Predictors of independence in instrumental activities of daily living: Amnestic versus nonamnestic MCI

Introduction: Individuals with mild cognitive impairment (MCI) demonstrate deficits in instrumental activities of daily living (IADL) that place them at high risk for progression to dementia. The cognitive profiles, IADL deficits, and risk of progression differ between MCI subgroups of amnestic (aMCI) and nonamnestic MCI (naMCI), though many studies of functional impairment have not examined these subgroups separately. This study aims to determine whether common neuropsychological measures, as well as the related concept of patient anosognosia, are associated with IADL functioning differently in aMCI compared to naMCI. Method: Seventy-one individuals were identified as naMCI, and 99 individuals were identified as aMCI based on neuropsychological evaluation. Controlling for age, gender, and education, we examined whether performance on neuropsychological tests predicted informant-rated IADL dysfunction. We also investigated the ability of patient awareness, as rated by clinicians and informants, to predict informant-rated IADL dysfunction within MCI subgroups. Results: Better performance in cognitive domains of attention/processing speed and executive functioning predicted IADL independence in aMCI, but not in naMCI. Exploratory analysis with a subset of these individuals revealed that after accounting for an estimate of cerebrovascular burden, better performance in Delayed Memory predicted IADL independence in the naMCI group, but not in the aMCI group. Lastly, informant, but not clinician, ratings of patient awareness predicted IADL independence within the aMCI group only. Conclusion: Neuropsychological performance on tests of attention/processing speed and executive functioning may be better able to predict cognitive contributions to IADL dysfunction specifically in aMCI. After controlling for vascular burden, memory deficits may be the earliest cognitive indication of IADL dysfunction in naMCI. These results suggest that executive functions and memory, in addition to patient’s awareness of deficits, differentially predict early IADL dysfunction in subgroups of MCI and can be used to formulate patient prognosis and recommendations on a more individualized basis.     

功能性电刺激在改善早期脑卒中患者日常生活活动能力中的应用

目的观察功能性电刺激对改善脑卒中偏瘫患者日常生活活动能力的作用。方法 68例脑卒中早期患者随机分为对照组(22例)、功能性电刺激(FES)组(23例)和安慰组(23例)。对照组只接受常规治疗,FES组同时接受常规治疗及功能性电刺激,安慰组接受常规治疗及假功能性电刺激。安慰组操作与FES组相同,但每次治疗时不通电。30min·d~(-1),共3w。患者在治疗前、治疗3w后分别接受FuglMeyer评定(FMA)、改良Barthel指数(MBI)评定。结果治疗3w后,与安慰组及对照组相比,FES组的FMA、MBI评分有明显提高,(P<0.05)。结论功能性电刺激能改善早期脑卒中患者的日常生活活动能力。     

Carotid Webs in Cryptogenic Ischemic Strokes: A Matched Case-Control Study

Background: Young individuals with symptomatic carotid webs may be predisposed to ischemic strokes. However, evidence remains scarce. This investigation reports the frequency of carotid webs among patients with cryptogenic strokes compared to a control group. Methods: Consecutive cryptogenic ischemic strokes and trauma patients were identified. Additional inclusion criteria required age 18-60 years and availability of head/neck computed tomography (CT) angiography. CT angiogram (CTA) neck images were evaluated independently by 2 fellowshiptrained specialists. A carotid web was defined by a shelf-like, linear filling defect in the posterior internal carotid artery bulb. Results: Of 1877 patients presenting with ischemic strokes in 2015-2017, 165 were diagnosed with cryptogenic strokes, 51 of whom met the inclusion criteria of age and CTA availability. Fifty one trauma cases were matched for age and sex. After imaging analysis, 13 carotid webs (25%) were identified in the 51 cryptogenic stroke group versus 0 (0%; P < .001) in trauma subjects. Thirty-nine of the 51 cryptogenic ischemic stroke patients were found with carotid anterior distribution infarcts, of which 9 (23%) were found with ipsilateral carotid webs. There were more proximal large vessel occlusions in the cryptogenic patients with carotid webs, compared to those without (P = .04). All carotid webs led to less than 30% degree of stenosis. Conclusions: Carotid webs were found at a significantly higher frequency in patients with cryptogenic ischemic strokes compared to controls, indicating a potentially thrombogenic nature of these lesions in young patients. Additionally, intracranial large vessel occlusions were more common in patients with symptomatic carotid webs, presenting with ipsilateral strokes.     

Relying on procedural memory to enhance independence in daily living activities: Smartphone use in a case of semantic dementia

Relying on procedural memory is a promising approach for interventions that address the cognitive difficulties found in semantic dementia. The aim of this study was to determine if procedural memory could be used to optimise learning of relevant smartphone functions in MH, a 55-year-old man with semantic dementia. The impact of learning to use specific smartphone applications, which display concepts and their semantic characteristics, on relearning useful significant concepts, was also explored in MH. This patient, who showed no deficits in procedural learning on a serial reaction time paradigm, was able to learn manipulations related to 15 smartphone functions although, because of his deficit in word comprehension, he generally needed verbal cues to clarify which functions he was asked to perform. Six months after the end of the intervention, he was still using 8 of the 15 functions regularly. However, repeated exposure to concepts through the use of two applications did not improve naming or retrieval of semantic attributes. This study showed the potential of relying on procedural memory to optimise learning of new technologies in the ecological rehabilitation of semantic dementia.     

Risk Factors for a First Febrile Seizure: A Matched Case-Control Study

Summary We conducted a matched casecontrol study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixtynine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (±6 months), site of routine pediatric care, and date of visit (±weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected preand perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a firstor in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.     

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review

Objective: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context.

Study Design and Setting: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of prede?ned inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure.

Conclusion: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.     

‘Quality of life at 90 days after stroke and its correlation to activities of daily living’: A prospective cohort study

BackgroundThe main goal of stroke rehabilitation is to improve the health-related quality of life (HRQoL). In developed countries, several studies evaluating the HRQoL among stroke survivors have been conducted. In India, HRQoL related to stroke as an important health care issue has not received sufficient attention. The study was conducted to encourage the professionals to use stroke-specific HRQoL scales in clinical practice as one of the measures of stroke outcome.ObjectivesTo study the correlation between activities of daily living (ADLs) and HRQoL at 90 days following an acute stroke.MethodsIn this prospective study, functional independence of patients admitted with stroke were measured using Barthel Index (BI). At 90 days post-stroke patients were assessed using two questionnaires.ResultsSignificant improvement in BI total and domains scores at 90 days (p < .001) were seen. At follow-up, Stroke Specific Quality of Life Scale-12 (SS-QoL-12) score for 59 patients was 48 (high QoL). Individuals scored lowest for psychosocial subscale of HRQoL compared to physical subscale. All items and the total score of the BI showed a significant positive partial correlation (p< .001) with the HRQoL total score. The self-care domain of BI showed the highest correlation with QoL total score at 0.88.ConclusionsPatient dependent in ADL constantly scored less in all QoL domains. The psychosocial QoL was found to be most affected even in the presence of complete functional independence paving way for further studies on factors that impact psychosocial QoL of stroke survivors.     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

Numerical activities of daily living: a short version

Neurological Sciences - Specific impairments in numerical functions may cause severe problems in everyday life that cannot be inferred from the available scales evaluating instrumental activities...     

Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects

A representative sample of the Leipzig population aged 75 years and older showed 61.8% of the participants with relevant deficits in their capacity for independent living, according to a combined activities of daily living/instrumental activities of daily living (ADL/IADL) scale. The quantity and quality of care needed almost exponentially increases above 85 years of age. Looking at potential reasons for ADL/IADL limitations, 44% of variance in single ADL/IADL activities and 75% of the combined ADL/IADL sum score could come from a minimal set of predictor variables. Most important are dementia- or mobility-related declines, but living conditions also explain small but significant amounts of variance. These seem initially impressive, yet analyses showed about half the explained variances shared among the mobility and dementia indicators, limiting the use not only of ADL/IADL sum scores but of many single ADL/IADL items as well. Before deriving specific conclusions from variations in ADL/IADL instruments, one must note that the data suggest that interpretations of covariations--whether for health/mobility or dementia--are useful and substantial only if both indicators/predictors are verified. The information given captures the mobility- and dementia-related variance if ADL/IADL items, facilitating more specific scale developments.     

Myasthenia gravis activities of daily living profile

The authors have developed an MG activities of daily living (ADL) profile (MG-ADL)-a simple eight-question survey of MG symptoms. In 254 consecutive encounters with established MG patients, the authors compared scores from the MG-ADL to the quantitative MG score (QMG)-a standardized, reliable scale used in clinical trials. The mean MG-ADL score was 4.89+/-3.63. The mean QMG score was 10.80+/-5.70. Pearson's correlation coefficient was 0.583 (p < 0.001). The MG-ADL is an easy-to-administer survey of MG that correlates well with the QMG and can serve as a secondary efficacy measurement in clinical trials.     

Effect of six-month standardized tertiary rehabilitation program on the activities of dally living in stroke patients with hemiplegia

BACKGROUND: At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE: To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN: A clinical observation. SETTING: Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. PARTICIPANTS: Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hosptial from January 1999 to June 2003, including 49 males and 33 females, 40–80 years of age, with a mean age of (65±11) years old. Inclusive criteria: According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score > 8 points, 40–80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria: Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group (n =42), and the others as the control group (n =40). Approval was obtained from the ethical committee of the hospital. METHODS: All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period (within about 1 month after attack), the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period (about 1–3 months after attack), the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30–45 minutes for each time, 4–5 days a week; At late period (about 3–6 months after attack), the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3–4 times a week, and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES: The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. RESULTS: Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up 10 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group (P < 0.01), and the score differences were also obviously higher than those in the control group (P < 0.01). The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22.50%, 46.43%, 75.95% and 89.52% of that of normal people respectively, and those in the control group were 17.09%, 25.77%, 43.38% and 55.00% respectively. The activities of daily living at admission and 1, 3 and 6 months in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the control group. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1st, 3rd and 6th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. CONCLUSION: Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.     

Geometric Features Associated with Middle Cerebral Artery Bifurcation Aneurysm Formation: A Matched Case-Control Study

ObjectivesThe pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. We aimed to identify image-based morphological parameters that were associated with middle cerebral artery (MCA) bifurcation aneurysms.Materials and methodsWe evaluated three-dimensional morphological parameters obtained from CT angiography (CTA) or digital subtraction angiography (DSA) from 317 patients with unilateral MCA bifurcation aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We chose the contralateral unaffected MCA bifurcation as the control group, in order to control for genetic and environmental risk factors. Diameters and angles of surrounding parent and daughter vessels of 634 MCAs were examined.ResultsUnivariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with smaller (≤ 3 mm) aneurysms only and with angles excluded, were also performed. In a multivariable conditional logistic regression model we showed that smaller diameter size ratio (OR 0.0004, 95% CI 0.0001–0.15), larger daughter-daughter angles (OR 1.08, 95% CI 1.06–1.11) and larger parent-daughter angle ratios (OR 4.24, 95% CI 1.77–10.16) were significantly associated with MCA aneurysm presence after correcting for other variables. In order to account for possible changes to the vasculature by the aneurysm, a subgroup analysis of small aneurysms (≤ 3 mm) was performed and showed that the results were similar.ConclusionsEasily measurable morphological parameters of the surrounding vasculature of the MCA may provide objective metrics to assess MCA aneurysm formation risk in high-risk patients.