Comorbidities and Health-Related Quality of Life Following Revascularization for Asymptomatic Critical Internal Carotid Artery Stenosis Treated with Carotid Endarterectomy or Angioplasty with Stenting.

BACKGROUND This study aimed to evaluate the relationship between existing comorbidities and the effectiveness of revascularization of asymptomatic critical internal carotid artery (ICA) stenosis treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) and short-term and long-term outcome in terms of health-related quality of life (HRQoL). MATERIAL AND METHODS Patients with asymptomatic critical ICA stenosis (n=62) included a group treated with CEA (n=31) and a group treated with CAS (n=31). A Health Assessment Questionnaire designed for this study was used to assess ten comorbidities, and the Short Form 36 Health Survey Questionnaire (SF-36) was used to evaluate HRQoL following CEA and CAS. RESULTS Three comorbidities significantly influenced the effectiveness of revascularization in all patients studied who underwent CEA and CAS, which included symptomatic atherosclerosis in other vascular areas (p=0.048), coronary artery disease (CAD) (p=0.004), and previous myocardial infarction (MI) (p=0.004). In the CEA group, CAD and previous MI were significant comorbidities (p=0.002), when compared with the CAS group (p=0.635). In the CAS group, chronic obstructive pulmonary disease (COPD) was a significant comorbidity in terms of outcome (p=0.025). CONCLUSIONS The comorbidities of atherosclerotic vascular disease, CAD, and previous MI had a significant influence of the effectiveness of the revascularization and postoperative HRQoL in all patients studied with asymptomatic critical ICA stenosis who were treated with CEA and CAS. When the two groups were compared, CAD and previous MI were significant comorbidities in the CEA group, and COPD was a significant comorbidity in the CAS group.

The Effects of Intellectual, Physical, and Social Activity on Further Prognosis in Mild Cognitive Impairment.

BACKGROUND Our goal was to specify the relationship between the level of activity (intellectual, physical, and social) in persons diagnosed with mild cognitive impairment (MCI) and the further progression of cognitive dysfunction. MATERIAL AND METHODS We examined 193 patients diagnosed with MCI (according to the criteria of the Working Group on Mild Cognitive Impairment) and under treatment at our Mental Disorders Clinic. It was assumed that these persons would remain under systematic psychiatric observation until dementia was diagnosed. The present study results from a seven-year observation period. The mini-mental state examination (MMSE), the Activity Scale (with the intellectual, physical, and social subscales), and the Instrumental Activities of Daily Living (IADL) scale were used to evaluate the participants' status at baseline. The MMSE was re-administered after one year and again at the end of the observation (either upon diagnosis of dementia or after seven years). At each meeting with the participant, the clinical diagnosis was verified to determine if the patient had dementia or not. Of the 193 people initially qualified for the study, 75 were available for the final analysis. RESULTS It was found that there was no statistically significant difference in the baseline MMSE scores between the persons with stable MCI and the persons who had progressed to dementia. However, statistically significant differences in the level of activity at baseline on both the global IADL scale and the Activity Scale between those with stable MCI and those who had progressed to dementia were found. These differences were manifested in the IADL subscales for telephone use, shopping, transportation, and personal finances, and in the physical activity subscale. CONCLUSIONS An evaluation of intellectual, physical, and social activity can be useful in determining the prognosis for the future course of MCI.

Health-Related Quality-of-Life and Functional Outcomes in Short-Stem Versus Standard-Stem Total Hip Arthroplasty: An 18-Month Follow-Up Cohort Study.

BACKGROUND Osteoarthritis (OA) progressively produces symptoms and disability that may significantly reduce health-related quality of life (HRQoL). Total hip arthroplasty (THA) is an important treatment for symptomatic OA. An alternative to standard-stem THA for younger patients is short-stem THA. The aim of this study was to investigate potential HRQoL and functional outcome differences between these patient groups to provide additional data that will be clinically useful in the decision making between the types of prosthesis. MATERIAL AND METHODS In an 18-month follow-up longitudinal cohort study, we conducted Harris Hip Score (HHS) evaluations and SF-36 questionnaires in a study group and a control group undergoing short-stem and standard-stem THA preoperatively and during follow-up at 1, 3, 6, 12, and 18 months. Effect size was calculated to estimate the size of changes in scores during follow-up between chosen time intervals. RESULTS A total of 168 patients were included in the study. The total HHS score was significantly increased postoperatively from 46.9 to 87.0 in the standard-stem group, and from 42.7 to 85.1 in the short-stem group. All SF-36 scores improved after THA in both groups. No HRQoL or functional differences were found in the use of either surgical option in the HHS or SF-36 score results (all p>0.05). CONCLUSIONS As there were no differences in HRQoL in the two groups, we strongly recommend considering short-stem THA, especially in younger patients, due to the benefit of future revision options and a minimally invasive approach.

Vascular Factors and Cognitive Dysfunction in Alzheimer Disease.

BACKGROUND: The purpose of the present study was to assess the influence of vascular factors on the degree of intensity and rate of progression of cognitive disorders in the course of Alzheimer Disease (AD). MATERIAL AND METHODS: The research group consisted of 39 persons, all of whom were diagnosed with AD according to the NINCDS/ADRDA criteria. We divided these patients into 2 subgroups, based on the vascular factors measured by the modified Hachinski Ischemic Scale (Ha-mod): group A, without the vascular component (HA-mod score of 0-1 point), and group B, with the vascular component (a score over 1 point). Cognitive functions were evaluated at baseline and again 2 years later, using the Cognitive Part of the Alzheimer Disease Assessment Scale (ADAS-cog). RESULTS: We found that the patients from subgroup B, with the stronger vascular component, demonstrated the highest intensity of cognitive disorders at baseline, both in terms of the overall ADAS-cog score, and in the subscores for ideational praxis, orientation, spoken language ability, comprehension of spoken language, and word-finding difficulty in spontaneous speech. Another variable which was connected with the intensity of dementia was age. After 2 years, however, the rate of progression of cognitive disorders was not significantly different between the 2 groups. CONCLUSIONS: The severity of vascular factors correlates directly with the intensity of cognitive disturbances. At the 2-year follow-up examination, however, no correlation was observed in the research group between greater vascular involvement and more rapid progression of cognitive disorders, as measured by the ADAS-cog scale.

A new form of neurotherapy for a patient with anxiety disorder and anomic aphasia after neurosurgery for a ruptured brain aneurysm post-COVID-19.

INTRODUCTION AND OBJECTIVE: The aim of this study is to evaluate the effectiveness of a new, neuromarker-based form of neurotherapy for a patient with anxiety disorders and anomic aphasia after a neurosurgical operation for a ruptured brain aneurysm of the left middle cerebral artery (MCA), detected after COVID-19. CASE REPORT: A 78-year-old right-handed patient, not previously treated for any chronic diseases except stage II hypertension, contracted COVID-19, confirmed by real time RT- PCR. He was treated on an outpatient basis. Two months later, he developed an unusually severe headache and disorientation. A ruptured brain aneurysm of the left MCA was diagnosed. The patient underwent a neurosurgical operation - clipping- very well, with no neurological or neuropsychiatric disorders, except for mild aphasia and occasional anxiety attacks. Four weeks after surgery, anxiety disorder and mild aphasia worsened. High levels of anxiety on the Hospital Anxiety and Depression (HAD) Scale, and mild anomic aphasia in the Boston Naming Test (BNT) was found. A functional neuromarker of anxiety in comparision to a normative database (Human Brain Index, HBI) was detected. The patient was offered a new, neuromarker-based form of neurotherapy, which proved effective in reducing the disorders. The patient improved in social communication and is gradually returning to social activities. CONCLUSION: In patients with anxiety disorders, anomic aphasia and related difficulties in social functioning after aSAH, especially after COVID-19, multidimensional diagnosis and therapy, preferably based on functional neuromarkers, is needed. HBI methodology can be successfully used in the neurodiagnosis and implementation of individualized neurotherapy for such patients.

Aggressive and impulsive behavior in Alzheimer's disease and progression of dementia.

BACKGROUND: The symptoms of Alzheimer's disease (AD) are numerous, including worsening of mood, psychotic symptoms, aggressive and impulsive behaviours, and many others. It is generally assumed that there exists a relationship between the severity of dementia and aggressive symptoms. The aim of this study was to assess the relationship between aggressive and impulsive behaviours and cognitive function disorders in AD patients. MATERIAL/METHODS: Forty-eight AD patients living in a nursing home were included in the research group on the basis of NINCDS/ADRDA criteria. The subjects underwent two years of naturalistic observation. The intensity of agitation and aggressive behaviours was assessed on the basis of the Cohen-Mansfield Agitation Inventory (CMAI). The Alzheimer's Disease Assessment Scale Cog (ADAS-cog) was used to assess cognitive function. Pharmacotherapy administered during the observation period was also taken into account. RESULTS: Thirty-one patients completed the two year long observation. Individuals with more severe cognitive deficiencies demonstrated a greater intensity of aggressive and impulsive behaviours, as assessed using the CMAI scale. Aggression escalated together with the development of dementia disorders. The intensity of dementia disorders was most significantly connected with physical agitation and verbal aggression. The use of neuroleptics and mood stabilisers decreased the progression of aggressive and impulsive behaviours. CONCLUSIONS: There is a relationship between cognitive functioning disorders and the intensification of aggressive and impulsive behaviours. More severe forms of dementia are connected with greater intensification of aggressive and impulsive behaviours as the disease progresses. Periodical administration of pharmacotherapy may reduce the development of aggressive behaviours.

Social intelligence and adequate self-expression in patients with orbitofrontal cortex injury and in the criminals.

BACKGROUND: The aim of present article is to compare patients with damage to the orbitofrontal cortex and prison inmates in terms of social intelligence and social intelligence monitoring. In addition, personal principles and emotional regulation of behavior will be assessed in both groups. MATERIAL/METHODS: 20 patients with orbitofrontal cortical injury, 20 prisoners and 20 controls answered questions from the Social Interactions Assessment Questionnaire. Then they evaluated their self-disclosure, reported their emotions related to self-disclosure and declared their personal principles concerning conversations with strangers. RESULTS: The patients with damage to the orbitofrontal cortex disclosed themselves to a stranger less appropriately than did other subjects, and did not assess it critically. They also violated their own declared principles, but did not feel embarrassed because of that. The prison inmates spoke out less forthrightly on many topics and felt confused during the whole examination. CONCLUSIONS: Damage to the the orbital part of frontal lobes may result in a disorder of self-disclosure monitoring and impairment of social intelligence in conversations with unknown persons. Prison inmates give information about themselves unwillingly, which may result from their specific experiences during criminal and judicatory procedures and confinement.

The quality of life of persons with TBI in the process of a comprehensive rehabilitation program.

BACKGROUND: The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program. MATERIAL/METHODS: The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation. RESULTS: The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained. CONCLUSIONS: A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.

Evaluation of a neurotherapy program for a child with ADHD with Benign Partial Epilepsy with Rolandic Spikes (BPERS) using event-related potentials.

BACKGROUND: We hypothesized that there would be a good response to relative beta training, applied to regulate the dynamics of brain function in a patient with benign partial epilepsy with Rolandic Spikes (BPERS), associated with neuropsychiatric deficits resembling the symptoms of attention deficit-hyperactivity disorder (ADHD). CASE REPORT: The patient, E.Z., age 9.3, was suffering from neuropsychiatric symptoms, cognitive dysfunction, especially attention deficits, and behavioral changes, rendering him unable to function independently in school and in many situations of everyday life. He was treated for epilepsy, but only slight progress was made. The patient took part in 20 sessions of relative beta training combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment and after the completion of the neurotherapy program. Neuropsychological testing at baseline showed multiple cognitive deficits. Over the course of neurotherapy, E.Z.'s verbal and non-verbal IQ increased significantly. His cognitive functions also improved, including immediate and delayed logical and visual recall on the WMS-III, maintaining attention on the WMS-III, and executive functions, but remained below norms. Physiologically, the patient showed substantial changes after neurotherapy, including fewer spikes and an increased P300 NOGO component. CONCLUSIONS: The cognitive deficits characteristic for ADHD in a child with BPERS may be unresponsive to antiepileptic treatment, but are reversible after a carefully selected neurotherapy program, combined with antiepileptic treatment. Event Related Potentials (ERPs) in the GO/NOGO task can be used to assess functional brain changes induced by neurotherapeutical programs.

A case of "borrowed identity syndrome" after severe traumatic brain injury.

BACKGROUND: It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury. CASE REPORT: We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative 'life-story' interviewing was undertaken to explore the mental state of a patient whose subjective, "first person" identity has been disengaged, despite the retention of significant amounts of objective, "third person" information about himself and his personal history (though this was also lost at a later stage in the patient's deterioration). Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory. CONCLUSIONS: The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation.

Differential diagnosis of behavioral variant of fronto-temporal dementia (bvFTD).

BACKGROUND: The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD). MATERIAL/METHOD: Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale-III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients--68 men and 46 women treated in the Reintegrative-Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdansk, who were suffering from various types of dementia. RESULTS: It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness. CONCLUSIONS: The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

Evaluation of differentiated neurotherapy programs for a patient after severe TBI and long term coma using event-related potentials.

BACKGROUND: This article examines the effectiveness of differentiated rehabilitation programs for a patient with frontal syndrome after severe TBI and long-term coma. We hypothesized that there would be a small response to relative beta training, and a good response to rTMS, applied to regulate the dynamics of brain function. CASE REPORT: M. L-S, age 26, suffered from anosognosia, executive dysfunction, and behavioral changes, after a skiing accident and prolonged coma, rendering him unable to function independently in many situations of everyday life. Only slight progress was made after traditional rehabilitation. The patient took part in 20 sessions of relative beta training (program A) and later in 20 sessions of rTMS (program B); both programs were combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment, after the completion of program A, and again after the completion of program B. As hypothesized, patient M.L-S showed small improvements in executive dysfunction and behavioral disorders after the conclusion of program A, and major improvement after program B. Similarly, in physiological changes the patient showed small improvement after relative beta training and a significant improvement of the P300 NOGO component after the rTMS program. CONCLUSIONS: The rTMS program produced larger physiological and behavioral changes than did relative beta training. A combination of different neurotherapeutical approaches (such as neurofeedback, rTMS, tDCS) can be suggested for similar severe cases of TBI. ERPs can be used to assess functional brain changes induced by neurotherapeutical programs.

Early neurorehabilitation in a patient with severe traumatic brain injury to the frontal lobes.

BACKGROUND: It seems to be generally believed that early neurostimulation after severe TBI is useless or even harmful, and neuropsychological intervention should not be initiated until the patient is medically stable. On the other hand, the unstimulated brain can incur irreversible damage. The purpose of the present study is to assess the impact of early neuropsychological rehabilitation on a patient with an extremely severe TBI. CASE REPORT: The patient, a 32-year old male, suffered a massive cranio-facial injury with significant loss of tissue in the right frontal lobes after being struck by a tram. Beginning two weeks after injury, after pharmacological coma, he was attended on a daily basis by a neuropsychologist and a neurolinguist, with the active assistance of his family, when he was still in critical condition and essentially without logical contact. By the time he returned to Scotland 4 weeks later, he was sitting up, writing complete, sensible and grammatical sentences, and making rapid progress every day despite the development of hydrocephalus. Over the course of neurorehabilitation, most of MF's cognitive dysfunctions resolved. Six months later, however, hydrocephalus was increasing and the patient was showing severe frontal syndrome. A personalized version of Community Based Rehabilitation was applied. After two weeks of intensive treatment considerable improvement was achieved and frontal syndrome was reduced. CONCLUSIONS: The present case suggests that the prevailing views regarding the inadvisability of early neurorehabilitation in the acute phase after TBI should be reconsidered.

Speech intelligibility in cerebral palsy children attending an art therapy program.

BACKGROUND: Dysarthia is a common sequela of cerebral palsy (CP), directly affecting both the intelligibility of speech and the child's psycho-social adjustment. Speech therapy focused exclusively on the articulatory organs does not always help CP children to speak more intelligibly. The program of art therapy described here has proven to be helpful for these children. MATERIAL/METHODS: From among all the CP children enrolled in our art therapy program from 2005 to 2009, we selected a group of 14 boys and girls (average age 15.3) with severe dysarthria at baseline but no other language or cognitive disturbances. Our retrospective study was based on results from the Auditory Dysarthria Scale and neuropsychological tests for fluency, administered routinely over the 4 months of art therapy. RESULTS: All 14 children in the study group showed some degree of improvement after art therapy in all tested parameters. On the Auditory Dysarthia Scale, highly significant improvements were noted in overall intelligibility (p<0.0001), with significant improvement (p<0.001) in volume, tempo, and control of pauses. The least improvement was noted in the most purely motor parameters. All 14 children also exhibited significant improvement in fluency. CONCLUSIONS: Art therapy improves the intelligibility of speech in children with cerebral palsy, even when language functions are not as such the object of therapeutic intervention.

Aggressive and impulsive behaviors in Frontotemporal dementia and Alzheimer's disease.

BACKGROUND: Differentiating FTD and AD is of great clinical significance, due to the very different efficacy of cholinesterase inhibitors in the two disorders. Previous studies have pointed to behavioral differences in FTD and AD, but less attention has been paid to comparing aggressive and impulsive behaviors in the AD and the FTD. MATERIAL/METHODS: Nursing home residents diagnosed with AD (NINCDS/ADRDA criteria) or the behavioral variant of FTD (Frontotemporal Dementia and Pick's Disease Working Group criteria) were included in the research group. Individuals diagnosed with AD who showed atrophy of the frontal lobes in neuroimaging were excluded from the study, as were patients matching the clinical criteria for bvFTD, but with lesions in the temporal lobes. Agitation and aggressive behaviors were assessed using the Cohen-Mansfield Agitation Inventory (CMAI), whereas behavioral and psychological symptoms were assessed with the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). RESULTS: The overall NPI-NH score, including with some partial scores (apathy/indifference and disinhibition), together with the intensity of aberrant motor behavior differentiated individuals with AD from those with bvFTD. On the CMAI scale, both the overall score and physical aggressive behaviors differentiated the two study groups. CONCLUSIONS: Our research confirms previous results indicating a greater intensity of behavioral pathology in FTD. A detailed assessment of aggressive behaviors revealed further differences between AD and FTD in this respect.

Rehabilitation of a patient with aphasia due to severe traumatic brain injury.

BACKGROUND: There has been little attention given to traumatic aphasia in recent neuropsychological literature. It is difficult to justify this relative neglect, however, since speech and language disturbances subsequent to traumatic brain injury (TBI) causa serious therapeutic difficulties. Hence the problems encountered by our patient, K.P., who had a severe TBI, are described in the present study. CASE REPORT: K.P. suffered from traumatic aphasia and executive dysfunction. These difficulties made her dependent upon others and unable to function by herself in many situations of everyday living. Very little progress was made in ordinary rehabilitation. Improvements in cognitive functioning were observed only after a novel staged program of rehabilitation, based on the microgenetic theory of brain function, had been implemented. CONCLUSIONS: After the last phase of rehabilitation K.P. became more self-dependent in social situations. The need for a deeper analysis of the patient's problems in both a personal and social context is stressed in order to adapt therapeutic procedures heuristically, consistent with a process-based approach.

Health-related quality of life in ischaemic stroke survivors after carotid endarterectomy (CEA) and carotid artery stenting (CAS): confounder-controlled analysis.

INTRODUCTION: Atherosclerotic carotid artery stenosis (CS)-related strokes are a significant overall stroke burden contributor. AIM: To evaluate the effect of surgical (carotid endarterectomy - CEA) vs. percutaneous (neuroprotected carotid artery stenting - CAS) carotid revascularization on health-related quality of life (HRQoL) in stroke survivors: analysis controlled for major HRQoL determinants beyond strokes. MATERIAL AND METHODS: Our database of 856 carotid revascularization procedures (48.7% symptomatic CS) performed over 3 years showed 42 pairs (CEA-CAS) of right hemispheric stroke patients matched for age, sex, marital and educational status, hyper-tension, heart failure and diabetes, who underwent uneventful carotid revascularization, experienced no major adverse clinical events, and completed the Short Form Outcome Study (SF-36) questionnaire within 7 days before, 14 days after, 6 months after, and 12 months after carotid revascularization. RESULTS: Baseline HRQoL was low and similar in both groups (30.8 ±4.6% vs. 29.1 ±3.9%, p = 0.68; data given for CEA vs. CAS). National Institute of Health Stroke Scale chronic severity was 5.4 ±2.8 vs. 5.9 ±3.1 (p = 0.44). Revascularization was associated with a major HRQoL improvement, that was significantly greater in CAS (60.4 ±9.2% vs. 71.5 ±6.2%, p < 0.001). At 6 months the CEA-CAS difference was narrower (70.7 ±9.7% vs. 74.6 ±5.9%, p = 0.026), becoming statistically insignificant at 12 months (72.6 ±6.7% vs. 75.1 ±5.1%, p = 0.062). The early CEA-CAS difference was driven by less bodily pain and better physical functioning/role-physical plus better role-emotional and higher general well-being scores in CAS (p < 0.05). CONCLUSIONS: Carotid revascularization has a major positive impact on stroke survivor patient-reported HRQoL. The improvement is initially greater in CAS, with the remaining difference small at 12 months and statistically insignificant.

Rehabilitation of an artist after right-hemisphere stroke.

BACKGROUND: Traditionally, in both medicine and neuropsychology, symptoms are defined as significant deviations in a given parameter from a "physiological" norm largely based on statistical studies of large populations. Thus the goal of rehabilitation is to bring the patient's performance within the bounds of acceptable variation from the norm, and this is what defines a good outcome. Although this model seems reasonable for "average" patients, in the case of "exceptional" patients an "average" outcome may not be acceptable. CASE REPORT: The present study describes the symptoms and successful rehabilitation of a prominent Polish artist, who was referred for rehabilitation after a right hemisphere stroke, and whose chief subjective complaint was the loss of artistic vision. The patient (female, ambidextrous) suffered an RH stroke at the age of 61. In traditional rehabilitation many symptoms resolved and others were well compensated, but the patient continued to complain that she had a "hole" in her brain and could not paint. A special program of rehabilitation was designed for her, based on art therapy, but including many unique elements, using a microgenetic, "bottom-up" approach to energize creativity and bypass obstacles. Ultimately the patient was able to resume her artistic career, thanks to the heuristic, holistic approach to therapy. CONCLUSIONS: The case described here raises a number of theoretical questions about art, imagination, and creativity in the brain, and the goals of rehabilitation in the case of talented and gifted individuals.

Behavioral and psychological symptoms in the preclinical stage of Alzheimer's disease.

BACKGROUND: AD is preceded by a lengthy preclinical period. Neural degeneration may lead to the appearance of behavioral and psychological symptoms, even before other clinical symptoms are manifest. We attempted to evaluate this symptomatology in preclinical AD. MATERIAL/METHODS: We recruited 291 care center residents who did not demonstrate dementia symptoms according to DSM-IV, whose MMSE score was at least 24, and who reached the first or second stage on the Global Deterioration Scale. Psychopathology was assessed using the AMDP, while the ADAS-cog was used to assess cognitive dysfunctions. Seven years later, 155 patients participated in the follow-up study (MMSE and ADAS-cog). If the MMSE was less than 24, a psychiatric workup was done to verify dementia. The AD group consisted of persons properly diagnosed with AD (n=25), while the control group consisted of persons in whom dementia had not developed. RESULTS: The AD and control groups differed in the level of psychopathological symptoms at baseline. The disparities related both to the global AMDP score and to every particular symptom category. The analysis did not disclose a pathognomonic symptom for preclinical AD, but there were many symptoms whose intensity differentiated AD patients from the controls. The degree of cognitive dysfunction seems to correlate with the clinical manifestation of some psychopathological symptoms in preclinical AD. CONCLUSIONS: The degeneration process before the clinical manifestation of dementia leads not only to the impairment of several cognitive functions, but also the intensification of behavioral and psychological symptoms.

Behavioral and psychological symptoms and the progression of dementia of the Alzheimer type in nursing home residents.

BACKGROUND: Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients. MATERIAL/METHODS: Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline. RESULTS: Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation. CONCLUSIONS: Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.