A Maloon | Search PubMed

PubMed1992

The Caretaker Obstreperous-Behavior Rating Assessment (COBRA) Scale.

OBJECTIVE: To evaluate the usefulness and reliability of the Caretaker Obstreperous-Behavior Rating Assessment (COBRA), a new test instrument for caretaker assessment of types and severity of "obstreperous behaviors" (OBs) in demented patients. DESIGN: COBRA was completed by caretakers of 31 outpatients and 36 nursing home inpatients with dementia. Test-retest reliability was determined when 25 of the outpatient caretakers re-evaluated their demented relative 1 week later; inter-rater reliability was determined on nursing home inpatients by comparing the reports of two nurse's aids with equivalent knowledge of seven of the patients. SETTING: (1) University medical center Alzheimer's Disease and Related Disorders Clinic; (2) community nursing home. PATIENTS: Thirty-one sequentially-seen outpatients with dementia; 36 nursing home patients with dementia. INTERVENTION: Following instruction in the use of the COBRA Scale, caretakers provided scores for their demented patient. The instrument has three unique features: (1) it divides OBs into four categories for ease of comprehension: Aggressive/Assaultive; Mechanical/Motor; Ideational/Personality; and Vegetative; (2) a companion videotape shown to caretakers in advance illustrates each behavior to improve reliability of reporting; (3) the significance of each OB is estimated with severity and frequency measures. MAIN OUTCOME MEASUREMENTS: Frequency and severity of OBs are epitomized in 12 summary scores. Test-retest correlations (for outpatients) and inter-rater correlations (for inpatients) were analyzed with Pearson Product Moment and Spearman Rank Order correlations. RESULTS: Prevalence of OBs and severity was reported for the experimental groups. Summary scores revealed test-retest correlations of .95 to .73 for 11 of 12 scores (outpatients), and inter-rater correlations of .99 to .73 for 8 of 12 scores (inpatients). Age, gender, and disease etiology were not significantly related to OBs; clinical severity correlated with type and severity of OBs. CONCLUSIONS: The COBRA scale provides a convenient, comprehensive, and reliable means for caretakers to identify the types and measure the severity of OBs in demented outpatients and nursing home inpatients. If additional studies confirm these observations, COBRA will be a useful instrument for assessing the effects of interventions on OBs in patients with dementia.

Aged↗

PubMed1985

Neurological complications of systemic vasculitis. A report of 2 cases.

In up to 72% of patients with systemic vasculitis the neurological system may be involved. This may be peripheral or central (brain or spinal cord), and is usually due to infarction or a ruptured aneurysm. Diagnosis and evaluation are based peripherally on examination of a biopsy specimen or centrally on angiography. Therapy is usually with steroids and/or immunosuppressive agents. Two patients with systemic necrotizing vasculitis with unusual neurological complications are presented.

Adult↗

PubMed1984

Neck manipulation causing stroke. Case reports.

Neck manipulation may cause injury to the vertebrobasilar arterial system with resultant brainstem ischaemia or infarction. This complication has been recognized for many years, and although rarely reported in the literature is a well-recognized problem encountered by neurologists. This article describes 3 patients with this condition seen at the Johannesburg Hospital. The probable pathogenesis is that a thrombus occurs at a site of vertebral artery injury created by sudden sharp neck movement chiefly between the axis and atlas. This thrombus may propagate or embolize. The therapeutic role of anticoagulants is discussed.

Adult↗

PubMed1983

Cerebral neoplasm simulating transient ischaemic attacks. A case report.

A 56-year-old woman with a 2-year history of recurrent attacks of paroxysmal expressive dysphasia mimicking transient ischaemic attacks was subsequently found to have a cerebral neoplasm. It is suggested that recurrent paroxysmal neurological deficit does not necessarily imply a vascular cause, but may be a feature of cerebral neoplasm, and that these patients should, in addition to other noninvasive diagnostic procedures, undergo computed tomography to exclude potentially treatable conditions.

Aphasia↗