Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · May 2015
Impact of anxiety on verbal and visuospatial working memory in patients with acute stroke without severe cognitive impairment.
Working memory is the most impaired cognitive domain in the acute phase of stroke. In a context where anxiety is highly prevalent, close attention must be paid to anxiety which could mimic mild to moderate working memory impairments. This is the first study to assess the contribution of state anxiety (the currently experienced level of anxiety) to the working memory (verbal, visuospatial) in patients with first-ever acute stroke without severe cognitive impairment. ⋯ In a stressful context, the contribution of state anxiety to reduced working memory performance is more pronounced in patients with acute stroke than in controls. These results are of particular relevance for clinicians assessing patients in the acute phase of stroke in which anxiety is highly prevalent.
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J. Neurol. Neurosurg. Psychiatr. · May 2015
Comparative StudyA multidisciplinary clinic approach improves survival in ALS: a comparative study of ALS in Ireland and Northern Ireland.
Amyotrophic lateral sclerosis (ALS) is a progressive debilitating neurodegenerative disease, with a life expectancy of 3-5 years from first symptom. There is compelling evidence that those who attend a multidisciplinary clinic experience improved survival. The purpose of the study was to explore the survival of patients with ALS ascertained through population-based Registers in the Republic of Ireland (RoI) and Northern Ireland (NI), and to determine whether centralisation of services confers advantage compared with community-based care supported by a specialist care worker. ⋯ Centralised multidisciplinary care confers a survival advantage for patients with ALS and is superior to devolved community-based care. We propose that multiple decision-making processes within a multidisciplinary setting lead to an enriched set of clinical encounters for the patient and carer that enhances clinical outcome.
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J. Neurol. Neurosurg. Psychiatr. · May 2015
Fatigue at time of CIS is an independent predictor of a subsequent diagnosis of multiple sclerosis.
Fatigue is a common, disabling symptom of multiple sclerosis (MS), but little is known about fatigue in patients with clinically isolated syndrome (CIS), often the presenting symptom of MS. We aimed to investigate the prevalence and severity of fatigue in patients with CIS, and its association with a diagnosis of clinically definite MS (CDMS). ⋯ Already at the stage of CIS, fatigue is a very common symptom, with a severity similar to fatigue in MS patients. This fatigue seems unrelated to the type or severity of the attack. Importantly, we found that fatigue was an independent predictor of a subsequent diagnosis of MS.
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J. Neurol. Neurosurg. Psychiatr. · May 2015
MRI in Leber's hereditary optic neuropathy: the relationship to multiple sclerosis.
Leber's hereditary optic neuropathy (LHON) and a multiple sclerosis (MS)-like illness appear to coexist 50 times more frequently than would be expected by chance. This association of LHON and MS (LMS) raises an important question about whether there could be a common pathophysiological mechanism involving mitochondrial dysfunction. ⋯ A blinded review of conventional brain MRIs shows that patients with LMS have a scan appearance indistinguishable from MS. Mitochondrial dysfunction could be a common pathophysiological pathway in the formation of white matter lesions. There appears to be a strong female influence on the radiological appearance as well as clinical development of MS in patients with LHON.
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J. Neurol. Neurosurg. Psychiatr. · May 2015
The grey matter correlates of impaired decision-making in multiple sclerosis.
People with multiple sclerosis (MS) have difficulties with decision-making but it is unclear if this is due to changes in impulsivity, risk taking, deliberation or risk adjustment, and how this relates to brain pathology. ⋯ These data clarify the features of decision-making deficits in MS, and provide the first evidence that they relate to grey and white matter abnormalities seen using MRI.