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PubMed1991

Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis.

Using death and functional status as end points, we prospectively analyzed the outcome 6 months after spontaneous intracerebral hemorrhage in 166 patients admitted to an acute-care stroke unit on the first day of their stroke. Seventy-one patients (43%) died, 69 (42%) had a satisfactory outcome, and 26 (16%) had a poor functional outcome. Early (30-day) survival was correlated with morphologic parameters on the initial computed tomogram (hemorrhage size, midline shift, and intraventricular spread of the hemorrhage), while later (6-month) survival was correlated with age. Using logistic regression, we found five independent predictors of satisfactory outcome at 6 months: age, hemorrhage size, intraventricular spread of the hemorrhage, limb paresis, and communication disorders. Of these, age was the most important predictor by far.

Adult↗
PubMed1995

Hypertension and diabetes mellitus as determinants of multiple lacunar infarcts.

BACKGROUND AND PURPOSE: We investigated the relationship between hypertension, diabetes mellitus, and lacunes. METHODS: From 1237 cases of ischemic stroke in the Stroke Data Bank of the National Institute of Neurological and Communicative Disorders and Stroke, data from 637 patients whose initial computed tomogram showed lacunar (n = 184) or nonlacunar infarcts (n = 453) were analyzed. The group with lacunar infarcts was further divided into subgroups according to whether the patients had multiple (n = 40) or single (n = 144) lacunar infarcts. The association of hypertension and diabetes mellitus with lacunar infarcts was investigated using logistic regression models that included age, sex, and cardiac disease. Similar models were used to analyze the effects of diastolic and systolic blood pressure. RESULTS: Hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1 to 6.0) and diabetes (OR, 2.3; 95% CI, 1.1 to 4.5) were significantly related to multiple but not to single lacunes. Cardiac disease was inversely associated with both single and multiple lacunes. Diastolic blood pressure significantly affected the probability of multiple lacunar infarcts (OR, 1.4; 95% CI, 1.04 to 1.9), whereas systolic pressure did not. CONCLUSIONS: There may be etiologically distinct lacunar infarct subgroups, with multiple lacunes being strongly related to hypertension and diabetes mellitus. Other stroke risk factors may be more important in patients with single lacunes. Diastolic rather than systolic pressure seems to be a major determinant of multiple lacunes.

Adult↗
PubMed2000

Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study.

BACKGROUND AND PURPOSE: The purpose of our study was to determine the functional and neuroanatomic correlates of poststroke depressive symptoms. METHODS: Patients with consecutive admissions to a regional stroke center for new-onset unilateral hemispheric stroke who met World Health Organization and National Institute of Neurological and Communicative Disorders and Stroke criteria were eligible for inclusion in a longitudinal study. Acutely, patients underwent CT scanning, and at 3 months and 1 year after stroke, depressive symptoms were assessed by using both the Montgomery-Asberg Depression Rating Scale and the Zung Self-Rating Depression Scale. The Functional Independence Measure (FIM) served as an indication of functional outcome and was obtained at 1 month, 3 months, and 1 year after stroke, along with other demographic information. The Talairach and Tournoux stereotactic atlas was used for the primary determination of CT lesion localization. Lesion proximity to the anterior frontal pole was also measured. RESULTS: Eighty-one patients participated in the longitudinal study. Stepwise linear regression analyses generated a highly significant model (F(3,76)=9.8, R(2)=28%, P<0.0005), with lower 1-month total FIM scores, living at home, and damage to the inferior frontal region predicting higher depression scores at 3 months. Similarly, lower 3-month total FIM scores correlated with higher 3-month depression scores, and lower 1-year total FIM scores correlated with higher 1-year depression scores. CONCLUSIONS: Functional measures correlated with poststroke depression across time and, together with neuroanatomic measures, predicted depressive symptoms longitudinally. Although inferior frontal lesion location, irrespective of side, appeared to play a role as a risk factor in this study, the degree of functional dependence after stroke imparted the greatest risk.

Activities of Daily Living↗
PubMed1990

Neuropathological findings in patients with clinical diagnoses of probable Alzheimer's disease.

To assess prospectively the accuracy of standard antemortem clinical diagnostic criteria for Alzheimer's disease, post-mortem examinations were performed on 25 patients who had met DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke criteria for probable Alzheimer's disease. Seventeen patients (68%) met neuropathological criteria for Alzheimer's disease. Two presenile-onset patients had diffuse neocortical senile plaques of insufficient number for definite Alzheimer's disease. Six patients had non-Alzheimer's disease diagnoses. Five of these six had presenile-onset dementia. These results suggest caution in the antemortem diagnosis of Alzheimer's disease in presenile-onset dementia.

Aged↗
PubMed1994

Clinical symptoms associated with age at onset in Alzheimer's disease.

OBJECTIVE: The aim of the study was to examine the relationship between age at onset of Alzheimer's disease and demographic and clinical characteristics in a large cohort of patients with Alzheimer's disease. METHOD: The subjects were 104 patients meeting the criteria for Alzheimer's disease of the National Institute of Neurological and Communicative Disorders and Stroke. The relationships of age at disease onset to cognitive and noncognitive variables and to rate of progression were explored by using multiple regression analysis. RESULTS: Earlier disease onset was associated with the presence of greater language and praxis difficulties and with the development of higher depression scores during the follow-up study period but not with faster disease progression. CONCLUSIONS: These findings suggest that in Alzheimer's disease, which is a clinically heterogeneous illness, younger age at onset may be related to the presence of more prominent language and praxis impairment and to development of greater depression during the disease course.

Age of Onset↗
PubMed1999

Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer's disease.

OBJECTIVE: The literature reports considerable variation in the rates of psychiatric morbidity for patients with dementia with Lewy bodies. The authors intended to clarify the frequency of psychiatric morbidity in dementia with Lewy bodies and how it differs from probable Alzheimer's disease. METHOD: The study incorporated two groups--a clinical case register cohort (98 with dementia with Lewy bodies; 92 with Alzheimer's disease) and 80 (40 with dementia with Lewy bodies: 40 with Alzheimer's disease) prospectively studied, neuropathologically confirmed cases. Diagnoses were made by using the McKeith et al. consensus criteria for dementia with Lewy bodies and the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease. Neuropathological diagnoses were made by using the consensus criteria for dementia with Lewy bodies and the Mirra et al. protocol for Alzheimer's disease. RESULTS: The occurrence of psychiatric symptoms was reported over 1 month. Hallucinations, depression, delusions, and delusional misidentification were all significantly higher for patients with dementia with Lewy bodies. The differences in frequency between dementia with Lewy bodies and Alzheimer's disease for auditory and visual hallucinations were especially pronounced for patients with mild cognitive impairment. The presence of psychiatric symptoms at presentation was a better discriminator between dementia with Lewy bodies and Alzheimer's disease than occurrence over the course of dementia. CONCLUSIONS: Delusional misidentification and hallucinations in the early stages of dementia may improve differentiation between patients with dementia with Lewy bodies and those with Alzheimer's disease and have important treatment implications.

Aged↗
PubMed2001

Syndromic validity of apathy in Alzheimer's disease.

OBJECTIVE: The study examined the usefulness and clinical correlates of specific diagnostic criteria for apathy in Alzheimer's disease. Whereas apathy is a frequent behavioral change in patients with Alzheimer's disease, the lack of standardized diagnostic criteria may explain the wide discrepancies in estimates of the frequency and demographic and clinical correlates of apathy. METHOD: A consecutive series of 319 patients who met the criteria for probable Alzheimer's disease established by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, 117 patients who met the DSM-IV criteria for depression without dementia, and 36 healthy individuals were assessed with a structured psychiatric interview. On the basis of modified Marin's criteria for apathy, they were classified into groups with or without apathy. RESULTS: Apathy was diagnosed in 37% of the 319 Alzheimer's disease patients, compared to none of the healthy comparison subjects. In 24% of the Alzheimer's disease sample, apathy coexisted with either dysthymic disorder or major depressive disorder, whereas 13% had apathy without depression. Apathy was diagnosed in 32% of the depressed nondemented patients, mostly in those with major depressive disorder. Apathy in Alzheimer's disease was significantly associated with severe impairments in activities of daily living and cognitive functions, older age, and poor awareness of behavioral and cognitive changes. CONCLUSIONS: This study provides partial validation of specific clinical criteria for apathy in Alzheimer's disease.

Affective Symptoms↗
PubMedDate not supplied

Hearing and age: research challenges and the National Institute on Aging.

Just as the ear trumpet once symbolized the elderly, so do contemporary approaches to hearing loss in the aged reflect many of the major themes in geriatrics and gerontology today. This paper begins by describing the National Institute on Aging (NIA) with particular emphasis on activities relevant to hearing in the elderly. Next, several areas of research interest, including the typology of presbycusis and related conditions, the epidemiology of auditory impairment in old age, the design of testing and research, and the rehabilitation of the hearing-impaired elderly, are addressed. The NIA and the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) are coordinating their efforts to stimulate investigation of these and related topics.

Aged↗
PubMed1993

Providing appropriate education for students with learning disabilities in regular education classrooms. National Joint Committee on Learning Disabilities.

This statement was developed by the National Joint Committee on Learning Disabilities (NJCLD). Representatives of the American Speech-Language-Hearing Association (ASHA) were Rhonda S. Work, Chair; Mabel L. Rice; Stan Dublinske, ex officio. Ann L. Carey, vice president for professional and governmental affairs, was the monitoring vice president. Other member organizations of the NJCLD include the Association on Handicapped Student Services Programs in Postsecondary Education; Council for Learning Disabilities; Division for Children with Communication Disorders; Division for Learning Disabilities; International Reading Association; Learning Disabilities Association of America; National Association of School Psychologists; Orton Dyslexia Society. This statement was approved by the ASHA Legislative Council in November 1990 (LC 26-90) [see Note 1].

Child↗
PubMedDate not supplied

The metabolic evaluation in Meniere's disease.

Meniere's disease remains today a poorly understood and difficult-to-manage inner ear problem. Numerous articles have been written about the medical and surgical management of Meniere's disease. Previous authors have suggested that a metabolic abnormality may be a contributing etiologic factor in the disease. Since 1976, 384 patients with Meniere's disease were seen in the Department of Otolaryngology and Communicative Disorders of the Cleveland Clinic Foundation. In 180 of these patients, the results of a metabolic evaluation were reviewed, including the five-hour glucose tolerance test, lipid profile, free thyroxine index, and the fluorescent treponemal antibody absorption test (FTA-ABS). The results of these tests suggest that thyroid abnormalities are rare in Meniere's disease. There may be a fairly high false-positive rate in using the FTA-ABS as a screening procedure. Carbohydrate abnormalities are found; however, hypoglycemia was not a major factor in this series of patients. A significant number of patients were found to have lipid abnormalities, and dietary management of these is believed helpful in the medical management of a patient with Meniere's disease.

Adolescent↗
PubMed2001

Single photon emission computed tomography and apolipoprotein E in Alzheimer's disease: impact of the epsilon4 allele on regional cerebral blood flow.

The aim of this study was to examine the impact of the apolipoprotein E (APOE) epsilon4 allele on semiquantitative regional cerebral blood flow (rCBF) in Alzheimer's disease. Single photon emission computed tomography technetium (SPECT) with (99m)Tc d,l-hexamethyl propylenamine oxine was used to determine rCBF in 41 consecutive patients (18 males/23 females) with probable Alzheimer's disease according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria (mean age 71.0 years; range 54-85). The mean Mini-Mental State Examination (MMSE) score was 20.4 (range 10-30). After normalization of CBF to mean blood flow in the cerebellum, values for rCBF in several cortical regions of interest, side-to-side asymmetry indices, and anterior-posterior ratios were calculated. Determination of the APOE genotype from blood samples was performed using restriction enzyme polymerase chain reaction technique. Multivariate regression analyses and the Wilcoxon rank-sum test for unpaired data (Mann-Whitney) were used for statistical analysis. The patients comprised 27APOE epsilon4-positive and 14APOE epsilon4-negative individuals. Five patients were APOE epsilon4 homozygotes. APOE epsilon4-positive patients had significantly reduced rCBF in the right frontal and left occipital lobes. On nonparametric analysis, the most prominent differences between epsilon4-negative and epsilon4-positive patients were demonstrated in subregions representing the frontal association cortex (Mann-Whitney, P < .01). Age-stratified analysis suggested that these findings could be demonstrated predominantly in the elderly patients. The results of this study suggest that the APOE genotype in itself may have an impact on the pattern of rCBF deficits in Alzheimer's disease. The more pronounced reduction of rCBF in frontal association cortex observed in elderly APOE epsilon4-positive patients might predict clinical progression.

Age Factors↗
PubMed2002

"Life is not worth living": hopelessness in Alzheimer's disease.

This study investigated the prevalence and clinical correlates of hopelessness among 91 patients diagnosed with probable Alzheimer's disease (AD) according to National Institute of Neurological Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Hopeless ideation was measured with Item 3 on the Hamilton Depression Rating Scale (Suicide), which inquires specifically whether the patient thinks "life is not worth living." The results showed that hopelessness was present in 10% (n = 9) of the sample. Patients with these cognitions evidenced greater psychological symptoms of mood disturbance and more insight into their cognitive and functional impairments. Unrelated factors included age, education, Mini-Mental State Examination score, neurovegetative signs of depression, affective expressions of depression, agitation/disinhibition, and psychosis. Although indifference is frequent in AD, these results indicate that thoughts of hopelessness are also a common phenomenon, occurring in approximately 10% of our probable AD cohort. These thoughts appear to be related to the subjective expressions of depression and anxiety rather than the neurovegetative or affective signs and are more prominent among patients with greater deficit awareness.

Affect↗
PubMedDate not supplied

Alzheimer's disease: the problem of incorrect clinical diagnosis.

We reviewed the medical records of eight patients clinically diagnosed with Alzheimer's disease who were found on autopsy to have neuropathologic findings inconsistent with Alzheimer's disease. The clinical criteria for the diagnosis of probable Alzheimer's disease from the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) were retrospectively applied to these patients. The patients presented with clinical features atypical for Alzheimer's disease early in the course of the disease, including focal neurologic findings, gait abnormalities, motor speech abnormalities, and extrapyramidal features. Attention to these clinical red flags may decrease the likelihood of misdiagnosis of Alzheimer's disease in a patient with a non-Alzheimer's disease cause of dementia.

Aged↗
PubMed1992

High-dose intravenous immune globulin in the management of severe Guillain-Barre syndrome.

OBJECTIVE: To evaluate the efficacy of high-dose intravenous gammaglobulin (IGIV) versus plasmapheresis in patients with severe Guillain-Barré syndrome (GBS) and compare the costs of both treatments. DESIGN: Retrospective review of all severely disabled GBS patients admitted between January 1 and December 31, 1990. SETTING: Neurologic unit of a tertiary-care center. PATIENTS: Six patients fulfilling the criteria for the diagnosis of GBS agreed upon by the ad hoc National Institute of Neurological and Communicative Disorders and Stroke committee. INTERVENTION: Four patients treated with plasmapheresis underwent three to six sessions of plasma exchange. Two patients received IGIV 0.4 g/kg/d administered over a five-day period. MAIN OUTCOME MEASURES: Recovery time, functional assessment (performed according to the grading scale used in the North American trial) at 30, 60, and 90 days after treatment. Cost of plasmapheresis, IGIV, and bed/day were compared. RESULTS: Clinical recovery appeared to be faster and more complete in the IGIV group than in the plasmapheresis group. No adverse reactions related to IGIV treatment appeared. The total cost was greater in the plasmapheresis group. CONCLUSIONS: These preliminary results suggest that IGIV may be more beneficial and less expensive than plasmapheresis in treatment of GBS. Definitive conclusions regarding the efficacy of IGIV in GBS will need to await the final analysis of the Ducht randomized multicenter trial comparing IGIV with plasmapheresis.

Adult↗
PubMed2003

Modeling and predicting hearing aid outcome.

Following a brief tutorial on the application of factor analysis to hearing aid outcome measures, three studies of hearing aid outcome measures in elderly adults are presented and analyzed. Two of the studies were completed at Indiana University (IU-1 and IU-2), and one was a collaborative multisite study by the Veterans Administration and the National Institute of Deafness and other Communication Disorders (NIDCD/VA). IU-1 measured hearing aid outcome in 173 elderly wearers of single-channel, linear, in-the-ear hearing aids with output-limiting compression, whereas IU-2 obtained the same extensive set of outcome measures from 53 elderly wearers of two-channel, wide-dynamic-range compression, in-the-canal hearing aids. In the NIDCD/VA study, 333 to 338 participants wore three single-channel circuits in succession, with each circuit housed within an in-the-ear shell. The three circuits included in that study and in this analysis were: (1) linear with peak clipping, (2) linear with output-limiting compression, and (3) single-channel, wide-dynamic-range compression. Evaluation of the many outcome measures completed in each study using principal components factor analysis revealed that from three (both IU studies) to five (NIDCD/VA study) principal components captured the individual differences in hearing aid outcome. This was independent of hearing aid type (in-the-ear or in-the-canal) and circuitry. Subsequent multiple regression analyses of individual differences in performance along each dimension of hearing aid outcome revealed that these individual differences could be accounted for reasonably well by various prefit variables for some dimensions of outcome, but not others. In general, measures of speech recognition performance were well accounted for by prefit measures, with the best predictors being hearing loss, cognitive performance, and age. Measures of hearing aid usage were less well accounted for by prefit measures, with the most accurate predictor of current hearing aid use being prior hearing aid use. The outcome dimension accounted for most poorly was that associated with hearing aid satisfaction, with subjective measures of aided sound quality being the best predictor of performance along this dimension of hearing aid outcome. Additional multicenter, large-scale studies are needed to develop more complete models of hearing aid outcome and to identify the variables that influence various aspects of hearing aid outcome. It is only through this additional research that it will be possible to optimize outcome for hearing aid wearers.

Journal Article↗
PubMed2005

Attention, monotropism and the diagnostic criteria for autism.

The authors conclude from a range of literature relevant to the autistic condition that atypical strategies for the allocation of attention are central to the condition. This assertion is examined in the context of recent research, the diagnostic criteria for autism in DSM-IV and ICD-10, and the personal experiences of individuals with autism including one of the authors of the article. The first two diagnostic criteria are shown to follow from the 'restricted range of interests' referred to in the third criterion. Implications for practice are indicated.

Attention↗
PubMed2001

Impact of neurorehabilitation on disability in patients with acutely and chronically disabling diseases of the nervous system measured by the Extended Barthel Index.

To study the impact of rehabilitation on disability in an unselected patient group with acutely and chronically disabling neurologic diseases, the Extended Barthel Index (EBI) was determined at the beginning and at the end of the rehabilitation stay in all patients admitted to our Neurorehabilitation Centre in Valens, Switzerland. Patients who reached the highest possible EBI score at entry ("ceiling effect"), with a short stay (<1 week), or with a deterioration due to other medical complications were excluded. Finally EBI data of 743 patients could be analyzed. The mean EBI at entry was 45 and 51 at discharge. The mean increase of the EBI score per week was 1.1 (SD, 1.7). The change of the EBI score was analyzed independently in patients with acute neurologic diseases admitted in the postacute phase (acute group) and patients with chronically disabling neurologic diseases (chronic group). As expected, the increase of the EBI score was higher in the acute group than in the chronic group; 80.8% of the acute group patients and 42.5% of the chronic group patients showed an increase of the EBI score at discharge. Both groups showed a significant EBI gain with a marked shift to higher EBI scores at discharge. The mean gain per week was 1.6 in the acute group and 0.5 in the chronic group, respectively. Analysis of EBI changes considering the different underlying diseases showed the highest increase in patients with stroke and traumatic brain injury.

Activities of Daily Living↗
PubMed2002

Speech and language therapy for dysarthria due to nonprogressive brain damage: a systematic Cochrane review.

BACKGROUND: Dysarthria is a common sequel of nonprogressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population. OBJECTIVE: To determine the efficacy of speech and language therapy interventions for adults with dysarthria following nonprogressive brain damage. DESIGN: Systematic review. SEARCH STRATEGY: This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and Linguistics and Language Behavior Abstracts were electronically searched. Hand-searching of the International Journal of Language and Communication Disorders and of reference lists from relevant articles and conference proceedings was also undertaken. Colleagues were approached to identify other possible published and unpublished studies. SELECTION CRITERIA: Unconfounded randomized controlled trials. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review. MAIN RESULTS: No trials of the required standard were identified. REVIEWERS' CONCLUSIONS: There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following nonprogressive brain damage. There is an urgent need for good quality research in this area.

Adult↗