PREDICTORS OF EARLY-ONSET DEPRESSION AFTER FIRST-EVER STROKE.

Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.

IMPROVEMENT OF COGNITIVE EFFICIENCY THROUGH COGNITIVE TRAINING IN HEALTHY SUBJECTS.

The aim of the study was to explore whether application of cognitive stimulation in young healthy subjects may improve their cognitive efficiency. The study included 12 healthy young subjects divided into two groups, experimental group and control group. Prior to cognitive stimulation treatment, both groups underwent baseline measurements with selected neuropsychological tests. The groups were matched with regard to the achievement on the baseline test. Only the experimental group underwent daily application of different computer-based cognitive tasks lasting for an hour a day for two weeks. After the treatment, both groups were tested with the same neuropsychological battery used at the baseline measurement. The experimental group showed a statistically significant difference between the measurements on the variables assessing immediate retention of visual material and recognition of verbal material. In addition, qualitative analysis showed that the experimental group also had better performance on the variables assessing delayed recall of visual material, visual and verbal range of attention, and delayed recall of verbal material. In conclusion, two-week cognitive stimulation in healthy subjects improves cognitive performance, expressed as higher average values of certain neuropsychological variables.

Risk factors of the first stroke.

INTRODUCTION: This study was aimed at investigating the vascular risk factors associated with the first stroke. It highlighted unfavorable trends in stroke mortality in the region gravitating towards the general hospital in Doboj. MATERIAL AND METHODS: The study included all patients hospitalized with the diagnosis of first stroke and their main vascular risk factors were explored, both in terms of their importance in the occurrence of stroke, and in terms of gender and age lines. The research results were statistically processed, analyzed and commented on. RESULTS: The most common risk factor for the first stroke included hypertension (70%), smoking (35%), heart diseases (28%), diabetes mellitus (28%), hyperlipoproteinemia (26%), atrial fibrillation (18.5%) and immoderate consumption of alcohol (17%). CONCLUSION: The presence of vascular risk factors in the majority of patients is important, and at least one of them was present in 80% of patients. Alcohol consumption, smoking and hyperlipoproteinemia were significantly more frequent in men, and atrial fibrillation was more frequent in women. Arterial hypertension, heart disease and diabetes mellitus were present

The effect of post stroke depression on functional outcome and quality of life.

In spite of being a common and important complication of stroke, post stroke depression is often overlooked, so its impact on stroke outcome remains under recognized. The aim of the study was to determine the effect of depression on functional outcome and quality of life in stroke patients. The study included 60 patients treated for their first clinical stroke, 30 of them diagnosed with depression and 30 patients without depression. Testing was done in all patients two and six weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale; functional impairment was determined by the Barthel Index; and post stroke quality of life was assessed by the Short Form 36 (SF-36) questionnaires. The patients with depression had significantly more severe functional disability both at baseline and after rehabilitation treatment, although the potential for functional recovery in depressed patients was less than in non-depressed ones. The quality of life in patients with post stroke depression was impaired more severely in all SF-36 domains compared with non-depressed stroke patients, with the domains of the role of emotional functioning and social relations being most severely affected.

Current status of stroke epidemiology in Greece: a panorama.

Although strokes have been documented since about 3 millennia, they remain today as one of the leading causes of mortality, as well as of subsequent serious long-term physical and mental morbidity, among patients in many different countries all over the world. Greece presents an increase in mortality rates according to World Health Organization, and this fact underlines the need for early diagnosis and treatment, as well as, the need to implement effective prevention strategies for strokes. This review makes an effort to describe the current status of stroke epidemiological features, as well as to present the risk factors prevalent in Greece. The incidence rate is 261-319/100,000 based on the recent population based registry. Stroke appears to be more prevalent in men than in women, and the mean age of stroke onset in Greece is at 70 years of age. Hypertension, atrial fibrillation, dyslipidaemia and diabetes mellitus are the major risk factors of stroke in the Greek population, while smoking is the most commonly documented modifiable risk factor in young adults with ischemic stroke. Similar to other parts of the world, ischemic stroke is the most common stroke type. The 28-day case fatality rate for men and women was 26.5%. The mean in-hospital cost per stroke patient was 3624.9 € and the mean rehabilitation cost of outpatients with stroke was 5553.3 €, while the cost proportion of hemorrhagic stroke is higher when compared to ischemic stroke. Stroke is a devastating condition with recognized challenges in identifying effective prevention programs. In Greece, limited data exists regarding the epidemiology of strokes. As a result, the need to conduct new studies and researches across the country is well documented.

Our experience with thrombolytic therapy -- preliminary report.

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Functional outcome after thrombolytic therapy.

In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score > or=90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score < or =2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a 'door-to-needle' time of less than 60 minutes and emphasize that 'time is brain'.

Effects of relapsing-remitting multiple sclerosis treatment with interferon beta-1b results of a three-year follow-up study.

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39 +/- 0.55 vs. 0.97 +/- 0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39 +/- 0.55 vs. 1.34 +/- 0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46 +/- 0.86 at baseline to 2.90 +/- 1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76 +/- 0.50 prior to treatment to 0.43 +/- 0.24 (P<0.001), yielding a 56.6% improvement and proving the disease modifying effect of interferon beta-1b. Seventeen (53.12%) patients remained relapse-free during the course of therapy. Among patients that experienced disease relapse, the mean time to first exacerbation was 11.5 +/- 8.34 months. Our study results were consistent with similar studies performed worldwide, clearly indicating that Interferon beta-1b therapy decreased the disease activity and had a beneficial effect on the progression of RRMS, with low incidence and severity of serious side effects. This study has paved way for further long-term follow up studies at our institution.

[Neurology today].

INTRODUCTION: Neurological disorders are common worldwide, regardless of race, nationality, age, sex, education or social status. They are a major cause of human suffering and mortality. The burden of neurological disorders in the community usually correlates with the proportion of the population aged 65 years and over. According to the latest reports of the World Health Organization (WHO), one billion of the world's population (one in six people) suffer from, and about 6.8 million (one in a thousand people) die annually from neurological disorders. In Europe, the economic cost of neurological diseases was estimated at about 139 billion euros in 2004. STROKE: Stroke is the most frequent neurological disorder, and the most common cause of severe disability compared to other diseases. Research into the genetics of stroke has shown advances in prevention, treatment and neuroprotection of the brain parenchyma. The rapid advances in the field of diagnostics are especially useful, particularly MRI, CT angiography and ultrasonography, providing early detection of changes in the blood vessels and the brain. MULTIPLE SCLEROSIS: The diagnosis of multiple sclerosis (MS) is usually based on clearly defined McDonald criteria. In the management of MS, early diagnosis of clinically definite MA as well as of clinically isolated syndrome, allow early initiation of immunomodulatory therapy. DEMENTIA: The prevalence of dementia is age-dependent, and it is higher in subjects aged 60 and over, but it doubles with every five years of age. The population over 65 years and the incidence of age-dependent diseases, are ever increasing. According to reports published in December 2005, the annual incidence of dementia ranges from 5.4-9.4%. PARKINSON'S DISEASE: As the population is growing older, more and more people are vulnerable to Parkinson's disease (PD). It is a neurodegenerative disease which occurs in 10-13 per 100,000 people annually, while its prevalence in Europe ranges from 60-187 per 100,000 people. The diagnosis is primarily based on clinical findings, while neuroimaging techniques, such as brain CT and MRI, are used in the differential diagnosis.