Journal of the neurological sciences
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Vascular dementia (VaD) is one of the most prevalent causes of dementia, and it is frequently misdiagnosed and undertreated in clinical practice. Because neuropsychological outcome depends, among other factors, on the size and location of the vascular brain injury, characterizing the cognitive profile of VaD has been especially challenging. Yet, there has been sufficient evidence to show a marked impairment of attention and executive functions, in particular in relation to Alzheimer disease. ⋯ The 88-point cut-off proposed for the ACE-R was associated with a sensitivity of 100% and a specificity of 100% for the detection of cognitive impairment, demonstrating a stronger capacity than the MMSE (sensitivity of 42% with its 23-point cut-off score). We also found that the verbal fluency subtest of the ACE-R may be potentially useful in discriminating patients with subcortical ischemic vascular dementia from patients with AD. We discuss the utility of these findings in the context of everyday clinical practice and we propose that future studies should evaluate the potential usefulness of combining the ACE-R with a brief screening tool of executive functioning.
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Depression is frequently associated with Parkinson disease (PD) but neural basis is still unclear. In previous studies white matter changes present as signal hyperintesities on T2-wighted MRI studies (WMHs) commonly observed in older adults have been associated with depressive symptomatology. In this study we investigated whether WMHs were associated with depression in PD patients with disease onset above the age of 60. ⋯ PD-D group had significantly higher WMHs scores BG regions when compared to controls. The only significance in multivariate analyses was shown for periventricular WMHs total score explaining the 39% of the variance in the depressive score. Our findings suggest that WMH in the deep white matter may contribute to depression in PD.
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Epidemiological studies show that vascular risk factors (e.g. atherosclerosis, diabetes, homocysteine, hypertension or cholesterol) may play a role in the development of Alzheimer's disease. Animal models may help to discover the role of vascular risk factors on cognition. In the present project we treated male Sprague Dawley rats with a diet containing homocysteine (hyperhomocysteinemia) or cholesterol (hypercholesterolemia) for 5 months or exposed the rats to ethanol (20% in drinking water) or a combination of cholesterol+ethanol (mix) for 12 months. ⋯ Levels of amyloid precursor protein, beta-amyloid((1-42)), as well as tau and phospho-tau 181 were significantly enhanced in the cortex of cholesterol-fed rats. A combination of ethanol and cholesterol did not further potentiate the effects on spatial memory, cholinergic neurons and blood-brain barrier leakage. The data suggest that chronic mild vascular risk factors over months induce small lesions of the brain capillaries in the cortex, which may contribute to the development of vascular dementia or also Alzheimer's disease.
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Evidence suggests that the autonomic nervous system may actively regulate the cerebral vasculature. In this study, central hemodynamics and brain oxy-hemoglobin, deoxy-hemoglobin and total hemoglobin changes (bO₂Hb, bdHb and bTHb) were monitored during infusion of epinephrine (0.06 μg/kg/min over 6 min, and 0.12 μg/kg/min for 3 min) in 12 men. ⋯ No evidence was found for reduction in cerebral oxygenation during a cold-pressor test. The results of the present study demonstrated that clinical doses of epinephrine result in a delayed increase in cortical blood volume due to an increase in Oxy-Hb, consistent with vasodilation.
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Multicenter Study
Validation of the Stroke-specific Quality of Life for patients after aneurysmal subarachnoid hemorrhage and proposed summary subscores.
The identification of aneurysmal subarachnoid hemorrhage (aSAH) patients with a decrease in health-related quality of life (HRQOL) is challenging. Failure of clinical trials has been partially attributed to lack of sensitivity in outcome measures. Stroke-specific Quality of Life (SS-QOL) is a disease-specific HRQOL tool widely applied in ischemic stroke researches, but not in aSAH. ⋯ Dichotomization of physical and psychosocial subtotal scores is valid and can simplify applications of the scale.