes.

  5. The impact of stroke on emotional intelligence.

    Science.gov (United States)

    Hoffmann, Michael; Cases, Lourdes Benes; Hoffmann, Bronwyn; Chen, Ren

    2010-10-28

    Emotional intelligence (EI) is important for personal, social and career success and has been linked to the frontal anterior cingulate, insula and amygdala regions. To ascertain which stroke lesion sites impair emotional intelligence and relation to current frontal assessment measurements. One hundred consecutive, non aphasic, independently functioning patients post stroke were evaluated with the Bar-On emotional intelligence test, "known as the Emotional Quotient Inventory (EQ-i)" and frontal tests that included the Wisconsin Card Sorting Test (WCST) and Frontal Systems Behavioral Inventory (FRSBE) for correlational validity. The results of a screening, bedside frontal network syndrome test (FNS) and NIHSS to document neurological deficit were also recorded. Lesion location was determined by the Cerefy digital, coxial brain atlas. After exclusions (n = 8), patients tested (n = 92, mean age 50.1, CI: 52.9, 47.3 years) revealed that EQ-i scores were correlated (negatively) with all FRSBE T sub-scores (apathy, disinhibition, executive, total), with self-reported scores correlating better than family reported scores. Regression analysis revealed age and FRSBE total scores as the most influential variables. The WCST error percentage T score did not correlate with the EQ-i scores. Based on ANOVA, there were significant differences among the lesion sites with the lowest mean EQ-i scores associated with temporal (71.5) and frontal (87.3) lesions followed by subtentorial (91.7), subcortical gray (92.6) and white (95.2) matter, and the highest scores associated with parieto-occipital lesions (113.1). 1) Stroke impairs EI and is associated with apathy, disinhibition and executive functioning. 2) EI is associated with frontal, temporal, subcortical and subtentorial stroke syndromes.

  6. Satisfaction in dementia and stroke caregivers: a comparative study Percepción de la satisfacción de cuidadores de personas con demencia y de cuidadores de personas con AVC Estudo comparativo: percepção da satisfação de cuidadores de pessoas com demência e cuidadores de pessoas com AVC

    Directory of Open Access Journals (Sweden)

    Margarida Sotto Mayor

    2009-10-01

    Full Text Available Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70 and stroke patients (n=44 by means of the Carer's Assessment of Satisfaction Index (CASI and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary and from interpersonal dynamics (caregiver as main beneficiary in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.La prestación informal de cuidados a las personas ancianas está vinculada a la presencia de dificultades y de satisfacciones. Generalmente la literatura gerontológica enfoca los aspectos de la dificultad, sin embargo no le ha dado la misma atención al análisis de la experiencia de la satisfacción. El propósito de este estudio transversal fue comparar la experiencia de satisfacción y de sintomatología depresiva de cuidadores de ancianos con demencia (n=70 y de cuidadores de ancianos con antecedentes de, por lo menos, un AVC (n=44, a través del Índice de Evaluación de la Satisfacción del Cuidador (CASI. Los resultados indican la presencia de sintomatología depresiva en ambos grupos; satisfacción intrapersonal (centrada en el anciano y interpersonal (centrada en el cuidador para los cuidadores de ancianos con demencia y, satisfacción intrapersonal (centrada en el cuidador para los cuidadores de personas con antecedentes de AVC. Se destaca la necesidad de comprender mejor las experiencias de satisfacción en los

  7. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  8. A continuum of executive function deficits in early subcortical vascular cognitive impairment: A systematic review and meta-analysis

    Science.gov (United States)

    Sudo, Felipe Kenji; Amado, Patricia; Alves, Gilberto Sousa; Laks, Jerson; Engelhardt, Eliasz

    2017-01-01

    ABSTRACT. Background. Subcortical Vascular Cognitive Impairment (SVCI) is a clinical continuum of vascular-related cognitive impairment, including Vascular Mild Cognitive Impairment (VaMCI) and Vascular Dementia. Deficits in Executive Function (EF) are hallmarks of the disorder, but the best methods to assess this function have yet to be determined. The insidious and almost predictable course of SVCI and the multidimensional concept of EF suggest that a temporal dissociation of impairments in EF domains exists early in the disorder. Objective: This study aims to review and analyze data from the literature about performance of VaMCI patients on the most used EF tests through a meta-analytic approach. Methods: Medline, Web of Knowledge and PsycINFO were searched, using the terms: “vascular mild cognitive impairment” OR “vascular cognitive impairment no dementia” OR “vascular mild neurocognitive disorder” AND “dysexecutive” OR “executive function”. Meta-analyses were conducted for each of the selected tests, using random-effect models. Results: Systematic review showed major discrepancies among the results of the studies included. Meta-analyses evidenced poorer performance on the Trail-Making Test part B and the Stroop color test by VaMCI patients compared to controls. Conclusion: A continuum of EF impairments has been proposed in SVCI. Early deficits appear to occur in cognitive flexibility and inhibitory control. PMID:29354217

  9. A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy.

    Science.gov (United States)

    Rubin, Courtney B; Hahn, Virginia; Kobayashi, Taisei; Litwack, Andrew

    2015-01-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was found to have diffuse and irregular narrowing of the left anterior descending artery and a drug eluting stent was deployed. Months later, she developed two subsequent episodes of unstable angina, requiring stent placement in the distal left anterior descending artery and the right coronary artery. Though the neurologic manifestations of CADASIL have been well described, these patients may also be predisposed to developing premature coronary artery disease. Patients with CADASIL and their physicians should be aware of this possible association because these patients may not be identified as high risk by traditional cardiovascular risk estimators. These patients may benefit from more aggressive interventions to reduce cardiac risk.

  10. A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

    Directory of Open Access Journals (Sweden)

    Courtney B. Rubin

    2015-01-01

    Full Text Available Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was found to have diffuse and irregular narrowing of the left anterior descending artery and a drug eluting stent was deployed. Months later, she developed two subsequent episodes of unstable angina, requiring stent placement in the distal left anterior descending artery and the right coronary artery. Though the neurologic manifestations of CADASIL have been well described, these patients may also be predisposed to developing premature coronary artery disease. Patients with CADASIL and their physicians should be aware of this possible association because these patients may not be identified as high risk by traditional cardiovascular risk estimators. These patients may benefit from more aggressive interventions to reduce cardiac risk.

  11. Voxel-based analysis of cerebral glucose metabolism in AD and non-AD degenerative dementia using statistical parametric mapping

    International Nuclear Information System (INIS)

    Li Zugui; Gao Shuo; Zhang Benshu; Ma Aijun; Cai Li; Li Dacheng; Li Yansheng; Liu Lei

    2008-01-01

    Objective: It is know that Alzheimer's disease (AD) and non-AD degenerative dementia have some clinical features in common. The aim of this study was to investigate the specific patterns of regional, cerebral glucose metabolism of AD and non-AD degenerative dementia patients, using a voxel-based 18 F-fluorodeoxyglucose (FDG) PET study. Methods: Twenty-three AD patients and 24 non-AD degenerative dementia patients including 9 Parkinson's disease with dementia(PDD), 7 frontal-temporal dementia (FTD), 8 dementia of Lewy bodies (DLB) patients, and 40 normal controls (NC)were included in the study. To evaluate the relative cerebral metabolic rate of glucose (rCMRglc), 18 F-FDG PET imaging was performed in all subjects. Subsequently, statistical comparison of PET data with NC was performed using statistical parametric mapping (SPM). Results: The AD-associated FDG imaging pattern typically presented as focal cortical hypometabolism in bilateral parietotemporal association cortes and(or) frontal lobe and the posterior cingulate gyms. As compared with the comparative NC, FTD group demonstrated significant regional reductions in rCMRglc in bilateral frontal, parietal lobes, the cingulate gyri, insulae, left precuneus, and the subcortical structures (including right putamen, right medial dorsal nucleus and ventral anterior nucleus). The PDD group showed regional reductions in rCMRglc in bilateral frontal cortexes, parietotemporal association cortexes, and the subcortical structures (including left caudate, right putamen, the dorsomedial thalamus, lateral posterior nucleus, and pulvinar). By the voxel-by-voxel comparison between the DLB group and NC group, regional reductions in rCMRglc included bilateral occipital cortexes, precuneuses, frontal and parietal lobes, left anterior cingulate gyms, right superior temporal cortex, and the subcortical structures including putamen, caudate, lateral posterior nucleus, and pulvinar. Conclusions: The rCMRglc was found to be different

  12. [Dementia: management and prevention].

    Science.gov (United States)

    Daher, Oscar; Nguyen, Sylvain; Smith, Cindi; Büla, Christophe; Démonet, Jean-François

    2016-04-20

    Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors.

  13. The influence of puberty on subcortical brain development.

    Science.gov (United States)

    Goddings, Anne-Lise; Mills, Kathryn L; Clasen, Liv S; Giedd, Jay N; Viner, Russell M; Blakemore, Sarah-Jayne

    2014-03-01

    Puberty is characterized by hormonal, physical and psychological transformation. The human brain undergoes significant changes between childhood and adulthood, but little is known about how puberty influences its structural development. Using a longitudinal sample of 711 magnetic resonance imaging scans from 275 individuals aged 7-20years, we examined how subcortical brain regions change in relation to puberty. Our regions of interest included the amygdala, hippocampus and corpus striatum including the nucleus accumbens (NA), caudate, putamen and globus pallidus (GP). Pubertal development was significantly related to structural volume in all six regions in both sexes. Pubertal development and age had both independent and interactive influences on volume for the amygdala, hippocampus and putamen in both sexes, and the caudate in females. There was an interactive puberty-by-age effect on volume for the NA and GP in both sexes, and the caudate in males. These findings suggest a significant role for puberty in structural brain development. © 2013. Published by Elsevier Inc. All rights reserved.

  14. Emotional responses to subcortical electrical stimulation in psychiatric patients.

    Science.gov (United States)

    Laitinen, L V

    1979-01-01

    Subcortical electrical stimulation was applied to the prospective surgical target area during 158 stereotactic operations in 135 psychiatric patients. The following target areas were studied: rostral cingulum below and in front of the genu of the corpus callosum (52 cases) genu (46) cingululum just above the genu (11) middle cingulum (6) anterior internal capsule (33) subcaudate region, 'substantia innominata' (10 cases). Forty-seven per cent of the cases reacted to stimulation with subjective emotional sensory responses. Stimulation of differ targets had significantly different results. Responses were obtained most frequently from the cingulum and genu, and least frequently from the anterior capsule and subcaudate regions. Stimulation of the rostral cingulum often caused 'negative' responses, i.e. an increase in or the appearance of anxiety and tension (11/15 cases). The opposite was true of the adjacent genu of the corpus callosum; on stimulation of this structure anxiety and tension disappeared or diminished (18/19 cases). Schizophrenic patients experienced such 'positive' responses significantly more often than non-schizophrenics. In non-anesthetized patients autonomic reactions were very rare.

  15. Frontotemporal dementia and primary progressive aphasia, a review

    Directory of Open Access Journals (Sweden)

    Kirshner HS

    2014-06-01

    Full Text Available Howard S KirshnerDepartment of Neurology, Vanderbilt University Medical Center, Nashville, TN, USAAbstract: Frontotemporal dementias are neurodegenerative diseases in which symptoms of frontal and/or temporal lobe disease are the first signs of the illness, and as the diseases progress, they resemble a focal left hemisphere process such as stroke or traumatic brain injury, even more than a neurodegenerative disease. Over time, some patients develop a more generalized dementia. Four clinical subtypes characterize the predominant presentations of this illness: behavioral or frontal variant FTD, progressive nonfluent aphasia, semantic dementia, and logopenic primary progressive aphasia. These clinical variants correlate with regional patterns of atrophy on brain imaging studies such as MRI and PET scanning, as well as with biochemical and molecular genetic variants of the disorder. The treatment is as yet only symptomatic, but advances in molecular genetics promise new therapies.Keywords: FTD, behavior variant or frontal variant FTD, pick's disease, PPA, progressive nonfluent aphasia

  16. Subcortical Band Heterotopia (SBH) in Rat Offspring Following Maternal Hypothyroxinemia: Structural and Functional Characteristics

    Science.gov (United States)

    Thyroid hormones (TH) play crucial roles in brain maturation, neuronal migration, and neocortical lamination. Subcortical band heterotopia (SBH) represent a class of neuronal migration errors in humans that are often associated with childhood epilepsy. We have previously reported...

  17. Subcortical and cortical correlates of pitch discrimination: Evidence for two levels of neuroplasticity in musicians

    DEFF Research Database (Denmark)

    Bianchi, Federica; Hjortkjær, Jens; Santurette, Sébastien

    2017-01-01

    superior temporal gyrus, Heschl's gyrus, insular cortex, inferior frontal gyrus, and in the inferior colliculus. Both subcortical and cortical neural responses predicted the individual pitch-discrimination performance. However, functional activity in the inferior colliculus correlated with differences...

  18. Eight novel mutations in MLC1 from 18 Iranian patients with megalencephalic leukoencephalopathy with subcortical cysts

    NARCIS (Netherlands)

    Kariminejad, Ariana; Rajaee, Ahmad; Ashrafi, Mahmoud Reza; Alizadeh, Houman; Tonekaboni, Seyed Hasan; Malamiri, Reza Azizi; Ghofrani, Mohamad; Karimzadeh, Parvaneh; Mohammadi, Mohsen Molla; Baghalshooshtari, Ali; Bozorgmehr, Bita; Kariminejad, Mohamad Hasan; Postma, N.; Abbink, Truus E. M.; van der Knaap, Marjo S.

    2015-01-01

    Megalencephalic leukoencephalopathy with subcortical cysts (MLC) (MIM #604004) is a rare autosomal recessive neurological disorder characterized by macrocephaly, motor and cognitive decline, ataxia, spasticity and occasional seizures. Magnetic resonance imaging (MRI) shows diffusely abnormal and

  19. Eight novel mutations in MLC1 from 18 Iranian patients with megalencephalic leukoencephalopathy with subcortical cysts

    NARCIS (Netherlands)

    Kariminejad, A.; Rajaee, A.; Ashrafi, M.R.; Alizadeh, H.; Tonekaboni, S.H.; Malamiri, R.A.; Ghofrani, M.; Karimzadeh, P.; Mohammadi, M.M.; Baghalshooshtari, A.; Bozorgmehr, B.; Kariminejad, M.H.; Postma, N.; Abbink, G.E.M.; van der Knaap, M.S.

    2015-01-01

    Megalencephalic leukoencephalopathy with subcortical cysts (MLC) (MIM #. 604004) is a rare autosomal recessive neurological disorder characterized by macrocephaly, motor and cognitive decline, ataxia, spasticity and occasional seizures. Magnetic resonance imaging (MRI) shows diffusely abnormal and

  20. Risk of Dementia Associated with Elevated Plasma Homocysteine in a Latin American Population

    Directory of Open Access Journals (Sweden)

    Inara J. Chacón

    2009-01-01

    Full Text Available The relationship between total homocysteine (tHcy and dementia risk remains controversial, as the association varies among populations and dementia subtypes. We studied a Venezuelan population that has high prevalence of both elevated tHcy and dementia. We tested the hypotheses that (1 elevated tHcy is associated with increased dementia risk, (2 the risk is greater for vascular dementia (VaD than for Alzheimer's disease (AD, and (3 a history of stroke may partly explain this association. 2100 participants (≥55 years old of the Maracaibo Aging Study underwent standardized neurological, neuropsychiatric, and cardiovascular assessments. Elevated tHcy was significantly associated with dementia, primarily VaD. When history of stroke and other confounding factors were taken into account, elevated tHcy remained a significant risk factor in older (>66 years, but not in younger (55–66 years subjects. Ongoing studies of this population may provide insight into the mechanism by which tHcy increases risk for dementia.

  1. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  2. Shared neural correlates of limb apraxia in early stages of Alzheimer's dementia and behavioural variant frontotemporal dementia.

    Science.gov (United States)

    Johnen, Andreas; Brandstetter, Lisa; Kärgel, Christian; Wiendl, Heinz; Lohmann, Hubertus; Duning, Thomas

    2016-11-01

    Limb apraxia denotes a cognitive impairment of gesture production. Lesion studies in patients with stroke point towards distinct neural processing streams for limb imitation and object-pantomime within left parietal and temporal cortex, respectively. Despite its frequent occurrence as an early symptom in both, Alzheimer's dementia (AD) and behavioural variant frontotemporal dementia (bvFTD), neural correlates of limb apraxia within these patient groups remain unexplored. Using voxel-based morphometry and multiple regression models, associations between limb apraxia and gray matter (GM) volume were investigated in 36 dementia patients (18 AD, 18 bvFTD) in early disease stages. Both dementia subtypes showed a comparable degree of limb apraxia. Although the patient groups showed distinct atrophy patterns with significantly more severe frontal GM loss in bvFTD, we found similar neural correlates of limb apraxia within posterior brain regions for both dementia subtypes: limb-imitation was associated with bilateral atrophy of superior, inferior and medial parietal cortex. Object-pantomime showed associations with GM volume in right middle temporal and angular gyrus. Our results argue for shared neural correlates of limb apraxia in AD and bvFTD and validate the syndrome as an important neuropsychological feature across different etiologies. Moreover, our results are compatible with neural models derived from patients with stroke, suggesting partly distinct neural representations of imitation and pantomime. Compared to patients with stroke however, AD and bvFTD showed more bilateral or even right lateralized neural representations of limb apraxia, proposing a greater influence of visuospatial impairments and spatial body representation deficits on praxis performance. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. The Association between Specific Substances of Abuse and Subcortical Intracerebral Hemorrhage Versus Ischemic Lacunar Infarction

    OpenAIRE

    Kaplan, Emma H.; Gottesman, Rebecca F.; Llinas, Rafael H.; Marsh, Elisabeth B.

    2014-01-01

    Background: Hypertension damages small vessels, resulting in both lacunar infarction and subcortical intracerebral hemorrhage (ICH). Substance abuse has also been linked to small vessel pathology. This study explores whether the use of specific substances (e.g., cocaine, tobacco) is associated with subcortical ICH over ischemia in hypertensive individuals. Methods: Patients with hypertension, admitted with lacunar infarcts (measuring 1 drink per day (women), >2 drinks per day (men). Logist...

  4. The Association Between Specific Substances of Abuse and Subcortical Intracerebral Hemorrhage versus Ischemic Lacunar Infarction

    OpenAIRE

    Emma H Kaplan; Rebecca F Gottesman; Rebecca F Gottesman; Rafael H Llinas; Rafael H Llinas; Elisabeth Breese Marsh; Elisabeth Breese Marsh

    2014-01-01

    Background: Hypertension damages small vessels, resulting in both lacunar infarction and subcortical intracerebral hemorrhage (ICH). Substance abuse has also been linked to small vessel pathology. This study explores whether the use of specific substances (eg., cocaine, tobacco) is associated with subcortical ICH over ischemia in hypertensive individuals.Methods: Patients with hypertension, admitted with lacunar infarcts (measuring 1 drink per day (women), >2 drinks per day (men). Logistic re...

  5. tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke.

    Science.gov (United States)

    Straudi, Sofia; Fregni, Felipe; Martinuzzi, Carlotta; Pavarelli, Claudia; Salvioli, Stefano; Basaglia, Nino

    2016-01-01

    Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL). Results. Both groups reported a significant improvement in FMA-UE score after treatment (p robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.

  6. Lewy Body Dementia Association

    Science.gov (United States)

    ... Read Story A New Mission In Life Don Kent is a licensed attorney with a brilliant career. ... Reserved Lewy Body Dementia Association, Inc. 912 Killian Hill Road S.W., Lilburn, GA 30047 © 2016 Lewy Body ...

  7. Dementia - daily care

    Science.gov (United States)

    ... Eating Handling their own personal care Help With Memory Loss People who have early memory loss can ... for people who have dementia to have decreased smell and taste. This will affect their enjoyment of ...

  8. Dementia with Lewy Bodies

    Science.gov (United States)

    ... occurs sporadically, in people with no known family history of the disease. However, rare familial cases have occasionally been reported. × Definition Dementia with Lewy bodies (DLB) is one of ...

  9. Sociopathic behavior and dementia.

    Science.gov (United States)

    Cipriani, Gabriele; Borin, Gemma; Vedovello, Marcella; Di Fiorino, Andrea; Nuti, Angelo

    2013-06-01

    The maintenance of appropriate social behavior is a very complex process with many contributing factors. Social and moral judgments rely on the proper functioning of neural circuits concerned with complex cognitive and emotional processes. Damage to these systems may lead to distinct social behavior abnormalities. When patients present with dysmoral behavior for the first time, as a change from a prior pervasive pattern of behavior, clinicians need to consider a possible, causative brain disorder. The aim is to explore sociopathy as a manifestation of dementia. We searched electronic databases and key journals for original research and review articles on sociopathy in demented patients using the search terms "sociopathy, acquired sociopathy, sociopathic behavior, dementia, and personality". In conclusion, dementia onset may be heralded by changes in personality including alteration in social interpersonal behavior, personal regulation, and empathy. The sociopathy of dementia differs from antisocial/psychopathic personality disorders.

  10. The many faces of dementia.

    Science.gov (United States)

    Shagam, Janet Yagoda

    2009-01-01

    Dementia is a progressive and incurable condition that in one way or another affects nearly everyone. Examples of specific types of dementia include Alzheimer disease, vascular dementia, frontotemporal dementia and dementia with Lewy bodies. Age is the primary risk factor for dementia and the long-term social and economic effects of dementia are immense. Functional medical imaging is an important research tool that eventually may become a practical screening tool for early-stage dementia, to confirm a clinical diagnosis and to help clinicians manage patient care. Functional medical imaging also may play a role in research regarding the development of new medications to prevent or delay the progression of Alzheimer disease and other dementias. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store.

  11. Nutrition in Severe Dementia

    OpenAIRE

    Pivi, Glaucia Akiko Kamikado; Bertolucci, Paulo Henrique Ferreira; Schultz, Rodrigo Rizek

    2012-01-01

    An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of...

  12. Reconceptualising dementia friendly communities

    OpenAIRE

    Wright, T.

    2014-01-01

    This Knowledgeshare piece takes a critical look at the concept of dementia-friendly communities by examining how that concept, which aims to build a better place for people with dementia to live, works to conceal and overlook the social, cultural, political, and economic realities of many marginalised people’s lived experiences. Drawing on knowledge from feminist social cultural theories I want to highlight some of the undisclosed subjectivities that are hidden in representations of people li...

  13. Improved labeling of subcortical brain structures in atlas-based segmentation of magnetic resonance images.

    Science.gov (United States)

    Yousefi, Siamak; Kehtarnavaz, Nasser; Gholipour, Ali

    2012-07-01

    Precise labeling of subcortical structures plays a key role in functional neurosurgical applications. Labels from an atlas image are propagated to a patient image using atlas-based segmentation. Atlas-based segmentation is highly dependent on the registration framework used to guide the atlas label propagation. This paper focuses on atlas-based segmentation of subcortical brain structures and the effect of different registration methods on the generated subcortical labels. A single-step and three two-step registration methods appearing in the literature based on affine and deformable registration algorithms in the ANTS and FSL algorithms are considered. Experiments are carried out with two atlas databases of IBSR and LPBA40. Six segmentation metrics consisting of Dice overlap, relative volume error, false positive, false negative, surface distance, and spatial extent are used for evaluation. Segmentation results are reported individually and as averages for nine subcortical brain structures. Based on two statistical tests, the results are ranked. In general, among four different registration strategies investigated in this paper, a two-step registration consisting of an initial affine registration followed by a deformable registration applied to subcortical structures provides superior segmentation outcomes. This method can be used to provide an improved labeling of the subcortical brain structures in MRIs for different applications.

  14. Phytosterols and Dementia.

    Science.gov (United States)

    Shuang, Rong; Rui, Xu; Wenfang, Li

    2016-12-01

    As the aging of the world's population is becoming increasingly serious, dementia-related diseases have become a hot topic in public health research. In recent years, human epidemiological studies have focused on lipid metabolism disorders and dementia. The efficacy of phytosterol intake as a cholesterol-lowering agent has been demonstrated. Phytosterols directly serve as ligands of the nuclear receptors, peroxisome proliferator-activated receptors (PPARs), activating Sirtuin 1 (SIRT-1), which are involved in the regulation of lipid metabolism and the pathogenesis of dementia. Moreover, phytosterols mediate cell and membrane cholesterol efflux or beta amyloid (Aβ) metabolism, which have preventative and therapeutic effects on dementia. Additionally, incorporation of plant sterols in lipid rafts can effectively reduce dietary fat and alter the dietary composition of fiber, fat and cholesterol to regulate appetite and calories. Overall, the objectives of this review are to explore whether phytosterols are a potentially effective target for the prevention of dementia and to discuss a possible molecular mechanism by which phytosterols play a role in the pathogenesis of dementia via the PPARs-SIRT-1 pathway.

  15. Computertomographic studies of dementia

    International Nuclear Information System (INIS)

    Kohlmeyer, K.

    1983-01-01

    It seems to be very complicated even for the experienced neurologist and psychiatrist to correlate the clinical syndrome of dementia to different causing cerebral processes such as a primarily degenerative brain atrophy, a chronic cerebrovascular insufficiency, or other rarer occurring brain diseases unless neurological signs and symptoms do indicate a focal brain lesion. Since computed tomography is able to show both focal and general changes of the brain tissue each patient presenting with a dementia clinically should be undergone such a neuroradiological investigation at least once, and if being negative even repeatedly. Computed tomography is able not only to detect unexpected treatable brain lesions as a cause of dementia for instance tumors, subdural hematomas, and communicating hydrocephalus to expect in about 6% of cases with the clinical diagnosis of dementia, but also it is able to help to make the differentialdiagnosis of the dementia of Alzheimer's and the multi-infarct-type in a high percentage. Nevertheless despite the use of computed tomography the pathogenesis of dementia even though being undoubtful clinically remains obscure in 15% of our material of 367 demented patients studied by computed tomography but presenting with a normal finding. (orig.) [de

  16. Early Dementia Screening

    Directory of Open Access Journals (Sweden)

    Peter K. Panegyres

    2016-01-01

    Full Text Available As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET, cerebrospinal fluid (CSF examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia.

  17. Driving After a Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  18. Apathy is associated with incident dementia in community-dwelling older people.

    Science.gov (United States)

    van Dalen, Jan Willem; Van Wanrooij, Lennard L; Moll van Charante, Eric P; Richard, Edo; van Gool, Willem A

    2018-01-02

    To assess whether apathy and depressive symptoms are independently associated with incident dementia during 6-year follow-up in a prospective observational population-based cohort study. Participants were community-dwelling older people in the Prevention of Dementia by Intensive Vascular Care trial, aged 70-78 years, without dementia at baseline. Apathy and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). Dementia during follow-up was established by clinical diagnosis confirmed by an independent outcome adjudication committee. Hazard ratios (HRs) were calculated using Cox regression analyses. Given its potentially strong relation with incipient dementia, the GDS item referring to memory complaints was assessed separately. Dementia occurred in 232/3,427 (6.8%) participants. Apathy symptoms were associated with dementia (HR 1.28, 95% confidence interval [CI] 1.12-1.45; p < 0.001), also after adjustment for age, sex, Mini-Mental State Examination score, disability, and history of stroke or cardiovascular disease (HR 1.21, 95% CI 1.06-1.40; p = 0.007), and in participants without depressive symptoms (HR 1.26, 95% CI 1.06-1.49; p = 0.01). Depressive symptoms were associated with dementia (HR 1.12, 95% CI 1.05-1.19), also without apathy symptoms (HR 1.16, 95% CI 1.03-1.31; p = 0.015), but not after full adjustment or after removing the GDS item on memory complaints. Apathy and depressive symptoms are independently associated with incident dementia in community-dwelling older people. Subjective memory complaints may play an important role in the association between depressive symptoms and dementia. Our findings suggest apathy symptoms may be prodromal to dementia and might be used in general practice to identify individuals without cognitive impairment at increased risk of dementia. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  19. Double Cortex Syndrome (Subcortical Band Heterotopia): A Case Report.

    Science.gov (United States)

    Momen, Ali Akbar; Momen, Mehdi

    2015-01-01

    Objective Approximately 5-10% of preschool age children are considered developmentally disabled. Brain Magnetic Resonance Imaging (MRI) plays a key role in the diagnostic evaluation in these children. Many congenital or acquired brain anomalies are revealed with MRIs. Although the majority of these abnormalities are sporadic but patients with subcortical band heterotopia or double cortex syndrome have sex-linked inheritance. We are going to present the first case in Iran from Ahvaz city, which was presented with status epilepticus associated with developmental delay and finally diagnosed as double cortex syndrome, because band heterotopia cases especially for continuous or generalized form is rare. A 4.5-year-old developmentally delayed girl was admitted for generalized tonic clonic seizure attack of 1 hr, upward gaze, locked mouth, and urinary incontinence (status epilepticus) in the child neurology ward. She had a history of recurrent seizures that started as febrile seizures since she was 12 months of age and had frequent admissions for having recurrent seizure attacks. She was the only child of consanguineous parents with negative family history of any neurologic problems. She was a product of uneventful term pregnancy, vaginal delivery with a low Apgar score at birth who was admitted for six days in the neonatal ward for hypotonia and cyanosis. At 4.5 years of age, she had HC: 45cm (spike-wave discharges. A brain MRI showed corpus callosal dysplasia, generalized band heterotopia, and polymicrogyria. She was discharged home with oral valproate and regular outpatient follow-ups. In the diagnostic evaluation of developmentally delayed and epileptic children, a brain MRI is strongly recommended for accurate diagnosis of anomalies such as neuronal migration disorders (band heterotopia) and others, because appropriate therapeutic management, prognosis, prevention, and genetic counseling for prenatal diagnosis are dependent on definite diagnosis of the proband case.

  20. Agomelatine Improves Apathy in Frontotemporal Dementia.

    Science.gov (United States)

    Callegari, Ilaria; Mattei, Chiara; Benassi, Francesca; Krueger, Frank; Grafman, Jordan; Yaldizli, Özgür; Sassos, Davide; Massucco, Davide; Scialò, Carlo; Nobili, Flavio; Serrati, Carlo; Amore, Mario; Cocito, Leonardo; Emberti Gialloreti, Leonardo; Pardini, Matteo

    2016-01-01

    Apathy is the most common initial symptom of frontotemporal dementia (FTD) and has been linked to frontal-subcortical dopaminergic system dysfunction. No pharmacological therapy has been approved for the treatment of apathy, but, on the basis of its physiopathological mechanism, we suspected that increasing prefrontal dopaminergic innervation could improve this disabling symptom. We evaluated a group of 24 nondepressed patients with a diagnosis of the behavioral variant of FTD, in order to determine the effectiveness on apathy of agomelatine, an antidepressant with MT1 and MT2 receptor agonism and 5-HT2C receptor antagonism; the latter leads to an increase in prefrontal dopaminergic and noradrenergic tone. To try to tease out the effects of 5-HT2C antagonism on apathy, patients were randomized, using a cross-over design, to receive either agomelatine 50 mg/day or sustained release melatonin 10 mg/day for 10 weeks in a double-blind procedure. At the end of the follow-up period, subjects receiving melatonin switched to agomelatine for the following 10 weeks. Agomelatine, but not melatonin, was associated with a significant reduction of apathy in FTD subjects and of caregiver distress due to patients' apathy. The switch from melatonin to agomelatine was associated with a reduction in apathetic behavior. Agomelatine was well-tolerated by all enrolled subjects. Our data, albeit preliminary, suggest that agomelatine could represent a novel useful approach to the treatment of apathy in FTD patients. © 2016 S. Karger AG, Basel.

  1. Pharmacotherapy of dementia

    Directory of Open Access Journals (Sweden)

    Ajit Avasthi

    2016-01-01

    Full Text Available This review aims to evaluate the existing evidence for pharmacotherapy for management of dementia. Data search strategies included electronic databases of relevant publications or cross-references. The searches were limited to acetyl cholinesterase inhibitors (AChEIs, memantine, antipsychotics, antidepressants, mood stabilizers, and benzodiazepines. Data in the form of meta-analysis and systemic reviews for treatment in five main types of dementia (Alzheimer′s, frontotemporal, Parkinson′s, Lewy body disease, and vascular type were extracted. If a meta-analysis or systemic review was not available, then the searches included evaluation of data in the form of double-blind, randomized controlled trials or open-label studies. Various studies suggest that compared to placebo, AChEIs and memantine are associated with better outcome in all domains of Alzheimer′s disease. In addition, combination therapy of AChEIs and memantine is superior to monotherapy with AChEIs in terms of behavioral disturbances, activities of daily living, and global assessment. In patients with dementia associated with Parkinson′s disease or Lewy body dementia, use of donepezil, rivastigmine, and memantine is associated with significant efficacy on the global outcome measures when compared with placebo. Compared to placebo, AChEIs, but not memantine, have also been shown to have better cognitive outcomes in patients with dementia associated with Parkinson′s disease or Lewy body dementia. Data are limited for the role of pharmacotherapy in management of frontotemporal dementia. In patients of vascular dementia, all AChEIs and memantine show some beneficial effects on cognition. Antidepressants and antipsychotics have been shown to be beneficial in management of behavioral symptoms and agitation. However, it is important to remember that there is black box warning for use of antipsychotics among patients with dementia. One of the major limitations of the research is

  2. Acupuncture for vascular dementia.

    Science.gov (United States)

    Peng, W N; Zhao, H; Liu, Z S; Wang, S

    2007-04-18

    Dementia is a widespread condition characterized by acquired global impairment of intellect, memory and personality, but with no impairment of consciousness. There is no definitive medical or surgical treatment for vascular dementia. Acupuncture is an ancient Chinese method which has been used for both the prevention and treatment of diseases for over three thousand years. Preliminary searches revealed more than 105 studies of acupuncture for treating vascular dementia. Benefit was reported in up to 70-91% of the treatment group. Body acupuncture and electroacupuncture were the most commonly used techniques. A comparison of electroacupuncture and acupuncture therapy alone suggested that the former was more effective in promoting the recovery of cognitive function. The objective is to assess the efficacy and possible adverse effects of acupuncture therapy for treating vascular dementia. The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement group's Specialized Register on 2 February 2007 which contains records from all major health care databases and many ongoing trials databases. In addition the Allied and Complementary Medicine Database was searched and the web was searched using the search engine Copernic. Randomized controlled trials testing acupuncture therapy in the treatment of vascular dementia were included regardless of language and publication types. The intervention and control group had to receive identical treatment apart from the acupuncture intervention. In view of possible confounding, studies in which acupuncture was combined with other treatments were subjected to subgroup analyses. Titles and abstracts identified from the searches were checked by two reviewers. If it was clear that the study did not refer to a randomized controlled trial in vascular dementia, it was excluded. If it was not clear from the abstract and title, then the full text of study was obtained for an independent assessment by two reviewers

  3. POST-STROKE COGNITIVE IMPAIRMENT – PHENOMENOLOGY AND PROGNOSTIC FACTORS

    Directory of Open Access Journals (Sweden)

    Maya Danovska

    2012-09-01

    Full Text Available Stroke patients are at higher risk of developing cognitive impairment. Cognitive dysfunctions, especially progressive ones, worsen stroke prognosis and outcome. A longitudinal follow-up of cognitive disorders, however, is rendered difficult by their heterogeneity and the lack of definitions generally agreed upon. Stroke is a major cause of cognitive deficit. The identification of risk factors, clinical determinants and laboratory markers of post-stroke cognitive deficit may help detect patients at increased risk of cognitive deterioration, and prevent or delay the occurrence of post-stroke cognitive impairments. Though inflammatory processes have been implicated in the pathogenesis of stroke, their role in the complex pathophysiological mechanisms of post-stroke cognitive impairment is not completely understood. Evidence suggests that elevated serum C-reactive protein is associated with both the increased risk of stroke and post-stroke cognitive deficit. The hypothesis of a possible relationship between markers of systemic inflammation and cognitive dysfunctions raises the question of how rational the option of applying non-steroidal anti-inflammatory drugs in a proper therapeutic window will be, especially during the acute phase of stroke, to prevent cognitive decline and dementia.

  4. Detection of Early Ischemic Changes in Noncontrast CT Head Improved with "Stroke Windows".

    Science.gov (United States)

    Mainali, Shraddha; Wahba, Mervat; Elijovich, Lucas

    2014-01-01

    Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P Windows (14% and 36%; P Windows (6% and 46%; P Windows significantly improved detection of EIC.

  5. Alcohol-related dementia: an update of the evidence

    Science.gov (United States)

    2013-01-01

    The characteristics of dementia relating to excessive alcohol use have received increased research interest in recent times. In this paper, the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS) are reviewed. Neuropathological and imaging studies suggest that excessive and prolonged use of alcohol may lead to structural and functional damage that is permanent in nature; however, there is debate about the relative contributions of the direct toxic effect of alcohol (neurotoxicity hypothesis), and the impact of thiamine deficiency, to lasting damage. Investigation of alcohol-related cognitive impairment has been further complicated by differing definitions of patterns of alcohol use and associated lifestyle factors related to the abuse of alcohol. Present diagnostic systems identify two main syndromes of alcohol-related cognitive impairment: ARD and WKS. However, 'alcohol-related brain damage' is increasingly used as an umbrella term to encompass the heterogeneity of these disorders. It is unclear what level of drinking may pose a risk for the development of brain damage or, in fact, whether lower levels of alcohol may protect against other forms of dementia. Epidemiological studies suggest that individuals with ARD typically have a younger age of onset than those with other forms of dementia, are more likely to be male, and often are socially isolated. The cognitive profile of ARD appears to involve both cortical and subcortical pathology, and deficits are most frequently observed on tasks of visuospatial function as well as memory and higher-order (executive) tasks. The WKS appears more heterogeneous in nature than originally documented, and deficits on executive tasks commonly are reported in conjunction with characteristic memory deficits. Individuals with alcohol-related disorders have the potential to at least

  6. Abnormal network connectivity in frontotemporal dementia: evidence for prefrontal isolation.

    Science.gov (United States)

    Farb, Norman A S; Grady, Cheryl L; Strother, Stephen; Tang-Wai, David F; Masellis, Mario; Black, Sandra; Freedman, Morris; Pollock, Bruce G; Campbell, Karen L; Hasher, Lynn; Chow, Tiffany W

    2013-01-01

    Degraded social function, disinhibition, and stereotypy are defining characteristics of frontotemporal dementia (FTD), manifesting in both the behavioral variant of frontotemporal dementia (bvFTD) and semantic dementia (SD) subtypes. Recent neuroimaging research also associates FTD with alterations in the brain's intrinsic connectivity networks. The present study explored the relationship between neural network connectivity and specific behavioral symptoms in FTD. Resting-state functional magnetic resonance imaging was employed to investigate neural network changes in bvFTD and SD. We used independent components analysis (ICA) to examine changes in frontolimbic network connectivity, as well as several metrics of local network strength, such as the fractional amplitude of low-frequency fluctuations, regional homogeneity, and seed-based functional connectivity. For each analysis, we compared each FTD subgroup to healthy controls, characterizing general and subtype-unique network changes. The relationship between abnormal connectivity in FTD and behavior disturbances was explored. Across multiple analytic approaches, both bvFTD and SD were associated with disrupted frontolimbic connectivity and elevated local connectivity within the prefrontal cortex. Even after controlling for structural atrophy, prefrontal hyperconnectivity was robustly associated with apathy scores. Frontolimbic disconnection was associated with lower disinhibition scores, suggesting that abnormal frontolimbic connectivity contributes to positive symptoms in dementia. Unique to bvFTD, stereotypy was associated with elevated default network connectivity in the right angular gyrus. The behavioral variant was also associated with marginally higher apathy scores and a more diffuse pattern of prefrontal hyperconnectivity than SD. The present findings support a theory of FTD as a disorder of frontolimbic disconnection leading to unconstrained prefrontal connectivity. Prefrontal hyperconnectivity may

  7. Cerebral blood flow and metabolism in multi-infarct dementia

    International Nuclear Information System (INIS)

    Ujike, Takashi; Terashi, Akiro; Soeda, Toshiyuki; Kitamura, Shin; Kato, Toshiaki; Iio, Masaaki.

    1985-01-01

    Cerebral blood flow and oxygen metabolism were studied in three aged normal volunteers and 10 patients with multi-infarct dementia (MID) by Positron Emission Tomography using O-15. The diagnosis of MID was done according to the Loeb's modified ischemic score and X-ray CT findings. The MID patients, whose X-ray CT showed localized low density areas in the subcortical white matter and basal ganglia and thalamus, were studied. No occulusion was observed at anterior cerebral artery and/or middle cerebral artery on cerebral angiography. All cases of MID were mild dementias. Regional CBF, rOEF and rCMRO 2 were measured by the steady state technique described by Terry Jones et al. The values of rCBF in MID patients were significantly low compared with those of aged normal subjects in frontal, temporal, occipital, parietal cortices and thalamus. The values of CMRO 2 in MID were significantly low in frontal, temporal, occipital cortices and thalamus compared with normal subjects'. The OEF was 0.46 in aged normal subjects, and 0.52 in MID patients. The MID patients in the early stage of dementia showed the increased oxygen extraction fraction, and this fact suggests that ischemia is a significant pathogenic mechanism in the production and progression of multi-infarct dementia. The decrease of CBF and CMRO 2 in MID compared from normal subjects' were most remarkable in frontal cortex. The impairment of mental functions in MID should be caused by the decreased neuronal activities in frontal association cortex. (author)

  8. Dementia - behavior and sleep problems

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000029.htm Dementia - behavior and sleep problems To use the sharing ... on this page, please enable JavaScript. People with dementia , often have certain problems when it gets dark ...

  9. Symptoms of Lewy Body Dementia

    Science.gov (United States)

    ... the fight against LBD! Donate Symptoms Lewy body dementia (LBD) has variable presentations that include cognitive difficulties ... wake cycle alterations. Cognitive impairment in Lewy body dementia (LBD) is often misdiagnosed as Alzheimer’s disease (AD). ...

  10. Subcortical18F-AV-1451 binding patterns in progressive supranuclear palsy.

    Science.gov (United States)

    Cho, Hanna; Choi, Jae Yong; Hwang, Mi Song; Lee, Seung Ha; Ryu, Young Hoon; Lee, Myung Sik; Lyoo, Chul Hyoung

    2017-01-01

    Accumulation of cortical and subcortical tau pathology is the primary pathological substrate for progressive supranuclear palsy (PSP). 18 F-AV-1451, a radiotracer that binds to the pathological tau protein, may be helpful for in vivo visualization and quantitation of tau pathology in PSP. The objectives of this study were to investigate cortical and subcortical 18 F-AV-1451 binding patterns in patients with PSP. We recruited 14 PSP patients and compared their cortical and subcortical binding patterns in 18 F-AV-1451 positron emission tomography (PET) studies with those of 15 Parkinson's disease (PD) patients and 15 healthy controls. In both the PD and PSP groups, subcortical 18 F-AV-1451 binding did not correlate with the severity of motor dysfunctions, and cortical binding did not differ between the controls and each patient group. However, the PSP patients showed greater 18 F-AV-1451 binding in the putamen, globus pallidus, subthalamic nucleus, and dentate nucleus when compared with the controls, whereas the PD patients showed lower 18 F-AV-1451 binding in the substantia nigra than controls. The PSP and PD patients showed distinct subcortical 18 F-AV-1451 binding patterns reflecting subcortical tau pathology in PSP and reduced nigral neuromelanin in PD. However, there was no correlation with the severity of motor dysfunction, no cortical regions with increased binding in PSP patients, and variable degrees of subcortical binding even in the controls. Therefore, the 18 F-AV-1451 PET may be less than ideal for assessing tau pathology in PSP. Further studies will be required to validate the clinical correlation and to understand the clinical utility of 18 F-AV-1451 PET for PSP patients. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  11. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...... not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat...

  12. Dementia in Latin America

    Science.gov (United States)

    Parra, Mario A.; Baez, Sandra; Allegri, Ricardo; Nitrini, Ricardo; Lopera, Francisco; Slachevsky, Andrea; Custodio, Nilton; Lira, David; Piguet, Olivier; Kumfor, Fiona; Huepe, David; Cogram, Patricia; Bak, Thomas; Manes, Facundo

    2018-01-01

    The demographic structure of Latin American countries (LAC) is fast approaching that of developing countries, and the predicted prevalence of dementia in the former already exceeds the latter. Dementia has been declared a global challenge, yet regions around the world show differences in both the nature and magnitude of such a challenge. This article provides evidence and insights on barriers which, if overcome, would enable the harmonization of strategies to tackle the dementia challenge in LAC. First, we analyze the lack of available epidemiologic data, the need for standardizing clinical practice and improving physician training, and the existing barriers regarding resources, culture, and stigmas. We discuss how these are preventing timely care and research. Regarding specific health actions, most LAC have minimal mental health facilities and do not have specific mental health policies or budgets specific to dementia. In addition, local regulations may need to consider the regional context when developing treatment and prevention strategies. The support needed nationally and internationally to enable a smooth and timely transition of LAC to a position that integrates global strategies is highlighted. We focus on shared issues of poverty, cultural barriers, and socioeconomic vulnerability. We identify avenues for collaboration aimed to study unique populations, improve valid assessment methods, and generate opportunities for translational research, thus establishing a regional network. The issues identified here point to future specific actions aimed at tackling the dementia challenge in LAC. PMID:29305437

  13. Antipsychotic Use in Dementia

    Science.gov (United States)

    Kirkham, Julia; Sherman, Chelsea; Velkers, Clive; Maxwell, Colleen; Gill, Sudeep; Rochon, Paula

    2016-01-01

    Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere. PMID:28212496

  14. Influence of dementia on pain

    NARCIS (Netherlands)

    Scherder, E

    2006-01-01

    In the next decades the number of older persons with dementia and with a painful condition will increase. This is an important conclusion since at this moment older persons with dementia and a painful condition receive less analgesic medication than older persons without dementia. One explanation

  15. Diagnostic criteria for vascular dementia

    NARCIS (Netherlands)

    Scheltens, P.; Hijdra, A. H.

    1998-01-01

    The term vascular dementia implies the presence of a clinical syndrome (dementia) caused by, or at least assumed to be caused by, a specific disorder (cerebrovascular disease). In this review, the various sets of criteria used to define vascular dementia are outlined. The various sets of criteria

  16. An Allometric Analysis of Sex and Sex Chromosome Dosage Effects on Subcortical Anatomy in Humans

    Science.gov (United States)

    Clasen, Liv; Giedd, Jay N.; Blumenthal, Jonathan; Lerch, Jason P.; Chakravarty, M. Mallar; Raznahan, Armin

    2016-01-01

    Structural neuroimaging of humans with typical and atypical sex-chromosome complements has established the marked influence of both Yand X-/Y-chromosome dosage on total brain volume (TBV) and identified potential cortical substrates for the psychiatric phenotypes associated with sex-chromosome aneuploidy (SCA). Here, in a cohort of 354 humans with varying karyotypes (XX, XY, XXX, XXY, XYY, XXYY, XXXXY), we investigate sex and SCA effects on subcortical size and shape; focusing on the striatum, pallidum and thalamus. We find large effect-size differences in the volume and shape of all three structures as a function of sex and SCA. We correct for TBV effects with a novel allometric method harnessing normative scaling rules for subcortical size and shape in humans, which we derive here for the first time. We show that all three subcortical volumes scale sublinearly with TBV among healthy humans, mirroring known relationships between subcortical volume and TBV among species. Traditional TBV correction methods assume linear scaling and can therefore invert or exaggerate sex and SCA effects on subcortical anatomy. Allometric analysis restricts sex-differences to: (1) greater pallidal volume (PV) in males, and (2) relative caudate head expansion and ventral striatum contraction in females. Allometric analysis of SCA reveals that supernumerary X- and Y-chromosomes both cause disproportionate reductions in PV, and coordinated deformations of striatopallidal shape. Our study provides a novel understanding of sex and sex-chromosome dosage effects on subcortical organization, using an allometric approach that can be generalized to other basic and clinical structural neuroimaging settings. SIGNIFICANCE STATEMENT Sex and sex-chromosome dosage (SCD) are known to modulate human brain size and cortical anatomy, but very little is known regarding their impact on subcortical structures that work with the cortex to subserve a range of behaviors in health and disease. Moreover

  17. Nutrition in Severe Dementia

    Directory of Open Access Journals (Sweden)

    Glaucia Akiko Kamikado Pivi

    2012-01-01

    Full Text Available An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

  18. Dementia in affective disorder

    DEFF Research Database (Denmark)

    Kessing, L V; Olsen, E W; Mortensen, P B

    1999-01-01

    OBJECTIVE: The aim of the study was to investigate whether patients with affective disorder have increased risk of developing dementia compared to other groups of psychiatric patients and compared to the general population. METHOD: In the Danish psychiatric central register, 3363 patients...... with unipolar affective disorder, 518 patients with bipolar affective disorder, 1025 schizophrenic and 8946 neurotic patients were identified according to the diagnosis at the first ever discharge from psychiatric hospital during the period from 1970 to 1974. The rate of discharge diagnosis of dementia...... on readmission was estimated during 21 years of follow-up. In addition, the rates were compared with the rates for admission to psychiatric hospitals with a discharge diagnosis of dementia for the total Danish population. RESULTS: Patients with unipolar and with bipolar affective disorder had a greater risk...

  19. Quantitative analysis of [18F]FDDNP PET using subcortical white matter as reference region

    International Nuclear Information System (INIS)

    Wong, Koon-Pong; Shao, Weber; Dahlbom, Magnus; Kepe, Vladimir; Liu, Jie; Satyamurthy, Nagichettiar; Barrio, Jorge R.; Wardak, Mirwais; Huang, Sung-Cheng; Small, Gary W.

    2010-01-01

    Subcortical white matter is known to be relatively unaffected by amyloid deposition in Alzheimer's disease (AD). We investigated the use of subcortical white matter as a reference region to quantify [ 18 F]FDDNP binding in the human brain. Dynamic [ 18 F]FDDNP PET studies were performed on 7 control subjects and 12 AD patients. Population efflux rate constants (k ' 2 ) from subcortical white matter (centrum semiovale) and cerebellar cortex were derived by a simplified reference tissue modeling approach incorporating physiological constraints. Regional distribution volume ratio (DVR) estimates were derived using Logan and simplified reference tissue approaches, with either subcortical white matter or cerebellum as reference input. Discriminant analysis with cross-validation was performed to classify control subjects and AD patients. The population estimates of k ' 2 in subcortical white matter did not differ significantly between control subjects and AD patients but the variability of individual estimates of k ' 2 determined in white matter was lower than that in cerebellum. Logan DVR showed dependence on the efflux rate constant in white matter. The DVR estimates in the frontal, parietal, posterior cingulate, and temporal cortices were significantly higher in the AD group (p 18 F]FDDNP with the Logan method which allows more accurate and less biased binding estimates, but a population efflux rate constant has to be determined a priori. (orig.)

  20. [Preventive strategies for dementia].

    Science.gov (United States)

    Müller, Patrick; Schmicker, Marlen; Müller, Notger G

    2017-05-01

    In the context of the demographically induced increase in the prevalence of dementia and the simultaneous lack of causal pharmacological therapies, preventive approaches are gaining in importance. By reducing risk factors and with measures which induce neuroplasticity successful aging can be supported. This article summarizes the current developments in preventing dementia by modification of life style factors. The main focus lies on the impact of cognitive and physical activity on neuroprotection. A promising approach combines both activities within a dance training program. Further studies that meet the demanding criteria of a randomized clinical trial are urgently needed.

  1. Palliative Care for Dementia.

    Science.gov (United States)

    Stewart, Jonathan T; Schultz, Susan K

    2018-03-01

    With the growing care needs for the older population at the end of their lives, there has been a substantial increase in attention to the management of the patient with dementia in hospice and palliative care services. This article reviews issues in access to care and the optimal management of the patient with dementia, particularly in the context of neuropsychiatric complexities. Special issues such as delirium, cachexia, behavioral symptoms, and pain management are addressed. Future challenges in research such as the development of better prognostic models are noted as well as the importance of attention to access to care. Published by Elsevier Inc.

  2. Parkinson Disease and Dementia.

    Science.gov (United States)

    Garcia-Ptacek, Sara; Kramberger, Milica G

    2016-09-01

    Dementia is a frequent complication of Parkinson disease (PD) with a yearly incidence of around 10% of patients with PD. Lewy body pathology is the most important factor in the development of Parkinson disease dementia (PDD) and there is evidence for a synergistic effect with β-amyloid. The clinical phenotype in PDD extends beyond the dysexecutive syndrome that is often present in early PD and encompasses deficits in recognition memory, attention, and visual perception. Sleep disturbances, hallucinations, neuroleptic sensitivity, and fluctuations are often present. This review provides an update on current knowledge of PDD including aspects of epidemiology, pathology, clinical presentation, management, and prognosis. © The Author(s) 2016.

  3. Montessori-based dementia care.

    Science.gov (United States)

    Cline, Janet

    2006-10-01

    Montessori-based Dementia Care is an approach used in Alzheimer's care that does not involve chemical or physical restraints. This program works by giving the elder with Alzheimer/Dementia a purpose by getting them involved. When staff/families care for a confused Alzheimer/Dementia patient, who is having behaviors, the Montessori program teaches them to look at what is causing the behavior. When assessing the elder to determine what is causing the behavior, the goal is to find the answer, but the answer cannot be dementia. The goal of the program is to bring meaning to the life of an Alzheimer/Dementia elder.

  4. Aromatherapy for dementia.

    Science.gov (United States)

    Forrester, Lene Thorgrimsen; Maayan, Nicola; Orrell, Martin; Spector, Aimee E; Buchan, Louise D; Soares-Weiser, Karla

    2014-02-25

    Complementary therapy has received great interest within the field of dementia treatment and the use of aromatherapy and essential oils is increasing. In a growing population where the majority of patients are treated by US Food and Drug Administration (FDA)-approved drugs, the efficacy of treatment is short term and accompanied by negative side effects. Utilisation of complimentary therapies in dementia care settings presents as one of few options that are attractive to practitioners and families as patients often have reduced insight and ability to verbally communicate adverse reactions. Amongst the most distressing features of dementia are the behavioural and psychological symptoms. Addressing this facet has received particular interest in aromatherapy trials, with a shift in focus from reducing cognitive dysfunction to the reduction of behavioural and psychological symptoms in dementia. To assess the efficacy of aromatherapy as an intervention for people with dementia. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, was searched on 26 November 2012 and 20 January 2013 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. All relevant randomised controlled trials were considered. A minimum length of a trial and requirements for follow-up were not included, and participants in included studies had a diagnosis of dementia of any type and severity. The review considered all trials using fragrance from plants defined as aromatherapy as an intervention with people with dementia and all relevant outcomes were considered. Titles and abstracts extracted by the searches were screened for their eligibility for potential inclusion in the review. For Burns 2011, continuous outcomes were estimated as the mean difference between groups and its 95% confidence interval using a fixed-effect model. For Ballard 2002, analysis of co-variance was used for all outcomes, with the

  5. COMPARATIVE EFFECTIVENESS OF MCI and DEMENTIA TREATMENTS IN A COMMUNITY-BASED DEMENTIA PRACTICE

    Science.gov (United States)

    2016-08-04

    Mild Cognitive Impairment; Dementia; Hypoxia; Hyperhomocysteinemia; Vitamin B 12 Deficiency; Iron Deficiency; Anemia; TBI; Neurodegenerative Disorders; Alzheimer's Disease; Vascular Dementia; Brain Injuries; Tauopathies; Parkinson's Disease; Lewy Body Dementia; Frontotemporal Dementia; TDP-43 Proteinopathies

  6. Creativity and dementia: a review.

    Science.gov (United States)

    Palmiero, Massimiliano; Di Giacomo, Dina; Passafiume, Domenico

    2012-08-01

    In these last years, creativity was found to play an important role for dementia patients in terms of diagnosis and rehabilitation strategies. This led us to explore the relationships between dementia and creativity. At the aim, artistic creativity and divergent thinking are considered both in non-artists and artists affected by different types of dementia. In general, artistic creativity can be expressed in exceptional cases both in Alzheimer's disease and Frontotemporal dementia, whereas divergent thinking decreases in dementia. The creation of paintings or music is anyway important for expressing emotions and well-being. Yet, creativity seems to emerge when the right prefrontal cortex, posterior temporal, and parietal areas are relatively intact, whereas it declines when these areas are damaged. However, enhanced creativity in dementia is not confirmed by controlled studies conducted in non-artists, and whether artists with dementia can show creativity has to be fully addressed. Future research directions are suggested.

  7. The Association Between Midlife Cardiorespiratory Fitness Levels and Later-Life Dementia

    Science.gov (United States)

    DeFina, Laura F.; Willis, Benjamin L.; Radford, Nina B.; Gao, Ang; Leonard, David; Haskell, William L.; Weiner, Myron F.; Berry, Jarett D.

    2013-01-01

    Background Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. Objective To assess the association between objectively measured midlife cardiorespiratory fitness (“fitness”) levels and development of all-cause dementia in advanced age. Design Prospective, observational cohort study. Setting Preventive medicine clinic. Patients 19 458 community-dwelling, nonelderly adults who had a baseline fitness examination. Measurements Fitness levels, assessed using the modified Balke treadmill protocol between 1971 and 2009, and incident all-cause dementia using Medicare Parts A and B claims data from 1999 to 2009. Results 1659 cases of incident all-cause dementia occurred during 125 700 person-years of Medicare follow-up (median follow-up, 25 years [interquartile range, 19 to 30 years]). After multivariable adjustment, participants in the highest quintile of fitness level had lower hazard of all-cause dementia than those in the lowest quintile (hazard ratio, 0.64 [95% CI, 0.54 to 0.77]). Higher fitness levels were associated with lower hazard of all-cause dementia with previous stroke (hazard ratio, 0.74 [CI, 0.53 to 1.04]) or without previous stroke (hazard ratio, 0.74 [CI, 0.61 to 0.90]). Limitations Dementia diagnoses were based on Medicare claims, and participants generally were non-Hispanic white, healthy, and well-educated and had access to preventive health care. This study evaluated fitness levels, so a specific exercise prescription cannot be generated from results and the findings may not be causal. Conclusion Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life. The magnitude and direction of the association were similar with or without previous stroke, suggesting that higher fitness levels earlier in life may lower

  8. Post-stroke language disorders.

    Science.gov (United States)

    Sinanović, Osman; Mrkonjić, Zamir; Zukić, Sanela; Vidović, Mirjana; Imamović, Kata

    2011-03-01

    Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. There are different definitions of aphasias, but the most widely accepted neurologic and/or neuropsychological definition is that aphasia is a loss or impairment of verbal communication, which occurs as a consequence of brain dysfunction. It manifests as impairment of almost all verbal abilities, e.g., abnormal verbal expression, difficulties in understanding spoken or written language, repetition, naming, reading and writing. During the history, many classifications of aphasia syndromes were established. For practical use, classification of aphasias according to fluency, comprehension and abilities of naming it seems to be most suitable (nonfluent aphasias: Broca's, transcortical motor, global and mixed transcortical aphasia; fluent aphasias: anomic, conduction, Wernicke's, transcortical sensory, subcortical aphasia). Aphasia is a common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with a prevalence of one-third of all stroke patients in acute phase, although there are reports on even higher figures. Many speech impairments have a tendency of spontaneous recovery. Spontaneous recovery is most remarkable in the first three months after stroke onset. Recovery of aphasias caused by ischemic stroke occurs earlier and it is most intensive in the first two weeks. In aphasias caused by hemorrhagic stroke, spontaneous recovery is slower and occurs from the fourth to the eighth week after stroke. The course and outcome of aphasia depend greatly on the type of aphasia. Regardless of the fact that a significant number of aphasias spontaneously improve, it is necessary to start treatment as soon as possible. The writing and reading disorders in stroke patients (alexias and agraphias) are more frequent than verified on routine examination, not only in less developed but also in large neurologic departments. Alexia is an acquired

  9. A Rapid Subcortical Amygdala Route for Faces Irrespective of Spatial Frequency and Emotion.

    Science.gov (United States)

    McFadyen, Jessica; Mermillod, Martial; Mattingley, Jason B; Halász, Veronika; Garrido, Marta I

    2017-04-05

    There is significant controversy over the existence and function of a direct subcortical visual pathway to the amygdala. It is thought that this pathway rapidly transmits low spatial frequency information to the amygdala independently of the cortex, and yet the directionality of this function has never been determined. We used magnetoencephalography to measure neural activity while human participants discriminated the gender of neutral and fearful faces filtered for low or high spatial frequencies. We applied dynamic causal modeling to demonstrate that the most likely underlying neural network consisted of a pulvinar-amygdala connection that was uninfluenced by spatial frequency or emotion, and a cortical-amygdala connection that conveyed high spatial frequencies. Crucially, data-driven neural simulations revealed a clear temporal advantage of the subcortical connection over the cortical connection in influencing amygdala activity. Thus, our findings support the existence of a rapid subcortical pathway that is nonselective in terms of the spatial frequency or emotional content of faces. We propose that that the "coarseness" of the subcortical route may be better reframed as "generalized." SIGNIFICANCE STATEMENT The human amygdala coordinates how we respond to biologically relevant stimuli, such as threat or reward. It has been postulated that the amygdala first receives visual input via a rapid subcortical route that conveys "coarse" information, namely, low spatial frequencies. For the first time, the present paper provides direction-specific evidence from computational modeling that the subcortical route plays a generalized role in visual processing by rapidly transmitting raw, unfiltered information directly to the amygdala. This calls into question a widely held assumption across human and animal research that fear responses are produced faster by low spatial frequencies. Our proposed mechanism suggests organisms quickly generate fear responses to a wide range

  10. Quantitative analysis of [{sup 18}F]FDDNP PET using subcortical white matter as reference region

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Koon-Pong; Shao, Weber; Dahlbom, Magnus; Kepe, Vladimir; Liu, Jie; Satyamurthy, Nagichettiar; Barrio, Jorge R. [David Geffen School of Medicine at UCLA, Department of Molecular and Medical Pharmacology, Los Angeles, CA (United States); Wardak, Mirwais; Huang, Sung-Cheng [David Geffen School of Medicine at UCLA, Department of Molecular and Medical Pharmacology, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, Department of Biomathematics, Los Angeles, CA (United States); Small, Gary W. [David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, UCLA Center on Aging, Los Angeles, CA (United States); Mary S. Easton Center for Alzheimer' s Disease Research, Los Angeles, CA (United States)

    2010-03-15

    Subcortical white matter is known to be relatively unaffected by amyloid deposition in Alzheimer's disease (AD). We investigated the use of subcortical white matter as a reference region to quantify [{sup 18}F]FDDNP binding in the human brain. Dynamic [{sup 18}F]FDDNP PET studies were performed on 7 control subjects and 12 AD patients. Population efflux rate constants (k{sup '}{sub 2}) from subcortical white matter (centrum semiovale) and cerebellar cortex were derived by a simplified reference tissue modeling approach incorporating physiological constraints. Regional distribution volume ratio (DVR) estimates were derived using Logan and simplified reference tissue approaches, with either subcortical white matter or cerebellum as reference input. Discriminant analysis with cross-validation was performed to classify control subjects and AD patients. The population estimates of k{sup '}{sub 2} in subcortical white matter did not differ significantly between control subjects and AD patients but the variability of individual estimates of k{sup '}{sub 2} determined in white matter was lower than that in cerebellum. Logan DVR showed dependence on the efflux rate constant in white matter. The DVR estimates in the frontal, parietal, posterior cingulate, and temporal cortices were significantly higher in the AD group (p<0.01). Incorporating all these regional DVR estimates as predictor variables in discriminant analysis yielded accurate classification of control subjects and AD patients with high sensitivity and specificity, and the results agreed well with those using the cerebellum as the reference region. Subcortical white matter can be used as a reference region for quantitative analysis of [{sup 18}F]FDDNP with the Logan method which allows more accurate and less biased binding estimates, but a population efflux rate constant has to be determined a priori. (orig.)

  11. Focal cortical dysplasia type IIb: completeness of cortical, not subcortical, resection is necessary for seizure freedom.

    Science.gov (United States)

    Wagner, Jan; Urbach, Horst; Niehusmann, Pitt; von Lehe, Marec; Elger, Christian E; Wellmer, Jörg

    2011-08-01

    Focal cortical dysplasia type IIb (FCD IIb) lesions are highly epileptogenic and frequently cause pharmacoresistant epilepsy. Complete surgical resection leads to seizure freedom in most cases. However, the term "complete" resection is controversial with regard to the necessity of performing resections of the subcortical zone, which is frequently seen in these lesions on magnetic resonance imaging (MRI). We retrospectively analyzed 50 epilepsy patients with histologically proven FCD IIb. The extent of surgical resection was determined by SPM5-based coregistration of the preoperative and postoperative MRI scans. Postoperative outcome was analyzed with regard to (1) the completeness of the resection of the cortical abnormality and (2) the completeness of the resection of the subcortical abnormality. Complete resection of the cortical abnormality led to postoperative seizure freedom (Engel class Ia) in 34 of 37 patients (92%), whereas incomplete cortical resection achieved this in only one of 13 patients (8%, p < 0.001). Among the patients with complete cortical resection, 36 had FCDs with a subcortical hyperintensity according to MRI. In this group, complete resection of the subcortical abnormality did not result in a better postoperative outcome than incomplete resection (90% vs. 93% for Engel class Ia, n.s.). Complete resection of the MRI-documented cortical abnormality in FCD IIb is crucial for a favorable postoperative outcome. However, resection of the subcortical hyperintense zone is not essential for seizure freedom. Therefore, sparing of the subcortical white matter may reduce the surgical risk of encroaching on relevant fiber tracts. In addition, these findings give an interesting insight into the epileptogenic propensity of different parts of these lesions. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  12. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  13. Methylphenidate modulates cerebral post-stroke reorganization.

    Science.gov (United States)

    Tardy, Jean; Pariente, Jérémie; Leger, Anne; Dechaumont-Palacin, Sophie; Gerdelat, Angélique; Guiraud, Vincent; Conchou, Fabrice; Albucher, Jean-François; Marque, Philippe; Franceries, Xavier; Cognard, Christophe; Rascol, Olivier; Chollet, François; Loubinoux, Isabelle

    2006-11-15

    We hypothesized that a single dose of methylphenidate (MP) would modulate cerebral motor activation and behavior in patients having suffered a subcortical stroke. Eight men with a single stroke on the corticospinal tract resulting in a pure motor hemiparesia were included in a randomized, cross-over, double-blind, placebo-controlled study. Patients were first evaluated 17 days after stroke onset by validated neurological scales, motor tests and fMRI (flexion/extension of the digits) after 20 mg MP or placebo. Seven days later, the patients underwent the same protocol and received the drug they had not taken at the first evaluation. Each patient was his own control. Placebo intake did not change performance. MP compared to placebo elicited a significant improvement in motor performance of the affected hand at the finger tapping test. MP induced: (1) a hyperactivation of the ipsilesional primary sensorimotor cortex including the motor hand and face areas and of the contralesional premotor cortex; (2) a hypoactivation of the ipsilesional anterior cingulum. Hyperactivation in the face motor area correlated positively with the improvement in performance. We demonstrated that the reorganized network may efficiently be targeted by the drug and that the effect of MP might partly rely on an improvement in attention/effort through cingulum modulation.

  14. Communication in conversation in stroke patients.

    Science.gov (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  15. Do brain lesions in stroke affect basic emotions and attachment?

    Science.gov (United States)

    Farinelli, Marina; Panksepp, Jaak; Gestieri, Laura; Maffei, Monica; Agati, Raffaele; Cevolani, Daniela; Pedone, Vincenzo; Northoff, Georg

    2015-01-01

    The aim of the current study was to investigate basic emotions and attachment in a sample of 86 stroke patients. We included a control group of 115 orthopedic patients (matched for age and cognitive status) without brain lesions to control for unspecific general illness effects of a traumatic recent event on basic emotions and attachment. In order to measure basic emotions and attachment style we applied the Affective Neuroscience Personality Scale (ANPS) and the Attachment Style Questionnaire (ASQ). The stroke patients showed significantly different scores in the SEEKING, SADNESS, and ANGER subscales of the ANPS as well as in the Relationship as Secondary Attachment dimension of the ASQ when compared to the control group. These differences show a pattern influenced by lesion location mainly as concerns basic emotions. Anterior, medial, left, and subcortical patients provide scores significantly lower in ANPS-SEEKING than the control group; ANPS-SADNESS scores in anterior, right, medial, and subcortical patients were significantly higher than those of the control group. ANPS-ANGER scores in posterior, right, and lateral patients were significantly higher than those in the control group; finally, the ANPS-FEAR showed slightly lower scores in posterior patients than in the control group. Minor effects on brain lesions were also individuated in the attachment style. Anterior lesion patients showed a significantly higher average score in the ASQ-Need for Approval subscale than the control group. ASQ-Confidence subscale scores differed significantly in stroke patients with lesions in medial brain regions when compared to control subjects. Scores at ANPS and ASQ subscales appear significantly more correlated in stroke patients than in the control group. Such finding of abnormalities, especially concerning basic emotions in stroke brain-lesioned patients, indicates that the effect of brain lesions may enhance the interrelation between basic emotions and attachment with

  16. Dementia and Assisted Living

    Science.gov (United States)

    Hyde, Joan; Perez, Rosa; Forester, Brent

    2007-01-01

    Purpose: This article presents an overview of what is known about dementia services in assisted living settings and suggests areas for future research. Design and Methods: We undertook a search of Medline, the "Journals of Gerontology," and "The Gerontologist." We then organized publications dealing with the target subject into 10 topic areas and…

  17. What to Ask: Dementia

    Science.gov (United States)

    ... I find out about programs for people with Alzheimer's disease and their caregivers? What is respite care and where can I ... centers have information on programs for people with Alzheimer's disease and their caregivers? QUESTIONS ABOUT NEUROPSYCHIATRIC AND BEHAVIORAL DISTURBANCES IN DEMENTIA ...

  18. Animal models of dementia

    DEFF Research Database (Denmark)

    Olsson, I. Anna S.; Sandøe, Peter

    2011-01-01

    This chapter aims to encourage scientists and others interested in the use of animal models of disease – specifically, in the study of dementia – to engage in ethical reflection. It opens with a general discussion of the moral acceptability of animal use in research. Three ethical approaches are ...

  19. Resveratrol, pterostilbene, and dementia.

    Science.gov (United States)

    Lange, Klaus W; Li, Shiming

    2018-01-01

    Resveratrol is a natural phytoestrogen with neuroprotective properties. Polyphenolic compounds including resveratrol exert in vitro antioxidant, anti-inflammatory, and antiamyloid effects. Resveratrol and its derivative pterostilbene are able to cross the blood-brain barrier and to influence brain activity. The present short review summarizes the available evidence regarding the effects of these polyphenols on pathology and cognition in animal models and human subjects with dementia. Numerous investigations in cellular and mammalian models have associated resveratrol and pterostilbene with protection against dementia syndromes such as Alzheimer's disease (AD) and vascular dementia. The neuroprotective activity of resveratrol and pterostilbene demonstrated in in vitro and in vivo studies suggests a promising role for these compounds in the prevention and treatment of dementia. In comparison to resveratrol, pterostilbene appears to be more effective in combatting brain changes associated with aging. This may be attributed to the more lipophilic nature of pterostilbene with its two methoxyl groups compared with the two hydroxyl groups of resveratrol. The findings of available intervention trials of resveratrol in individuals with mild cognitive impairment or AD do not provide evidence of neuroprotective or therapeutic effects. Future clinical trials should be conducted with long-term exposure to preparations of resveratrol and pterostilbene with high bioavailability. © 2017 BioFactors, 44(1):83-90, 2018. © 2017 International Union of Biochemistry and Molecular Biology.

  20. Animal models of dementia

    DEFF Research Database (Denmark)

    Olsson, I. Anna S.; Sandøe, Peter

    2011-01-01

    This chapter aims to encourage scientists and others interested in the use of animal models of disease – specifically, in the study of dementia – to engage in ethical reflection. It opens with a general discussion of the moral acceptability of animal use in research. Three ethical approaches...

  1. Coping with Dementia

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Villemoes; Waldorff, Frans Boch; Waldemar, Gunhild

    2008-01-01

    -being. The spouse appeared to be the most important social relation. The most significant worries of the patients were about communication in relation to their spouse, and about the reaction of the spouse to the consequences of the disease. Keywords coping; dementia; everyday life; patients’ perspective; social...

  2. Dementia and driving.

    Science.gov (United States)

    O'Neill, D; Neubauer, K; Boyle, M; Gerrard, J; Surmon, D; Wilcock, G K

    1992-04-01

    Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on self-certification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of self-certification of health by the elderly for driver-licensing purposes needs to be reassessed.

  3. 123I-IMP-SPECT in vascular dementia

    International Nuclear Information System (INIS)

    Namura, Yasuhiro; Miyoshi, Toshihiko; Shio, Hideo; Yamaguchi, Shinya; Kimura, Jun

    1990-01-01

    Cerebral blood flow (CBF) was studied by N-isopropyl-p- 123 I-iodoamphetamine (IMP)-single photon emission computed tomography (SPECT) in patients with vascular dementia. Patients were divided by CT/MRI findings into multiple or localized type and cortical or subcortical type. Of patients with multiple lesions in the cortex, the reduction of CBF was noted in several cortex corresponding to CT/MRI findings. Patients in this group had a high incidence of aphasia, agraphia, dyscalculia, and amnesia. Patients with multiple lesions in the white matter and basal ganglia were subdivided into 3 groups by clinical manifestations. CBF in those with dementia showed generalized reduction in all cerebral cortex and especially in bilateral frontal regions. CBF in those with slightly impaired mentality was almost normal. In another group with pseudobulbar palsy and/or extrapyramidal sings, CBF was reduced intermediately only in bilateral frontal regions. Typical symptoms in demented patients were apathy, emotional lability, and forgetfulness. In those with the localized type, CBF was reduced in cerebral cortical areas correlating with the impaired mental functions. (author)

  4. sup 123 I-IMP-SPECT in vascular dementia

    Energy Technology Data Exchange (ETDEWEB)

    Namura, Yasuhiro; Miyoshi, Toshihiko; Shio, Hideo; Yamaguchi, Shinya; Kimura, Jun (Kyoto Univ. (Japan). Hospital)

    1990-12-01

    Cerebral blood flow (CBF) was studied by N-isopropyl-p-{sup 123}I-iodoamphetamine (IMP)-single photon emission computed tomography (SPECT) in patients with vascular dementia. Patients were divided by CT/MRI findings into multiple or localized type and cortical or subcortical type. Of patients with multiple lesions in the cortex, the reduction of CBF was noted in several cortex corresponding to CT/MRI findings. Patients in this group had a high incidence of aphasia, agraphia, dyscalculia, and amnesia. Patients with multiple lesions in the white matter and basal ganglia were subdivided into 3 groups by clinical manifestations. CBF in those with dementia showed generalized reduction in all cerebral cortex and especially in bilateral frontal regions. CBF in those with slightly impaired mentality was almost normal. In another group with pseudobulbar palsy and/or extrapyramidal sings, CBF was reduced intermediately only in bilateral frontal regions. Typical symptoms in demented patients were apathy, emotional lability, and forgetfulness. In those with the localized type, CBF was reduced in cerebral cortical areas correlating with the impaired mental functions. (author).

  5. Dementia friendly, dementia capable, and dementia positive: concepts to prepare for the future.

    Science.gov (United States)

    Lin, Shih-Yin; Lewis, Frances Marcus

    2015-04-01

    With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer's Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer's Project Act, which led to the formation of the Advisory Council on Alzheimer's Research, Care, and Services and the launch of the first National Plan to Address Alzheimer's Disease. The term "dementia capable" was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.' national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Stroke syndromes in young people.

    Science.gov (United States)

    Chambers, B R; Bladin, P F; McGrath, K; Goble, A J

    1981-01-01

    All contributory factors to the unusual occurrence of stroke in young people were evaluated in patients under age 40 admitted to the Stroke Unit of the Austin Hospital in Melbourne, Australia. Over the August 1977 to December 1980 period there were 700 admissions. Of these 14 patients were under the age of 40. There were 7 males and 7 females whose ages ranged from 17-38 years. Each patient was screened for factors which might contribute to premature vascular disease including hypertension, diabetes, smoking, obesity, and hyperlipidemia. In addition, the following tests were performed to exclude an arteritic process: full blood examination; ESR; protein electrophoresis; syphilis serology; and the presence of antinuclear factor. Each of the 14 patients suffered cerebral infarction. A summary of each case is presented in a table. In 9 patients, infarction occurred in the carotid territory of supply. Large cortical infarcts with or without subcortical involvement occurred in cases 1-8, of whom 5 had major vessel occlusion demonstrated angiographically and another had stenosing and ulcerative atheromatous disease at the extracranial carotid bifurcation. In a further 4 patients, infarction occurred within the vertebrobasilar territory and was either confined to the brain stem, the occiptal cortex, or involved both. Angiograms were performed in 2 of these patients and showed irregular narrowing of the vertebral artery which was interpreted as spasm and segmentally narrowing of the basilar artery. The final patient had several ischemic events which included right sided amaurosis fugax, and left frontal, right parieto-occipital and left occipital infarctions. Angiography was normal. All patients survived the stroke and were able to go home. There may be an interrelationship between the pathological findings of Irey et al. (1978) and the effect oral contraceptives (OCs) has on migraine. This is relevant to Case 13. Sustained exposure to OCs may produce the pathological

  7. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Apraxias in neurodegenerative dementias.

    Science.gov (United States)

    Chandra, Sadanandavalli Retnaswami; Issac, Thomas Gregor; Abbas, Mirza Masoom

    2015-01-01

    Apraxia is a state of inability to carry out a learned motor act in the absence of motor, sensory or cerebellar defect on command processed through the Praxis circuit. Breakdown in default networking is one of the early dysfunction in cortical dementias and result in perplexity, awkwardness, omission, substitution errors, toying behavior and unrecognizable gestures in response to command with voluntary reflex dissociation where, when unobserved patient will carry out reflex movements normally. Awareness into the organicity of these phenomenas will help in early diagnosis, which will help in initiating appropriate treatment and slowing down the progression of the disease. The aim was to look for the various kinds of apraxias in patients with dementia using appropriate simple tests. Three hundred patients satisfying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for dementia were evaluated in detail with mandatory investigations for dementia followed by testing for ideational, ideomotor, limb-kinetic, buccopharyngeal, dressing apraxia, constructional apraxia and gait apraxias in addition to recording of rare apraxias when present. Alzheimer's disease showed maximum association with apraxias in all the phases of the disease ideational, ideomotor, dressing and constructional apraxias early and buccopharyngeal and gait apraxia late. Frontotemporal lobe dementia showed buccopharyngeal and gait apraxias late into the disease. Cortical basal ganglionic degeneration showed limb apraxias and diffuse Lewy body disease showed more agnosias and less apraxias common apraxias seen was Ideational and Ideomotor. Recognition of the apraxias help in establishing organicity, categorization, caregiver education, early strategies for treatment, avoiding anti-psychotics and introducing disease modifying pharmacotherapeutic agents and also prognosticating.

  9. Music Perception in Dementia.

    Science.gov (United States)

    Golden, Hannah L; Clark, Camilla N; Nicholas, Jennifer M; Cohen, Miriam H; Slattery, Catherine F; Paterson, Ross W; Foulkes, Alexander J M; Schott, Jonathan M; Mummery, Catherine J; Crutch, Sebastian J; Warren, Jason D

    2017-01-01

    Despite much recent interest in music and dementia, music perception has not been widely studied across dementia syndromes using an information processing approach. Here we addressed this issue in a cohort of 30 patients representing major dementia syndromes of typical Alzheimer's disease (AD, n = 16), logopenic aphasia (LPA, an Alzheimer variant syndrome; n = 5), and progressive nonfluent aphasia (PNFA; n = 9) in relation to 19 healthy age-matched individuals. We designed a novel neuropsychological battery to assess perception of musical patterns in the dimensions of pitch and temporal information (requiring detection of notes that deviated from the established pattern based on local or global sequence features) and musical scene analysis (requiring detection of a familiar tune within polyphonic harmony). Performance on these tests was referenced to generic auditory (timbral) deviance detection and recognition of familiar tunes and adjusted for general auditory working memory performance. Relative to healthy controls, patients with AD and LPA had group-level deficits of global pitch (melody contour) processing while patients with PNFA as a group had deficits of local (interval) as well as global pitch processing. There was substantial individual variation within syndromic groups. Taking working memory performance into account, no specific deficits of musical temporal processing, timbre processing, musical scene analysis, or tune recognition were identified. The findings suggest that particular aspects of music perception such as pitch pattern analysis may open a window on the processing of information streams in major dementia syndromes. The potential selectivity of musical deficits for particular dementia syndromes and particular dimensions of processing warrants further systematic investigation.

  10. Bradycardia in frontotemporal dementia.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F; Torregrosa Quesada, J M

    2014-03-01

    Numerous regions of the brain, such as the medial frontal cortex, orbitofrontal cortex, insula, and amygdala, participate in the autonomic control of cardiovascular functions such as heart rate. The degenerative process in frontotemporal dementia (FTD) involves the listed anatomical structures and may therefore produce dysautonomic cardiovascular symptoms. To observe whether or not non-cardiogenic bradycardia was more frequent in a group of patients with FTD than in subjects with mild cognitive impairment or dementia of a different aetiology. Once patients with primary cardiac arrhythmia were excluded, we registered the heart rates of 258 patients with cognitive symptoms (36 with FTD, 22 with Alzheimer disease, 23 with vascular dementia, 10 with other dementias, and 167 with non-dementia cognitive impairment). Bradycardia (<60 beats/minute) was significantly more frequent in patients with FTD. This difference remained significant after excluding subjects undergoing treatment with a potentially bradycardic effect. Bradycardia was more prevalent in behavioural FTD cases than in cases of the aphasic variant, and we detected a trend toward higher frequency among patients with more pronounced right hemisphere atrophy. Moreover, mean systolic blood pressure in FTD patients was lower than in other participants, and systolic hypotension (<120 and <100mm Hg) was more prevalent. Bradycardia was more frequent in the FTD sample than in other patients with cognitive symptoms. Further investigations will be necessary before we may consider bradycardia to be a sign supporting diagnosis of FTD or its behavioural variant. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  11. PET studies in dementia

    Energy Technology Data Exchange (ETDEWEB)

    Herholz, K. [Neurologische Universitaetsklinik and Max-Planck-Inst. fuer neurologische Forschung, Koeln (Germany)

    2003-04-01

    Measurement of local cerebral glucose metabolism (lCMRGlc) by positron emission tomography (PET) and {sup 18}F-2-fluoro-2-deoxy-D-glucose (FDG) has become a standard technique during the past 20 years and is now available at many university hospitals in all highly developed countries. Many studies have documented a close relation between lCMRGlc and localized cognitive functions, such as language and visuoconstructive abilities. Alzheimer's disease (AD) is characterized by regional impairment of cerebral glucose metabolism in neocortical association areas (posterior cingulate, temporoparietal and frontal multimodal association cortex), whereas primary visual and sensorimotor cortex, basal ganglia, and cerebellum are relatively well preserved. In a multicenter study comprising 10 PET centers (Network for Efficiency and Standardization of Dementia Diagnosis, NEST-DD) that employed an automated voxel-based analysis of FDG PET images, the distinction between controls and AD patients was 93% sensitive and 93% specific, and even in very mild dementia (at Mini Mental Status Examination (MMSE) 24 or higher) sensitivity was still 84% at 93% specificity. Significantly abnormal metabolism in mild cognitive deficit (MCI) indicates a high risk to develop dementia within the next two years. Reduced neocortical glucose metabolism can probably be detected with FDG PET in AD on average one year before onset of subjective cognitive impairment. In addition to glucose metabolism, specific tracers for dopamine synthesis ({sup 18}F-F-DOPA) and for ({sup 11}C-MP4A) are of interest for differentiation among dementia subtypes. Cortical acetylcholine esterase activity (AChE) activity is significantly lower in patients with AD or with dementia with Lewy bodies (DLB) than in age-matched normal controls. In LBD there is also impairment of dopamine synthesis, similar to Parkinson disease. (author) 115 refs.

  12. Atrial Fibrillation and Stroke

    Science.gov (United States)

    ... a brain scan) that, over time, can cause dementia, so prevention is important. x Prognosis AF, which affects as ... a brain scan) that, over time, can cause dementia, so prevention is important. View Full Prognosis Clinical Trials Throughout ...

  13. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  14. Comparison of verbal and emotional responses of elderly people with mild/moderate dementia and those with severe dementia in responses to seal robot, PARO

    Directory of Open Access Journals (Sweden)

    Kazue eTakayanagi

    2014-09-01

    Full Text Available The differences in verbal and emotional responses to a baby seal robot, PARO, of elderly people with dementia residing at an elderly nursing care facility were analyzed. There were two groups of elderly people: one was with mild/moderate dementia (M-group that consisted with 19 elderly residents in the general ward, and the other was with severe dementia (S-group that consisted with 11 elderly residents in the dementia ward.Method: Each elderly resident in both groups interacted with either PARO or a control (stuffed lion toy: Lion brought by a staff at each resident’s private room. Their responses were recorded on video. Behavioral analysis of the initial 6 minutes of the interaction was conducted using a time sampling method. Results: In both groups, subjects talked more frequently to PARO than to Lion, showed more positive changes in emotional expression with PARO than with Lion, and laughed more frequently with PARO than with Lion. Subjects in M-group even showed more negative emotional expressions with Lion than with PARO. Furthermore, subjects in S-group showed neutral expression more frequently with Lion than with PARO, suggesting more active interaction with PARO. For subjects in M-group, frequencies of touching and stroking, frequencies of talking to staff member, and frequencies of talking initiated by staff member were significantly higher with Lion than with PARO.Conclusion: The elderly people both with mild/moderate dementia and with severe dementia showed greater interest in PARO than in Lion. The results suggest that introducing PARO may increase willingness of the staff members to communicate and work with elderly people with dementia, especially those with mild/moderate dementia who express their demand of communication more than those with severe dementia.

  15. Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia.

    Science.gov (United States)

    Gold, Gabriel; Kövari, Enikö; Herrmann, François R; Canuto, Alessandra; Hof, Patrick R; Michel, Jean-Pierre; Bouras, Constantin; Giannakopoulos, Panteleimon

    2005-06-01

    Most previous studies addressed the cognitive impact of lacunar infarcts using radiologic correlations that are known to correlate poorly with neuropathological data. Moreover, absence of systematic bilateral assessment of vascular lesions and masking effects of Alzheimer disease pathology and macrovascular lesions may explain discrepancies among previous reports. To define the relative contribution of silent lacunes to cognitive decline, we performed a detailed analysis of lacunar and microvascular pathology in both cortical and subcortical areas of 72 elderly individuals without significant neurofibrillary tangle pathology or macrovascular lesions. Cognitive status was assessed prospectively using the Clinical Dementia Rating (CDR) scale; neuropathological evaluation included Abeta-protein deposition staging and bilateral assessment of microvascular ischemic pathology and lacunes; statistical analysis included multivariate models controlling for age, amyloid deposits, and microvascular pathology. Thalamic and basal ganglia lacunes were negatively associated with CDR scores; cortical microinfarcts, periventricular and diffuse white matter demyelination also significantly affected cognition. In a multivariate model, cortical microinfarcts and thalamic and basal ganglia lacunes explained 22% of CDR variability; amyloid deposits and microvascular pathology explained 12%, and the assessment of thalamic and basal ganglia lacunes added an extra 17%. Deep white matter lacunes were not related to cognitive status in univariate and multivariate models. In agreement with the recently proposed concept of subcortical ischemic vascular dementia, our autopsy series provides important evidence that gray matter lacunes are independent predictors of cognitive decline in elderly individuals without concomitant dementing processes such as Alzheimer disease.

  16. Statin Use, Incident Dementia and Alzheimer Disease in Elderly African Americans.

    Science.gov (United States)

    Hendrie, Hugh C; Hake, Ann; Lane, Kathleen; Purnell, Christianna; Unverzagt, Frederick; Smith-Gamble, Valerie; Murrell, Jill; Ogunniyi, Adesola; Baiyewu, Olusegun; Callahan, Chris; Saykin, Andrew; Taylor, Stanley; Hall, Kathleen; Gao, Su

    2015-08-07

    To investigate the association between statin use, incident dementia, and Alzheimer disease (AD) in a prospective elderly African American cohort. Two stage design with a screening interview followed by a comprehensive in-home assessment conducted over an eight-year period. Diagnoses of incident AD and dementia were made by consensus. Statin use was collected at each evaluation. Measurements of low-density lipoprotein cholesterol (LDL), C-reactive protein (CRP) and APOE genotype were obtained from baseline blood samples. Logistic regression models were used to test the association of statin use on incident dementia and AD and its possible association with lipid and CRP levels. Indianapolis, Indiana. From an original cohort of 2629 participants, a subsample of 974 African Americans aged >70 years with normal cognition, at least one follow up evaluation, complete statin information, and biomarker availability were included. Incident dementia and incident AD. After controlling for age at diagnosis, sex, education level, presence of the APOE ε4 allele and history of stroke for the incident dementia model, baseline use of statins was associated with a significantly decreased risk of incident dementia (OR=.44, P=.029) and incident AD (OR=.40, P=.029). The significant effect of statin use on reduced AD risk and trend for dementia risk was found only for those participants who reported consistent use over the observational period (incident AD: P=.034; incident dementia: P=.061). Additional models found no significant interaction between baseline statin use, baseline LDL, or CRP level and incident dementia/AD. Consistent use of statin medications during eight years of follow-up resulted in significantly reduced risk for incident AD and a trend toward reduced risk for incident dementia.

  17. Preventing Stroke Deaths

    Science.gov (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  18. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  19. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  20. A clinical study on cognitive impairment in post-ischemic stroke patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    LI Chen

    2012-02-01

    Full Text Available Objective To explore the relation between metabolic syndrome (MetS and cognitive impairment after ischemic stroke. Methods Ninety-four cases of first ischemic stroke patients were divided into stroke without MetS group (n = 54 and stroke with MetS group (n = 40 according to the diagnostic criteria for MetS defined by Metabolic Syndrome Researching Group of Chinese Diabetes Society. All patients underwent Mini-Mental State Examination (MMSE, Clock Drawing Test (CDT, animal Verbal Fluency Test (aVFT, Trial Making Test-A (TMT-A at 2 weeks and 3 months after stroke to evaluate mental state such as verbal learning memory, and executive, attentional and visuospatial abilities. The incidence and development of cognitive impairment were also assessed. Results At 2 weeks and 3 months after stroke, the incidence of cognitive impairment were 24.47% (23/94 and 22.34% (21/94, respectively, and in the cognitive impairment patients the incidence of non-dementia were 21.28% (20/94 and 19.15% (18/94, while the incidence of dementia were 3.19% (3/94 and 3.19% (3/94, respectively. The incidence of cognitive impairment was higher in the stroke patients with MetS than the stroke patients without MetS, 37.50% (15/40 vs 14.81% (8/54 (Z = 2.500, P = 0.012 at 2 weeks after stroke and 35.00% (14/40 vs 12.96% (7/54 (Z = 2.513, P = 0.012 at 3 months after stroke. In the scores of MMSE, delay recall and CDT of the stroke patients with MetS were all lower than those without MetS at 2 weeks after stroke and at 3 months after stroke (P < 0.05, for all. The stroke patients with MetS had more cognition deterioration than the stroke patients without MetS at 3 months after stroke, the difference was significant (Z = 2.134, P = 0.033. Conclusion MetS can increase the incidence of cognitive impairment, especially non-dementia cognitive impairment in post ischemic stroke. Executive dysfunction and hypomnesis are often seen. The development of cognitive impairment in stroke patients

  1. Anatomical correlates of reward-seeking behaviours in behavioural variant frontotemporal dementia

    Science.gov (United States)

    Sturm, Virginia E.; Seeley, William W.; Miller, Bruce L.; Kramer, Joel H.; Rosen, Howard J.

    2014-01-01

    Behavioural variant frontotemporal dementia is characterized by abnormal responses to primary reward stimuli such as food, sex and intoxicants, suggesting abnormal functioning of brain circuitry mediating reward processing. The goal of this analysis was to determine whether abnormalities in reward-seeking behaviour in behavioural variant frontotemporal dementia are correlated with atrophy in regions known to mediate reward processing. Review of case histories in 103 patients with behavioural variant frontotemporal dementia identified overeating or increased sweet food preference in 80 (78%), new or increased alcohol or drug use in 27 (26%), and hypersexuality in 17 (17%). For each patient, a primary reward-seeking score of 0–3 was created with 1 point given for each target behaviour (increased seeking of food, drugs, or sex). Voxel-based morphometry performed in 91 patients with available imaging revealed that right ventral putamen and pallidum atrophy correlated with higher reward-seeking scores. Each of the reward-related behaviours involved partially overlapping right hemisphere reward circuit regions including putamen, globus pallidus, insula and thalamus. These findings indicate that in some patients with behavioural variant frontotemporal dementia, low volume of subcortical reward-related structures is associated with increased pursuit of primary rewards, which may be a product of increased thalamocortical feedback. PMID:24740987

  2. Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke.

    Science.gov (United States)

    Feigin, V L; Barker-Collo, S; Parag, V; Senior, H; Lawes, C M M; Ratnasabapathy, Y; Glen, E

    2010-11-02

    Studying long-term stroke outcomes including body functioning (neurologic and neuropsychological impairments) and activity limitations and participation is essential for long-term evidence-based rehabilitation and service planning, resource allocation, and improving health outcomes in stroke. However, reliable data to address these issues is lacking. This study (February 2007-December 2008) sourced its participants from the population-based incidence study conducted in Auckland in 2002-2003. Participants completed structured self-administered questionnaires, and a face-to-face interview including a battery of neuropsychological tests. Logistic regression analysis was used to analyze associations between and within functional outcomes and their potential predictors. Of 418 5-year stroke survivors, two-thirds had good functional outcome in terms of neurologic impairment and disability (defined as modified Rankin Score <3), 22.5% had cognitive impairment indicative of dementia, 20% had experienced a recurrent stroke, almost 15% were institutionalized, and 29.6% had symptoms suggesting depression. Highly significant correlations were found between and within various measurements of body functioning (especially neuropsychological impairments), activity, and participation. Age, dependency, and depression were independently associated with most outcomes analyzed. The strong associations between neuropsychological impairment and other functional outcomes and across various measurements of body functioning, activity, and participation justify utilizing a multidisciplinary approach to studying and managing long-term stroke outcomes. Observed gender and ethnic differences in some important stroke outcomes warrant further investigations.

  3. Understanding Life After Stroke

    OpenAIRE

    Hjelmblink, Finn

    2008-01-01

    Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...

  4. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

  5. Dementia and legal competency.

    Science.gov (United States)

    Filaković, Pavo; Erić, Anamarija Petek; Mihanović, Mate; Glavina, Trpimir; Molnar, Sven

    2011-06-01

    The legal competency or capability to exercise rights is level of judgment and decision-making ability needed to manage one's own affairs and to sign official documents. With some exceptions, the person entitles this right in age of majority. It is acquired without legal procedures, however the annulment of legal capacity requires a juristic process. This resolution may not be final and could be revoked thorough the procedure of reverting legal capacity - fully or partially. Given the increasing number of persons with dementia, they are often subjects of legal expertise concerning their legal capacity. On the other part, emphasis on the civil rights of mentally ill also demands their maximal protection. Therefore such distinctive issue is approached with particular attention. The approach in determination of legal competency is more focused on gradation of it's particular aspects instead of existing dual concept: legally capable - legally incapable. The main assumption represents how person with dementia is legally capable and should enjoy all the rights, privileges and obligations as other citizens do. The aspects of legal competency for which person with dementia is going to be deprived, due to protection of one's rights and interests, are determined in legal procedure and then passed over to the guardian decided by court. Partial annulment of legal competency is measure applied when there is even one existing aspect of preserved legal capability (pension disposition, salary or pension disposition, ability of concluding contract, making testament, concluding marriage, divorce, choosing whereabouts, independent living, right to vote, right to decide course of treatment ect.). This measure is most often in favour of the patient and rarely for protection of other persons and their interests. Physicians are expected to precisely describe early dementia symptoms which may influence assessment of specific aspects involved in legal capacity (memory loss, impaired task

  6. Artefactual subcortical hyperperfusion in PET studies normalized to global mean: lessons from Parkinson's disease

    DEFF Research Database (Denmark)

    Borghammer, Per; Cumming, Paul; Aanerud, Joel

    2008-01-01

    AIM: Recent studies of Parkinson's disease (PD) report subcortical increases of cerebral blood flow (CBF) or cerebral metabolic rate of glucose (CMRglc), after conventional normalization to the global mean. However, if the global mean CBF or CMRglc is decreased in the PD group, this normalization...

  7. Expanded functional coupling of subcortical nuclei with the motor resting-state network in multiple sclerosis

    DEFF Research Database (Denmark)

    Dogonowski, Anne-Marie; Siebner, Hartwig R; Sørensen, Per Soelberg

    2013-01-01

    is characterised by more widespread motor connectivity in the basal ganglia while cortical motor resting-state connectivity is preserved. The expansion of subcortical motor resting-state connectivity in MS indicates less efficient funnelling of neural processing in the executive motor cortico-basal ganglia...

  8. Subcortical structures in humans can be facilitated by transcranial direct current stimulation

    NARCIS (Netherlands)

    Nonnekes, Johan Hendrik; Arrogi, Anass; Munneke, Moniek; van Asseldonk, Edwin H.F.; Oude Nijhuis, Lars; Geurts, Alexander; Weerdesteyn, Vivian

    2014-01-01

    BACKGROUND: Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that alters cortical excitability via application of a weak direct current. Interestingly, it was demonstrated in cats that tDCS can facilitate subcortical structures as well (Bolzonii et al., J

  9. Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

    NARCIS (Netherlands)

    Nonnekes, Johan Hendrik; Arrogi, A.; Munneke, M.A.M.; van Asseldonk, Edwin H.F.; Oude Nijhuis, L.B.; Geurts, A.C.; Weerdesteyn, V.

    2014-01-01

    Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that alters cortical excitability. Interestingly, in recent animal studies facilitatory effects of tDCS have also been observed on subcortical structures. Here, we sought to provide evidence for the potential

  10. Subcortical structures in humans can be facilitated by transcranial direct current stimulation

    NARCIS (Netherlands)

    Nonnekes, J.H.; Arrogi, A.; Munneke, M.A.M.; Asseldonk, E.H. van; Nijhuis, L.B.; Geurts, A.C.H.; Weerdesteyn, V.G.M.

    2014-01-01

    Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that alters cortical excitability. Interestingly, in recent animal studies facilitatory effects of tDCS have also been observed on subcortical structures. Here, we sought to provide evidence for the potential

  11. Is Intraoperative Diffusion tensor Imaging at 3.0T Comparable to Subcortical Corticospinal tract Mapping?

    Czech Academy of Sciences Publication Activity Database

    Ostrý, S.; Belšan, T.; Otáhal, Jakub; Beneš, V.; Netuka, D.

    2013-01-01

    Roč. 73, č. 5 (2013), s. 797-807 ISSN 0148-396X Institutional support: RVO:67985823 Keywords : corticospinal tract * intraoperative tractography * intraoperative image distortion * motor-evoked potentials * subcortical mapping Subject RIV: FH - Neurology Impact factor: 3.031, year: 2013

  12. Technical principles of direct bipolar electrostimulation for cortical and subcortical mapping in awake craniotomy.

    Science.gov (United States)

    Pallud, J; Mandonnet, E; Corns, R; Dezamis, E; Parraga, E; Zanello, M; Spena, G

    2017-06-01

    Intraoperative application of electrical current to the brain is a standard technique during brain surgery for inferring the function of the underlying brain. The purpose of intraoperative functional mapping is to reliably identify cortical areas and subcortical pathways involved in eloquent functions, especially motor, sensory, language and cognitive functions. The aim of this article is to review the rationale and the electrophysiological principles of the use of direct bipolar electrostimulation for cortical and subcortical mapping under awake conditions. Direct electrical stimulation is a window into the whole functional network that sustains a particular function. It is an accurate (spatial resolution of about 5mm) and a reproducible technique particularly adapted to clinical practice for brain resection in eloquent areas. If the procedure is rigorously applied, the sensitivity of direct electrical stimulation for the detection of cortical and subcortical eloquent areas is nearly 100%. The main disadvantage of this technique is its suboptimal specificity. Another limitation is the identification of eloquent areas during surgery, which, however, could have been functionally compensated postoperatively if removed surgically. Direct electrical stimulation is an easy, accurate, reliable and safe invasive technique for the intraoperative detection of both cortical and subcortical functional brain connectivity for clinical purpose. In our opinion, it is the optimal technique for minimizing the risk of neurological sequelae when resecting in eloquent brain areas. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Mendelian Genes and Risk of Intracerebral Hemorrhage and Small-Vessel Ischemic Stroke in Sporadic Cases.

    Science.gov (United States)

    Chong, Michael; O'Donnell, Martin; Thijs, Vincent; Dans, Antonio; López-Jaramillo, Patricio; Gómez-Arbeláez, Diego; Mondo, Charles; Czlonkowska, Anna; Skowronska, Marta; Oveisgharan, Shahram; Yusuf, Salim; Paré, Guillaume

    2017-08-01

    Mendelian strokes are rare genetic disorders characterized by early-onset small-vessel stroke. Although extensively studied among families with syndromic features, whether these genes affect risk among sporadic cases is unknown. We sequenced 8 genes responsible for Mendelian stroke in a case-control study of sporadic stroke cases (≤70 years). Participants included 1251 primary stroke cases of small-vessel pathology (637 intracerebral hemorrhage and 614 small-vessel ischemic stroke cases) and 1716 controls from the INTERSTROKE study (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World). Overall, the prevalence of canonical disease-causing mutations was 0.56% in cases and 0.23% in controls (odds ratio=1.89; 95% confidence interval, 0.54-7.57; P =0.33). CADASIL (Cerebral Autosomal Dominant Arteriopathies with Subcortical Infarcts and Leukoencephalopathies) mutations were more frequent among cases (0.48%) than controls (0.23%) but were not significantly associated with stroke risk (odds ratio=2.03; 95% confidence interval, 0.58-8.02; P =0.27). Next, we included all rare nonsynonymous mutations to investigate whether other types of mutations may contribute to stroke risk. Overall, 13.5% of cases and 14.2% of controls were carriers of at least one rare nonsynonymous mutation among the 8 Mendelian stroke genes. Mutation carriers were not at elevated risk of stroke (odds ratio=0.93; 95% confidence interval, 0.75-1.16; P =0.55). In the absence of syndromic features and family history of stroke, screening for Mendelian mutations among small-vessel stroke patients is unlikely to have high diagnostic utility. © 2017 American Heart Association, Inc.

  14. Post-stroke cognitive impairments: diagnosis and therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Natalia Vyacheslavovna Pizova

    2013-01-01

    Full Text Available Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI. Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.

  15. Crossed Aphasia and Visuo-Spatial Neglect Following a Right Thalamic Stroke: A Case Study and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Lieve De Witte

    2008-01-01

    Full Text Available Crossed aphasia in dextrals (CAD following pure subcortical lesions is rare. This study describes a right-handed patient with an ischemic lesion in the right thalamus. In the post-acute phase of the stroke, a unique combination of ‘crossed thalamic aphasia’ was found with left visuo-spatial neglect and constructional apraxia. On the basis of the criteria used in Mariën et al. [67], this case-report is the first reliable representative of vascular CAD following an isolated lesion in the right thalamus. Furthermore, this paper presents a detailed analysis of linguistic and cognitive impairments of ‘possible’ and 'reliable' subcortical CAD-cases published since 1975. Out of 25 patients with a pure subcortical lesion, nine cases were considered as ‘possibly reliable or reliable’. A review of these cases reveals that: (1 demographic data are consistent with the general findings for the entire group of vascular CAD, (2 the neurolinguistic findings do not support the data in the general CAD-population with regard to (a the high prevalence of transcortical aphasia and (b the tendency towards a copresence of an oral versus written language dissociation and a ‘mirror-image’ lesion-aphasia profile, (3 subcortical CAD is not a transient phenomenon, (4 the lesion-aphasia correlations are not congruent with the high incidence of anomalous cases in the general CAD-population, (5 neuropsychological impairments may accompany subcortical CAD.

  16. Frontotemporal dementia: An updated overview

    OpenAIRE

    Mohandas, E.; Rajmohan, V.

    2009-01-01

    Frontotemporal dementia (FTD) is a progressive neurodegenerative syndrome occurring between 45 and 65 years. The syndrome is also called frontotemporal lobar degeneration (FTLD). However, FTLD refers to a larger group of disorders FTD being one of its subgroups. The other subgroups of FTLD are progressive nonfluent aphasia (PFNA), and semantic dementia (SD). FTLD is characterized by atrophy of prefrontal and anterior temporal cortices. FTD occurs in 5-15% of patients with dementia and it is t...

  17. A physical model for dementia

    Science.gov (United States)

    Sotolongo-Costa, O.; Gaggero-Sager, L. M.; Becker, J. T.; Maestu, F.; Sotolongo-Grau, O.

    2017-04-01

    Aging associated brain decline often result in some kind of dementia. Even when this is a complex brain disorder a physical model can be used in order to describe its general behavior. A probabilistic model for the development of dementia is obtained and fitted to some experimental data obtained from the Alzheimer's Disease Neuroimaging Initiative. It is explained how dementia appears as a consequence of aging and why it is irreversible.

  18. Dementia, Clinical Aspects

    Directory of Open Access Journals (Sweden)

    Docu Any Axelerad

    2017-12-01

    Full Text Available Disordered arousal leads to a confusional state with an incoherent line of thought, temporal disorientation, poor recall, visual illusions, hallucinations and disordered behavior. With the exception of dementia with Lewy bodies, which is characterized by fluctuating confusion, other disorders causing dementia persist and deteriorate over months or years, and are not characterized by fluctuations or confusional episodes, except when other medical or environmental perturbations disrupt the arousal systems of the brain (e.g. intercurrent infection, anoxia. Sometimes, their hallucinations are different, with a religious tendency, and maybe we must insist with anamnesis related to previous religious beliefs, to see if it is possible to correlate some damaged area than cause hallucinations, are reliable with our faith.

  19. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  20. Disruptions in cortico-subcortical covariance networks associated with anxiety in new-onset childhood epilepsy

    Directory of Open Access Journals (Sweden)

    Camille Garcia-Ramos

    2016-01-01

    Full Text Available Anxiety disorders represent a prevalent psychiatric comorbidity in both adults and children with epilepsy for which the etiology remains controversial. Neurobiological contributions have been suggested, but only limited evidence suggests abnormal brain volumes particularly in children with epilepsy and anxiety. Since the brain develops in an organized fashion, covariance analyses between different brain regions can be investigated as a network and analyzed using graph theory methods. We examined 46 healthy children (HC and youth with recent onset idiopathic epilepsies with (n = 24 and without (n = 62 anxiety disorders. Graph theory (GT analyses based on the covariance between the volumes of 85 cortical/subcortical regions were investigated. Both groups with epilepsy demonstrated less inter-modular relationships in the synchronization of cortical/subcortical volumes compared to controls, with the epilepsy and anxiety group presenting the strongest modular organization. Frontal and occipital regions in non-anxious epilepsy, and areas throughout the brain in children with epilepsy and anxiety, showed the highest centrality compared to controls. Furthermore, most of the nodes correlating to amygdala volumes were subcortical structures, with the exception of the left insula and the right frontal pole, which presented high betweenness centrality (BC; therefore, their influence in the network is not necessarily local but potentially influencing other more distant regions. In conclusion, children with recent onset epilepsy and anxiety demonstrate large scale disruptions in cortical and subcortical brain regions. Network science may not only provide insight into the possible neurobiological correlates of important comorbidities of epilepsy, but also the ways that cortical and subcortical disruption occurs.

  1. Subcortical structures in humans can be facilitated by transcranial direct current stimulation.

    Directory of Open Access Journals (Sweden)

    Jorik Nonnekes

    Full Text Available Transcranial direct current stimulation (tDCS is a noninvasive brain stimulation technique that alters cortical excitability. Interestingly, in recent animal studies facilitatory effects of tDCS have also been observed on subcortical structures. Here, we sought to provide evidence for the potential of tDCS to facilitate subcortical structures in humans as well. Subjects received anodal-tDCS and sham-tDCS on two separate testing days in a counterbalanced order. After stimulation, we assessed the effect of tDCS on two responses that arise from subcortical structures; (1 wrist and ankle responses to an imperative stimulus combined with a startling acoustic stimulus (SAS, and (2 automatic postural responses to external balance perturbations with and without a concurrent SAS. During all tasks, response onsets were significantly faster following anodal-tDCS compared to sham-tDCS, both in trials with and without a SAS. The effect of tDCS was similar for the dominant and non-dominant leg. The SAS accelerated the onsets of ankle and wrist movements and the responses to backward, but not forward perturbations. The faster onsets of SAS-induced wrist and ankle movements and automatic postural responses following stimulation provide strong evidence that, in humans, subcortical structures--in particular the reticular formation--can be facilitated by tDCS. This effect may be explained by two mechanisms that are not mutually exclusive. First, subcortical facilitation may have resulted from enhanced cortico-reticular drive. Second, the applied current may have directly stimulated the reticular formation. Strengthening reticulospinal output by tDCS may be of interest to neurorehabilitation, as there is evidence for reticulospinal compensation after corticospinal lesions.

  2. Aberrant Functional Connectivity and Structural Atrophy in Subcortical Vascular Cognitive Impairment: Relationship with Cognitive Impairments

    Directory of Open Access Journals (Sweden)

    Xia eZhou

    2016-02-01

    Full Text Available Abnormal structures in the cortical and subcortical regions have been identified in subcortical vascular cognition impairment (SVCI. However, little is known about the functional alterations in SVCI, and no study refers to the functional connectivity in the prefrontal and subcortical regions in this context. The medial prefrontal cortex (MPFC is an important region of the executive network and default mode network (DMN, and the subcortical thalamus plays vital roles in mediating or modulating these two networks. To investigate both thalamus- and MPFC-related functional connectivity as well as its relationship with cognition in SVCI, 32 SVCI patients and 23 control individuals were administered neuropsychological assessments. They also underwent structural and functional magnetic resonance imaging (MRI scans. Voxel-based morphometry (VBM and functional connectivity analysis were performed to detect gray matter (GM atrophy and to characterize the functional alterations in the thalamus and the MPFC. For structural data, we observed that GM atrophy was distributed in both cortical regions and subcortical areas. For functional data, we observed that the thalamus functional connectivity in SVCI was significantly decreased in several cortical regions (i.e., the orbitofrontal lobe (OFL, which are mainly involved in executive function and memory function. However, connectivity was increased in several frontal regions (i.e., the inferior frontal gyrus (IFG, which may be induced by the compensatory recruitment of the decreased functional connectivity. The MPFC functional connectivity was also decreased in executive- and memory-related regions (i.e., the anterior cingulate cortex (ACC along with a motor region (i.e., the supplementary motor region (SMA. In addition, the cognitive performance was closely correlated with functional connectivity between the left thalamus and the left OFL in SVCI. The present study thus provides evidence for an association

  3. Continuous physical examination during subcortical resection in awake craniotomy patients: Its usefulness and surgical outcome.

    Science.gov (United States)

    Bunyaratavej, Krishnapundha; Sangtongjaraskul, Sunisa; Lerdsirisopon, Surunchana; Tuchinda, Lawan

    2016-08-01

    To evaluate the value of physical examination as a monitoring tool during subcortical resection in awake craniotomy patients and surgical outcomes. Authors reviewed medical records of patients underwent awake craniotomy with continuous physical examination for pathology adjacent to the eloquent area. Between January 2006 and August 2015, there were 37 patients underwent awake craniotomy with continuous physical examination. Pathology was located in the left cerebral hemisphere in 28 patients (75.7%). Thirty patients (81.1%) had neuroepithelial tumors. Degree of resections were defined as total, subtotal, and partial in 16 (43.2%), 11 (29.7%) and 10 (27.0%) patients, respectively. Median follow up duration was 14 months. The reasons for termination of subcortical resection were divided into 3 groups as follows: 1) by anatomical landmark with the aid of neuronavigation in 20 patients (54%), 2) by reaching subcortical stimulation threshold in 8 patients (21.6%), and 3) by abnormal physical examination in 9 patients (24.3%). Among these 3 groups, there were statistically significant differences in the intraoperative (p=0.002) and early postoperative neurological deficit (p=0.005) with the lowest deficit in neuronavigation group. However, there were no differences in neurological outcome at later follow up (3-months p=0.103; 6-months p=0.285). There were no differences in the degree of resection among the groups. Continuous physical examination has shown to be of value as an additional layer of monitoring of subcortical white matter during resection and combining several methods may help increase the efficacy of mapping and monitoring of subcortical functions. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. [Neuropathology of frontotemporal dementia].

    Science.gov (United States)

    Murayama, Shigeo

    2008-11-01

    Frontotemporal dementia (FTD) is a clinical phenotype of dementia, characterized by complex of clinical symptoms, including disinhibition, character change, increased appetite, sexual misconduct and language problems. Frontotemporal lobar degeneration (FTLD) is a pathological classification of neurodegenerative disorder and its core consists of Pick's disease (PiD). Historically, PiD was morphologically subclassified into three types, but recent immunocytochemical investigations defined type I as PiD with Pick bodies (three repeat tauopathy), type II as corticobasal degeneration (CBD, four repeat tauopathy) and type III as FTLD with ubiquitinated inclusions (FTLD-U). The recent progress provided an evidence that the majority of FTLD-U represented primary TDP 43 proteionopathy. Three major clinical phenotypes of FTLD consist of FTD, semantic dementia (SD) and progressive non-fluent aphasia (PNFA). Clinical and pathological correlative studies demonstrated that majority of the background pathology of FTD is PiD with Pick bodies, that of SD is FTLD-U and that of PNFA is CBD, although there are too many exceptions. Although FTD is one of the major clinical manifestations of FTLD, the most frequent pathological background of FTD is Alzheimer disease (AD). The degenerative processes causing FTD symptoms include dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and argyrophilic grain disease. Moreover, vascular process such as Binswanger disease and inflammatory process such as neurosyphilis could also present with FTD symptoms. Since FTD requires special clinical care distinct from AD, clinical diagnosis of FTD is quite important. But for the fundamental treatment based on background pathological processes, surrogate biomarkers, including structural and functional neuroimages and findings of cerebrospinal fluid, blood and urine, should be pursued for future progress in FTD research.

  5. Palliative care in advanced dementia.

    Science.gov (United States)

    Merel, Susan E; Merel, Susan; DeMers, Shaune; Vig, Elizabeth

    2014-08-01

    Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have benefits for patients, families, and the health system. Elements of a palliative approach include discussion of prognosis and goals of care, completion of advance directives, and a thoughtful approach to common complications of advanced dementia. Physicians caring for patients with dementia should formulate a plan for end-of-life care in partnership with patients, families, and caregivers, and be prepared to manage common symptoms at the end of life in dementia, including pain and delirium. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Dementia and oral health

    Directory of Open Access Journals (Sweden)

    Sérgio Spezzia

    2015-12-01

    Full Text Available Dementia is a neurodegenerative disease that progressively and irreversibly affects the central nervous system, leading to a decline in cognitive function. There is loss of brain function, which affects memory, thought, language, judgment and behavior. Since the patients present difficulties with self-care, there is a compromised oral hygiene. There will inevitably be loss of self-care during the course of the disease. The moment one diagnoses dementia, one should refer the patient to a dentist for evaluation, since the more severe the disease is, the harder it is to perform orthodontic procedures, due to loss of patient cooperation. Dental treatment will include guidance on essential oral hygiene for caregivers and family members, since these will be responsible for its performance, as the patient will be unable to perform basic self-care. When a proper dental plan with preventive approach is performed, acting from the diagnosis of the disease on, one can assist in improving the quality of life of these individuals. This paper aims to conduct an update of studies on the oral effects caused by dementia.

  7. Insulin, cognition, and dementia

    Science.gov (United States)

    Cholerton, Brenna; Baker, Laura D.; Craft, Suzanne

    2015-01-01

    Cognitive disorders of aging represent a serious threat to the social and economic welfare of current society. It is now widely recognized that pathology related to such conditions, particularly Alzheimer’s disease, likely begins years or decades prior to the onset of clinical dementia symptoms. This revelation has led researchers to consider candidate mechanisms precipitating the cascade of neuropathological events that eventually lead to clinical Alzheimer’s disease. Insulin, a hormone with potent effects in the brain, has recently received a great deal of attention for its potential beneficial and protective role in cognitive function. Insulin resistance, which refers to the reduced sensitivity of target tissues to the favorable effects of insulin, is related to multiple chronic conditions known to impact cognition and increase dementia risk. With insulin resistance-associated conditions reaching epidemic proportions, the prevalence of Alzheimer’s disease and other cognitive disorders will continue to rise exponentially. Fortunately, these chronic insulin-related conditions are amenable to pharmacological intervention. As a result, novel therapeutic strategies that focus on increasing insulin sensitivity in the brain may be an important target for protecting or treating cognitive decline. The following review will highlight our current understanding of the role of insulin in brain, potential mechanisms underlying the link between insulin resistance and dementia, and current experimental therapeutic strategies aimed at improving cognitive function via modifying the brain’s insulin sensitivity. PMID:24070815

  8. Cognitive training for dementia

    Directory of Open Access Journals (Sweden)

    Konta, Brigitte

    2005-12-01

    Full Text Available The aim of the HTA report is to evaluate the effectiveness of cognitive training methods to treat cognitive disorders of dementia and other diseases with cognitive deficits. For this purpose, a systematic literature search was carried out first based on the DIMDI superbase retrieval. The identified publications were judged and selected by two independent, methodically competent experts. 33 publications were included in the report. Based on the studies for a normal cognitive development in old age a theory that healthy older people have a considerable capacity reserve for an improved performance in abstract abilities of thinking can be assumed. The first symptoms for older people at risk for dementia are a reduced cognitive capacity reserve. Cognitive training methods therefore focus abilities of abstract memory. Apart from types of dementia another two groups of diseases with cognitive deficits were included in the HTA report: cerebral lesions and schizophrenic psychoses. Studies with mild as well as forms of dementia heavy forms including the Alzheimer disease were included. The described training methods were very heterogeneous with regard to their contents, the temporal sequence and the outcome parameter. The studies were methodically partly contestable. Approximately a third of the studies of all publications could show improvements in the cognitive achievements by the training. Three studies concerning cognitive training methods in case of cerebral lesions were included. All three studies demonstrated a significant improvement in the training group in some outcome parameters. Special cognitive training methods were used for the treatment of cognitive deficits at schizophrenic psychoses. The neurocognitive training (NET, the "Cognitive Remediation Therapy" as well as the strategic training with coaching proved to be effective. The studies, however, were hardly comparable and very heterogeneous in detail. Summarising the cognitive training

  9. Global Cognitive Dysfunction in First Ever Uschaemic Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    1998-01-01

    Full Text Available Cerebro-vascular disease in an important and a frequent cause of dementia. However, the prevalence and magnitude of global cognitive dysfunction in acute stroke has not been studied. Folstein′s mini mental state examination (MMSE is 2 sensitive and reliable test and may serve as a simple tool for screening dementia. Fifty consecutive patients with first ever completed stroke in life and no past history of cognitive disturbances were administered MMSE at least 10 days after the onset of stroke. Cranial CT scans were done in all after 48 hours of stroke. CT scans were blindly analysed and graded for number, location and volume of infarctions, white matter leukoaraiosis (WMLA and cortical and sub cortical atrophy. The radiological parameters of those with MMSE score of 23 or less on MMSE. Of all the conventional risk factors, only age of the patients was significantly higher in the "demented" group. Of the radiological parameters namely-number and volume of infarcts, WMLA, bi-frontal ratio (BFR, 3rd ventricular ratio (3 VR, cella media index (CMI and cortical index (CI, only cortical index was significantly more among patients with lower MMSE scores. Prevalence of global cerebral dysfunction first ever ischaemic stroke was 46% in this study. Advanced age and cortical atrophy appear to contribute to the low scores on MMSE. Though, volume and number of infarctions were higher among patients with low score, the differences were not statistically significant.

  10. Prevention of Stroke in Patients With Silent Cerebrovascular Disease : A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

    NARCIS (Netherlands)

    Smith, Eric E; Saposnik, Gustavo; Biessels, Geert Jan; Doubal, Fergus N; Fornage, Myriam; Gorelick, Philip B; Greenberg, Steven M; Higashida, Randall T; Kasner, Scott E; Seshadri, Sudha

    2017-01-01

    Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to

  11. Selective associative phonagnosia after right anterior temporal stroke.

    Science.gov (United States)

    Luzzi, Simona; Coccia, Michela; Polonara, Gabriele; Reverberi, Carlo; Ceravolo, Gabriella; Silvestrini, Mauro; Fringuelli, Fabio; Baldinelli, Sara; Provinciali, Leandro; Gainotti, Guido

    2017-05-12

    We report the case of a 48 year old men who developed a selective impairment in famous voice recognition after ischemic stroke in right subcortical structures (lenticular nucleus and head of the caudate) and right anterior temporal lobe. He underwent fibrinolytic treatment. During the following days he progressively recovered and was discharged without neurological focal sign. Patent foramen ovale was found. When he got back to his house he noticed that he was unable to recognize the voice of his favoured singers and needed to ask who was the singer to his relatives. Neuropsychological examination revealed a selective impairment in famous voice recognition in the absence of alteration of voice perception, face perception and famous face recognition. All other neuropsychological domains were spared. In particular language, memory and executive functions were intact. Neuroimaging carried out by means of PET and MRI revealed two small ischemic lesions in the right subcortical region, involving lenticular and caudate nuclei and in the right temporal pole. To our knowledge, this is the first case described in literature of a patient showing a selective associative phonagnosia after right anterior temporal stroke. The present case helps to clarify the brain circuits underlying famous voice recognition and adds evidence in favour of a right hemisphere involvement in processing knowledge of familiar voices. These findings are discussed in relation to current models of brain organization of person-specific and general semantic knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  13. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  14. Subcortical White Matter Changes with Normal Aging Detected by Multi-Shot High Resolution Diffusion Tensor Imaging.

    Directory of Open Access Journals (Sweden)

    Sheng Xie

    Full Text Available Subcortical white matter builds neural connections between cortical and subcortical regions and constitutes the basis of neural networks. It plays a very important role in normal brain function. Various studies have shown that white matter deteriorates with aging. However, due to the limited spatial resolution provided by traditional diffusion imaging techniques, microstructural information from subcortical white matter with normal aging has not been comprehensively assessed. This study aims to investigate the deterioration effect with aging in the subcortical white matter and provide a baseline standard for pathological disorder diagnosis. We apply our newly developed multi-shot high resolution diffusion tensor imaging, using self-feeding multiplexed sensitivity-encoding, to measure subcortical white matter changes in regions of interest of healthy persons with a wide age range. Results show significant fractional anisotropy decline and radial diffusivity increasing with age, especially in the anterior part of the brain. We also find that subcortical white matter has more prominent changes than white matter close to the central brain. The observed changes in the subcortical white matter may be indicative of a mild demyelination and a loss of myelinated axons, which may contribute to normal age-related functional decline.

  15. Subcortical White Matter Changes with Normal Aging Detected by Multi-Shot High Resolution Diffusion Tensor Imaging.

    Science.gov (United States)

    Xie, Sheng; Zhang, Zhe; Chang, Feiyan; Wang, Yishi; Zhang, Zhenxia; Zhou, Zhenyu; Guo, Hua

    2016-01-01

    Subcortical white matter builds neural connections between cortical and subcortical regions and constitutes the basis of neural networks. It plays a very important role in normal brain function. Various studies have shown that white matter deteriorates with aging. However, due to the limited spatial resolution provided by traditional diffusion imaging techniques, microstructural information from subcortical white matter with normal aging has not been comprehensively assessed. This study aims to investigate the deterioration effect with aging in the subcortical white matter and provide a baseline standard for pathological disorder diagnosis. We apply our newly developed multi-shot high resolution diffusion tensor imaging, using self-feeding multiplexed sensitivity-encoding, to measure subcortical white matter changes in regions of interest of healthy persons with a wide age range. Results show significant fractional anisotropy decline and radial diffusivity increasing with age, especially in the anterior part of the brain. We also find that subcortical white matter has more prominent changes than white matter close to the central brain. The observed changes in the subcortical white matter may be indicative of a mild demyelination and a loss of myelinated axons, which may contribute to normal age-related functional decline.

  16. Cerebral microbleeds are not associated with long-term cognitive outcome in patients with transient ischemic attack or minor stroke.

    Science.gov (United States)

    Brundel, Manon; Kwa, Vincent I H; Bouvy, Willem H; Algra, Ale; Kappelle, L Jaap; Biessels, Geert Jan

    2014-01-01

    Cerebral microbleeds have been related to cerebrovascular disease and dementia. They occur more frequently in patients with ischemic stroke than in the general population, but their relation to cognition in these patients is uncertain, particularly in the long run. We examined the relationship between microbleeds in patients with a transient ischemic attack (TIA) or minor ischemic stroke, and cognitive performance 4 years later. Participants were recruited from a prospective multicenter cohort of patients with a TIA or minor ischemic stroke (n=397). They underwent magnetic resonance imaging (MRI), including a T2*-weighted sequence, within 3 months after their ischemic event. Microbleeds, atrophy, lacunae and white matter hyperintensities (WMH) were rated visually. Cognitive status was examined in 94% of all patients who were still alive after a mean interval of 3.8 years by the Dutch version of the Telephone Interview for Cognitive Status (TICS; n=280) or by an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) obtained from a close relative if a TICS could not be obtained (n=48). The relationship between presence of microbleeds and TICS or IQCODE score was assessed with linear regression analyses adjusted for age, sex, educational level and time interval between MRI and cognitive evaluation. The mean age was 65±12 years at inclusion. The vascular event at inclusion was a TIA in 170 patients (52%) and a minor ischemic stroke in 155 patients (47%). Microbleeds were present in 11.6% of the patients. Patients with microbleeds were significantly older than patients without microbleeds (70±9 vs. 64±12 years), more often had hypertension, and had more cerebral atrophy, WMH and lacunae on MRI (all pTICS score was 35.3±5.9 for patients with microbleeds (n=29) and 34.6±5.2 for patients without microbleeds (n=251); the adjusted mean difference (95% CI) was 1.69 (-0.01 to 3.38). The total IQCODE score was 66.0±10.8 for patients with microbleeds (n=9

  17. Herpes Zoster and Dementia: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Chen, Vincent Chin-Hung; Wu, Shu-I; Huang, Kuo-You; Yang, Yao-Hsu; Kuo, Ting-Yu; Liang, Hsin-Yi; Huang, Kuan-Lun; Gossop, Michael

    Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster. © Copyright 2017 Physicians Postgraduate Press, Inc.

  18. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  19. Microinfarcts in an older population-representative brain donor cohort (MRC CFAS): Prevalence, relation to dementia and mobility, and implications for the evaluation of cerebral Small Vessel Disease.

    Science.gov (United States)

    Ince, P G; Minett, T; Forster, G; Brayne, C; Wharton, S B

    2017-08-01

    Microinfarcts, small ischaemic foci common in ageing brain, are associated with dementia and gait dysfunction. We determined their relationship with dementia, mobility and cerebrovascular disease in an older population-representative brain donor cohort. These data on microinfarcts were evaluated in relation to pathological assessments of clinically significant cerebral small vessel disease (SVD). Microinfarcts were assessed in the MRC Cognitive Function and Ageing Study (n = 331). Nine brain areas were staged according to the number of areas affected. 36% of brains showed at least 1 microinfarct. Higher cortical microinfarct stage was associated with dementia at death (OR 1.41, 95% CI 1.02; 1.96, P = 0.038), whilst cortical and subcortical microinfarct stages were associated with impaired mobility (OR 1.36, 95% CI 1.05-1.74; P 0.018) and falls (OR 1.96, 95% CI 1.11-3.43; P = 0.02). Adding data on microinfarcts to a definition of SVD, based on white matter lesions (WMLs), lacunes and significant arteriosclerosis, were assessed by comparing area under ROC curve (AUC) with and without microinfarcts. SVD was significantly related to dementia status with or without inclusion of microinfarcts. Modelling potential pathological definitions of SVD to predict dementia or impaired mobility indicated optimal prediction using combined assessment of WMLs, lacunes and microinfarcts. Cortical (dementia) and subcortical microinfarcts (impaired mobility) are related to diverse clinical outcomes. Optimal pathological assessment of significant SVD in brain ageing is achieved based on WMLs, lacunes and microinfarcts and may not require subjective assessment of the extent and severity of arteriosclerosis. © 2016 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society.

  20. Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation.

    Science.gov (United States)

    Viscogliosi, Giovanni; Ettorre, Evaristo; Chiriac, Iulia Maria

    2017-09-01

    Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed. Dementia cases were ascertained by consensus of 2 experienced geriatricians. Dementia severity was assessed using the Clinical Dementia Rating scale (CDR). 316 AF patients (ages 74.7±7.0years, 55.7% women) with high stroke risk (77.5% had a CHA 2 DS 2 VASC score ≥3), low bleeding and falling risk, and no neuropsychiatric/behavioral symptoms, were included. 60.1% were prescribed with OAT. Among patients with dementia (n=86, 27.2%), 22.0% received inadequate antithrombotic prophylaxis (i.e. antiplatelet) and 38.5% no treatment. Proportion of those receiving inadequate or no prophylaxis increased at increasing CDR score. By multiple regression models, either dementia (yes vs no), OR=1.33, 95%CI=1.11-1.46, pdementia severity (CDR>1), OR=2.38, 95%CI=2.19-2.60, pDementia might be associated with underuse of OAT in older AF patients even in the absence of established contraindications. Future studies are needed to assess the real dimension of the problem and clinician's barriers to prescribing OAT in demented patients. Copyright © 2017. Published by Elsevier B.V.

  1. Frequency-dependent changes in the amplitude of low-frequency fluctuations in subcortical ischemic vascular disease (SIVD): a resting-state fMRI study.

    Science.gov (United States)

    Li, Chuanming; Liu, Chen; Yin, Xuntao; Yang, Jun; Gui, Li; Wei, Luqing; Wang, Jian

    2014-11-01

    Resting-state functional magnetic resonance imaging (RS-fMRI) allowed researchers to detect intrinsic brain activity during rest and has been considered an analytical tool for evaluation of dementia. Previously, subcortical ischemic vascular disease (SIVD) has been found decreased amplitude low-frequency fluctuations (ALFF) in a widely frequency range (0.01-0.08Hz) in the bilateral precuneus and increased ALFF values in the bilateral anterior cingulate cortex (ACC), left insula and hippocampus, which showed significant correlations with the cognitive performance. In this study we analyzed the ALFF of 30 patients with SIVD in two different frequency bands (slow-5: 0.01-0.027Hz; slow-4: 0.027-0.073Hz). In the slow-5 band, SIVD patients compared with controls exhibited significant higher ALFF in the bilateral anterior cingulate cortex, right putamen and right supplementary motor area, while lower ALFF in the right precuneus and right angular gyrus. A close correlation was found between the ALFF value of the right angular gyrus and ADL scores. In the slow-4 band, SIVD patients only exhibited increased ALFF in the bilateral anterior cingulate cortex, right putamen, left fusiform gyrus, and no correlation with cognitive scores was found. Our data demonstrate that SIVD patients have widespread abnormal intrinsic neural oscillations, which are dependent on specific frequency bands. ALFF of right angular gyrus at slow-5 band is more specific for SIVD and may be a useful tool to help SIVD diagnosis. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. [Frequency and characteristics of strokes involving the perforating arteries in the Department of Neurology at the Befelatanana General Hospital, Antananarivo].

    Science.gov (United States)

    Rasaholiarison, Nomena Finiavana; Randrianasolo, Rahamefy Odilon; Rajaonarison, Lala Andriamasinavalona; Rakotomanana, Jenny Larissa; Razafimahefa, Julien; Tehindrazanarivelo, Alain Djacoba

    2017-01-01

    Strokes of the perforating arteries are mainly arteriolopathies. They result in dementia and stroke recurrence. This study aimed to evaluate the frequency and characteristics of these strokes to better prevent these complications. We conducted a descriptive, retrospective study in the department of neurology at the Befelatanana general hospital, Antananarivo over the period 01 March-25 September 2015. All patients with abrupt neurological deficit and deep brain involvement on brain scanner were included in the study. The features of strokes involving the perforating arteries were collected. Data were processed with SPSS 20 software. Out of 172 patients with a stroke, 83(48.25%) had stroke involving the perforating arteries. Stroke involving the perforating arteries affected young people (65.06%) aged less than 65 years and preferentially the male population (61.44%). Haemorrhagic forms accounted for 67.46%. Thirty-one patients (37.34%) had stroke recurrences and, among them, almost a quarter had 2 recurrences (38.70%) in less than a year. All patients with recurrence had dysexecutive disorder (p < 0.0001) and poor antihypertensive medication adherence. Mortality accounted for only 6.02% in patients with onset of these strokes during hospitalization. Specific neurologic follow-up is necessary after a first stroke involving perforating arteries in order to make an early diagnosis of dementia and to prevent recurrences.

  3. [Automobile driving capacity in dementia].

    Science.gov (United States)

    Seeger, Rolf

    2015-04-01

    Dementia influences at an early stage the driving aptitude of motor vehicle steering persons. Every year in Switzerland, around 16'000 driving permit holders suffer newly from dementia; therefore the driving aptitude is questioned, especially because of possibly limited executive functions. Individuals with early-stage dementia often may show a dangerous driving stile. However, a mild dementia does not a priori exclude the driving aptitude, and less than half of these drivers can continue driving for another 1 - 3 years. In contrast, there is no further driving aptitude in presence of moderate dementia. In the assessment of driving aptitude, the underlying cause of dementia is always taken into account. Cognitive short tests such as the Mini-Mental Status Exam, Clock Drawing Test and Trail-Making Test are not suitable to make reliable statements about the aptitude to drive, but these tests are very important for the initial diagnosis of dementia in primary care practice and can lead the way for further examination concerning driving aptitude. The legally prescribed regular check-up for motorists aged over 70 years in Switzerland provides an ideal opportunity for early detection of incipient dementia. The practical procedure for the assessment of aptitude to drive in the primary care practice is presented. The physician-guided on-road driving test represents a meaningful, practical and relatively cost-effective tool for the evaluation of driving aptitude in cases of doubt.

  4. Diagnosis and management of dementia

    African Journals Online (AJOL)

    2007-09-19

    Sep 19, 2007 ... Dementia is an acquired syndrome of memory decline with at least one other cognitive deficit in language, ... the diagnosis and management of dementia, memory lapses in the elderly are still erroneously brushed off at ..... because of sedation and anticholinergic side-effects. BPSD are associated with a.

  5. The MRI brain correlates of depressed mood, anhedonia, apathy, and anergia in older adults with and without cognitive impairment or dementia

    Science.gov (United States)

    Lavretsky, Helen; Zheng, Ling; Weiner, Michael W.; Mungas, Dan; Reed, Bruce; Kramer, Joel H.; Jagust, William; Chui, Helena; Mack, Wendy J.

    2008-01-01

    SUMMARY Objectives We examined the magnetic resonance imaging (MRI) correlates of depressed mood, apathy, anhedonia, and anergia in older adults with and without cognitive impairment or dementia. Methods This analysis included 270 community-dwelling older adults (59% male; 79% Caucasian; mean age 74.4 years) who were recruited into a multi-center longitudinal observational study of subcortical ischemic vascular disease (SIVD).The distribution of cognitive status included: cognitively intact (38%), cognitively impaired (27%), or demented (35%). All subjects underwent MRI and 41% were classified as having subcortical lacunes. MRI measures included cortical gray and white matter volumes, lacunar volumes in subcortical white and gray matter structures, volume of white matter hyperintensities, and total hippocampal volume. Depressed mood, anhedonia, anergia, and apathy apparent at the time of assessment were assessed using a behavioral assessment Associations between neuropsychiatric symptoms and MRI variables were evaluated using logistic regression. Results Subjects with neuropsychiatric symptoms were more likely to be cognitively impaired or demented than those without neuropsychiatric symptoms. In multivariate models controlling for cognitive status, age, gender, and education, higher lacunar volume in white matter was independently associated with the presence of all four neuropsychiatric symptoms. Conclusions We report an association between the lacunar volumes in the white matter and depressed mood, anhedonia, apathy, and anergia, thus supporting the role of subcortical ischemic vascular disease in the pathogenesis of late-life neuropsychiatric disorders. PMID:18412291

  6. [Dementia due to Endocrine Diseases].

    Science.gov (United States)

    Matsunaga, Akiko; Yoneda, Makoto

    2016-04-01

    Endocrine diseases affecting various organs, such as the pituitary gland, the thyroid, the parathyroid, the adrenal glands and the pancreas, occasionally cause dementia. While Alzheimer's disease (AD) is the main cause of dementia in the elderly and is untreatable, dementia caused by endocrine diseases is treatable in most cases. However, patients with dementia associated with endocrine diseases show memory impairments similar to those found in AD, often leading to misdiagnoses. Patients with endocrine diseases often present with other characteristic systemic and neuropsychiatric symptoms caused by altered hormone levels. Such neuropsychiatric symptoms include involuntary movements, depression, seizures, and muscle weakness. In these cases, abnormalities in imaging and blood or urine tests are helpful in making a differential diagnosis. As delays in the diagnosis and treatment of these patients may cause irreversible brain damage, it is imperative for clinicians to carefully exclude the possibility of latent endocrine diseases when treating patients with dementia.

  7. Atrial fibrillation, stroke, and quality of life.

    Science.gov (United States)

    Chinitz, Jason S; Castellano, Jose M; Kovacic, Jason C; Fuster, Valentin

    2012-04-01

    Contemporary management of atrial fibrillation imposes many challenges, particularly in the setting of our aging population. In addition to well-recognized consequences, such as stroke and mortality, emerging evidence relates atrial fibrillation to elevated risk of dementia, posing further therapeutic challenges. As the incidence of atrial fibrillation rises with age, the balance of controlling stroke risk and limiting major hemorrhage on anticoagulation has become increasingly critical in elderly patients. Appreciation of more extensive risk factors has made it possible to identify patients at very low risk of thromboembolism and higher risk of bleeding. However, practice guidelines in the United States and abroad have occasionally divergent viewpoints regarding how to best manage patients in various risk strata. Options for stroke prevention have expanded with novel antithrombotics and promising mechanical alternatives to anticoagulation, which may be at least as effective in preventing stroke without increasing bleeding risk. Catheter ablation has demonstrated impressive success at preventing atrial fibrillation recurrence in selected patients, and has the potential to further improve outcomes. In addition, the role of antiplatelet medications in patients deemed unsuitable for anticoagulation has been better clarified, although novel agents require further study to assess their impact on thromboembolism. High-bleeding risks associated with the concomitant use of multiple antithrombotics remains a major obstacle in patients with indications for both antiplatelet and anticoagulant therapy. © 2012 New York Academy of Sciences.

  8. Teaching Mands to Older Adults with Dementia

    Science.gov (United States)

    Oleson, Chelsey R.; Baker, Jonathan C.

    2014-01-01

    Millions of Americans are diagnosed with dementia, and that number is only expected to rise. The diagnosis of dementia comes with impairments, especially in language. Furthermore, dementia-related functional declines appear to be moderated by environmental variables (Alzheimer's Association, "Alzheimer's & Dementia: The Journal of the…

  9. Increased risk of dementia in patients with mild traumatic brain injury: a nationwide cohort study.

    Directory of Open Access Journals (Sweden)

    Yi-Kung Lee

    Full Text Available BACKGROUND: It is known that the risk of dementia in patients with moderate to severe traumatic brain injury (TBI is higher. However, the relationship between mild traumatic brain injury (mTBI and dementia has never been established. OBJECTIVES: We investigated the incidences of dementia among patients with mTBI in Taiwan to evaluate if there is higher risk compared with general population. METHODS: We utilized a sampled National Health Insurance (NHI claims data containing one million beneficiaries. We followed all adult beneficiaries from January 1, 2005 till December 31, 2009 to see if they had been diagnosed with dementia. We further identify patients with mTBI and compared their risk of dementia with the general population. RESULTS: We identified 28551 patients with mTBI and 692382 without. After controlled for age, gender, urbanization level, socioeconomic status, diabetes, hypertension, coronary artery disease, hyperlipidemia, history of alcohol intoxication, history of ischemic stroke, history of intracranial hemorrhage and Charlson Comorbidity Index Score, the adjusted hazard ratio is 3.26 (95% Confidence interval, 2.69-3.94. CONCLUSIONS: TBI is an independent significant risk factor of developing dementia even in the mild type.

  10. Acute phencyclidine administration induces c-Fos-immunoreactivity in interneurons in cortical and subcortical regions

    DEFF Research Database (Denmark)

    Hervig, Mona E; Thomsen, Morten S; Kalló, Imre

    2016-01-01

    and subcortical areas, but whether such induction occurs in specific populations of GABAergic interneuron subtypes still remains to be established. We performed an immunohistochemical analysis of the PCP-induced c-Fos-immunoreactivity (IR) in parvalbumin (PV) and calbindin (CB) interneuron subtypes in the cortex...... and thalamus of rats. A single dose of PCP (10mg/kg, s.c.) significantly increased total number of c-Fos-IR in: (1) the prelimbic, infralimbic, anterior cingulate, ventrolateral orbital, motor, somatosensory and retrosplenial cortices as well as the nucleus accumbens (NAc), field CA1 of the hippocampus (CA1......) field of hippocampus and mediodorsal thalamus (MD); (2) PV-IR cells in the ventrolateral orbitofrontal and retrosplenial cortices and CA1 field of hippocampus; and (3) CB-IR cells in the motor cortex. Overall, our data indicate that PCP activates a wide range of cortical and subcortical brain regions...

  11. Retinal projections to the subcortical visual system in congenic albino and pigmented rats

    Science.gov (United States)

    Fleming, Mark D.; Benca, Ruth M.; Behan, Mary

    2007-01-01

    The primary visual pathway in albino mammals is characterized by an increased decussation of retinal ganglion cell axons at the optic chiasm and an enhanced contralateral projection to the dorsal lateral geniculate nucleus. In contrast to the primary visual pathway, little is known about the organization of retinal input to most nuclei of the subcortical visual system in albino mammals. The subcortical visual system is a large group of retinorecipient nuclei in the diencephalon and mesencephalon. These areas mediate a range of behaviors that include both circadian and acute responses to light. We used a congenic strain of albino and pigmented rats with a mutation at the c locus for albinism (Fischer 344-c/+; La Vail and Lawson, 1986) to quantitatively assess the effects of albinism on retinal projections to a number of subcortical visual nuclei including the ventral lateral hypothalamus (VLH), ventral lateral preoptic area (VLPO), olivary pretectal nucleus (OPN), posterior limitans (PLi), commissural pretectal area (CPA), intergeniculate leaflet (IGL), ventral lateral geniculate nucleus (vLGN) and superior colliculus (SC). Following eye injections of the neuroanatomical tracer cholera toxin-β, the distribution of anterogradely transported label was measured. The retinal projection to the contralateral VLH, PLi, CPA and IGL was enhanced in albino rats. No significant differences were found between albino and pigmented rats in retinal input to the VLPO, OPN and vLGN. These findings raise the possibility that enhanced retinofugal projections to subcortical visual nuclei in albinos may underlie some light-mediated behaviors that differ between albino and pigmented mammals. PMID:16996223

  12. The role of frontal-subcortical circuits in the development of obsessive-compulsive disorders

    OpenAIRE

    M. A. Kutlubaev

    2016-01-01

    The paper presents a concise review of investigations into the role of impaired frontal-subcortical circuits in the development of obsessive-compulsive disorder (OCD). It gives data on the frequency of neurosis-like symptoms of the OCD spectrum in neurological diseases.The development of OCD is associated with an imbalance between the activity of the direct (activating) and indirect (inhibitory) pathways of the cortico-striatal-thalamo-cortical feedback loop. These data are confirmed by the r...

  13. Early developmental gene enhancers affect subcortical volumes in the adult human brain.

    Science.gov (United States)

    Becker, Martin; Guadalupe, Tulio; Franke, Barbara; Hibar, Derrek P; Renteria, Miguel E; Stein, Jason L; Thompson, Paul M; Francks, Clyde; Vernes, Sonja C; Fisher, Simon E

    2016-05-01

    Genome-wide association screens aim to identify common genetic variants contributing to the phenotypic variability of complex traits, such as human height or brain morphology. The identified genetic variants are mostly within noncoding genomic regions and the biology of the genotype-phenotype association typically remains unclear. In this article, we propose a complementary targeted strategy to reveal the genetic underpinnings of variability in subcortical brain volumes, by specifically selecting genomic loci that are experimentally validated forebrain enhancers, active in early embryonic development. We hypothesized that genetic variation within these enhancers may affect the development and ultimately the structure of subcortical brain regions in adults. We tested whether variants in forebrain enhancer regions showed an overall enrichment of association with volumetric variation in subcortical structures of >13,000 healthy adults. We observed significant enrichment of genomic loci that affect the volume of the hippocampus within forebrain enhancers (empirical P = 0.0015), a finding which robustly passed the adjusted threshold for testing of multiple brain phenotypes (cutoff of P < 0.0083 at an alpha of 0.05). In analyses of individual single nucleotide polymorphisms (SNPs), we identified an association upstream of the ID2 gene with rs7588305 and variation in hippocampal volume. This SNP-based association survived multiple-testing correction for the number of SNPs analyzed but not for the number of subcortical structures. Targeting known regulatory regions offers a way to understand the underlying biology that connects genotypes to phenotypes, particularly in the context of neuroimaging genetics. This biology-driven approach generates testable hypotheses regarding the functional biology of identified associations. Hum Brain Mapp 37:1788-1800, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Genetic influences on schizophrenia and subcortical brain volumes: large-scale proof of concept

    OpenAIRE

    Franke, B.; Stein, J. L.; Ripke, S.; Anttila, V.; Hibar, D. P.; van Hulzen, K. J.; Arias-Vasquez, A.; Smoller, J. W.; Nichols, T. E.; Neale, M. C.; McIntosh, A. M.; Lee, P.; McMahon, F. J.; Meyer-Lindenberg, A.; Mattheisen, M.

    2016-01-01

    Schizophrenia is a devastating psychiatric illness with high heritability. Brain structure and function differ, on average, between people with schizophrenia and healthy individuals. As common genetic associations are emerging for both schizophrenia and brain imaging phenotypes, we can now use genome-wide data to investigate genetic overlap. Here we integrated results from common variant studies of schizophrenia (33,636 cases, 43,008 controls) and volumes of several (mainly subcortical) brain...

  15. Abnormal subcortical brain morphology in patients with knee osteoarthritis: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Cui Ping eMao

    2016-01-01

    Full Text Available Despite the involvement of subcortical brain structures in the pathogenesis of chronic pain and persistent pain as the defining symptom of knee osteoarthritis (KOA, little attention has been paid to the morphometric measurements of these subcortical nuclei in patients with KOA. The purpose of this study is to explore the potential morphological abnormalities of subcortical brain structures in patients with KOA as compared to healthy control subjects by using high resolution MRI. Structural MRI data were acquired from 26 patients with KOA and 31 demographically similar healthy individuals. The MR data were analyzed by using FMRIB's integrated registration and segmentation tool (FIRST. Both volumetric analysis and surface-based shape analysis were performed to characterize the subcortical morphology. The normalized volumes of bilateral caudate nucleus were significantly smaller in the KOA group than in the control group (P = 0.004. There was also a trend toward smaller volume of the hippocampus in KOA as compared to the control group (P = 0.027. Detailed surface analyses further localized these differences with a greater involvement of the left hemisphere (P < 0.05, corrected for the caudate nucleus. Hemispheric asymmetry (right larger than left of the caudate nucleus was found in both KOA and control groups. Besides, no significant correlation was found between the structural data and pain intensities. Our results indicated that patients with KOA had statistically significant smaller normalized volumes of bilateral caudate nucleus and a trend toward smaller volume of the hippocampus as compared to the control subjects. Further investigations are necessary to characterize the role of caudate nucleus in the course of chronicity of pain associated with KOA.

  16. Hearing it again and again: on-line subcortical plasticity in humans.

    Science.gov (United States)

    Skoe, Erika; Kraus, Nina

    2010-10-26

    Human brainstem activity is sensitive to local sound statistics, as reflected in an enhanced response in repetitive compared to pseudo-random stimulus conditions [1]. Here we probed the short-term time course of this enhancement using a paradigm that assessed how the local sound statistics (i.e., repetition within a five-note melody) interact with more global statistics (i.e., repetition of the melody). To test the hypothesis that subcortical repetition enhancement builds over time, we recorded auditory brainstem responses in young adults to a five-note melody containing a repeated note, and monitored how the response changed over the course of 1.5 hrs. By comparing response amplitudes over time, we found a robust time-dependent enhancement to the locally repeating note that was superimposed on a weaker enhancement of the globally repeating pattern. We provide the first demonstration of on-line subcortical plasticity in humans. This complements previous findings that experience-dependent subcortical plasticity can occur on a number of time scales, including life-long experiences with music and language, and short-term auditory training. Our results suggest that the incoming stimulus stream is constantly being monitored, even when the stimulus is physically invariant and attention is directed elsewhere, to augment the neural response to the most statistically salient features of the ongoing stimulus stream. These real-time transformations, which may subserve humans' strong disposition for grouping auditory objects, likely reflect a mix of local processes and corticofugal modulation arising from statistical regularities and the influences of expectation. Our results contribute to our understanding of the biological basis of statistical learning and initiate a new investigational approach relating to the time-course of subcortical plasticity. Although the reported time-dependent enhancements are believed to reflect universal neurophysiological processes, future

  17. Hearing it again and again: on-line subcortical plasticity in humans.

    Directory of Open Access Journals (Sweden)

    Erika Skoe

    2010-10-01

    Full Text Available Human brainstem activity is sensitive to local sound statistics, as reflected in an enhanced response in repetitive compared to pseudo-random stimulus conditions [1]. Here we probed the short-term time course of this enhancement using a paradigm that assessed how the local sound statistics (i.e., repetition within a five-note melody interact with more global statistics (i.e., repetition of the melody.To test the hypothesis that subcortical repetition enhancement builds over time, we recorded auditory brainstem responses in young adults to a five-note melody containing a repeated note, and monitored how the response changed over the course of 1.5 hrs. By comparing response amplitudes over time, we found a robust time-dependent enhancement to the locally repeating note that was superimposed on a weaker enhancement of the globally repeating pattern.We provide the first demonstration of on-line subcortical plasticity in humans. This complements previous findings that experience-dependent subcortical plasticity can occur on a number of time scales, including life-long experiences with music and language, and short-term auditory training. Our results suggest that the incoming stimulus stream is constantly being monitored, even when the stimulus is physically invariant and attention is directed elsewhere, to augment the neural response to the most statistically salient features of the ongoing stimulus stream. These real-time transformations, which may subserve humans' strong disposition for grouping auditory objects, likely reflect a mix of local processes and corticofugal modulation arising from statistical regularities and the influences of expectation. Our results contribute to our understanding of the biological basis of statistical learning and initiate a new investigational approach relating to the time-course of subcortical plasticity. Although the reported time-dependent enhancements are believed to reflect universal neurophysiological

  18. Early Developmental Gene Enhancers Affect Subcortical Volumes in the Adult Human Brain

    Science.gov (United States)

    Becker, Martin; Guadalupe, Tulio; Franke, Barbara; Hibar, Derrek P.; Renteria, Miguel E.; Stein, Jason L.; Thompson, Paul M.; Francks, Clyde; Vernes, Sonja C.; Fisher, Simon E.

    2016-01-01

    Genome-wide association screens aim to identify common genetic variants contributing to the phenotypic variability of complex traits, such as human height or brain morphology. The identified genetic variants are mostly within noncoding genomic regions and the biology of the genotype–phenotype association typically remains unclear. In this article, we propose a complementary targeted strategy to reveal the genetic underpinnings of variability in subcortical brain volumes, by specifically selecting genomic loci that are experimentally validated forebrain enhancers, active in early embryonic development. We hypothesized that genetic variation within these enhancers may affect the development and ultimately the structure of subcortical brain regions in adults. We tested whether variants in forebrain enhancer regions showed an overall enrichment of association with volumetric variation in subcortical structures of >13,000 healthy adults. We observed significant enrichment of genomic loci that affect the volume of the hippocampus within forebrain enhancers (empirical P = 0.0015), a finding which robustly passed the adjusted threshold for testing of multiple brain phenotypes (cutoff of P < 0.0083 at an alpha of 0.05). In analyses of individual single nucleotide polymorphisms (SNPs), we identified an association upstream of the ID2 gene with rs7588305 and variation in hippocampal volume. This SNP-based association survived multiple-testing correction for the number of SNPs analyzed but not for the number of subcortical structures. Targeting known regulatory regions offers a way to understand the underlying biology that connects genotypes to phenotypes, particularly in the context of neuroimaging genetics. This biology-driven approach generates testable hypotheses regarding the functional biology of identified associations. PMID:26890892

  19. Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients.

    Science.gov (United States)

    Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang

    2017-05-01

    Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing. Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests. OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients. OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Does Stroke Contribute to Racial Differences in Cognitive Decline?

    Science.gov (United States)

    Levine, Deborah A.; Kabeto, Mohammed; Langa, Kenneth M.; Lisabeth, Lynda D.; Rogers, Mary A.M.; Galecki, Andrzej T.

    2015-01-01

    Background and Purpose It is unknown whether blacks’ elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition. Methods Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998–2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time. Results We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black–white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; Pstroke on cognition did not statistically differ by race (P=0.52). Conclusions In this population-based cohort of older adults, incident stroke did not explain black–white differences in cognitive decline or impact cognition differently by race. PMID:25999389

  1. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Association between exercise habits and subcortical gray matter volumes in healthy elderly people: A population-based study in Japan

    Directory of Open Access Journals (Sweden)

    Mikie Yamamoto

    2017-06-01

    Conclusion: Subjects with exercise habits show larger subcortical gray matter volumes than subjects without exercise habits in community-dwelling elderly subjects in Japan. Specifically, the volume of the nucleus accumbens correlates with both exercise habits and cognitive preservation.

  3. Human subcortical brain asymmetries in 15,847 people worldwide reveal effects of age and sex.

    Science.gov (United States)

    Guadalupe, Tulio; Mathias, Samuel R; vanErp, Theo G M; Whelan, Christopher D; Zwiers, Marcel P; Abe, Yoshinari; Abramovic, Lucija; Agartz, Ingrid; Andreassen, Ole A; Arias-Vásquez, Alejandro; Aribisala, Benjamin S; Armstrong, Nicola J; Arolt, Volker; Artiges, Eric; Ayesa-Arriola, Rosa; Baboyan, Vatche G; Banaschewski, Tobias; Barker, Gareth; Bastin, Mark E; Baune, Bernhard T; Blangero, John; Bokde, Arun L W; Boedhoe, Premika S W; Bose, Anushree; Brem, Silvia; Brodaty, Henry; Bromberg, Uli; Brooks, Samantha; Büchel, Christian; Buitelaar, Jan; Calhoun, Vince D; Cannon, Dara M; Cattrell, Anna; Cheng, Yuqi; Conrod, Patricia J; Conzelmann, Annette; Corvin, Aiden; Crespo-Facorro, Benedicto; Crivello, Fabrice; Dannlowski, Udo; de Zubicaray, Greig I; de Zwarte, Sonja M C; Deary, Ian J; Desrivières, Sylvane; Doan, Nhat Trung; Donohoe, Gary; Dørum, Erlend S; Ehrlich, Stefan; Espeseth, Thomas; Fernández, Guillén; Flor, Herta; Fouche, Jean-Paul; Frouin, Vincent; Fukunaga, Masaki; Gallinat, Jürgen; Garavan, Hugh; Gill, Michael; Suarez, Andrea Gonzalez; Gowland, Penny; Grabe, Hans J; Grotegerd, Dominik; Gruber, Oliver; Hagenaars, Saskia; Hashimoto, Ryota; Hauser, Tobias U; Heinz, Andreas; Hibar, Derrek P; Hoekstra, Pieter J; Hoogman, Martine; Howells, Fleur M; Hu, Hao; Hulshoff Pol, Hilleke E; Huyser, Chaim; Ittermann, Bernd; Jahanshad, Neda; Jönsson, Erik G; Jurk, Sarah; Kahn, Rene S; Kelly, Sinead; Kraemer, Bernd; Kugel, Harald; Kwon, Jun Soo; Lemaitre, Herve; Lesch, Klaus-Peter; Lochner, Christine; Luciano, Michelle; Marquand, Andre F; Martin, Nicholas G; Martínez-Zalacaín, Ignacio; Martinot, Jean-Luc; Mataix-Cols, David; Mather, Karen; McDonald, Colm; McMahon, Katie L; Medland, Sarah E; Menchón, José M; Morris, Derek W; Mothersill, Omar; Maniega, Susana Munoz; Mwangi, Benson; Nakamae, Takashi; Nakao, Tomohiro; Narayanaswaamy, Janardhanan C; Nees, Frauke; Nordvik, Jan E; Onnink, A Marten H; Opel, Nils; Ophoff, Roel; Paillère Martinot, Marie-Laure; Papadopoulos Orfanos, Dimitri; Pauli, Paul; Paus, Tomáš; Poustka, Luise; Reddy, Janardhan Yc; Renteria, Miguel E; Roiz-Santiáñez, Roberto; Roos, Annerine; Royle, Natalie A; Sachdev, Perminder; Sánchez-Juan, Pascual; Schmaal, Lianne; Schumann, Gunter; Shumskaya, Elena; Smolka, Michael N; Soares, Jair C; Soriano-Mas, Carles; Stein, Dan J; Strike, Lachlan T; Toro, Roberto; Turner, Jessica A; Tzourio-Mazoyer, Nathalie; Uhlmann, Anne; Hernández, Maria Valdés; van den Heuvel, Odile A; van der Meer, Dennis; van Haren, Neeltje E M; Veltman, Dick J; Venkatasubramanian, Ganesan; Vetter, Nora C; Vuletic, Daniella; Walitza, Susanne; Walter, Henrik; Walton, Esther; Wang, Zhen; Wardlaw, Joanna; Wen, Wei; Westlye, Lars T; Whelan, Robert; Wittfeld, Katharina; Wolfers, Thomas; Wright, Margaret J; Xu, Jian; Xu, Xiufeng; Yun, Je-Yeon; Zhao, JingJing; Franke, Barbara; Thompson, Paul M; Glahn, David C; Mazoyer, Bernard; Fisher, Simon E; Francks, Clyde

    2017-10-01

    The two hemispheres of the human brain differ functionally and structurally. Despite over a century of research, the extent to which brain asymmetry is influenced by sex, handedness, age, and genetic factors is still controversial. Here we present the largest ever analysis of subcortical brain asymmetries, in a harmonized multi-site study using meta-analysis methods. Volumetric asymmetry of seven subcortical structures was assessed in 15,847 MRI scans from 52 datasets worldwide. There were sex differences in the asymmetry of the globus pallidus and putamen. Heritability estimates, derived from 1170 subjects belonging to 71 extended pedigrees, revealed that additive genetic factors influenced the asymmetry of these two structures and that of the hippocampus and thalamus. Handedness had no detectable effect on subcortical asymmetries, even in this unprecedented sample size, but the asymmetry of the putamen varied with age. Genetic drivers of asymmetry in the hippocampus, thalamus and basal ganglia may affect variability in human cognition, including susceptibility to psychiatric disorders.

  4. A high-resolution probabilistic in vivo atlas of human subcortical brain nuclei.

    Science.gov (United States)

    Pauli, Wolfgang M; Nili, Amanda N; Tyszka, J Michael

    2018-04-17

    Recent advances in magnetic resonance imaging methods, including data acquisition, pre-processing and analysis, have benefited research on the contributions of subcortical brain nuclei to human cognition and behavior. At the same time, these developments have led to an increasing need for a high-resolution probabilistic in vivo anatomical atlas of subcortical nuclei. In order to address this need, we constructed high spatial resolution, three-dimensional templates, using high-accuracy diffeomorphic registration of T 1 - and T 2 - weighted structural images from 168 typical adults between 22 and 35 years old. In these templates, many tissue boundaries are clearly visible, which would otherwise be impossible to delineate in data from individual studies. The resulting delineations of subcortical nuclei complement current histology-based atlases. We further created a companion library of software tools for atlas development, to offer an open and evolving resource for the creation of a crowd-sourced in vivo probabilistic anatomical atlas of the human brain.

  5. Energy landscape analysis of the subcortical brain network unravels system properties beneath resting state dynamics.

    Science.gov (United States)

    Kang, Jiyoung; Pae, Chongwon; Park, Hae-Jeong

    2017-04-01

    The configuration of the human brain system at rest, which is in a transitory phase among multistable states, remains unknown. To investigate the dynamic systems properties of the human brain at rest, we constructed an energy landscape for the state dynamics of the subcortical brain network, a critical center that modulates whole brain states, using resting state fMRI. We evaluated alterations in energy landscapes following perturbation in network parameters, which revealed characteristics of the state dynamics in the subcortical brain system, such as maximal number of attractors, unequal temporal occupations, and readiness for reconfiguration of the system. Perturbation in the network parameters, even those as small as the ones in individual nodes or edges, caused a significant shift in the energy landscape of brain systems. The effect of the perturbation on the energy landscape depended on the network properties of the perturbed nodes and edges, with greater effects on hub nodes and hubs-connecting edges in the subcortical brain system. Two simultaneously perturbed nodes produced perturbation effects showing low sensitivity in the interhemispheric homologous nodes and strong dependency on the more primary node among the two. This study demonstrated that energy landscape analysis could be an important tool to investigate alterations in brain networks that may underlie certain brain diseases, or diverse brain functions that may emerge due to the reconfiguration of the default brain network at rest. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Low- and high-frequency subcortical SEP amplitude reduction during pure passive movement.

    Science.gov (United States)

    Insola, Angelo; Padua, Luca; Mazzone, Paolo; Valeriani, Massimiliano

    2015-12-01

    To investigate the effect of pure passive movement on both cortical and subcortical somatosensory evoked potentials (SEPs). Median nerve SEPs were recorded in 8 patients suffering from Parkinson's disease (PD) and two patients with essential tremor. PD patients underwent electrode implantation in the subthalamic (STN) nucleus (3 patients) and pedunculopontine (PPTg) nucleus (5 patients), while 2 patients with essential tremor were implanted in the ventral intermediate nucleus (VIM) of the thalamus. In anesthetized patients, SEPs were recorded at rest and during a passive movement of the thumb of the stimulated wrist from the intracranial electrode contacts and from the scalp. Also the high-frequency oscillations (HFOs) were analyzed. Amplitudes of both deep and scalp components were decreased during passive movement, but the reduction was higher at cortical than subcortical level. Also the HFOs were reduced by movement. The different amount of the movement-related decrease suggests that the cortical SEP gating is not only the result of a subcortical somatosensory volley attenuation, but a further mechanism acting at cortical level should be considered. Our results are important for understanding the physiological mechanism of the sensory-motor interaction during passive movement. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Behavioral and subcortical signatures of musical expertise in Mandarin Chinese speakers.

    Science.gov (United States)

    Dawson, Caitlin; Tervaniemi, Mari; Aalto, Daniel

    2018-01-01

    Both musical training and native language have been shown to have experience-based plastic effects on auditory processing. However, the combined effects within individuals are unclear. Recent research suggests that musical training and tone language speaking are not clearly additive in their effects on processing of auditory features and that there may be a disconnect between perceptual and neural signatures of auditory feature processing. The literature has only recently begun to investigate the effects of musical expertise on basic auditory processing for different linguistic groups. This work provides a profile of primary auditory feature discrimination for Mandarin speaking musicians and nonmusicians. The musicians showed enhanced perceptual discrimination for both frequency and duration as well as enhanced duration discrimination in a multifeature discrimination task, compared to nonmusicians. However, there were no differences between the groups in duration processing of nonspeech sounds at a subcortical level or in subcortical frequency representation of a nonnative tone contour, for fo or for the first or second formant region. The results indicate that musical expertise provides a cognitive, but not subcortical, advantage in a population of Mandarin speakers.

  8. Expanded functional coupling of subcortical nuclei with the motor resting-state network in multiple sclerosis.

    Science.gov (United States)

    Dogonowski, Anne-Marie; Siebner, Hartwig R; Sørensen, Per Soelberg; Wu, Xingchen; Biswal, Bharat; Paulson, Olaf B; Dyrby, Tim B; Skimminge, Arnold; Blinkenberg, Morten; Madsen, Kristoffer H

    2013-04-01

    Multiple sclerosis (MS) impairs signal transmission along cortico-cortical and cortico-subcortical connections, affecting functional integration within the motor network. Functional magnetic resonance imaging (fMRI) during motor tasks has revealed altered functional connectivity in MS, but it is unclear how much motor disability contributed to these abnormal functional interaction patterns. To avoid any influence of impaired task performance, we examined disease-related changes in functional motor connectivity in MS at rest. A total of 42 patients with MS and 30 matched controls underwent a 20-minute resting-state fMRI session at 3 Tesla. Independent component analysis was applied to the fMRI data to identify disease-related changes in motor resting-state connectivity. Patients with MS showed a spatial expansion of motor resting-state connectivity in deep subcortical nuclei but not at the cortical level. The anterior and middle parts of the putamen, adjacent globus pallidus, anterior and posterior thalamus and the subthalamic region showed stronger functional connectivity with the motor network in the MS group compared with controls. MS is characterised by more widespread motor connectivity in the basal ganglia while cortical motor resting-state connectivity is preserved. The expansion of subcortical motor resting-state connectivity in MS indicates less efficient funnelling of neural processing in the executive motor cortico-basal ganglia-thalamo-cortical loops.

  9. Intra- and interhemispheric variations of diffusivity in subcortical white matter in normal human brain

    Energy Technology Data Exchange (ETDEWEB)

    Yoshiura, Takashi; Noguchi, Tomoyuki; Hiwatashi, Akio; Togao, Osamu; Yamashita, Koji; Nagao, Eiki; Kamano, Hironori; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan)

    2010-01-15

    Our purpose was to reveal potential regional variations in water molecular diffusivity within each cerebral hemisphere and across the right and left hemispheres. Diffusion-weighted images of 44 healthy right-handed adult male subjects were obtained using a diffusion tensor imaging sequence. Mean diffusivity (MD) values in subcortical white matter (WM) within 39 regions in each hemisphere were measured using an automated method. Intrahemispheric comparisons of MDs in subcortical WM were performed among six brain regions (frontal, parietal, occipital and temporal lobes and pre- and postcentral gyri). Interhemispheric comparisons of MDs were performed between the right and left counterparts of the 39 regions. In both hemispheres, diffusivity in the precentral gyrus was lower than those in other regions, while diffusivity in the parietal lobe was higher than others. MD asymmetry in which the left was lower than the right was found in the parietal lobe, middle occipital gyrus, and medial and orbital aspects of the frontal lobe. The converse asymmetry was revealed in the frontal operculum, supplementary motor cortex, temporal lobe, limbic cortices, precuneus and cuneus. Our results revealed significant intra- and interhemispheric regional variations in MD in subcortical WM, which may be related to different densities of axons and myelin sheaths. (orig.)

  10. Common late-onset subcortical cerebral hemorrhage following excessive alcohol consumption: a case report

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.; Velioglu, M.; Aribal, S.; Sonmez, G.; Basekim, C.

    2012-01-01

    Full text: 50 year old male patient who was suffering from cooperation disorder and bilaterally blindness was admitted to our emergency service. He was addicted to alcohol and had excessive alcohol consumption the day before. Cranial nonenhanced CT was normal. T2 weighed MR imaging performed at 1,5 T unit showed high signal intensity in bilateral putaminal foci. In this localization diffusion-weighed images (DWI) were hyperintense due to restricted diffusion and low ADC values. After two weeks, drowsiness and confusion were appeared suddenly. Cranial nonenhanced CT was showed extensive subcortical white matter and basal ganglia abnormalities consistent with edema and hemorrhagic changes. The patient was transferred to intensive care unit and died after one day. In methanol intoxication, cerebral and intraventricular hemorrhage, cerebellar necrosis, diffuse cerebral edema, bilateral subcortical white matter necrosis and edema were defined It should also be known that 2 or 3 weeks after ingestion of methyl alcohol, the deterioration of the patient's general situation is responsible for cerebral subcortical hemorrhage. We have also thought that patients' mortality and morbidity can be reduced with radiological imaging due to early diagnosis

  11. Behavioral and subcortical signatures of musical expertise in Mandarin Chinese speakers.

    Directory of Open Access Journals (Sweden)

    Caitlin Dawson

    Full Text Available Both musical training and native language have been shown to have experience-based plastic effects on auditory processing. However, the combined effects within individuals are unclear. Recent research suggests that musical training and tone language speaking are not clearly additive in their effects on processing of auditory features and that there may be a disconnect between perceptual and neural signatures of auditory feature processing. The literature has only recently begun to investigate the effects of musical expertise on basic auditory processing for different linguistic groups. This work provides a profile of primary auditory feature discrimination for Mandarin speaking musicians and nonmusicians. The musicians showed enhanced perceptual discrimination for both frequency and duration as well as enhanced duration discrimination in a multifeature discrimination task, compared to nonmusicians. However, there were no differences between the groups in duration processing of nonspeech sounds at a subcortical level or in subcortical frequency representation of a nonnative tone contour, for fo or for the first or second formant region. The results indicate that musical expertise provides a cognitive, but not subcortical, advantage in a population of Mandarin speakers.

  12. Subcortical volumetric differences between clinical stages of young people with affective and psychotic disorders.

    Science.gov (United States)

    Eggins, Peta S; Hatton, Sean N; Hermens, Daniel F; Hickie, Ian B; Lagopoulos, Jim

    2018-01-30

    The aim of this study was to investigate differences in subcortical and hippocampal volumes between healthy controls, young people at an early stage of affective and psychotic disorders and those in more advanced stages, to identify markers associated with functional outcomes and illness severity. Young people presenting to youth mental health services with admixtures of depressive, manic and psychotic symptoms (n = 141), and healthy counterparts (n = 49), aged 18-25 were recruited. Participants underwent magnetic resonance imaging, clinical assessments and were rated as to their current clinical stage. Eighty-four patients were classified at the attenuated syndrome stage (Stage 1b) and 57 were classified as having discrete and persistent disorders (Stage 2+). Automated segmentation was performed using NeuroQuant® to determine volumes of subcortical and hippocampus structures which were compared between groups and correlated with clinical and functional outcomes. Compared to healthy controls, Stage 2+ patients showed significantly reduced right amygdala volumes. Whereas Stage 1b patients showed significantly reduced left caudate volumes compared to healthy controls. Smaller left caudate volume correlated with greater psychological distress and impaired functioning. This study shows a clinical application for an automated program to identify and track subcortical changes evident in young people with emerging psychopathology. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  13. Visual exploration in Parkinson's disease and Parkinson's disease dementia.

    Science.gov (United States)

    Archibald, Neil K; Hutton, Sam B; Clarke, Michael P; Mosimann, Urs P; Burn, David J

    2013-03-01

    Parkinson's disease, typically thought of as a movement disorder, is increasingly recognized as causing cognitive impairment and dementia. Eye movement abnormalities are also described, including impairment of rapid eye movements (saccades) and the fixations interspersed between them. Such movements are under the influence of cortical and subcortical networks commonly targeted by the neurodegeneration seen in Parkinson's disease and, as such, may provide a marker for cognitive decline. This study examined the error rates and visual exploration strategies of subjects with Parkinson's disease, with and without cognitive impairment, whilst performing a battery of visuo-cognitive tasks. Error rates were significantly higher in those Parkinson's disease groups with either mild cognitive impairment (P = 0.001) or dementia (P dementia group but was also affected in those subjects with Parkinson's disease with mild cognitive impairment. When compared with control subjects and cognitively normal subjects with Parkinson's disease, saccade amplitudes were significantly reduced in the groups with mild cognitive impairment or dementia. Fixation duration was longer in all Parkinson's disease groups compared with healthy control subjects but was longest for cognitively impaired Parkinson's disease groups. The strongest predictor of average fixation duration was disease severity. Analysing only data from the most complex task, with the highest error rates, both cognitive impairment and disease severity contributed to a predictive model for fixation duration [F(2,76) = 12.52, P ≤ 0.001], but medication dose did not (r = 0.18, n = 78, P = 0.098, not significant). This study highlights the potential use of exploration strategy measures as a marker of cognitive decline in Parkinson's disease and reveals the efficiency by which fixations and saccades are deployed in the build-up to a cognitive response, rather than merely focusing on the outcome itself. The prolongation of fixation

  14. Interrogating personhood and dementia

    Science.gov (United States)

    Higgs, Paul; Gilleard, Chris

    2016-01-01

    ABSTRACT Objectives: To interrogate the concept of personhood and its application to care practices for people with dementia. Method: We outline the work of Tom Kitwood on personhood and relate this to conceptualisations of personhood in metaphysics and in moral philosophy. Results: The philosophical concept of personhood has a long history. The metaphysical tradition examines the necessary and sufficient qualities that make up personhood such as agency, consciousness, identity, rationality and second-order reflexivity. Alternative viewpoints treat personhood as a matter of degree rather than as a superordinate category. Within moral philosophy personhood is treated as a moral status applicable to some or to all human beings. Conclusion: In the light of the multiple meanings attached to the term in both metaphysics and moral philosophy, personhood is a relatively unhelpful concept to act as the foundation for developing models and standards of care for people with dementia. Care, we suggest, should concentrate less on ambiguous and somewhat abstract terms such as personhood and focus instead on supporting people's existing capabilities, while minimising the harmful consequences of their incapacities. PMID:26708149

  15. A "client-centred activities of daily living" intervention for persons with stroke

    DEFF Research Database (Denmark)

    Guidetti, Susanne; Ranner, Maria; Tham, Kerstin

    2015-01-01

    diagnosed with dementia, and were able to understand instructions. Data collection was performed by blinded assessors. The primary outcome, perceived participation, was assessed with the Stroke Impact Scale 3.0, domain 8. The secondary outcomes, participation, independence in ADL, and life satisfaction...

  16. Genetics Home Reference: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

    Science.gov (United States)

    ... of CADASIL GeneReview: CADASIL MedlinePlus Encyclopedia: Multi-Infarct Dementia General Information from MedlinePlus (5 links) Diagnostic Tests Drug Therapy Genetic Counseling Palliative Care Surgery and Rehabilitation Related Information How are genetic ...

  17. Obesity in Indian subjects with Vascular Dementia

    OpenAIRE

    Chandra, Mina; Anand, Kuljeet Singh Anand

    2015-01-01

    ABSTRACT Background: Obesity is considered a public health challenge in South Asia. Obesity is an independent risk factor in vascular dementia. It also contributes to other risk factors of vascular dementia like hypertension, coronary artery disease, dyslipidaemia and diabetes. As the rate of obesity in Indian subjects with vascular dementia is not known, we decided to assess obesity in subjects with vascular dementia. Methods: Subjects with vascular dementia presenting to Mem...

  18. Bilingualism at the core of the brain: structural differences between bilinguals and monolinguals revealed by subcortical shape analysis

    OpenAIRE

    Burgaleta, Miguel; Sanjuán, Ana; Ventura Campos, Noelia; Ávila, César; Sebastián Gallés, Núria

    2016-01-01

    Naturally acquiring a language shapes the human brain through a long-lasting learning and practice process. This is supported by previous studies showing that managing more than one language from early childhood has an impact on brain structure and function. However, to what extent bilingual individuals present neuroanatomical peculiarities at the subcortical level with respect to monolinguals is yet not well understood, despite the key role of subcortical gray matter for a number of language...

  19. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  20. Reminiscence therapy for dementia.

    Science.gov (United States)

    Woods, Bob; O'Philbin, Laura; Farrell, Emma M; Spector, Aimee E; Orrell, Martin

    2018-03-01

    This updated Cochrane Review of reminiscence therapy (RT) for dementia was first published in 1998, and last updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. RT is implemented widely in a range of settings using a variety of formats. To assess the effects of RT on people living with dementia and their carers, taking into account differences in its implementation, including setting (care home, community) and modality (group, individual). We searched ALOIS (the Cochrane Dementia and Cognitive Improvement Group's Specialized Register) on 6 April 2017 using the search term 'reminiscence.' We included all randomised controlled trials of RT for dementia in which the duration of the intervention was at least four weeks (or six sessions) and that had a 'no treatment' or passive control group. Outcomes of interest were quality of life (QoL), cognition, communication, behaviour, mood and carer outcomes. Two authors (LOP and EF) independently extracted data and assessed risk of bias. Where necessary, we contacted study authors for additional information. We pooled data from all sufficiently similar studies reporting on each outcome. We undertook subgroup analysis by setting (community versus care home) and by modality (individual versus group). We used GRADE methods to assess the overall quality of evidence for each outcome. We included 22 studies involving 1972 people with dementia. Meta-analyses included data from 16 studies (1749 participants). Apart from six studies with risk of selection bias, the overall risk of bias in the studies was low.Overall, moderate quality evidence indicated RT did not have an important effect on QoL immediately after the intervention period compared with no treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) -0.12 to 0.33; I 2 = 59%; 8 studies; 1060 participants

  1. Stroke in a patient with tuberculous meningitis and HIV infection

    Directory of Open Access Journals (Sweden)

    Maria Bruna Pasticci

    2013-02-01

    Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

  2. Cortex integrity relevance in muscle synergies in severe chronic stroke

    Directory of Open Access Journals (Sweden)

    Eliana eGarcía-Cossio

    2014-09-01

    Full Text Available Background: Recent experimental evidence has indicated that the motor system coordinates muscle activations through a linear combination of muscle synergies that are specified at the spinal or brainstem networks level. After stroke upper limb impairment is characterized by abnormal patterns of muscle activations or synergies. Objective: This study aimed at characterizing the muscle synergies in severely affected chronic stroke patients. Furthermore, the influence of integrity of the sensorimotor cortex on synergy modularity and its relation with motor impairment was evaluated. Methods: Surface electromyography from 33 severely impaired chronic stroke patients was recorded during six bilateral movements. Muscle synergies were extracted and synergy patterns were correlated with motor impairment scales. Results: Muscle synergies extracted revealed different physiological patterns dependent on the preservation of the sensorimotor cortex. Patients without intact sensorimotor cortex showed a high preservation of muscle synergies. On the contrary, patients with intact sensorimotor cortex showed poorer muscle synergies preservation and an increase in new generated synergies. Furthermore, the preservation of muscle synergies correlated positively with hand functionality in patients with intact sensorimotor cortex and subcortical lesions only.Conclusions: Our results indicate that severely paralyzed chronic stroke patient with intact sensorimotor cortex might sculpt new synergy patterns as a response to maladaptive compensatory strategies.

  3. Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study.

    Science.gov (United States)

    Derby, Carol A; Katz, Mindy J; Lipton, Richard B; Hall, Charles B

    2017-11-01

    Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach. To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015. In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence. Birth year and age. Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV. Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction

  4. A claims data-based comparison of comorbidity in individuals with and without dementia.

    Science.gov (United States)

    Bauer, Kathrin; Schwarzkopf, Larissa; Graessel, Elmar; Holle, Rolf

    2014-01-28

    Multimorbidity is common in advanced age, and is usually associated with negative - yet to some extent preventable - health outcomes. Detecting comorbid conditions is especially difficult in individuals with dementia, as they might not always be able to sufficiently express discomfort. This study compares relevant comorbidity complexes in elderly people with and without dementia, with a particular look at gender- and living environment-specific differences. Moreover, associations between selected comorbid conditions and dementia are reviewed more closely. Using 2006 claims data from a large German Statutory Health Insurance fund, 9,139 individuals with dementia and 28,614 age- and gender-matched control subjects aged 65 years and older were identified. A total of 30 comorbidity complexes were defined based on ICD-10 codes. Corresponding prevalence rates were calculated, and the association between a distinct condition and dementia was evaluated via logistic regression in the overall sample as well as in analyses stratified by gender and living environment. Individuals with dementia were more likely to be diagnosed with 15 comorbidity complexes, including Parkinson's, stroke, diabetes, atherosclerosis (supposed dementia risk factors) or fluids and electrolyte disorders, insomnia, incontinence, pneumonia, fractures and injuries (supposed sequelae). In contrast, they were less likely to be diagnosed with 11 other conditions, which included vision and hearing problems, diseases of the musculoskeletal system, lipoprotein disorders and hypertension. In a gender-stratified analysis, the patterns remained largely the same, but a bigger comorbidity gap between cases and control subjects emerged in the male population. Restricting the analysis to community-living individuals did not lead to any substantial changes. Besides strengthening the evidence on accepted dementia risk factors and sequelae, the analyses point to particular conditions that are likely to remain untreated

  5. Diffusion tensor imaging (DTI) in dementia patients with frontal lobe symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Naik, Mala; Geitung, Jonn-Terje (Dept. of Geriatrics, Haraldsplass Deaconess Hospital, Bergen (Norway)), e-mail: mnaik@broadpark.no; Lundervold, Arvid (Dept. of Biomedicine, Univ. of Bergen (Norway)); Nygaard, Harald (Olaviken Hospital (Norway))

    2010-07-15

    Background: Diffusion tensor imaging (DTI) is a recent MRI technique demonstrating white matter tracts in the brain. Dementia is a neurodegenerative disease and this method has been used to demonstrate the loss of axonal fibers and myelin and decrease of fiber density in this condition. Purpose: To study a possible correlation between frontal lobe symptoms in patients with dementia and reduced fractional anisotropy (FA) in white matter/fascicles in the frontal lobes. Material and Methods: The study included 23 patients with dementia and frontal lobe symptoms and 20 controls (10 Alzheimer patients without frontal lobe symptoms and 10 normal controls). Clinical tests and MRI with DTI were performed. FA in subcortical white matter of both the frontal lobes was analyzed and correlated with clinical frontal score tests. Results: We found a significant correlation between frontal score results and reduction in FA in the frontal lobes. The FA in the study group was significantly lower than the FA in the control group. Conclusion: The present study reveals that there is a probable correlation between the extent of frontal lobe symptoms and FA in fascicles/white matter tissue in the frontal lobes

  6. Subcortical Region Segmentation using Fuzzy Based Augmented Lagrangian Multiphase Level Sets Method in Autistic MR Brain Images.

    Science.gov (United States)

    Jac Fredo, A R; Kavitha, G; Ramakrishnan, S

    2015-01-01

    In this work, the subcortical regions of control and autistic MR brain are segmented from the skull stripped images using Fuzzy C-Means (FCM) based Augmented Lagrangian (AL) multiphase level set method. The FCM method is used as he intensity discriminator for the multiphase level set method. The AL function avoids the re-initialization procedure. The segmented subcortical regions are validated with the ground truth images using dice similarity index. The texture features such as energy and entropy are calculated from the extracted cortical and subcortical regions. The results show that the multiphase level set method is able to segment the subcortical regions such as corpus callosum, brain stem and cerebellum. The dice similarity index gives above 0.85 for controls and 0.8 for autistic subjects. The texture feature energy calculated from the cortical region is high in autistics compared to the control subjects and vice versa in the case of entropy. The energy calculated from the subcortical regions is high in controls and entropy is high in autism subjects. Comparatively, the energyand entropy calculated from the total brain and brain stem gives significant variation (pcontrol and autistic images. As the delayed growth of subcortical region is associated with high values of entropy, this study is clinically significant in the mass screening of neurodevelopmental disorders such as autism.

  7. Bilingualism at the core of the brain. Structural differences between bilinguals and monolinguals revealed by subcortical shape analysis.

    Science.gov (United States)

    Burgaleta, Miguel; Sanjuán, Ana; Ventura-Campos, Noelia; Sebastian-Galles, Núria; Ávila, César

    2016-01-15

    Naturally acquiring a language shapes the human brain through a long-lasting learning and practice process. This is supported by previous studies showing that managing more than one language from early childhood has an impact on brain structure and function. However, to what extent bilingual individuals present neuroanatomical peculiarities at the subcortical level with respect to monolinguals is yet not well understood, despite the key role of subcortical gray matter for a number of language functions, including monitoring of speech production and language control - two processes especially solicited by bilinguals. Here we addressed this issue by performing a subcortical surface-based analysis in a sample of monolinguals and simultaneous bilinguals (N=88) that only differed in their language experience from birth. This analysis allowed us to study with great anatomical precision the potential differences in morphology of key subcortical structures, namely, the caudate, accumbens, putamen, globus pallidus and thalamus. Vertexwise analyses revealed significantly expanded subcortical structures for bilinguals compared to monolinguals, localized in bilateral putamen and thalamus, as well as in the left globus pallidus and right caudate nucleus. A topographical interpretation of our results suggests that a more complex phonological system in bilinguals may lead to a greater development of a subcortical brain network involved in monitoring articulatory processes. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. L-3-n-butylphthalide protects against vascular dementia via activation of the Akt kinase pathway.

    Science.gov (United States)

    Huai, Yaping; Dong, Yanhong; Xu, Jing; Meng, Nan; Song, Chunfeng; Li, Wenbin; Lv, Peiyuan

    2013-07-05

    As a neuroprotective drug for the treatment of ischemic stroke, 3-n-butylphthalide, a celery seed extract, has been approved by the State Food and Drug Administration of China as a clinical therapeutic drug for ischemic stroke patients. L-3-n-butylphthalide possesses significant efficacy in the treatment of acute ischemic stroke. The activated Akt kinase pathway can prevent the death of nerve cells and exhibit neuroprotective effects in the brain after stroke. This study provides the hypothesis that l-3-n-butylphthalide has a certain therapeutic effect on vascular dementia, and its mechanism depends on the activation of the Akt kinase pathway. A vascular dementia mouse model was established by cerebral repetitive ischemia/reperfusion, and intragastrically administered l-3-n-butylphthalide daily for 28 consecutive days after ischemia/reperfusion, or 7 consecutive days before ischemia/reperfusion. The Morris water maze test showed significant impairment of spatial learning and memory at 4 weeks after operation, but intragastric administration of l-3-n-butylphthalide, especially pretreatment with l-3-n-butylphthalide, significantly reversed these changes. Thionine staining and western blot analylsis showed that preventive and therapeutic application of l-3-n-butylphthalide can reduce loss of pyramidal neurons in the hippocampal CA1 region and alleviate nerve damage in mice with vascular dementia. In addition, phosphorylated Akt expression in hippocampal tissue increased significantly after l-3-n- butylphthalide treatment. Experimental findings demonstrate that l-3-n-butylphthalide has preventive and therapeutic effects on vascular dementia, and its mechanism may be mediated by upregulation of phosphorylated Akt in the hippocampus.

  9. Test Your Stroke Knowledge

    Science.gov (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  10. Heart and Stroke Encyclopedia

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  11. Stroke Connection Magazine

    Science.gov (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  12. Stroke (For Kids)

    Science.gov (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  13. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  14. Late onset myoclonic epilepsy in Down syndrome and dementia

    Directory of Open Access Journals (Sweden)

    Annapia Verri

    2012-09-01

    Full Text Available Specific forms of epilepsy may be found at various ages in Down Syndrome (DS and a sharp increase in the incidence of epilepsy with age has been documented. A specific type of myoclonic epilepsy associated with cognitive decline has been reported as “senile myoclonic epilepsy” or “late onset myoclonic epilepsy in DS” (LOMEDS. We report a new case of LOMEDS, documented by clinical and neurophysiological evaluation and psychometric assessment (DSDS and DMR. MF, male, affected by DS, was referred in 2004 at 40 years of age; he had no personal or familial history of epilepsy. Since one year, the patient presented cognitive deterioration, characterized by regression of language abilities, loss of memory, and loss of sphincters control. A brain TC showed mild brainstem and sub-cortical atrophy. In 2006, myoclonic jerks involving upper limbs occurred mainly after awakening. EEG showed a low voltage 8 Hz background activity with diffuse slow activity, intermingled with spikes or polyspikes, persisting during NREM sleep. MF was initially treated with clonazepam and after with topiramate, resulting in partial seizures control. MRI (2008 demonstrated diffuse brain atrophy, associated with marked ventricular enlargement. At the psychometric evaluation, onset of dementia was evident late in 2004, with transition to the middle stage in 2006. Last assessment (2009 showed the clinical signs of a late stage of deterioration, with loss of verbal abilities and autonomous ambulation. Using levetiracetam till 2,000 mg/die, myoclonic jerks decreased but are still present every day after awakening. On the EEG slow and poorly organized background activity with bilateral polyspike-wave discharges was recorded. Therefore, we documented a parallel progression of dementia and myoclonic epilepsy in a DS subject.

  15. Mortality and nursing care dependency one year after first ischemic stroke: an analysis of German statutory health insurance data.

    Science.gov (United States)

    Kemper, Claudia; Koller, Daniela; Glaeske, Gerd; van den Bussche, Hendrik

    2011-01-01

    Aphasia, dementia, and depression are important and common neurological and neuropsychological disorders after ischemic stroke. We estimated the frequency of these comorbidities and their impact on mortality and nursing care dependency. Data of a German statutory health insurance were analyzed for people aged 50 years and older with first ischemic stroke. Aphasia, dementia, and depression were defined on the basis of outpatient medical diagnoses within 1 year after stroke. Logistic regression models for mortality and nursing care dependency were calculated and were adjusted for age, sex, and other relevant comorbidity. Of 977 individuals with a first ischemic stroke, 14.8% suffered from aphasia, 12.5% became demented, and 22.4% became depressed. The regression model for mortality showed a significant influence of age, aphasia, and other relevant comorbidity. In the regression model for nursing care dependency, the factors age, aphasia, dementia, depression, and other relevant comorbidity were significant. Aphasia has a high impact on mortality and nursing care dependency after ischemic stroke, while dementia and depression are strongly associated with increasing nursing care dependency.

  16. Biomarkers of the Dementia

    Directory of Open Access Journals (Sweden)

    Mikio Shoji

    2011-01-01

    Full Text Available Recent advances in biomarker studies on dementia are summarized here. CSF Aβ40, Aβ42, total tau, and phosphorylated tau are the most sensitive biomarkers for diagnosis of Alzheimer's disease (AD and prediction of onset of AD from mild cognitive impairment (MCI. Based on this progress, new diagnostic criteria for AD, MCI, and preclinical AD were proposed by National Institute of Aging (NIA and Alzheimer's Association in August 2010. In these new criteria, progress in biomarker identification and amyloid imaging studies in the past 10 years have added critical information. Huge contributions of basic and clinical studies have established clinical evidence supporting these markers. Based on this progress, essential therapy for cure of AD is urgently expected.

  17. Music therapy in dementia

    DEFF Research Database (Denmark)

    McDermott, Orii; Crellin, Nadia; Ridder, Hanne Mette Ochsner

    2013-01-01

    Objective Recent reviews on music therapy for people with dementia have been limited to attempting to evaluate whether it is effective, but there is a need for a critical assessment of the literature to provide insight into the possible mechanisms of actions of music therapy. This systematic review...... uses a narrative synthesis format to determine evidence for effectiveness and provide insight into a model of action. Method The narrative synthesis framework consists of four elements: (i) theory development; (ii) preliminary synthesis of findings; (iii) exploration of relationships between studies......; and (iv) assessment of the robustness of the synthesis. Results Electronic and hand searches identified 263 potentially relevant studies. Eighteen studies met the full inclusion criteria. Three distinctive strands of investigations emerged: eight studies explored behavioural and psychological aspects...

  18. Robotherapy with Dementia Patients

    Directory of Open Access Journals (Sweden)

    Francisco Martín

    2013-01-01

    Full Text Available Humanoids have increasingly become the focus of attention in robotics research in recent years, especially in service and personal assistance robotics. This paper presents the application developed for humanoid robots in the therapy of dementia patients as a cognitive stimulation tool. The behaviour of the robot during the therapy sessions is visually programmed in a session script that allows music to play, physical movements (dancing, exercises, etc., speech synthesis and interaction with the human monitor. The application includes the control software on board the robot and some tools like the visual script generator or a monitor to supervise the robot behaviour during the sessions. The robot application's impact on the patient's health has been studied. Experiments with real patients have been performed in collaboration with a centre of research in neurodegenerative diseases. Initial results show a slight or mild improvement in neuropsychiatric symptoms over other traditional therapy methods.

  19. Coping with Dementia

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Villemoes; Waldorff, Frans Boch; Waldemar, Gunhild

    2008-01-01

    -living with a spouse. The analysis revealed that the basic social psychological problem faced by patients with mild AD was their awareness of decline in personal dignity and value. Coping strategies used to meet these problems were adaptations to the altered situation in order to maintain a feeling of well......-being. The spouse appeared to be the most important social relation. The most significant worries of the patients were about communication in relation to their spouse, and about the reaction of the spouse to the consequences of the disease. Keywords coping; dementia; everyday life; patients’ perspective; social......Abstract The aim of this study was to analyse how patients with mild Alzheimer’s disease (AD) cope with the changes they face concerning everyday life and social relations. This study used a grounded theory approach in the analysis of interview data from 11 persons with mild AD, home...

  20. The profile of behavioral and psychological symptoms in vascular cognitive impairment with and without dementia.

    Science.gov (United States)

    Gupta, Meena; Dasgupta, Abhijit; Khwaja, Geeta Anjum; Chowdhury, Debashish; Patidar, Yogesh; Batra, Amit

    2013-10-01

    The objective of this study was to compare the occurrence and severity of behavioral and psychological symptoms of dementia (BPSD) between vascular dementia (VaD) and vascular cognitive impairment-no dementia (VCI-ND). Consecutive patients presenting with cognitive impairment at least 3 months after an ischemic stroke and with a Hachinski Ischemic Score ≥4 were included. VaD was diagnosed as per National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for probable VaD and VCI-ND on the lines of the Canadian study of health and aging. The severity of cognitive impairment and the behavioral/psychological symptoms were studied by means of the clinical dementia rating scale and the neuropsychiatric inventory (NPI) respectively. All patients with VaD and 89% of those with VCI-ND had at least one BPSD. The mean no. of symptoms per patient and the total NPI scores were higher in VaD than in VCI-ND. Apathy and night-time behavior disturbances were significantly more common and severe in VaD. BPSD are very common both in VCI-ND and in VaD. The profile of BPSD is similar in both groups, albeit more severe in VaD. The net burden of BPSD is higher in VaD as compared to VCI-ND.

  1. Species characterization and responses of subcortical insects to trap-logs and ethanol in a hardwood biomass plantation: Subcortical insects in hardwood plantations

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David R. [D. B. Warnell School of Forestry and Natural Resources; University of Georgia; 180 E. Green Street Athens GA 30602 U.S.A.; Brissey, Courtney L. [D. B. Warnell School of Forestry and Natural Resources; University of Georgia; 180 E. Green Street Athens GA 30602 U.S.A.; Gandhi, Kamal J. K. [D. B. Warnell School of Forestry and Natural Resources; University of Georgia; 180 E. Green Street Athens GA 30602 U.S.A.

    2015-01-02

    1. We characterized subcortical insect assemblages in economically important eastern cottonwood (Populus deltoides Bartr.), sycamore (Platanus occidentalis L.) and sweetgum (Liquidambar styraciflua L.) plantations in the southeastern U.S.A. Furthermore, we compared insect responses between freshly-cut plant material by placing traps directly over cut hardwood logs (trap-logs), traps baited with ethanol lures and unbaited (control) traps. 2. We captured a total of 15 506 insects representing 127 species in four families in 2011 and 2013. Approximately 9% and 62% of total species and individuals, respectively, and 23% and 79% of total Scolytinae species and individuals, respectively, were non-native to North America. 3. We captured more Scolytinae using cottonwood trap-logs compared with control traps in both years, although this was the case with sycamore and sweetgum only in 2013. More woodborers were captured using cottonwood and sweetgum trap-logs compared with control traps in both years, although only with sycamore in 2013. 4. Ethanol was an effective lure for capturing non-native Scolytinae; however, not all non-native species were captured using ethanol lures. Ambrosiophilus atratus (Eichhoff) and Hypothenemus crudiae (Panzer) were captured with both trap-logs and control traps, whereas Coccotrypes distinctus (Motschulsky) and Xyleborus glabratus Eichhoff were only captured on trap-logs. 5. Indicator species analysis revealed that certain scolytines [e.g. Cnestus mutilates (Blandford) and Xylosandrus crassiusculus (Motschulsky)] showed significant associations with trap-logs or ethanol baits in poplar or sweetgum trap-logs. In general, the species composition of subcortical insects, especially woodboring insects, was distinct among the three tree species and between those associated with trap-logs and control traps.

  2. Exploratory Study of the Influence of Posture and Hand Task on Corticomotor Excitability of Upper Extremity Muscles After Stroke.

    Science.gov (United States)

    Renner, Caroline I; Hanna, Sophia; Ludwig, Ricarda; Lukats, Balazs; Hummelsheim, Horst

    2017-09-01

    To explore the interaction between postural stability and hand task on the corticospinal excitability (CE) of upper extremity muscles and how it is affected by lesion location. Cross-sectional explorative survey. Inpatient rehabilitation center. Participants (N=81) were neurologically healthy subjects (volunteer sample, n=36) and patients with stroke (convenience sample, n=45; mean time since stroke, 45d), stratified according to lesion location: pure subcortical strokes (n=25) and strokes with cortical involvement (n=20). Not applicable. Motor-evoked potentials were recorded simultaneously from the first dorsal interosseus (FDI) muscle and biceps brachii (BB) during rest and during low and forceful activation of the FDI in 4 different postural positions (supine, sitting, sitting unsupported, standing) and compared. Posture modulated CE of the FDI and BB during performance of a motor task but not at rest. The influence of postural position on CE of the FDI depended on force demand and lesion location: the control and subcortical stroke group demonstrated significantly higher CE of the FDI when performing the forceful task in the supine and stable sitting positions, respectively, compared with standing. In contrast, the cortical stroke group exhibited significantly higher CE of the FDI when performing the low-force task in a stable sitting position compared with standing. Posture influences CE of the FDI and BB in healthy subjects and patients with stroke differentially depending on hand task, but not at rest. A stable sitting posture increased excitability of the FDI in patients with stroke. These findings imply that hand rehabilitation protocols may be influenced by posture. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Dementia, Caregiving, and Controlling Frustration

    Science.gov (United States)

    ... A You are here Home Dementia, Caregiving, and Controlling Frustration Order this publication Printer-friendly version The ... Caregiver Alliance Learn more CAREGIVER STORIES Honoring Your Parents My parents lived together and they received 24- ...

  4. Does lithium protect against dementia?

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Forman, Julie Lyng; Andersen, Per Kragh

    2010-01-01

    OBJECTIVE: To investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of subsequent dementia. METHODS: Linkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis...... to the rate of dementia during the period with one prescription of these drugs. CONCLUSIONS: Continued treatment with lithium was associated with a reduced rate of dementia in patients with bipolar disorder in contrast to continued treatment with anticonvulsants, antidepressants, or antipsychotics...... of mania or bipolar disorder and subsequent diagnoses of dementia in Denmark during a period from 1995 to 2005. RESULTS: A total of 4,856 patients with a diagnosis of a manic or mixed episode or bipolar disorder at their first psychiatric contact were included in the study. Among these patients, 2,449 were...

  5. The Italian Dementia National Plan

    Directory of Open Access Journals (Sweden)

    Teresa Di Fiandra

    2015-12-01

    Full Text Available The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1 promote health- and social-care interventions and policies; 2 create/strengthen the integrated network of services for dementia based on an integrated approach; 3 implement strategies for promoting appropriateness and quality of care; and 4 improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

  6. Age-dependent exacerbation of white matter stroke outcomes: a role for oxidative damageand inflammatory mediators

    Science.gov (United States)

    Rosenzweig, Shira; Carmichael, S. Thomas

    2013-01-01

    Background and Purpose Subcortical white matter stroke (WMS) constitutes up to 30% of all stroke subtypes. Mechanisms of oligodendrocyte and axon injury and repair play a central role in the damage and recovery following this type of stroke, and a comprehensive study of these processes requires a specialized experimental model that is different from common large artery, “gray matter” stroke models. Diminished recovery from stroke in aged patients implies that damage and repair processes are affected by advanced age, but such effects have not been studied in WMS. Methods WMS was produced with focal microinjection of the vasoconstrictor L-NIO into the subcortical white matter ventral to the mouse forelimb motor cortex in young adult (2 months), middle aged (15 months) and aged mice (24 months). Results WMS produced localized oligodendrocyte cell death with higher numbers of apoptotic cells and greater oxidative damage in aged brains than in young-adult brains. Increased expression of MCP1 and TNFα in motor cortex neurons correlated with a more distributed microglial activation in aged brains 7 days after WMS. At 2 months aged mice displayed increased white matter atrophy and greater loss of corticostriatal connections compared to young-adult mice. Behavioral testing revealed an age-dependent exacerbation of forelimb motor deficits caused by the stroke, with decreased long-term functional recovery in aged animals. Conclusions Age has a profound effect on the outcome of WMS, with more prolonged cell death and oxidative damage, increased inflammation, greater secondary white matter atrophy and a worse behavioral effect in aged vs young-adult mice. PMID:23868277

  7. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  8. Hemorrhagic Stroke in Children

    OpenAIRE

    Jordan M.D., Lori C.; Hillis M.D., Argye E.

    2007-01-01

    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  9. Mild Cognitive Impairment and Progession to Dementia: New Findings

    Science.gov (United States)

    ... All Cognitive Disorders/Dementia http: / / n. neurology. org/ / cgi/ collection/ all_ cognitive_ disorders_ dementia Assessment of cognitive disorders/dementia http: / / n. neurology. org/ / cgi/ collection/ assessment_ of_ cognitive_ disorde rs_ dementia Cognitive ...

  10. Dementia presenting with visual complaints

    OpenAIRE

    Koutroumanos, Nikolaos; Clarke, Michael P; Mosimann, Urs Peter

    2009-01-01

    A 78-year-old female developed memory problems after a 2-year history of persistent visual complaints. Ocular pathology did not explain the extent of her perceived visual impairment. Cognitive screening tests found prominent visuo-constructive deficits and a comprehensive dementia assessment revealed the diagnosis of Alzheimer’s disease. This case describes visual complaints as the initial symptom of dementia, pre-dating memory impairment by several years. We discuss clinical signs of cerebra...

  11. Resources for people with dementia

    Science.gov (United States)

    Frank, Christopher; Feldman, Sid; Schulz, Mary

    2011-01-01

    Abstract Objective To summarize services provided by the Alzheimer Society and discuss other supports and resources available for the management of people with dementia. Sources of information Ovid MEDLINE was searched using the terms dementia, Alzheimer disease, community health services utilization, and caregiver stress. Main message Early diagnosis of dementia has been shown to be of benefit to patients and caregivers. Referral to the Alzheimer Society can help with nonpharmacologic management of dementia at the time of diagnosis and at any time during the course of the illness. Services include education about dementia, caregiver support, coordination of community services, and a variety of written resources for patients and caregivers. When available, the First Link program can assist with referral by minimizing the need for patients or caregivers to contact their local society branches. Other resources, including respite care and technological approaches to managing wandering, are discussed. Conclusion The Alzheimer Society is an important part of dementia management, and family physicians should always consider referral at the time of diagnosis, regardless of the severity of the condition. First Link, when it is available, can facilitate referral. Resources such as respite care and day programs should be considered when available. PMID:22170190

  12. Dementia: sociological and philosophical constructions.

    Science.gov (United States)

    Davis, Daniel H J

    2004-01-01

    This analysis presents a challenge to the biomedical view of dementia as a disease. This view is critiqued from two perspectives: those of sociology and philosophy. Because these domains inform the creation of the medical discourse, their analysis provides an important refinement to the apprehension of the phenomenon of dementia. From the work of Foucault, and in particular his analysis of the historical origins of modern medicine, the sociological construction of dementia is considered. Following this, the philosophical question of Being is discussed, considering particularly the positions of Heidegger and Merleau-Ponty. Lastly aspects of dementia nursing that are damaging to those relatives forced to take on the role of primary carer are isolated, in the context of Kitwood's view that it is possible to maintain personhood at the extremes of this condition. It is suggested that this critique of sociological and philosophical foundations of dementia might offer a way of approaching the dismantling of the self and revise current conceptions of dementia care for the better.

  13. Palliative care for dementia patients.

    Science.gov (United States)

    Hirot, France

    2016-12-01

    Dementia is a life-limiting disease without curative treatments but the data suggest that advanced dementia is not viewed as a terminal diagnosis by physicians. Although symptoms of dementia and cancer patients are similar, palliative care is less frequently proposed for dementia patients. However, professionals and family members of demented patients strongly favor comfort care for end-stage dementia. To improve the patients' relief near the end of life, advance care planning with patients and their proxies should be encouraged. It should start as soon as possible so that the patient can still be actively involved and his preferences, values, needs and beliefs elicited. Written advance directives or enrollment in hospice care are associated with quality of dying. Yet caregivers are sometimes concerned about applying palliative care too early or that advance plans would be invalidated if relatives or patients changed their mind. Therefore, general practitioners and palliative care specialists need to better collaborate to provide greater information and improve comfort and quality of life of dementia patients.

  14. THE IMPACT OF COMORBIDITY ON COGNITIVE PARAMETERS AFTER ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Mirena Valkova

    2012-10-01

    Full Text Available Objective: The aim of our study is to examine the impact of comorbidity on cognitive parameters after the first ever ischemic stroke.Material and methods: We examined 112 patients (aged 46 to 84 (66.67± 5.96, 69 males and 43 females with first ever ischemic stroke. For cognitive assessment we used Mini Mental State Examination (MMSE, 10 word test (for short term memory and delayed recall, Isaack’s test for verbal fluency (VF, Geriatric depression scale (GDS, Hamilton depression scale (HDS, Blessed dementia information memory concentration test (revised, BDIMCT, Benton Visual Retention test (A,E; BVRT – number of corrects and number of errors and Wiskonsin Card Sorting Test (number of errors, WCST. The patients were examined on two step model. At acute stage, after collecting medical history, somatic and neurological examinations, MMSE, 10 words test and HDS were applied. At subacute stroke stage (90±5 days after first stroke symptoms, all cognitive tests were used. „STATGRAPHICS Plus 5.0 (free version” was used for statistical analysis.Results: Chronic ischemic heart disease and chronic obstructive pulmonary disease are the most important additional risk factors for cognitive decline. Thyroid pathology, renal failure and anemia are independently associated with poststroke depression.Conclusions: On the basis of these data we can conclude that vascular risk factors are independently associated with cognitive and emotional changes after stroke and their effects should be assessed and taken into account for subsequent treatment of stroke survivors.

  15. Cerebral Perfusion and the Risk of Dementia: A Population-Based Study.

    Science.gov (United States)

    Wolters, Frank J; Zonneveld, Hazel I; Hofman, Albert; van der Lugt, Aad; Koudstaal, Peter J; Vernooij, Meike W; Ikram, M Arfan

    2017-08-22

    Cerebral hypoperfusion has previously been associated with mild cognitive impairment and dementia in various cross-sectional studies, but whether hypoperfusion precedes neurodegeneration is unknown. We prospectively determined the association of cerebral perfusion with subsequent cognitive decline and development of dementia. Between 2005 and 2012, we measured cerebral blood flow by 2-dimensional phase-contrast magnetic resonance imaging in participants of the population-based Rotterdam Study without dementia. We determined the association of cerebral perfusion (mL/100mL/min) with risk of dementia (until 2015) using a Cox model, adjusting for age, sex, demographics, cardiovascular risk factors, and apolipoprotein E genotype. We repeated analyses for Alzheimer disease and accounting for stroke. We used linear regression to determine change in cognitive performance during 2 consecutive examination rounds in relation to perfusion. Finally, we investigated whether associations were modified by baseline severity of white matter hyperintensities. Of 4759 participants (median age 61.3 years, 55.2% women) with a median follow-up of 6.9 years, 123 participants developed dementia (97 Alzheimer disease). Lower cerebral perfusion was associated with higher risk of dementia (adjusted hazard ratio, 1.31; 95% confidence interval per standard deviation decrease, 1.07-1.61), similar for Alzheimer disease only, and unaltered by accounting for stroke. Risk of dementia with hypoperfusion was higher with increasing severity of white matter hyperintensities (with severe white matter hyperintensities; hazard ratio, 1.54; 95% confidence interval, 1.11-2.14). At cognitive reexamination after on average 5.7 years, lower baseline perfusion was associated with accelerated decline in cognition (global cognition: β=-0.029, P =0.003), which was similar after excluding those with incident dementia, and again most profound in individuals with higher volume of white matter hyperintensities ( P

  16. [Early detection and prevention of dementia].

    Science.gov (United States)

    Urakami, Katsuya

    2014-04-01

    Dementia is about 15% aged 65 and over people now, and is regarded as the common disease. Early symptoms, such as forgetfulness, tend to be overlooked. Alzheimer type dementia is now possible to treat with medication. Therefore, early diagnosis and early treatment are required. Prevention of dementia is also expected and dementia checkup attracts attention. Although there was little data with high evidence, I introduced some reports about dementia prevention including our data. Dementia prevention is an important issue and establishment of evidence is desired in the near future.

  17. The Cost of Dementia in Denmark

    DEFF Research Database (Denmark)

    Kronborg Andersen, C; Søgaard, Jes; Hansen, E

    1999-01-01

    In a population-based study of dementia, the cost of care for 245 demented elderly and 490 controls matched by age and gender was estimated. Dementia of Alzheimer's type was diagnosed according to the NINCDS-ADRDA criteria, and vascular dementia and other types of dementia were diagnosed according...... to the DSM-IIIR criteria. Severity of dementia was determined by the Clinical Dementia Rating scale. The annual cost of medical care, domestic care, home help, nursing home and special equipment for nondemented patients was DKK 22,000 per person while the cost for very mildly, mildly, moderately and severely...

  18. Profile of clinically-diagnosed dementias in a neuropsychiatric ...

    African Journals Online (AJOL)

    Alzheimer's disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and ...

  19. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  20. Colonization Dynamics of Subcortical Insects on Forest Sites With Relatively Stressed and Unstressed Loblolly Pine Trees.

    Science.gov (United States)

    Helbig, Christiane E; Coyle, David R; Klepzig, Kier D; Nowak, John T; Gandhi, Kamal J K

    2016-08-01

    Loblolly pine (Pinus taeda L.) is the most important commercial tree species in the southeastern United States. Since the 1950s, there have been reports of loblolly pines showing reduced growth and increased mortality, particularly in central Alabama and western Georgia, United States; the phenomenon is termed as southern pine decline (SPD). Recently, the role of rhizophagous (root-feeding) insects in loblolly pine health within the context of SPD has come under greater scrutiny. We investigated the impacts of subcortical insects, particularly rhizophagous weevils (Coleoptera: Curculionidae), on loblolly pine health in northeastern Georgia. We created plots-representing a gradient of increased relative tree stress-from ungirdled trees, ungirdled trees baited with ethanol and turpentine (ungirdled-baited), and girdled trees. In total, 10,795 subcortical insects from four families (Buprestidae, Cerambycidae, Curculionidae, and Siricidae) and >82 species were trapped in two years. Almost half of the insects trapped (46% of individuals and 11% of species) were nonnative to North America. Insect captures in plots with girdled trees were 61 and 187% greater than those with ungirdled-baited and ungirdled trees, respectively. Tree treatment impacted captures of native, but not nonnative insects. Relative feeding area by the rhizophagous weevils Hylobius pales (Herbst) and Pachylobius picivorus (Germar) on pine twigs placed in pitfall traps was 1, 17, and 82% in plots with ungirdled, ungirdled-baited, and girdled trees, respectively. Hence, there was a strong association of native subcortical insects, especially rhizophagous weevils, with relatively highly stressed trees, confirming that they are secondary instead of primary pine colonizers. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Executive function and cerebral blood flow on dorsolateral prefrontal cortex in cases of subcortical infarction

    International Nuclear Information System (INIS)

    Hasegawa, Akira; Utsumi, Hiroya

    2006-01-01

    In order to clarify the extent of dysexecutive function of patients with subcortical infarctions, participants of this study underwent neuropsychological tests and single photon emission computerized tomography (SPECT). These participants were categorized into two groups; patients with basal ganglia lesions (BG group) (n=5) and those with white matter lesions (WM group) (n=12). Participants were administered executive function tests as a part of a comprehensive neuropsychological battery. Administered executive measures included the Wisconsin Card Sorting Test (WCST), the Ruff Figural Fluency Test (RFFT), the Controlled Oral Word Association Test (COWAT), and the Trait Making Test; Parts A and B. There were no group differences in their age, years of education and global cognitive performance. Student's t-tests were conducted to determine group differences in executive function. As a result, the number of total errors, the number of perseverative errors and the number of categories completed on the WCST were significantly worse for the BG group than for the WM group. These groups did not differ on other measures administered. In addition, all participants underwent SPECT, and their results were compared with the normal control data. Hypoperfusion was found on parts of the bilateral frontal, temporal, and parietal lobes for the BG and WM groups. These tendencies stood out in the right hemisphere of the BG group. The BG group exhibited decreased cerebral blood flow (CBF) on the area of right side dorsolateral prefrontal cortex (DLPFC) (e.g., Brodmann area 44). These analyses revealed that individuals with BG lesions showed significant executive declines that might be associated with decreased CBF in the subcortical-frontal system. It may support the idea that BG is connected with DLPFC via frontal-subcortical neuronal circuit. Patients with BG lesions may experience dysexecutive function due to the phenomenon of diaschisis from the disruption of this circuit. (author)

  2. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  3. Marchiafava-Bignami disease: magnetic resonance imaging findings in corpus callosum and subcortical white matter

    Energy Technology Data Exchange (ETDEWEB)

    Kawarabuki, Kentaro E-mail: bukky@h2.dion.ne.jp; Sakakibara, Takehiko; Hirai, Makoto; Yoshioka, Yuji; Yamamoto, Yasumasa; Yamaki, Tarumi

    2003-11-01

    A case of Marchiafava-Bignami disease (MBD) is presented using magnetic resonance imaging (MRI). A patient with a long history of alcoholism developed a gait disturbance with involuntary movements at the lower extremities. MRI scans taken at the onset showed no particular abnormalities. He progressed to a coma 10 days later. MRI scans taken 20 days after the onset showed a focal lesion at the genu of the corpus callosum and he was diagnosed as having MBD. In addition, multiple lesions were observed in bilateral frontoparietal subcortical white matter. These lesions demonstrated similar intense MRI signals as the corpus callosum.

  4. Hyperconnective and hypoconnective cortical and subcortical functional networks in multiple system atrophy.

    Science.gov (United States)

    Rosskopf, Johannes; Gorges, Martin; Müller, Hans-Peter; Pinkhardt, Elmar H; Ludolph, Albert C; Kassubek, Jan

    2018-04-01

    In multiple system atrophy (MSA), the organization of the functional brain connectivity within cortical and subcortical networks and its clinical correlates remains to be investigated. Whole-brain based 'resting-state' fMRI data were obtained from 22 MSA patients (11 MSA-C, 11 MSA-P) and 22 matched healthy controls, together with standardized clinical assessment and video-oculographic recordings (EyeLink ® ). MSA patients vs. controls showed significantly higher ponto-cerebellar functional connectivity and lower default mode network connectivity (p hyperconnectivity) and a function disconnection syndrome (hypoconnectivity) that may occur in a consecutive sequence. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  6. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  7. The Societal Cost of Dementia in Singapore: Results from the WiSE Study.

    Science.gov (United States)

    Abdin, Edimansyah; Subramaniam, Mythily; Achilla, Evanthia; Chong, Siow Ann; Vaingankar, Janhavi Ajit; Picco, Louisa; Sambasivam, Rajeswari; Pang, Shirlene; Chua, Boon Yiang; Ng, Li Ling; Chua, Hong Choon; Heng, Derrick; Prince, Martin; McCrone, Paul

    2016-01-01

    There is currently limited evidence on the economic burden that dementia exerts on multi-ethnic Asian populations. The present study aimed to estimate the economic cost of dementia in Singapore. We used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older Singapore Resident population aged 60 years and above. Generalized linear modeling was used to estimate factors associated with costs. The total cost of dementia in 2013 was estimated at S$532 million (95% CI, S$361 million to S$701 million) while the annual cost per person was estimated at S$10,245 per year (95% CI, S$6,954 to S$12,495). Apart from dementia, higher total societal cost were also significantly associated with older age, Indian ethnicity, and those who were diagnosed with heart problems, stroke, diabetes or depression, whereas being divorced/separated, lower education, and those who were diagnosed with hypertension were significantly associated with lower total societal cost. The study provides a rich body of information on healthcare utilization and cost of dementia, which is essential for future planning of services for the elderly population.

  8. Clinical Pregenetic Screening for Stroke Monogenic Diseases: Results From Lombardia GENS Registry.

    Science.gov (United States)

    Bersano, Anna; Markus, Hugh Stephen; Quaglini, Silvana; Arbustini, Eloisa; Lanfranconi, Silvia; Micieli, Giuseppe; Boncoraglio, Giorgio B; Taroni, Franco; Gellera, Cinzia; Baratta, Silvia; Penco, Silvana; Mosca, Lorena; Grasso, Maurizia; Carrera, Paola; Ferrari, Maurizio; Cereda, Cristina; Grieco, Gaetano; Corti, Stefania; Ronchi, Dario; Bassi, Maria Teresa; Obici, Laura; Parati, Eugenio A; Pezzini, Alessando; De Lodovici, Maria Luisa; Verrengia, Elena P; Bono, Giorgio; Mazucchelli, Francesca; Zarcone, Davide; Calloni, Maria Vittoria; Perrone, Patrizia; Bordo, Bianca Maria; Colombo, Antonio; Padovani, Alessandro; Cavallini, Anna; Beretta, Simone; Ferrarese, Carlo; Motto, Cristina; Agostoni, Elio; Molini, Graziella; Sasanelli, Francesco; Corato, Manuel; Marcheselli, Simona; Sessa, Maria; Comi, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Uccellini, Davide; Capitani, Erminio; Tancredi, Lucia; Arnaboldi, Marco; Incorvaia, Barbara; Tadeo, Carlo Sebastiano; Fusi, Laura; Grampa, Giampiero; Merlini, Giampaolo; Trobia, Nadia; Comi, Giacomo Pietro; Braga, Massimiliano; Vitali, Paolo; Baron, Pierluigi; Grond-Ginsbach, Caspar; Candelise, Livia

    2016-07-01

    Lombardia GENS is a multicentre prospective study aimed at diagnosing 5 single-gene disorders associated with stroke (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, MELAS [mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], hereditary cerebral amyloid angiopathy, and Marfan syndrome) by applying diagnostic algorithms specific for each clinically suspected disease We enrolled a consecutive series of patients with ischemic or hemorrhagic stroke or transient ischemic attack admitted in stroke units in the Lombardia region participating in the project. Patients were defined as probable when presenting with stroke or transient ischemic attack of unknown etiopathogenic causes, or in the presence of young age at onset, or positive familial history or of specific clinical features. Patients fulfilling diagnostic algorithms specific for each monogenic disease (suspected) were referred for genetic analysis. In 209 patients (57.4±14.7 years), the application of the disease-specific algorithm identified 227 patients with possible monogenic disease. Genetic testing identified pathogenic mutations in 7% of these cases. Familial history of stroke was the only significant specific feature that distinguished mutated patients from nonmutated ones. The presence of cerebrovascular risk factors did not exclude a genetic disease. In patients prescreened using a clinical algorithm for monogenic disorders, we identified monogenic causes of events in 7% of patients in comparison to the 1% to 5% prevalence reported in previous series. © 2016 American Heart Association, Inc.

  9. Altered default mode and affective network connectivity in stroke patients with and without dysphagia.

    Science.gov (United States)

    Li, Shasha; Zhou, Muke; Yu, Bo; Ma, Zhenxing; Chen, Sihan; Gong, Qiyong; He, Li; Huang, Xiaoqi; Lui, Su; Wang, Xiaotong; Zhou, Dong; He, Chengqi

    2014-02-01

    Neuroimaging studies in stroke patients provide substantial evidence for the involvement of widespread cortical and subcortical regions in the control of swallowing. Although the affective network and the default mode network are functionally related to "autonomic" and "volitional" swallowing, little is known about their functional changes in dysphagic stroke patients. Unbiased seeds functional connectivity analysis was used to study the connectivity patterns of these resting-state networks. Resting-state functional magnetic resonance imaging was performed in stroke patients with (n = 12) and without dysphagia (n = 12). Compared with healthy controls, stroke patients with and without dysphagia had decreased functional connectivity in the default mode network and the affective network. Moreover, stroke patients with dysphagia also had decreased functional connectivity in both the default mode network and the affective network relative to patients without dysphagia. The difference in the extent of impairment in the default mode network and affective network of stroke patients with and without dysphagia may lead to improved understanding of the neuropathophysiological mechanism and rehabilitation of dysphagia.

  10. More than just channeling: The role of subcortical mechanisms in executive functions - Evidence from the Stroop task.

    Science.gov (United States)

    Saban, William; Gabay, Shai; Kalanthroff, Eyal

    2017-03-10

    The literature has long emphasized the role of the cerebral cortex in executive functions. Recently, however, several researchers have suggested that subcortical areas might also be involved in executive functions. The current study explored the possibility that subcortical mechanisms have a functional role in adaptive resolution of Stroop interference. We asked 20 participants to complete a cued task-switching Stroop task with variable cue-target intervals (CTI). Using a stereoscope, we manipulated which eye was shown the relevant dimension and which was shown the irrelevant dimension. This technique allowed us to examine the involvement of monocularly segregated - subcortical - regions of the visual processing stream. The interference effect was modulated by this eye-of-origin manipulation in the 0 CTI condition. This finding provides a novel indication for the notion that subcortical regions have a functional role in the resolution of Stroop interference. This indication suggests that cortical regions are not solely involved and that a dynamic interaction between cortical and subcortical regions is involved in executive functions. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Which risk factors are more associated with ischemic stroke than intracerebral hemorrhage in patients with atrial fibrillation?

    Science.gov (United States)

    McGrath, Emer R; Kapral, Moira K; Fang, Jiming; Eikelboom, John W; ó Conghaile, Aengus; Canavan, Michelle; O'Donnell, Martin J

    2012-08-01

    The decision to prescribe oral anticoagulant therapy in patients with atrial fibrillation is based on an assessment of the competing risks of ischemic stroke and major bleeding, of which intracerebral hemorrhage (ICH) is the most important type. We sought to determine the comparative importance of risk factors for ischemic stroke and ICH in patients with acute stroke and atrial fibrillation with particular emphasis on risk factors common to both stroke types. Consecutive patients with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network constituted the cohort. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. Risk factors included: (1) those previously reported to be risk factors for both ischemic stroke and major bleeding (particularly ICH) ("shared" risk factors, including age, alcohol, hypertension, diabetes mellitus, renal impairment, prior stroke/transient ischemic attack and preadmission dementia); and (2) other risk factors associated with either stroke subtype alone. A total of 3197 patients presented with atrial fibrillation and acute stroke, of which 12.2% presented with ICH. Of the "shared" risk factors, age (OR, 1.19; 95% CI, 1.06-1.34 per decade) and prior stroke/transient ischemic attack (OR, 1.45; 95% CI, 1.12-1.87) were more associated with ischemic stroke than ICH, whereas a history of hypertension (OR, 0.89; 95% CI, 0.68-1.17), diabetes mellitus (OR 1.23; 95% CI, 0.92-1.64), renal impairment (OR, 1.28; 95% CI, 0.95-1.71), and alcohol intake were not more strongly associated with either stroke subtype. Of the risk factors known to be associated with both ischemic stroke and ICH in patients with atrial fibrillation, we found that none had a stronger association with ICH. Older age was more strongly associated with ischemic stroke than ICH.

  12. Dementia - keeping safe in the home

    Science.gov (United States)

    ... to the outside. Keep car keys out of sight. To prevent harm when someone with dementia does ... 2016. Budson AE, Solomon PR. Life adjustments for memory loss, Alzheimer's disease, and dementia. In: Budson AE, ...

  13. Genetics Home Reference: dementia with Lewy bodies

    Science.gov (United States)

    ... dementia with Lewy bodies may also experience a sharp drop in blood pressure upon standing (orthostatic hypotension), ... Genetic Changes Mutations in the SNCA or SNCB gene cause dementia with Lewy bodies . GBA gene mutations ...

  14. Comparative cardiovascular safety of dementia medications

    DEFF Research Database (Denmark)

    Fosbøl, Emil L; Peterson, Eric D; Holm, Ellen

    2012-01-01

    To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark.......To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark....

  15. Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

    Science.gov (United States)

    Castilla-Guerra, Luis; Fernandez-Moreno, Maria del Carmen

    2016-01-01

    Hypertension is the most important potentially reversible risk factor for stroke in all age groups; high blood pressure (BP) is also associated with increased risk of recurrent stroke in patients who have already had an ischemic or hemorrhagic event. Twenty-four hour ambulatory BP monitoring (ABPM) has become an important tool for improving the diagnosis and management of hypertension, and is increasingly used to assess patients with hypertension. Nevertheless, although ABPM devices are increasingly used for assessment of hypertension, their value in the chronic management of hypertension in patients with stroke has not been systematically studied. In fact, among large-scale randomized trials for secondary stroke prevention, only the Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention trial included 24-hour ABPM. ABPM has demonstrated chronic disruption of the circadian rhythm of BP after acute phase of stroke and has shown higher sensitivity compared to office BP in evaluating the effectiveness of antihypertensive treatment among stroke survivors. High 24-hour BP is an independent predictor for cerebrovascular events, brain microbleeds, and subsequent development of dementia. Nevertheless, although stroke care guidelines endorse the importance of hypertension management, the specific role of ABPM among stroke survivors after the acute phase of disease has not been established. Further studies are needed to clarify whether routine application of ABPM among these patients should be recommended. PMID:26687120

  16. The potential for prevention of dementia across two decades: the prospective, population-based Rotterdam Study.

    Science.gov (United States)

    de Bruijn, Renée F A G; Bos, Michiel J; Portegies, Marileen L P; Hofman, Albert; Franco, Oscar H; Koudstaal, Peter J; Ikram, M Arfan

    2015-07-21

    Cardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades. We included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors. During 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05-0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06-0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07-0.62) in the original cohort and 0.33 (95 % CI, 0.07-0.77) in the extended cohort. A substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades.

  17. Stuttering Due To Ischemic Stroke

    OpenAIRE

    Sahin, Huseyin Alparslan; Krespi, Yakup; Yilmaz, Ahmet; Coban, Oguzhan

    2005-01-01

    Acquired stuttering is a disorder of the fluency of speech. The mechanism underlying stuttering is unknown. It may occur after bilateral and unilateral cortical or subcortical brain damage. We report two cases who had stuttering resulting from left parietal infarction.

  18. Danshen diversity defeating dementia.

    Science.gov (United States)

    Hügel, Helmut M; Jackson, Neale

    2014-02-01

    Salvia miltiorrhiza (danshen) is widely used for the clinical treatment of cerebral ischemia and cardiovascular diseases. Its diverse molecular makeup of simple and poly hydroxycinnamic acids and diterpenoid quinones are also associated with its beneficial health effects such as improved cognitive deficits in mice, protection of neuronal cells, prevention of amyloid fibril formation and preformed amyloid fibril disaggregation related to Alzheimer's disease. Whilst the in vitro studies have therapeutic promise, the anti-dementia effect/impact of danshen however depends on its absorbed constituents and pharmacokinetic properties. Both the water and lipid danshen fractions have been shown to have low oral bioavailability and at physiological pH, the polyphenolic carboxylate anions are not brain permeable. To tap into the many neuroprotective and other biological benefits of danshen, the key challenge resides in developing danshen nanopharmaceuticals, semi-synthetic pro-drug forms of its constituents to improve its biocompatability, that is, absorption, circulation in bloodstream and optimization of BBB permeability. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Coping with Dementia

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Villemoes; Waldorff, Frans Boch; Waldemar, Gunhild

    2008-01-01

    Abstract The aim of this study was to analyse how patients with mild Alzheimer’s disease (AD) cope with the changes they face concerning everyday life and social relations. This study used a grounded theory approach in the analysis of interview data from 11 persons with mild AD, home-living with ......Abstract The aim of this study was to analyse how patients with mild Alzheimer’s disease (AD) cope with the changes they face concerning everyday life and social relations. This study used a grounded theory approach in the analysis of interview data from 11 persons with mild AD, home......-living with a spouse. The analysis revealed that the basic social psychological problem faced by patients with mild AD was their awareness of decline in personal dignity and value. Coping strategies used to meet these problems were adaptations to the altered situation in order to maintain a feeling of well......-being. The spouse appeared to be the most important social relation. The most significant worries of the patients were about communication in relation to their spouse, and about the reaction of the spouse to the consequences of the disease. Keywords coping; dementia; everyday life; patients’ perspective; social...

  20. Influence of statin therapy at time of stroke onset on functional outcome among patients with atrial fibrillation.

    Science.gov (United States)

    Ko, Darae; Thigpen, Jonathan L; Otis, James A; Forster, Kristen; Henault, Lori; Quinn, Emily; Tripodis, Yorghos; Berger, Peter B; Limdi, Nita; Hylek, Elaine M

    2017-01-15

    Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF. We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated. Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia. Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Teaching Mands to Older Adults with Dementia

    OpenAIRE

    Oleson, Chelsey R.; Baker, Jonathan C.

    2014-01-01

    Millions of Americans are diagnosed with dementia, and that number is only expected to rise. The diagnosis of dementia comes with impairments, especially in language. Furthermore, dementia-related functional declines appear to be moderated by environmental variables (Alzheimer’s Association, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association 8:131–168 2012; American Psychiatric Association, 2000; Engelman et al., Journal of Applied Behavior Analysis 32:107–110, 1999; Engelman ...

  2. Recognition of dementia in hospitalized older adults.

    Science.gov (United States)

    Maslow, Katie; Mezey, Mathy

    2008-01-01

    Many hospital patients with dementia have no documented dementia diagnosis. In some cases, this is because they have never been diagnosed. Recognition of Dementia in Hospitalized Older Adults proposes several approaches that hospital nurses can use to increase recognition of dementia. This article describes the Try This approaches, how to implement them, and how to incorporate them into a hospital's current admission procedures. For a free online video demonstrating the use of these approaches, go to http://links.lww.com/A216.

  3. Brain perfusion SPECT in dementia syndromes

    International Nuclear Information System (INIS)

    Libus, P.; Stupalova, J.; Kuzelka, I.; Konrad, J.

    2002-01-01

    Aim: Brain perfusion SPECT is used in differential diagnostics of dementia syndromes. First of all the aim is to distinguish vascular dementia from degenerative dementia and to differentiate dementia from delirium, psychiatric syndromes, depression and secondary dementia, which is important in relation to therapy. The purpose of our study was to detect significance of BP SPECT and include it into the diagnostic process in dementia syndromes. Materials and methods: 51 women and 63 men aged 55 - 88 were evaluated in the study. The patients correspond to the general criteria of dementia diagnosis. They were sent to the examination by neurological, internal and psychiatric departments and out-patient departments. All patients were examined by 99mTc ECD SPECT using a double head camera PRISM 200 VP with LEHR collimator. The scintigraphic data were evaluated by the visual and semiquantitative analysis. Results: It was established that most patients in our group had vascular dementia, while Alzheimer's disease was second. In other groups we found out dementia at strategic infarct location, e.g. in gyrus angularis in the dominant hemisphere, frontal temporal lobe dementia and alcoholic dementia. Twenty-four patients had a normal diagnosis. Fifteen of them had a somatic reason of the delirious state and were re-classified into pseudodementia. Nine patients were not diagnostically included and the examination will repeated in four months time. Conclusion: We have found out a good applicability of brain perfusion SPECT in dementia syndromes diagnosis in our work. The best diagnosticable and most specific were the findings in multi-infarct dementia, Alzheimer's disease and frontal temporal lobe dementia. When vascular dementia is concerned we can even distinguish dementia at strategic infarction location, e.g. in thalamus, basal frontal telencefalon, in gyrus angularis of the dominant hemisphere, etc

  4. Depression and the risk for dementia

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2012-01-01

    Depression is associated with increased risk of subsequent development of dementia; however, the nature of the association is still poorly understood. The purpose of the review was based on recent studies to discuss whether depression is a prodromal state of dementia or an independent risk factor...... for dementia, as well as to discuss how the type of depression, the type of dementia, and antidepressant treatment influence the association....

  5. Dementia literacy in older adults.

    Science.gov (United States)

    Loi, Samantha M; Lautenschlager, Nicola T

    2015-09-01

    With the increasing aging population, it is predicted that there will also be a rise in the number of people with dementia. Although there is no definitive cure, early detection and access to treatment and services remains the cornerstone of management. Misinformation and poor knowledge about dementia may lead to delayed diagnosis. A study of dementia literacy was undertaken to explore current knowledge in a metropolitan city in Australia. A vignette describing an older person with symptoms of cognitive impairment was posted out to volunteers at the local hospital. The majority of participants surveyed correctly identified that the person in the vignette was suffering from symptoms of dementia or cognitive impairment. However, there was more variation with regard to types of treatment available and appropriate help-seeking behavior. Although people are able to identify symptoms of dementia when they are presented in a scenario, the reality is often not as clear. More education to improve knowledge with regard to this increasingly common disorder is required so that appropriate interventions can be made available. © 2014 Wiley Publishing Asia Pty Ltd.

  6. Dementia and rural nuclear medicine

    International Nuclear Information System (INIS)

    Cowell, S.F.; Davison, A.; Logan-Sinclair, P.; Sturt University, Dubbo, NSW; Greenough, R.

    2003-01-01

    Full text: The rapid increase in dementia is directly related to the growing number of aged people in developed countries, such as Australia. This increase heightens the need for accurate dementia diagnosis to ensure treatment resources are appropriately allocated. However, current diagnostic methods are unable to determine specific dementia types limiting the effectiveness of many care plans. The lack of specialist resources in rural Australian communities presents nuclear medicine with an opportunity to make a significant impact on the management of this disease. This investigation aimed to identify how SPECT perfusion imaging could maximise its role in the management of dementia in a rural New South Wales setting. The study reviewed all Technetium 99m HMPAO SPECT brain studies over a three-year period. This included a medical record audit, review of all diagnostic imaging reports and an analysis of referral patterns. The results of this study provide compelling evidence that, even in a rural setting, brain SPECT, in conjunction with neuropsychological testing, offers high accuracy in determining the presence and type of dementia. In addition, the study found more than 30% of referrers had no training in SPECT, emphasising the importance of ensuring that brain SPECT reports, in a rural setting, educate and specify to referrers the significance and exact disease type found in the study. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  7. Association between Frailty and Dementia

    DEFF Research Database (Denmark)

    Kulmala, J; Nykänen, I; Mänty, Minna Regina

    2014-01-01

    Background: Frailty is commonly considered as a syndrome with several symptoms, including weight loss, exhaustion, weakness, slow walking speed and physical inactivity. It has been suggested that cognitive impairment should be included in the frailty index, however the association between frailty...... dementia with Lewy bodies and 8 persons (1%) had some other type of dementia. Multivariate logistic regression models showed that frail persons were almost 8 times more likely to have cognitive impairment (OR 7.8, 95% CI 4.0-15.0), 8 times more likely to have some kind of dementia (OR 8.0, 95% CI 4.......0-15.9), almost 6 times more likely to have vascular dementia (OR 5.6, 95% CI 1.2-25.8) and over 4 times more likely to have Alzheimer's disease (OR 4.5, 95% CI 2.1-9.6) than persons who were robust. Conclusion: Frailty is strongly associated with cognitive impairment and clinically diagnosed dementia among...

  8. Cerebral blood flow in acute and chronic ischemic stroke using xenon-133 inhalation tomography

    DEFF Research Database (Denmark)

    Vorstrup, S; Paulson, O B; Lassen, N A

    1986-01-01

    Serial measurements of cerebral blood flow (CBF) were performed in 12 patients with acute symptoms of ischemic cerebrovascular disease. CBF was measured by xenon-133 inhalation and single photon emission computer tomography. Six patients had severe strokes and large infarcts on the CT scan...... in the infarct and peri-infarct tissue. Of the remaining 6 patients, one had a pontine infarct and one had no lesions on the CT scan, both having normal angiograms and CBF maps. Four patients had small deep or subcortical CT lesions, and showed a slight, but persistent CBF reduction of about 6-8% in the parietal...

  9. Early MR detection of cortical and subcortical hypoxic-ischemic encephalopathy in full-term-infants

    Energy Technology Data Exchange (ETDEWEB)

    Christophe, C. [Dept. of Pediatric Radiology, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium); Clercx, A. [Dept. of Pediatrics, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium); Blum, D. [Dept. of Pediatrics, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium); Hasaerts, D. [Dept. of Pediatrics, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium); Segebarth, C. [Dept. of Magnetic Resonance, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium); Perlmutter, N. [Dept. of Pediatric Radiology, Hopital Univ. des Enfants Reine Fabiola, Univ. Libre de Bruxelles (Belgium)

    1994-12-01

    Four observations illustrate the potential of MR imaging in the early depiction of multiple types of neuropathologic lesions which may coexist in the full-term newborn, upon severe hypoxic-ischemic encephalopathy (HIE). In particular, diffuse, postnatal involvement of cerebral cortex and subcortical white matter (WM) is demonstrated. Cortical hyperintensity on both proton-density- and T1-weighted images is probably related to cellular necrosis which is distributed diffusely or parasigattally. Hyperintense, frontal, subcortical WM edging on proton-density-weighted images results from the increase of water concentration, induced either by infract or by edema. Diffuse WM areas of low intensity on T1-weighted images and of high intensity on T2-weighted images are presumably related to cytotoxic and/or vasogenic edema, proportional to the underlying damaged tissues. On follow-up MR examinations, several months later, the importance of cortical atrophy and of the myelination delay appeared related to the importance of the lesions detected during the post-natal period. (orig.)

  10. Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

    Energy Technology Data Exchange (ETDEWEB)

    Malghem, Jacques; Omoumi, Patrick; Lecouvet, Frederic; Berg, Bruno vande [Universite Catholique de Louvain, Departement de radiologie et d' imagerie medicale, Bruxelles (Belgium)

    2015-10-15

    Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Societe d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery. (orig.)

  11. Different Profiles of Verbal and Nonverbal Auditory Impairment in Cortical and Subcortical Lesions

    Directory of Open Access Journals (Sweden)

    Reza Nilipour

    2010-08-01

    Full Text Available A B S T R A C T Introduction:We investigated differential role of cortical and subcortical regions in verbal and non-verbal sound processing in ten patients who were native speakers of Persian with unilateral cortical and/or unilateral and bilateral subcortical lesions and 40 normal speakers as control subjects. Methods: The verbal tasks included monosyllabic, disyllabic dichotic and diotic tasks, and nonverbal tasks were semantic, asemantic recognition and sound localization. Results: Different profiles of ear extinction and hemispatial neglect was observed in our Left Hemisphere-Damaged (LHD patients. Right Hemisphere-Damaged (RHD patients with basal ganglia lesions showed mild hemi-spatial inattention of the ipsilesional and contralesional hemispace. LHD patients showed deficient performance in sound localization, but no evidence of significant impairment in sound localization was found in RHD patients except one. The patients with basal ganglia lesions irrespective of lesion side had impaired performance in semantic recognition. The results are suggestive of a network consisting of left and right basal ganglia and left cortical regions for non-verbal sound recognition. Discussion: The results also indicate a different role for left basal ganglia in sound object segregation versus sound localization.

  12. Direct Microtubule-Binding by Myosin-10 Orients Centrosomes toward Retraction Fibers and Subcortical Actin Clouds.

    Science.gov (United States)

    Kwon, Mijung; Bagonis, Maria; Danuser, Gaudenz; Pellman, David

    2015-08-10

    Positioning of centrosomes is vital for cell division and development. In metazoan cells, spindle positioning is controlled by a dynamic pool of subcortical actin that organizes in response to the position of retraction fibers. These actin "clouds" are proposed to generate pulling forces on centrosomes and mediate spindle orientation. However, the motors that pull astral microtubules toward these actin structures are not known. Here, we report that the unconventional myosin, Myo10, couples actin-dependent forces from retraction fibers and subcortical actin clouds to centrosomes. Myo10-mediated centrosome positioning requires its direct microtubule binding. Computational image analysis of large microtubule populations reveals a direct effect of Myo10 on microtubule dynamics and microtubule-cortex interactions. Myo10's role in centrosome positioning is distinct from, but overlaps with, that of dynein. Thus, Myo10 plays a key role in integrating the actin and microtubule cytoskeletons to position centrosomes and mitotic spindles. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Modulation of Cortical-subcortical Networks in Parkinson’s Disease by Applied Field Effects

    Directory of Open Access Journals (Sweden)

    Christopher William Hess

    2013-09-01

    Full Text Available Studies suggest that endogenous field effects may play a role in neuronal oscillations and communication. Non-invasive transcranial electrical stimulation with low-intensity currents can also have direct effects on the underlying cortex as well as distant network effects. While Parkinson's disease (PD is amenable to invasive neuromodulation in the basal ganglia by deep brain stimulation, techniques of non-invasive neuromodulation like transcranial direct current stimulation (tDCS and transcranial alternating current stimulation (tACS are being investigated as possible therapies. tDCS and tACS have the potential to influence the abnormal cortical-subcortical network activity that occurs in PD through sub-threshold changes in cortical excitability or through entrainment or disruption of ongoing rhythmic cortical activity. This may allow for the targeting of specific features of the disease involving abnormal oscillatory activity, as well as the enhancement of potential cortical compensation for basal ganglia dysfunction and modulation of cortical plasticity in neurorehabilitation. However, little is currently known about how cortical stimulation will affect subcortical structures, the size of any effect, and the factors of stimulation that will influence these effects.

  14. Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE for Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Benjamin Ritsma

    2014-01-01

    Full Text Available Background. Spontaneous intracerebral hemorrhage (ICH is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative managem