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Biomedical subjects

R G Robinson

Publications and source records attributed to R G Robinson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Effects of anxiety disorder on impairment and recovery from stroke.

The effect of anxiety disorder on recovery from impairment following stroke was examined in 142 patients with acute stroke who had follow-up evaluations. Anxiety disorder significantly interacted with depression to influence the severity and course of depression, outcome of activities of daily living, and social functioning. Anxiety disorder, however, did not affect cognitive impairment, which was influenced only by major depression. These data suggest that the existence of anxiety disorders plays an important role in the prognosis of patients with poststroke depression. These data also suggest that depression and anxiety disorder may have different mechanisms.

Aged↗
PubMed1998

Gender differences in poststroke depression.

In stroke and other medical illnesses, secondary depression may be associated with different factors in women than in men. The authors examined 301 consecutive admissions for acute treatment of cerebrovascular accident for gender differences in depression, psychosocial factors, physical impairment, and lesion location. Women were twice as frequently diagnosed with major depression as men. Women with major depression had a greater frequency of left hemisphere lesions than men. In men, major depression was associated with greater impairment in activities of daily living, and greater severity of depression was associated with greater impairment in daily activities and social functioning. In women, greater severity of depression was associated with prior diagnosis of psychiatric disorder and cognitive impairment. These findings suggest a different nature of poststroke depression in men and women and may have implications for its treatment.

Activities of Daily Living↗
PubMed1998

Treatment issues in poststroke depression.

Depression is perhaps the most frequent emotional disorder to occur after a stroke. These depressions may be either major or minor in type and usually remit within the first year after the stroke. In addition to emotional suffering, poststroke depression has been associated with inhibited physical recovery, impaired cognitive functioning, and increased mortality. Determining whether these consequences of stroke may be improved by treatment of depression constitutes both a major challenge and an enormous opportunity for new approaches to poststroke pharmacotherapy. Previous controlled and uncontrolled treatment trials have provided partial support for the hypothesis that mood, cognitive, physical, and survival consequences of poststroke depression may be improved by antidepressant therapy.

Activities of Daily Living↗
PubMed1997

Social impairment and depression after traumatic brain injury.

OBJECTIVE: Previous studies have shown that social impairment is associated with major depression throughout the first year after traumatic brain injury (TBI). This study examined the specific social factors that were associated with post-TBI depression. METHOD: A consecutive series of 65 patients with closed head injuries were cross-sectionally and longitudinally examined using a semistructured psychiatric interview, the Hamilton Depression Rating Scale, and the Social Functioning Exam during in-hospital care and at 3-, 6-, 9-, and 12-month follow-ups. RESULTS: Depressed subjects showed poorer social functioning at the initial evaluation, and at 6, 9, and 12 months. Measures of preinjury job dissatisfaction and fear of job loss were significantly associated with depression at the initial evaluation. Concurrent impaired close personal relationships as well as continued fear of job loss were associated with depression at 6, 9, and 12 months after TBI. CONCLUSIONS: These findings suggest that two of the psychosocial factors associated with depression during the acute TBI period (patient's satisfaction with work and fear of job loss) are the same as those operant during the chronic period, but an additional psychosocial factor (close interpersonal relationships) is also operant during the chronic period. These findings support the need for early targeted social intervention in cases of TBI.

Adult↗
PubMed1997

Mechanism of disinhibition after brain lesions.

Disinhibition syndromes, ranging from mildly inappropriate social behavior to full blown mania, may result from lesions to specific brain areas. Several studies in patients with closed head injuries, brain tumors, stroke lesions, and focal epilepsy have demonstrated a significant association between disinhibition syndromes and dysfunction of orbitofrontal and basotemporal cortices of the right hemisphere. Based on the phylogenetic origin of these cortical areas and their main connections with dorsal regions related to visuospatial functions, somatosensation, and spatial memory, the orbitofrontal and basotemporal cortices may selectively inhibit or release motor, instinctive, affective, and intellectual behaviors elaborated in the dorsal cortex. Thus, dysfunction of these heteromodal ventral brain areas may result in disinhibited behaviors.

Adult↗
PubMed1997

Cognitive impairment in the euthymic phase of chronic unipolar depression.

Cognitive functioning in the nonsymptomatic phase and the long-term cognitive outcome of patients with mood disorders are both heuristic and important clinical issues in the study of mood disorders. Literature findings are inconsistent because of design confounds. We tried to address these issues while controlling for several confounds including age, education, gender differences in neurobehavioral functioning, and diagnosis. Nonsymptomatic patients with a history of chronic unipolar depression and bipolar affective disorder and healthy male individuals were administered neuropsychological tests to assess attention, visual-motor tracking, executive abilities, and immediate verbal memory. Subjects had comparable depression scores at the time of testing. Disease duration was 7.5 years (SD 5.1) for unipolar and 11 years (SD 7.3) for bipolar patients. Unipolar patients were more impaired than healthy normal comparison subjects on measures of visual-motor sequencing (Trail Making Test A, p < .05), executive function (Trail Making Test B, Stroop Test Color/Word Trial, p < .05), and immediate memory and attention (CERAD 1st trial, WAIS Digit Symbol subtest, p < .05). Differences between bipolar patients and normal comparison subjects did not reach significance in any of the selected measures. Male patients with a history of chronic unipolar disorder are at risk for cognitive impairment in the nonsymptomatic phase of their disease. Cognitive disturbance is the type seen with prefrontal dysfunction and may be assessed with standard neuropsychological assessments.

Bipolar Disorder↗
PubMed1997

Generalized anxiety and depression. Assessment over 2 years after stroke.

The authors examined the course of anxiety up to 2 years after stroke in relation to depressive symptoms, impairment in activities of daily living (ADLs), and social functioning. One hundred forty-two patients were evaluated at 3, 6, 12, and 24 months after stroke. Anxiety was associated with greater depression severity at all follow-up visits. Depression severity was associated with impairment in ADLs at followup; association of anxiety and impairment in ADLs was present only at the intake visit, with independent effects only for women. Women reported more symptoms of both anxiety and depression during the 2-year period. Younger patients reported more anxiety symptoms, but there was no difference between age-groups in depressive symptoms. Severity of anxiety was also related to higher depression scores at initial hospitalization, but not in the remainder of the 2-year period. In summary, anxiety is associated with increased severity of depressive symptoms and greater impairment in function primarily during the acute hospitalization period. Women and younger patients also may be more vulnerable to anxiety after stroke.

Activities of Daily Living↗
PubMed1997

Neuropsychiatric consequences of stroke.

Numerous emotional and behavioral disorders occur following cerebrovascular lesions. Depression is the most common of these, affecting up to 40% of patients. Clinical correlates of post-stroke depression include severity of physical and cognitive impairment as well as location of brain injury. Perhaps the most compelling reason to identify post-stroke depression, however, is its substantial impact on recovery in activities of daily living, cognitive function, and survival. Antidepressant medication has been shown to effectively treat depression, although its administration may require careful clinical monitoring. Other post-stroke emotional/behavioral disorders include mania, bipolar disorder, anxiety disorder, apathy, and pathological crying. Controlled studies have not documented the effect of these disorders on long-term recovery, but the potential impact of syndromes such as mania and apathy on rehabilitation efforts or pathological crying on social functioning are evident. With the exception of pathological crying, which has been shown to respond to antidepressant drug therapy, the other post-stroke emotional/behavioral disorders need to be evaluated in controlled treatment trials for response to therapy.

Affective Symptoms↗
PubMed1997

Long-term cognitive impairment associated with caudate stroke.

BACKGROUND AND PURPOSE: Neuropsychiatric findings were examined in 91 patients with acute focal subcortical lesions to determine whether cognitive outcome would differ depending on whether the head of the caudate or other subcortical structures were injured. METHODS: Patients were evaluated using the Mini-Mental State Examination (MMSE), Hamilton Rating Scale for Depression, and modified Present State Examination. Patients were reexamined at short-term (3 to 6 months) or long-term (1 to 2 years) follow-up. RESULTS: There were no significant intergroup differences in the MMSE scores at the initial evaluation or at short-term follow-up. At long-term follow-up, however, patients with either right or left caudate lesions had significantly lower MMSE scores than patients with other subcortical lesions. CONCLUSIONS: A significant number of patients with caudate infarction deteriorate in their intellectual function between 1 and 2 years after stroke. This phenomenon could be mediated through disruption of cortical projections to the caudate.

Caudate Nucleus↗
PubMed1997

Emotional activation of limbic circuitry in elderly normal subjects in a PET study.

OBJECTIVE: This study was undertaken to identify brain structures associated with emotion in normal elderly subjects. METHOD: Eight normal subjects aged 55-78 years were shown film clips intended to provoke the emotions of happiness, fear, or disgust as well as a neutral state. During emotional activation, regional cerebral blood flow was measured with the use of [15O]H2O positron emission tomography imaging, and subjective emotional responses were recorded. Data were analyzed by subtracting the values during the neutral condition from the values in the various emotional activations. RESULTS: The stimuli produced a general activation in visual pathways that included the primary and secondary visual cortex, involving regions associated with object and spatial recognition. In addition, the specific emotions produced different regional limbic activations, which suggests that different pathways may be used for different types of emotional stimuli. CONCLUSIONS: Emotional activation in normal elderly subjects was associated with increases in blood flow in limbic and paralimbic brain structures. Brain activation may be specific to the emotion being elicited but probably involves complex sensory, association, and memory circuitry. Further studies are needed to identify activations that are specific for emotion.

Aged↗
PubMed1997

Vegetative and psychological symptoms associated with depressed mood over the first two years after stroke.

INTRODUCTION: In patients with acute physical illness, symptoms used in the diagnosis of major depression such as sleep or appetite disturbance may be nonspecific for depression. This study was undertaken to examine the association of depressed mood with other depressive symptoms to determine which symptoms were most useful in the accurate diagnosis of major depression after stroke. METHODS: Using a structured mental status examination, 142 patients with acute stroke were followed at three, six, twelve, and twenty-four months. RESULTS: The median number of vegetative and psychological symptoms among patients with depressed mood was more than three times the respective rates among nondepressed patients at all time points over two years. Autonomic anxiety, morning depression, subjective anergia, worrying, brooding, loss of interest, hopelessness, and lack of self-confidence were significantly more frequent among depressed patients than nondepressed patients throughout the entire two-year period. Some symptoms such as anxious foreboding and loss of libido, as well as self-depreciation, feelings of guilt, and irritability were no longer significantly more common among depressed compared with nondepressed patients after six months. Standard DSM-IV diagnostic criteria and modified DSM-IV diagnostic criteria which included only specific symptoms of depression (i.e., symptoms which were significantly more frequent among depressed than nondepressed mood patients) yielded similar frequencies of major depression diagnosis. There were only a few patients (i.e., 2% to 3%) with depressive symptoms without a depressed mood (perhaps "masked" depression). CONCLUSIONS: Vegetative and psychological depressive symptoms are significantly more common in depressed patients over the first two years after stroke and DSM-IV criteria do not overdiagnose major depression even in this population with chronic physical illness. The symptoms which characterize major depression appear to change between the subacute and chronic post-stroke periods.

Adult↗
PubMed1997

Cerebellar size and cognition: correlations with IQ, verbal memory and motor dexterity.

The objective of this study was to examine the structure/function relationship between in vivo cerebellar size and higher cognitive function in a sample of healthy young subjects. The design of the study involved correlation of in vivo cerebellar volume measurements with measures of general intelligence (WAIS-R V&P FSIQ, Vocabulary, Block Design, and Digit Span subtests), motor dexterity (Halstead-Reitan Finger Tapping), verbal (WMS Logical Memory), and visual (Rey-Osterrieth Figure) memory covaring for cerebrum size. A similar analysis was performed using left temporal lobe volumes as a control region. The sample consisted of 62 healthy subjects (30 females, 32 males) enrolled as controls at the MHCRC at the University of Iowa Hospitals and Clinics. This independent sample does not overlap with the groups studied in our previous report on the relationship between cerebellar and brain size and IQ. Cerebellar and total brain size were estimated through automatic, atlas-based volume measurements using MR images obtained with a T1-weighted three-dimensional SPGR sequence on a 1.5-T GE Signa scanner and locally developed software. Cerebellar volume significantly correlated with Finger Tapping (left hand: r = 0.218, p < 0.05; right hand: r = 0.211, p < 0.05) and with memory retention of complex narrative material (r = 0.27, p < 0.02). Cerebellar volume correlated with general intelligence in the expected direction (r = 0.19, p < 0.07). This study confirms previous work indicating that the cerebellum may make a contribution to several aspects of cognition. Cerebellar volume significantly correlated with the ability to retain already encoded information in the verbal domain and with fine motor dexterity. Cerebellar volume positively correlated with general but the relationship did not reach statistical significance. The structural/functional relationship between cerebellum and verbal memory abilities is consistent with evolutionary theory for the phylogenetical increase in the size of the cerebellum.

Adult↗
PubMed1996

The validity of observed depression as a criteria for mood disorders in patients with acute stroke.

The validity of observed depression as a criteria for major or minor depression was assessed among 301 patients with acute stroke. Patients who acknowledged a depressed mood or loss of interest (standard depression) were compared to patients who denied depression but were 'observed' to be depressed (non-standard depression) for the clinical correlates of depression. Although standard and non-standard major depressions had some clinical correlates such as increased frequency of female gender and prior psychiatric history, standard major depression patients had a significantly higher frequency of left hemisphere lesions than the non-standard major depression patients. These results support the validity of 'observed' depression as a criteria for major depression but also suggest the possibility that failure to report depressed mood may identify a condition with a different etiology than depression that is recognized and acknowledged. Observed depression, however, was not validated among patients with minor depression since there were no clinical or phenomenological differences from non-depression.

Activities of Daily Living↗
PubMed1996

Scurvy results in decreased collagen synthesis and bone density in the guinea pig animal model.

The effect of severe ascorbic acid deficiency on bone remodeling and collagen synthesis was evaluated in a 21 day experiment, using the scorbutic guinea pig model. Animals (n = 6-7/group) were assigned to one of three groups: scorbutic, pair-fed ascorbic acid-replete, or ad libitum ascorbic acid-replete groups. After 2 weeks, scorbutic animals started voluntarily decreasing food intake and losing weight. By day 19-21, at which time bone and tissue samples were collected and analyzed, scorbutic animals decreased food intake to 46% of usual and lost 9% body weight. Serum 25OHD3, 1,25(OH)2D3, calcium, and albumin were significantly lower (p < 0.05) in the scorbutic animals than in the other groups. Bone mineral density and bone mineral content of the proximal and central femur were significantly lower in the scorbutic group than in the other groups (p < 0.05). Morphometric analysis of tibia indicated significantly lower bone volume, fewer and thinner trabeculae, and a thinner growth plate in the scorbutic group, compared to the pair-fed and ad libitum groups (p < 0.05). Osteoclast surface was about 60% higher in the scorbutic group than in the pair-fed and ad libitum control groups (0.05 < p < 0.10). Mechanical strength of the femur and lumbar vertebral body tended to be lower when bone mass was altered in the same group. Collagen synthesis of articular cartilage and tendons was lower in the scorbutic group than in the pair-fed or ad libitum groups (p < 0.05). In conclusion, scurvy but not food restriction, per se, results in alterations in bone mass and tissue collagen synthesis.

Analysis of Variance↗
PubMed1996

Suicidal plans in patients with stroke: comparison between acute-onset and delayed-onset suicidal plans.

Three hundred one patients were examined for suicidal plans during the acute hospital period following stroke and at 3, 6, 12, and 24 months' follow-up. It was found that 6.6% of patients developed suicidal plans during the initial in-hospital evaluation (acute-onset suicidal plans) and 11.3% of patients developed suicidal plans at 3, 6, 12, or 24 months' follow-up (delayed-onset suicidal plans). The development of both acute and delayed-onset suicidal plans was strongly related to the existence of depressive disorders, especially major depression, and to a prior history of stroke. Acute-onset suicidal plans were also related to premorbid alcohol abuse. Acute-onset suicidal patients had more anterior lesion location and delayed-onset suicidal patients had more posterior stroke lesions. Delayed-onset suicidal plans were not related to alcohol abuse but tended to be associated with greater physical impairment and poorer social support during the acute poststroke period. These data suggest that the etiology of these two types of suicidal plans may be different with acute onset related to biological mechanisms and delayed onset related to psychological mechanisms.

Acute Disease↗
PubMed1996

Long-term low ascorbic acid intake reduces bone mass in guinea pigs.

The effect of long-term (1 y) low to excess ascorbic acid (AA) intake on bone mass was evaluated using guinea pigs that were 12-14 d old at the start of the experiment. Dietary AA was low (0.15 g/ kg diet) (n = 7), normal (0.50 g/kg) (n = 8) or excess (10 g/kg) (n = 8). After 12 mo, total body bone mineral density (BMD, mg/cm2) and bone mineral content (BMC, g) were determined by dual energy X-ray absorptiometry. Histomorphometric analysis of the cancellous bone of the proximal tibial metaphysis was completed after in vivo dual fluorochrome labeling. Total body BMD of the low AA group was 4.9% lower (P < 0.05), and total body BMC was 12.4% lower (P < 0.05) than in the normal AA group. Total body BMD and BMC were similar in normal and excess AA groups and in the low and excess AA groups. Histomorphometric analysis indicated significantly greater (P < 0.05) double-labeled bone surface, mineralizing surface, and bone formation rate in the low AA guinea pigs compared with the normal AA animals. Thus, there was greater bone turnover in the low AA group than in the normal AA guinea pigs. No differences in histomorphometric endpoints existed between the normal AA and excess AA groups. Long-term AA deficiency, during the period of rapid growth and slower phases of skeletal maturation, resulted in bone abnormalities in adult guinea pig skeletons. Long-term dietary AA excess caused no such abnormalities.

Absorptiometry, Photon↗
PubMed1996

Suicidal plans in patients with acute stroke.

The clinical correlates of suicidal thoughts were examined among a group of 301 patients with acute stroke. A total of 20 patients (6.6%) had suicidal thoughts. Previous history of stroke was associated with suicidal thoughts. Suicidal thoughts, however, were not related to severity of physical impairment. Most patients with suicidal thoughts met criteria for major depression. Other risk factors included younger age, poor social support, sensory deficit, and impaired cognitive function. Patients with suicidal plans had depression characterized by social withdrawal and brooding and self blame. Early identification of risk factors including the existence of depression may lead to effective therapeutic intervention.

Acute Disease↗