Stroke dementia

In studies where subjects are mentally or physically unable to give proper consent, special arrangements will need to be made. Where appropriate, the ICF will be read to the subject in the presence of a witness, or consent will be provided by the next of kin or the subject s representatives. Studies in which the study subjects cannot provide informed consent will become more frequent as more difficult indications, for example, trauma, stroke, dementia and the handicapped or very young children, become the focus of clinical trials. The pharmaceutical physician should ensure that established mechanisms for consent are followed with agreement of the lEC and in compliance with ICH GCP chapter 4.8, FDA Title 21 CFR Part 50 sections 24-273 gpj p)ii-ective Articles 4 and 5. ... 

The statins may lower the risk of CHD by decreasing inflammation, an important component of atherogene-sis. Lovastatin decreased elevated plasma levels of C-reactive protein, a marker for cellular inflammation, and acute coronary events in patients with relatively low plasma cholesterol levels. Recent studies also suggest that use of statins may decrease the risk of stroke, dementia, and Alzheimer s disease and may improve bone... 

Most studies of post-stroke dementia are of hospital series and tend to focus on major strokes very few include patients with TIA. Prevalence rates in hospital-based series vary from... 

Fig. 31.1. Pooled prevalence of rates for post-stroke dementia within three to six months of stroke in hospital-based studies that did not exclude pre-stroke dementia. Cl, confidence interval. Study sources Klimkowicz-Mrowiec et ol. (2006) Zhou et ol. (2004) Barba et ol. (2001) Tang et ol. 2004a,b) Pohjasvaara et ol. (1999) Desmond (2004) Henon et at. (1997, 2001).

The exact etiology of post-stroke dementia is unclear. A stroke may cause decompensation of a brain with pre-existing reduced cognitive reserve, as suggested by the increased risk of dementia after stroke in those with prior CIND. In addition, factors such as hypertension that cause the vascular changes predisposing to stroke may also contribute... 

Cordoliani-Mackowiak M, Henon H, Pruvo J etal. (2003). Post stroke dementia influence of hippocampal atrophy. Archives of Neurology 60 585-590... 

The Group organizes study days, mini-symposia and workshops. Topics have included the pharmaceutical care of patients with stroke, dementia and osteoporosis plus a day on ophthalmological problems. 

SPECT scans measure radiotracer uptake by tissues and provide cross-sectional images of the brain. This technique has been used extensively to assess cerebral blood flow. Although the resolution of SPECT is not as good as PET, the availability has led to wide clinical use in disorders such as stroke, dementia, and epilepsy. 

True. Excessive alcohol use can lead to many health problems. Heart and liver disease, increased risks of strokes, stomach, liver and mouth cancer, and dementia are all associated with excess alcohol use. 

However, when used in excess it can lead to a wide range of physical and mental problems, e.g. heart and liver disease, cancers, increased risk of stroke, mood and personality changes and dementia (Korsakoff s psychosis). 

Finally, AIDS dementia has parallels with cerebral ischemia or stroke and again the key mechanism appears to involve overactivation of glutamate receptors, in particular the NMDA receptor, followed by excessive influx of calcium and the generation of free radicals. 

History of prior ischemic stroke greater than 3 months ago, dementia, or known intracranial pathology not covered above under absolute contraindications... 

CVA, seizure disorders, dementia, stroke, migraine, encephalitis, vestibular dysfunction Cardiovascular Disorders... 

Dementia, migraine, Parkinson s disease, seizures, stroke, neoplasms, poor pain control Respiratory system... 

The most common causes of continuous central vertigo are medication, brain damages due to stroke or dementia, cerebellar atrophy and psychological reactions. It can also be a symptom of general cerebral ischemia due to hypotension, medication or cardiac arrhythmia. 

At this time, however, we are not aware of any compounds selected primarily by their neuroprotection activity on rodent models that have established clinical efficacy for dementias or related neurodegenerative diseases. This may be partially explained by their priority development for stroke, and clinicians have found it is difficult or unlikely to slow the ischemia in patients if they are not treated aggressively within 3 h of the initial ischemic event. The speed of neurodegeneration in stroke (cerebral ischemia) makes it a much more difficult target for drug intervention than neurodegeneration from slower pathologies such as Alzheimer s, Parkinson s, and malfunctions in neurotransmitters. 

Female or male 50-85 years old with a caregiver Mini Mental Status (MMS) test between 16 and 26 inclusive Clinical Dementia Rating (CDR) test inferior or equal to 1 National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer s Disease and Related Disorders Association (NINCDS/ADRDA) test positive for Alzheimer s disease Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM IV) test positive for dementia Exclusion Criteria ... 

Cardiovascular and cerebrovascular disorders associated with lipid metabolism disturbance and atherosclerosis represent major risk factors for dementia (3,25,59). Atherosclerosis is the primary cause of heart disease and stroke in which genetic and environmental factors converge (553). More than 90% of patients older than 70-80 yr with dementia show signs of atherosclerosis in their arteries and a clear cerebrovascular component in their dementia process. It is very likely that pure AD is practically absent in octogenarians, in whom the prevalent diagnosis is vascular or mixed dementia (3,25,59), in which the APOE-4 allele also accumulates (18-20,554). 

Chapman, J., Wang, N., Treves, T.A., Korczyn, A.D., Borstein, N.M. (1998) ACE, MTHFR, factor V Leiden, and APOE polymorphisms in patients with vascular and Alzheimer s dementia. Stroke, 29, 1401-1404. 

The results of the WHI (Women s Health Initiative) Estrogen Plus Progesterone clinical trial revealing increased incidence of breast cancer, heart disease, stroke, and dementia are provided in J. E. Rossouw et al., JAMA 288 321-333 (2002). 

The cause of Alzheimer s disease is unknown, but genetic factors clearly play a role. One clue supporting this view is provided by the observation that individuals with Down syndrome, a common cause of mental retardation, frequently develop a dementia similar to Alzheimer s disease during early adulthood. Vascular dementia, which is also called multi-infarct dementia, results from the accumulation of tiny strokes. Individually, these strokes or infarcts are too small to cause any noticeable problem, but as they accumulate, they produce deficits similar to Alzheimer s disease. Other neurological diseases such as Parkinson s disease, Pick s disease, and Huntington s disease cause slow deterioration of the brain that ultimately leads to a degenerative dementia. 

The risk factors for vascular dementia are essentially the same as those for stroke and heart attack. They include high blood pressure, heart disease, diabetes mellitus, sickle cell disease, obesity, smoking, alcohol use, depression, and high cholesterol levels. 

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