Background and purpose: There is a need for empirical studies to define criteria for vascular cognitive impairment (VCI)subtypes. In this paper, we report the predictive validity of a subtype classification scheme bas...Background and purpose: There is a need for empirical studies to define criteria for vascular cognitive impairment (VCI)subtypes. In this paper, we report the predictive validity of a subtype classification scheme based on clinical and radiographic features. Methods: Nine Canadian memory clinics participated in the Consortium to Investigate Vascular Impairment of Cognition. This cohort consisted of 1347 patients, of whom 324 had VCI, and was followed for up to 30 months. Results: Clinical and neuroimaging features defined three subtypes: vascular cognitive impairment, no dementia, (n = 97), vascular dementia (n = 101) and mixed neurodegenerative/vascular dementia (n = 126). Any ischemic lesion on neuroimaging increased the odds (odds ratio = 9.31; 95% confidence interval 6.46, 13.39) of a VCI diagnosis. No VCI subtype, however, was associated with a specific neuroimaging abnormality. Compared to those with no cognitive impairment, patients with each VCI subtype had higher rates of death and institutionalization (hazard ratio for combined adverse events = 6.08, p < 0.001). Conclusions: Both clinical features and radiographic features help establish a diagnosis of VCI. The outcomes of VCI subtypes, however, are more strongly associated with clinical features than with radiographic ones.展开更多
Background and Purpose-Patients with hemiparetic stroke have impaired balan ce control. Some patients (“ pushers” ) are resistant to accepting weight on a nd actively “ push” away from the nonparetic side. This re...Background and Purpose-Patients with hemiparetic stroke have impaired balan ce control. Some patients (“ pushers” ) are resistant to accepting weight on a nd actively “ push” away from the nonparetic side. This research identified p ushers from stroke patients with moderate to severe hemiparesis and examined lon gitudinal changes in symptoms, level of impairment, and functional independence. Methods -Prospective sample of hemiparetic stroke patients (n=65) located in Toronto, Canada. Detailed clinical assessments were performed within 10 days pos tonset, at 6 weeks, and at 3 months. Results -At 1 week after stroke, 63% of patients demonstrated features of pushing. In 62% of pushers, symptoms resolv ed by 6 weeks, whereas in 21% , pushing symptoms persisted at 3 months. Motor r ecovery and functional abilities at 3 months were significantly lower among the pushers compared with the nonpushers. Pushers also had a significantly longer ho spital length of stay (89 days versus 57 days). It is noteworthy that motor and functional recovery improved significantly over the 3-month study period for b oth pushers and nonpushers. Conclusions -Identification of stroke patients wit h pushing symptoms has prognostic implications for recovery. In light of this po tential recovery, rehabilitation specialists need to refine treatment approaches for the pushers to further improve functional outcome.展开更多
文摘Background and purpose: There is a need for empirical studies to define criteria for vascular cognitive impairment (VCI)subtypes. In this paper, we report the predictive validity of a subtype classification scheme based on clinical and radiographic features. Methods: Nine Canadian memory clinics participated in the Consortium to Investigate Vascular Impairment of Cognition. This cohort consisted of 1347 patients, of whom 324 had VCI, and was followed for up to 30 months. Results: Clinical and neuroimaging features defined three subtypes: vascular cognitive impairment, no dementia, (n = 97), vascular dementia (n = 101) and mixed neurodegenerative/vascular dementia (n = 126). Any ischemic lesion on neuroimaging increased the odds (odds ratio = 9.31; 95% confidence interval 6.46, 13.39) of a VCI diagnosis. No VCI subtype, however, was associated with a specific neuroimaging abnormality. Compared to those with no cognitive impairment, patients with each VCI subtype had higher rates of death and institutionalization (hazard ratio for combined adverse events = 6.08, p < 0.001). Conclusions: Both clinical features and radiographic features help establish a diagnosis of VCI. The outcomes of VCI subtypes, however, are more strongly associated with clinical features than with radiographic ones.
文摘Background and Purpose-Patients with hemiparetic stroke have impaired balan ce control. Some patients (“ pushers” ) are resistant to accepting weight on a nd actively “ push” away from the nonparetic side. This research identified p ushers from stroke patients with moderate to severe hemiparesis and examined lon gitudinal changes in symptoms, level of impairment, and functional independence. Methods -Prospective sample of hemiparetic stroke patients (n=65) located in Toronto, Canada. Detailed clinical assessments were performed within 10 days pos tonset, at 6 weeks, and at 3 months. Results -At 1 week after stroke, 63% of patients demonstrated features of pushing. In 62% of pushers, symptoms resolv ed by 6 weeks, whereas in 21% , pushing symptoms persisted at 3 months. Motor r ecovery and functional abilities at 3 months were significantly lower among the pushers compared with the nonpushers. Pushers also had a significantly longer ho spital length of stay (89 days versus 57 days). It is noteworthy that motor and functional recovery improved significantly over the 3-month study period for b oth pushers and nonpushers. Conclusions -Identification of stroke patients wit h pushing symptoms has prognostic implications for recovery. In light of this po tential recovery, rehabilitation specialists need to refine treatment approaches for the pushers to further improve functional outcome.
