Cognitive impairment aspects in subcortical dementia patients

Cognitive impairment aspects in subcortical dementia patients

Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320 303 Background: Depression-executive dysfunction syndrome DES is state leading t...

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Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320

303

Background: Depression-executive dysfunction syndrome DES is state leading to cognitive retardation, which represents the basis of vascular dementia in late life. Establish DES after stroke may help to choose patients with high risk of dementia. Objectives: The aim of this study was the assessment of DES prevalence among poststroke patients, risk factors and clinical and radiological correlates of DES. Patients and methods: A prospective study of 147 stroke patients was carried out. Type, side and site of stroke were assessed by conventional MRI. Stroke severity was evaluated according to NIHSS at acute stage and 3 months poststroke. Global cognitive function, daily activity index were evaluated by MMSE, Barthel Index (BI), depressive symptoms were assessed by Hamilton Depression Rating Scale(HAM-D) before discharge and three months poststroke. Executive function was investigated in depressive groups by a neuropsychological battery (letter fluency, Stroop test, Wisconsin Card Sorting Test, digit span, letter number sequencing). According to test data, patients were divided in two groups: I group-with DES, II group-without DES. They were compared due to vascular risk factors, clinical, demographic and radiological variables. Statistical evaluation was performed by SPSS. Results and conclusion: From 147 stroke patients depression-executive dysfunction syndrome was diagnosed in 24 (16.3%) cases. Patients with DES (I group) more often had damage of the left hemisphere, prevalence of ischemic with basal ganglia lesion. Multiple linear logistic regression analysis revealed a significant share of hypertension, age, previous history of stroke and female gender in the development of DES. Comparison of these two groups revealed that patients with DES had lower MMSE, higher NIHSS and BI score, worse ADL index.

was to evaluate the clinical features that are preponderant in our patients and their relationship to the anatomopathological lesions. Methods: The study group was composed of 60 patients with vascular dementia. They underwent clinical, neuropsychological and MRI examination. The results were compared to 60 normal ageing controls. Results: The study group patients presented lacunar infarcts in putamen, globus pallidus, thalamus, frontal white matter and pons. Severe agitation, depression, anxiety and apathy were frequent in patients with SIVD. We found delusions more frequent in patients with bilateral subcortical vascular lesions. Monosimptomatic delusions or complex late-onset paraphrenic disorders were present. These patients were more aggressive and exhibited more activity disturbances than nondelusional patients. Misidentification syndromes occurred in a quarter of the patients with delusions. Depression and anxiety was present in left frontal lesions. Also we found more depression in right posterior lesions during the post stroke period. Patients with putamen and globus pallidus lesions presented apathya, obsessions and compulsions, especially in bilateral lesions. Conclusion: Anathomopathological lesions can not entirely explain the cognitive and clinical profile in vascular dementia.

doi:10.1016/j.jns.2009.02.239

Relation to stroke etiology and topography

Natural history of post-stroke cognitive decline in subacute stage

M. Hoffmann, A.M. Bozorg University of South Florida, Tampa, FL, USA

M.-K. Oha, E.K. Kanga, B.S. Knowb, N.-J. Paika a Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul, South Korea b Department of Rehabilitation Medicine, Dongguk University Hospital, Seoul, South Korea Background and aims: Cognitive decline after stroke is common, and most studies of cognitive disorders after stroke report vascular dementia as the main outcome. However, natural history of post-stroke cognitive decline remains unclear. The aim of this study is to describe the natural history of cognitive decline after stroke. Methods: General cognitive function was assessed using Mini Mental State Examination (MMSE) in five cognitive domains (orientation, registration, attention and calculation, recall, language) at two different time points after first ever stroke in 23 patients (13 males and 10 females; average 68.4±12.8 years). Results: MMSEs were measured at 23.2±12.4 (range 6–55) and 86.1±30.7 (range 48–181) days after the stroke. Total score improved from 16.5±10.7 at initial measure to 21.0±7.5 at follow-up measure (P=0.007 by paired t-test). At each domain, registration (from 2.2±1.3 to 2.9±0.3; P=0.012), recall (from 0.6±1.0 to 1.3±1.2; P=0.008) and language (from 5.6±3.4 to 6.9±1.9; P=0.023) scores were significantly improved at follow up measure as compared with initial ones. However, orientation (from 5.9±3.9 to 7.2±3.3; P=0.070), attention and calculation (from 2.1±2.2 to 2.7±1.8; P=0.117) were comparable over time. Conclusions: This study suggests that cognitive decline after stroke improves over time in the sub-acute stage, and this should be considered in the diagnosis of post-stroke vascular dementia. Further studies are required to identify more long-term changes of cognitive function in this population. doi:10.1016/j.jns.2009.02.240

doi:10.1016/j.jns.2009.02.241

Vascular cognitive syndromes in 2389 stroke patients

Background: Cognitive syndromes (CS) after stroke may be important to measure and monitor for management and emerging therapies. Methods: A validated cognitive examination was administered during the first month of stroke presentation and analyzed according to 5 large scale networks for cognition and correlated with neuropsychological tests. Multivariate analyses were performed to determine association of cognitive syndromes with etiology (TOAST classification) topography and neurological deficit by NIHSS. Results: After specific exclusions, one or more CS was present in 112 of 309 (36%) TIA patients versus 1569/1796 (87%) stroke patients (p = < 0.001). The frequency of frontal network syndromes (FNS) was 908/ 1796 (51%), left hemisphere network (LH) syndromes 646/1796, (36%), right hemisphere (RH) network syndromes 275/1796 (15.3%), occipitotemporal network (OT) syndromes 107/1796 (6%), hippocampal limbic (HL) network syndromes 397/1796 (22%) and miscellaneous (M) syndromes of 481/1796 (27%). Stroke etiology and their signature CS by multivariate analyses, revealed significant associations for LH with cardioembolism (OR 1.61, p = 0.0029), FNS and “other” etiology (OR 1.96, p = < 0.0001) and HL also for “other” etiology (OR 1.57, p = 0.0026). Coma (OR 2.95, p = < 0.0001) and encephalopathy (OR 2.82, p = < 0.0001) were both associated significantly with hemorrhage. A left hemisphere lesion was associated with LH cognitive syndromes (OR 9.26, p = < 0.0001). A FNS was associated with frontal lesions (OR 5.19, p = < 0.0001) as well as subcortical lesions (OR 1.91, p = < 0.0001). The M group of CS were associated with subtentorial (OR 1.86, p = 0.0283) and right hemisphere lesions (OR 2.47, p = < 0.0001) The LH and RH syndromes had the highest NIHSS and differed significantly from all others. Conclusions: CS are present in the vast majority of stroke patients. Certain stroke subtypes are associated with specific CS. Certain signature CS result from lesions that relate to the major cognitive networks. doi:10.1016/j.jns.2009.02.242

Cognitive impairment aspects in subcortical dementia patients R.D. Chirileanu, M. Simu, D. Reisz, R. Popa, S. Tamasan Emergency Clinic Hospital Timisoara, Neurology Department, University of Medicine and Pharmacy, Timisoara, Romania Background and aim: Subcortical ischemic vascular dementia is caused by small vessel disease and has generally a subacute onset, related to the presence of white matter ischemic lesions and lacunes. The aim of the study

Neurolinguistic and acoustic analysis of speech and language disorders secondary to diffuse subcortical vascular lesions: A case report G. Tomica, M. Stojanovicb, A. Pavlovica, P. Stankovicb, J. Zidverc-Trajkovica, Z. Jovanovica, M. Mijajlovica, A. Radojicica, N. Sternica a Institute of Neurology, Clinical Center of Serbia, Belgrade, Serbia b Institute For Otorhinolaryngology, Clinical Center of Serbia, Belgrade, Serbia