Long-Term Cognitive Impairment After First-Ever Ischemic Stroke in Young Adults.

Long-Term Cognitive Impairment After First-Ever Ischemic Stroke in Young Adults.

Stroke. 2013 May 7;
Schaapsmeerders P, Maaijwee NA, van Dijk EJ, Rutten-Jacobs LC, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, Kessels RP, de Leeuw FE

BACKGROUND AND PURPOSE: Up to 14% of all ischemic strokes occur in young adults (<50 years). Poststroke cognitive performance is a decisive determinant of their quality of life. However, virtually no studies report on cognition after young stroke, especially not on the long term. This long-term perspective is important because young patients have a long life expectancy during which they start forming a family, have an active social life, and make decisive career moves. We aimed to evaluate the long-term cognitive outcome. METHODS: All consecutive patients between January 1, 1980, and November 1, 2010, with a first-ever young ischemic stroke were recruited for cognitive assessment, using a matched stroke-free population as a reference. Composite Z scores for 7 cognitive domains were calculated and the ANCOVA model was used (Bonferroni correction). A below average performance was defined as >1.0 SD below the age-adjusted mean of the controls and cognitive impairment as >1.5 SD. RESULTS: Two hundred seventy-seven patients and 146 matched controls completed cognitive assessment (mean follow-up, 11.0 years, SD, 8.2; age, 50.9 years, SD, 10.3). Long-term cognitive outcome after an ischemic stroke was worse in most cognitive domains compared with a nonstroke population. Up to 50% of the patients had a below average performance or cognitive impairment. Deficits in processing speed, working memory, and attention were most common. CONCLUSIONS: Even 11 years after ischemic stroke in young adults, a substantial proportion of patients must cope with permanent cognitive deficits. These results have implications for information given to patients and rehabilitation services. HubMed – rehab


Evoked potential tests in clinical diagnosis.

Tidsskr Nor Laegeforen. 2013 May 7; 133(9): 960-965
Sand T, Kvaløy MB, Wader T, Hovdal H

BACKGROUND Evoked potentials (EP) are used to demonstrate conduction disturbances in the central nervous system. This paper provides an overview of the areas in which EP is used in clinical neurophysiological diagnostics, with the emphasis on coma and demyelinating disease.METHOD The article is based on a literature search in PubMed and the authors’ long experience of neurophysiological diagnostics.RESULTS Somatosensory evoked potential (SEP) can provide reliable prognostic information about failure to return to consciousness as early as 24 hours after anoxic coma has occurred. If coma is caused by a brain trauma, cerebrovascular episode or other neurological disease, SEP and brainstem auditory evoked potential (BAEP) provide information about which sensory brainstem paths are damaged, which can also be useful for planning rehabilitation. Normal SEP and BAEP in cases of coma caused by trauma are associated with a favourable prognosis. Visually evoked potential (VEP) can often reveal signs of a history of optic neuritis. SEP and BAEP can also reveal subclinical CNS lesions and be a supplementary test in the diagnosis of multiple sclerosis.INTERPRETATION SEP and BAEP have a high clinical value for comatose patients. Evoked potentials are also important in intraoperative monitoring. The clinical value of VEP is high when the question of a history of optic neuritis is crucial for a diagnosis of multiple sclerosis. Some selected patients who are being assessed for demyelinating disease will benefit from a full EP study. HubMed – rehab


[Rehabilitation and palliative care of patients with severe COPD must be integrated.]

Ugeskr Laeger. 2013 Apr 29; 175(18): 1277-1280
Ringbæk T, Wilcke T

Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy, occupational therapy and medical treatment are adjusted to the improvement of the current quality of life with new treatment goals and decision on cessation of treatment including oxygen without subjective effect. Palliation with end-of-life discussion must be integrated in COPD rehabilitation programmes especially for patients with frequent exacerbations. HubMed – rehab


[COPD treatment in general practice in Denmark is into a rapid development.]

Ugeskr Laeger. 2013 Apr 29; 175(18): 1271-1276
Nielsen LM, Elbrønd J

In this article the change towards pro-activity in the treatment of chronic obstructive pulmonary disease (COPD) is reviewed. Implementing International Classification of Primary Care and COPD indicators registration provide opportunity for quality assurance by quality reports and follow-up. Changing practice organization supports teamwork for the benefit of the patients. Municipal COPD rehabilitation has become available. Cooperation is improved by an overview of municipal services on www.sundhed.dk and by a correspondence module. Tracing COPD and applying data must be enhanced. In the years to come we will benefit from the collected data for research in general practice. HubMed – rehab