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Rather than dictating to the patient purchase trazodone 100mg mastercard symptoms 6 dpo, he/she helps the patient to decide about change based on understanding/information buy trazodone 100 mg on-line medicine net. The pre- contemplative stage generic 100 mg trazodone with amex symptoms uti, where the patient has not yet considered change and may be under pressure from third parties (e buy trazodone 100 mg amex medicine administration. The contemplative stage is present when a client has done some thinking about the benefits and drawbacks associated with changing behaviour. Careful discussion aims at reappraisal of ambivalent thinking and bolstering of self-efficacy. A course of action is discussed, as are ways of coping with the effects of change. During the action phase the patient must build up social skills, gather support, avoid precipitants (pubs, certain foods, etc), and continue to examine the negative consequences of reverting to former habits. Outcome research: Prioleau ea (1982) could find no convincing benefit over placebo for a ‘real patient’ of receiving psychotherapy and Storr (1979) and Wampold (1999) held that outcome is independent of underlying school of psychotherapy! Svartberg and Stiles (1991), in a meta-analysis of short-term psychodynamic psychotherapy, found greater changes in treated than in comparable untreated patients, but no difference in outcome for different forms of therapy. Outcome research has become more rigorous over the intervening years,(Roth & Fonagy, 1996) although Clare’s statement quoted at the start of this chapter 3343 is still held to be true by many clinicians. Knekt ea (2008) compared short- and long-term psychodynamic therapies for mood and anxiety disorders and found that the former gave the quickest and the latter the best results, although they could not answer who would benefit from receiving either approach. Research should include an intention to treat analysis and also report on adverse effects such as excessive introversion, exacerbation of symptoms and acting-out behaviour. Compliance with somatic therapies has not been routinely monitored in comparative studies. Back in the 1950s, when psychoanalysis held sway, the typical characteristics of dropouts from therapy were described as poor, uneducated, non-integrated socially, less persevering with other treatments, and dissatisfied with treatment. Also, the stated form of psychotherapy in a published paper may not match what was given in reality. Problems with randomised controlled trials and psychotherapy (Margison & Bateman, 2006) Danger of randomising people to unsuitable treatment 3345 Expectation of therapy influences outcome Starts as random with small numbers and attrition thereafter (i. For example, in a component analysis of cognitive-behavioural therapy, Borkovec ea (2002) compared applied relaxation plus self-control desensitisation, cognitive therapy, and their combination in patients with generalised anxiety disorder and found no significant differences between them. A potential fallacy is that treatments, including psychotherapy, administered over long periods of time may coincide with a remission or resolution rather than directly result in cure. Treating Chronic Depression with Disciplined Personal Involvement: Cognitive Behavioral Analysis System of Psychotherapy. Ugo Cerletti was professor psychiatry in Rome from 1935 and Bini was his assistant. Bini realised that the high mortality among dogs given electrical treatment was the fact that placement of electrodes at head and rectum led to passage of current through the heart. Photically induced convulsions (given without anaesthetic) are possible but are not employed in practice. Holmberg and Thesleff of Karolinska Institute, Stockholm, suggested using succinylcholine in 1952. A printed pamphlet or booklet can be of great help to patients 3362 and relatives. This has been interpreted as either placing trust in the doctor or as reflecting inadequate attempts to get true consent. In the case of patients who are unable to sign, because of their mental (including cognitive) status or legal status the local legal requirements should be followed. The (Irish) Mental Health Act 2001 requires A major omission in the Mental Health Act 2001 is the lack of provision for treating voluntary patients who suffer deterioration of mental status but do not seek to leave hospital. Outpatients Have a relative at the centre or one arranged for journey home Should not drive, operate dangerous machinery, or otherwise take risks 3365 The digit used for pulse oximetry should be free of nail polish. Medication may be required to reduce the chances of inhalation in cases of oesophageal reflux. Two-thirds of the population have a seizure threshold of 100- 200 mC, but the range is probably 20-800 or so. Recovery from the treatment should also be noted regularly, as should response of the underlying disorder and cognitive status. Buchan ea (1992) found that deluded-retarded cases lost twice as many points on the Hamilton Depression Scale as did a group without these characteristics. It may reduce the frequency of petit mal attacks and terminate epilepsia partialis continua. Wells & Bjorkstein, 1989; Weller, 1992; Metzger, 1999; Weiner ea, 2001; Marangell ea, 2003, p. This author continues antidepressants as long as they were or could be helpful, especially with in-patients. There have been some concerns that lithium may be associated with delirium, catatonia or prolonged seizures, although opinion is ‘divergent’. Major depression with psychotic features in elderly female with advanced Parkinson’s disease and in situ deep brain stimulator 2009. Bipolar affective disorder I with psychotic symptoms in Fahr disease __________________________________________________________________________________________ Complications With adequate precautions significant problems are rare. Some authorities use labetalol (Trandate), a short-acting blocker of both alpha and beta receptors, to prevent tachycardia. Postictal delirium affects a minority of patients and usually abates in much less than an hour. Reassurance, gentle restraint, nursing in a quiet area, and, when necessary, medication (diazepam, midazolam, haloperidol) are the basis of management. Rarely one may encounter unilateral (Mason, 1955) or bilateral (O’Shea ea, 1996; O’Shea, 2001) foot drop for which many theories have been proposed, e. There is some evidence that a thrice weekly frequency may be superior in terms of speed of clinical response. Higher dose of muscle relaxant than usual may be needed in cases with osteoporosis. Weiner ea (2001) suggest that a wedge be placed under the patient’s right hip if the pregnancy is greater than 20 weeks duration in order to displace the womb from the great vessels. The remainder of this mostly chronic group was suffering from schizophrenia or schizoaffective disorder. Malitz & Sackeim, 1986) and many clinicians believe that higher doses of electricity are more effective than lower doses despite the fact that both produce a seizure. Therefore use the minimum amount of electrical energy required to induce a convulsion. One can reduce the amount of energy by a perpendicular rise and/or fall in stimulus amplitude to maximise the amount of energy transmitted at peak amplitude. Constant current, brief pulse equipment giving a train of voltage pulses constitutes a more satisfactory physiological stimulus. An Indian study found that lower (50 pulses/second) was more efficient in inducing a seizure than was a higher (200 pulses/second) stimulus pulse frequency (the lower frequency caused a greater reduction in seizure threshold) and there were no significant cardiovascular responses between the two frequencies. Kho ea (2004) found that 3410 high seizure energy index predicted rapid response in major depression. Until this debate is resolved seizure duration of at least 15 seconds is desirable.
Rowena Sidbury Hall trazodone 100 mg low price symptoms 8 days post 5 day transfer, Class of 1943 (Febru- Preference is given to students from either ary) trazodone 100 mg without prescription treatment viral meningitis, of Silver Spring order trazodone 100 mg visa medicine quotes, Maryland order trazodone 100mg without a prescription symptoms by dpo. She served Florida or Maryland who wish to specialize in as a member of the faculty in the School of the feld of cardiology. Hoelzer (d ‘02) to be used for Each year the Association designates for scholarships for students who would not be honor distinguished former members of the able to attend Johns Hopkins Medical School Johns Hopkins medical community. Morris Joseph has created a scholarship Memorial Scholarship Fund Established in fund to defray the cost of a room in Reed Hall 1992 by Dr. Kennedy’s 50th Class scholarship aid to needy medical students in Reunion, this fund was established in 1993 to the School of Medicine. Irene Sluckis to provide scholarship Koteen upon his eightieth birthday by his assistance in the School of Medicine. The income is to be used for scholar- Waddie Pennington Jackson Scholarship ship aid to fnancially needy students in the Fund This scholarship fund was established School of Medicine. Kress Scholarship Fund Estab- in memory of his wife, Bessie Gills Jackson, lished in 1987 by a bequest from the estate of income from which is to provide scholarship Milton Kress. The income from this endowed support for needy students in the School of gift is to be used as scholarships for needy Medicine. The stu- Edwin Bosley and Dorothy Duncan Jar- dents and amounts of each scholarship is rett Memorial Fund for Medical Scholar- to be selected by the Dean of the School of ships Established in 1977 by a gift from Mr. This fund honors ship monies will be made available to fnan- their children, Andrew J. Nancy Jenison Scholarship Fund izes their parents, Alan and Caroline Laster Through a generous bequest from Dr. Blanche Jenison, a member of the Class of Andrew and Steven Laster served as mem- 1911, a scholarship fund was established bers of the Johns Hopkins Hospital staff in in 1963 to provide fnancial assistance for the Department of Medicine. Maurice Lenarsky Scholarship Fund Board of the Johns Hopkins Hospital makes This fund was established in 1991 by Jane an annual contribution to the School of Lenarsky in honor of her father Dr. Maurice Medicine to provide fnancial assistance to Lenarsky upon his eightieth birthday. Joseph Spauld- annual scholarship to a deserving woman ing Scholarship This scholarship was estab- medical student, was established in 1957 by lished by Mrs. Martin Macht, an alumnus of the School Rose Meinhardt Fund An endowed scholar- of Medicine. This fund is to provide a fnan- ship established by the estate of Rose Mein- cial needy student in the School of Medicine hardt to provide assistance to needy, deserv- through the four years of study. Houston Merritt Scholarship Fund cation This scholarship fund will be used Established in 1990 with a gift from the estate to support a medical student with fnancial of H. Martin is a 1950 graduate of the School of Adolf Meyer Scholarship Established by a Medicine. Bessie Darling Black Fund This fund was established in 2003 by Massey; the income is to be used for scholar- the Mildvan family to honor their devotion to ships in the School of Medicine. The Manfred Mayer Scholarship Fund Estab- income from this fund is to be used to assist lished in 1985 by the colleagues and friends students in the Five Year Program with pref- of Dr. Manfred Mayer to provide scholarships erence to be given to students from the state to support needy medical students with spe- of Oregon. The scholarship was established in honor John Scott McFarland Scholarship Fund of Dr. Moore’s 35th School of Medicine An endowment fund established in 1965 Reunion, with income to be used to provide under the will of Dr. McFarland, a scholarship assistance to fnancially needy member of the Class of 1902. McGraw Scholarship Fund This Morawetz are available to students in the scholarship was established by The McGraw School of Medicine who are in need of fnan- Foundation in April 1983 with the purpose of cial support. Sandra Morse Scholarship Fund This This fund was established in 1974 by an fund was established in 1993 by M. The income is to be used to sup- cal school students had given her during her port fnancially needy students in the School 29 year tenure as Director of Financial Aid. Edwin Leonard McQuade Scholarship vide assistance to fnancially needy students Fund The income from this endowment, in the School of Medicine. Donald Scholarship This fund was established Mulder established this endowment fund to provide tuition scholarships to medical to provide scholarships for needy medical students. Myatt Parker Endowed Scholarship Fund Estab- Memorial Scholarship Established by the lished in 1996 by Ronald E. Myatt, in memory of her and provide scholarship support to students in the her spouse, Leslie, School of Medicine Class School of Medicine. Park Scholarship Fund An Jesse Myers Scholarship Fund Established endowment fund, established by friends, for- in 1971 in memory of Jesse Myers, who was mer students, and professional colleagues killed in an automobile accident while he was of Dr. Park at the time of his eightieth birth- a First Year student in the School of Medi- day, December 30, 1957, with income allo- cine. The fund is to be used to assist minority cated to student scholarships in the School students at the School of Medicine. This fund provides scholarship whose paintings hang in the Johns Hopkins assistance to deserving medical students in University and Hospital. Payne Scholarship Fund This Nu Sigma Nu Medical Student Scholar- endowment fund was established by Mr. William Hillis, an alumnus of Samuel Payne and to provide scholarships the School of Medicine and a former mem- for deserving students from the state of ber of our faculty. Penney Memorial Scholarship Medicine, and it gives recognition to the past Fund An endowment fund was established in contributions of the Nu Sigma Fraternity to 1986 by Della N. Giacomo and Jan Pirzio-Biroli Scholar- Paul O’Sullivan, a graduate of the School of ship Fund This fund was endowed in 2001 Medicine in 1943, to provide scholarships to by the estate of Giacomo Pirzio-Biroli, Class fnancially needy medical students. Reinhard Medical Scholar- to experience similarly enlightened medical ship These are endowed scholarships made education in the tradition of Johns Hopkins. Reinhard, a graduate of the Fund Family, friends, and former classmates School of Medicine. The fund provides fnancial assis- this fund provides scholarships for medical tance to deserving students in the School of students with preference given to Jewish Medicine. Richardson Fund Established Established in 1980 with a gift from the estate as a bequest from the estate of Dr. The income from this fund is to scholarship aid to students in the School of be used for scholarships for worthy students Medicine. Alvin Riebling Scholarship Fund A gift general practitioners in the feld of family from Dr. Rosenfeld Scholarship Fund ment, established in 1993, is used to provide Established in 1990 by the Estate of Madalyn scholarships for students in the School of Schwentker Rosenfeld, this fund in memory Medicine. Rosenfeld’s father, Jesse Rosen- Radiology Fund for Medical Students feld, his mother, Rose R. Morgan Depart- sister, Carolyn Rosenfeld, is to be used to ment of Radiology and Radiological Science provide students residing in the state of Mary- has established a scholarship fund for medi- land with scholarship support.
Conclusion: All contact pressure values in the time buy trazodone 100 mg amex treatment zone guiseley, and the movement distance was 2 buy 100 mg trazodone mastercard medications jfk was on. Conclusion: By the conventional method to analysis was useful for evaluating the effects of the different socket shapes gait with an image trazodone 100mg amex symptoms kidney stones, the movement in the knee is not able to meas- and will help to optimize prosthetic sockets for individual patients buy generic trazodone 100mg on line medications you cant take with grapefruit. By our devised method, the measurement of the horizontal sliding between the femur and the tibia distance is possible on gait. Domen4 Analysis Laboratory of Department of Medical Rehabilitation of 1Institute of Rehabilitation Science- Tokuyukai Medical Corpora- Dr. The study involved 18 to 35-year- tion, Department of Research, Toyonaka, Japan, 2Kansai Rehabili- old males living in Surabaya who had fulflled the inclusion crite- tation Hospital, Department of Rehabilitation, Toyonaka, Japan, ria. The subject of study was asked to walk subsequently barefoot, 3Kansai Rehabilitation Hospital, Department of Diagnosis and with 3 cm, and with 5 cm high heels. Results: We ment of Rehabilitation Medicine, Nishinomiya, Japan enrolled healthy sample of 15 males who are in inclusion criteria. The difference of erector spinal muscle activity between those who Introduction/Background: Sinus of the shoulder complex is de- walked barefoot compared to 3 cm heels was 5. In measurement, trunk motion, if it is meas- between those who walked with 3 cm compared to those with 5 ured, does not need to be constrained, because the sinus can be cm high heels was 14. Con- Republic of Korea, 3Soonchunhyang University, Division of Mo- clusion: As for the shoulder complex motion with natural trunk lecular Cancer Research in Soonchunhyang Medical Research In- motion in healthy males, w-Sinus was found to be approximately stitute, Cheonan, Republic of Korea 1. For future evaluation of compensatory trunk Introduction/Background: Diabetic skin is known to have defcient motion in shoulder motion of patient, this value could be used as wound healing properties, but little is known of its intrinsic biome- reference-value for normal range. We hypothesize that diabetic skin has inferior biomechanical properties at baseline, rendering it more prone to injury. Results: At ment of Rehabilitation-, Hengyang, China, 2West China Hospital- baseline, human diabetic skin was biomechanically inferior com- Sichuan University, Department of Rehabilitation, Chengdu, China pared to nondiabetic skin, with excessive distensibility (p<0. Material and Methods: Sixty female Sprague-Dawley trix were signifcantly higher in diabetic skin (p<0. In the frst batch, the rats were randomly divided into three involved in collagen metabolism were detected only in the diabetic groups (n=10): sham-operated (Sham-0 group), ovariectomized skin. Although it is a well- ate School of Medicine, Internal Medicine and Rehabilitation Sci- known swallowing exercise, its physiological mechanism is not ence, Sendai, Japan fully understood. This demonstrates the need for further study of evidence of renal damage was alleviated in response to exercise. Material and Methods: Prospective, Introduction/Background: People with stroke usually have defcits longitudinal and descriptive study from Mar to Jul 2014 in a Cardiac in locomotion skills because of hemiparetic disabilities. Research has shown that gaiting training could improve calisthenic program which lasted 4 weeks (12 sessions mínimum). Thus, the purpose of this study was to inves- Eventually, the stress test was performed again. Results: 5 patients tigate if the gait training had an effect on balance ability of stroke where included. Material and Methods: 21 stroke patients participated in the frst exercise test where from 3. At the end of minutes per day, three times a week for six weeks, and the control the program, the 5 where class Ib. This training effect obtained in this study 2 1 may have helped the patients stood stably. Introduction/Background: Retaining gait ability is critically impor- tant for patients with severe hemiplegia after stroke. Kob- tients from gait training because the motion of knee joint is quite ayashi2 different between these orthosis. Material and Methods: A 50-year old, male patient with se- vere hemiplegia on the left side was transferred to our convalescent Introduction/Background: Local cryotherapy is effective for the rehabilitation hospital at day 52. Conclusion: This case suggests that gait train- score) at pre-operatively and 28 days after surgery and the walk- ing with transitional settings of knee-joint motion may facilitate ing speed at pre-operatively 2weeks and 1month after surgery. There is effect of re- and total hemoglobin in the muscle were measured before and after sistance exercise to disuse atrophy in increasing the soleus muscle the 15-minutes intervention, together with the temperature at the skin fber diameter of Rattus novergicus. The local blood circu- lation and tissue temperature were followed until 30 minutes after the intervention and collected at the interval of 5 minutes. Exclusion criteria were previous stroke, preceding epilepsy, severe cognitive impairments, seri- 898 ous cardiac or orthopedic problems, or metallic implants. Results: The intervention 1 2 2 2 was completed for all 4 patients with right hemiplegia. During immobi- lization, protein synthesis and the amount of myofbrils fbers de- creases. First group received elec- 1Hyogo College of Medicine Hospital, Rehabilitation, Nishinomi- trical stimulation with frequency of 2 Hz, 2 × 3 hours/day with ya, Japan, 2Ssayama Medical Center Hyogo College of Medicine, 2-hours rest in between. Second group was given resistance ex- Rehabilitation, Sasayama, Japan, 3Hyogo College of Medicine, ercise, i. Third group was given the frst groups treatments as well as the second groups treatments. Introduction/Background: An important goal for stroke patients is In the end, soleus muscle was taken-turned into histopathology the recovery of gait performance, because almost all stroke patients preparation,stained with Hematoxylin eosin. In the Japanese guidelines for stroke soleus muscle fbers were measured using micrometer 400 × mag- rehabilitation, the effect of rehabilitation with functional electrical nifcation. Material and Methods: Study participants were stroke patients with recent stroke onset within 6 months or more. Staff results are best summarized as follows: ogy- and Biotechnology -Faculty of Sciences-, Kenitra, Morocco “The patients and family … have expressed the class has many pos- Introduction/Background: Brain vulnerability to infammation is itive … and lasting effects - more relaxed, sleep better, feel more high during the early postnatal age and perinatal infection could connected with themselves or their loved ones, less pain, and more result in long-lasting neuropsychiatric disorders, including autism motivated. In overall patient experience while providing low cost self-help skills the present study, we have assessed the effcacy of an extract of with the potential for long-term carry over. Material and Methods: the program has expanded to all units in the frst rehab hospital, and To counteract hippocampal microglia activation and depressive- to three more rehab hospitals in the same healthcare system. Moreover, we and Engineering, Taoyuan, Taiwan, Taipei Veterans General Hos- demonstrate for the frst time, that Thymelaea lythroides, similarly pital, Physical Medicine and Rehabilitation Department, Taipei, J Rehabil Med Suppl 55 Poster Abstracts 263 Taiwan, 3National Central University, Department of Computer (p>0. Conclusion: The rehabilitation therapies could modify the disability after stroke. Material and Methods: We used Fugl-Meyer lower limb muscles stimulation will be investigated. And classify patient to the good recovery and general recovery group according the improvement of the assessment. Sakane 1Ibaraki Prefectural University of Health Sciences, Department the motion in the frst stage. For the good recovery group, patients of Orthopaedic Surgery, Ami-machi- Inashiki-gun, Japan, 2Tokyo improve to master the motion, but less related to the speed.
Combined memantine added to donepezil may produce increased gains in terms of global outcome trazodone 100 mg lowest price treatment quadriceps tendonitis, activities of daily living discount trazodone 100mg amex medications you cant drink alcohol with, behaviour purchase trazodone 100 mg overnight delivery medicine 4 you pharma pvt ltd, and cognition discount 100mg trazodone mastercard medicine 853. It seems to have acetylcholinesterase activity but with little effect on butylcholinesterase. There is some evidence of efficacy when used alone or in combination with ginkgo biloba. However, DeKosky ea (2008) assigned 3,069 community volunteers aged at least 75 years with either normal cognition or mild cognitive impairment to either placebo or ginkgo biloba 120 mg twice daily and followed them up for a median of 6. Whilst the vinca alkaloid vinpocetine improves learning and memory in animals it does not benefit dementia sufferers. A number of secretases are involved in beta-amyloid peptide (40-42 amino acids) production from amyloid precursor protein. R-flurbiprofen, a gamma-secretase modulator, leads to shorter amino acids that do not lead to Aβ accumulation. Hypercholesterolaemia accelerates amyloid pathology and reduced cholesterol intake slows plaque 2814 development in transgenic mouse models, a finding that may have some application in humans. However, because more educated people may be more likely to take such drugs, the effects of education have to be controlled for in research. Ginkgo biloba, from the leaves of the maidenhair tree, was used in Chinese medicine for millennia; concerns have been raised over a tendency to cause bleeding. The ‘essential oil’ contains cineole, borneol and thujone and the leaf contains many chemicals such as oleic and tannic acids. There may be thrombosis of leptomeningeal or cortical vessels leading to many small infarcts. There is evidence for an increased risk for dementia in people with affective disorders (e. Most studies were of short duration, they were more often unpublished, and they were usually funded by the pharmaceutical industry. Schneider ea (2006) found adverse effects of atypical antipsychotic drugs for treatment of psychosis, aggression, or agitation in Alzheimer patients outweighed any therapeutic advantages. Sultzer ea (2008) used antipsychotic drugs for psychosis or agitated/aggressive behaviour in outpatients with Alzheimer’s disease: the drugs were useful for certain symptoms (e. Conventional antipsychotic drugs may carry similar risks for mortality when used in demented subjects. In the substantia nigra they are brightly eosinophilic (pink) with hyaline core and paler halo; in cortex they are faintly eosinophilic and have no core. They were considered confined to idiopathic Parkinson’s disease 2822 (paralysis agitans) until recent years. Friedrich Heinrich Levy (1885-1950) discovered these bodies in the brains of Parkinson’s disease patients in 1912 when with Alzheimer at Kraepelin’s Royal Psychiatric Clinic in Munich. Bennett ea (2006) prospectively reported that 7-14% of non-demented/non-cognitively impaired people who died had Lewy body pathology. Lewy bodies contain ubiquitin and alpha-synuclein and antibodies to these proteins can be used in postmortem tissue as a method of detecting these bodies. The dose of alpha-synuclein (number of genes) may play a role in the aetiology of dementia. In Parkinson’s disease up to 70% of cells are lost from the substantia nigra before symptoms manifest themselves. Cognitive decline has correlated with both neuroleptic usage and with persecutory ideas! L-deprenyl has been suggested for Parkinsonism but it may precipitate hallucinations. Atypical antipsychotic drugs may cause as many problems do as typical agents, although olanzapine, quetiapine, aripiprazole or clozapine may be useful. The usual visual hallucinations are of people or animals that may disappear when the patient stares at the image. Also, the patient may see (illusions) things such as a face in detailed objects like a bush. The German neuropathologist Friedrich Heinrich Lewy (1885-1950), while working with Alzheimer, described spherical neuronal inclusions. Parkinson’s disease patients with overt dementia are no more often depressed than in those without dementia. Anergia, motor retardation, and early awakening may be equally severe in Parkinson’s disease patients with and without depression. A mutation of the gene for α-synuclein on chromosome 4 is associated with rare, autosomal dominant, early-onset Parkinson’s disease. Non-significant neurone loss in cortical areas affected by Lewy bodies (perhaps synaptic dysfunction is operative? Olanzapine indication in dementia terminated because of reports of increased mortality and stroke in that group. Larson (1993) listed the risk factors for vascular 2832 dementia as old age, high blood pressure, smoking, diabetes mellitus , cardiac disorders, atrial fibrillation, and extracranial arterial disease. A twin study from Norway 2828 [123I]-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane. There was much heterogeneity in the way such lesions were measured and analysed and some studies were omitted because of use of different scales that viewed white matter hyperintensities as continuous variables. Scores (in brackets) are given for abrupt onset (2), stepwise deterioration (1), fluctuating course (2), nocturnal confusion (1), relative preservation of personality (1), depression (1), somatic complaints (1), emotional incontinence (1), history of hypertension (1) or strokes (2), evidence of associated atherosclerosis (1), and focal neurological symptoms (2) or signs (2). The Index does not take account of imaging findings and are of diminished applicability in cases of insidious onset. Probable vascular dementia = early onset of abnormal gait (magnetic, marche à petit pas, apraxic-ataxic, or parkinsonian), unsteady/prone to falling, early onset of urinary incontinence, pseudobulbar palsy (dysphagia, dysarthria, emotional incontinence), changes in mood and personality, and psychomotor retardation, perseveration, and difficulty shifting/maintain sets. Definite vascular dementia = clinical criteria for probable case, biopsy/autopsy histology favours cerebrovascular disease, plaques/tangles do not exceed what would be expected at patient’s age, and no other cause of dementia. No association between decline in cognitive function and frequency of severe hypoglycaemia has been found, but high mean glycated haemoglobin concentration and a moderate decline in motor speed and psychomotor deficiency has been reported. There are many possible mechanisms involved (ranging from genes to hypertension and vascular pathology). Blood pressure should be controlled , 2834 low dose aspirin might help , and there may be a role for surgical correction of carotid artery stenosis. Antidepressants may be augmented with calcium channel blockers, such as the centrally active nimodipine, in post-stroke depression. However, extreme degrees of atherosclerosis in the postmortem specimen are quite compatible with clinically normal cognitive functioning. Pathology in vascular dementia Lenticulostriate branches of middle cerebral artery most often affected Vasculature progressively narrows, bloats, twists, and becomes yellow and rigid Supple vessels give way to corrugated drainpipes Brain parenchyma may be normal, cystic, infarcted, necrotic, or scarred 2838 Dementia is due to cerebral softening from multiple small infarctions of brain tissue - it is not the cerebral arteriosclerosis per se that causes dementia Middle cerebral artery most often involved Followed by posterior artery supplying areas important for memory, e.
