Medline Abstract
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, N-2312 Ottestad, Norway. |  | ||||||||||||||||||||||||||
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OBJECTIVE: To determine the effect of discontinuing antidepressant treatment in people with dementia and neuropsychiatric symptoms. DESIGN: Double blind, randomised, parallel group, placebo controlled trial. SETTING: Norwegian nursing homes; residents recruited by 16 study centres in Norway from August 2008 to June 2010. PARTICIPANTS: 128 patients with Alzheimer's disease, dementia or vascular dementia, and neuropsychiatric symptoms (but no depressive disorder), who had been prescribed escitalopram, citalopram, sertraline, or paroxetine for three months or more. We excluded patients with severe somatic disease or terminal illness, or who were unable to take tablets or capsules as prescribed. INTERVENTIONS: Antidepressant treatment was discontinued over one week in 63 patients, and continued in 68 patients. We assessed patients at baseline, four, seven, 13, and 25 weeks. MAIN OUTCOME MEASURES: Primary outcomes were score differences between study groups in the Cornell scale of depression in dementia and the neuropsychiatric inventory (10 item version) after 25 weeks. Secondary outcomes were score differences in the clinical dementia rating scale, unified Parkinson's disease rating scale, quality of life-Alzheimer's disease scale, Lawton and Brody's physical self maintenance scale, and severe impairment battery. RESULTS: Using a linear multilevel model analysis, we found that the discontinued group had significantly higher scores on the Cornell scale after 25 weeks than the continuation group (difference -2.89 (95% confidence interval -4.76 to -1.02); P=0.003). We saw a similar result in the mean total score for the neuropsychiatric inventory after 25 weeks, but this difference was non-significant (-5.96 (-12.35 to 0.44); P=0.068). We confirmed these results by non-response analysis (>30% worsening on the Cornell scale)-significantly more patients worsened in the discontinuation group than in the continuation group (32 (54%) v 17 (29%); P=0.006). We found no significant differences between the groups for secondary outcomes. Forty seven (37%) patients withdrew from the study early. CONCLUSIONS: Discontinuation of antidepressant treatment in patients with dementia and neuropsychiatric symptoms leads to an increase in depressive symptoms, compared with those patients who continue with treatment. | |||||||||||||||||||||||||||
Sunday, March 18, 2012
Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms
Thursday, August 4, 2011
Longitudinal changes of structural connectivity in traumatic axonal injury
August 3, 201110.1212/WNL.0b013e31822c61d7 Neurology WNL.0b013e31822c61d7
- J.Y. Wang, PhD,
- K. Bakhadirov, MD,
- H. Abdi, PhD,
- M.D. Devous Sr., PhD,
- C.D. Marquez de la Plata, PhD,
- C. Moore, MA,
- C.J. Madden, MD and
- R. Diaz-Arrastia, MD, PhD
+ Author Affiliations
1. From the Department of Cognition and Neuroscience (J.Y.W., K.B., H.A., M.D.D.) and Center for Brain Health (C.D.M.d.l.P.), University of Texas at Dallas, Richardson; and Departments of Radiology (H.A., M.D.D.), Neurology (C.M., R.D.-A.), and Neurosurgery (C.J.M.), University of Texas Southwestern Medical Center, Dallas. Dr. Diaz-Arrastia is currently with the Center for Neuroscience and Regenerative Medicine, Uniformed Services University for the Health Sciences, Rockville, MD.- Address correspondence and reprint requests to Dr. Ramon Diaz-Arrastia, Center for Neuroscience and Regenerative Medicine, Uniformed Services University for the Health Sciences, 12725 Twinbrook Parkway, Rockville, MD 20852 Ramon.Diaz-Arrastia@usuhs.mil
Abstract
Objectives: To identify structural connectivity change occurring during the first 6 months after traumatic brain injury and to evaluate the utility of diffusion tensor tractography for predicting long-term outcome.
Methods: The participants were 28 patients with mild to severe traumatic axonal injury and 20 age- and sex-matched healthy control subjects. Neuroimaging was obtained 0–9 days postinjury for acute scans and 6–14 months postinjury for chronic scans. Long-term outcome was evaluated on the day of the chronic scan. Twenty-eight fiber regions of 9 major white matter structures were reconstructed, and reliable tractography measurements were determined and used.
Results: Although most (23 of 28) patients had severe brain injury, their long-term outcome ranged from good recovery (16 patients) to moderately (5 patients) and severely disabled (7 patients). In concordance with the diverse outcome, the white matter change in patients was heterogeneous, ranging from improved structural connectivity, through no change, to deteriorated connectivity. At the group level, all 9 fiber tracts deteriorated significantly with 7 (corpus callosum, cingulum, angular bundle, cerebral peduncular fibers, uncinate fasciculus, and inferior longitudinal and fronto-occipital fasciculi) showing structural damage acutely and 2 (fornix body and left arcuate fasciculus) chronically. Importantly, the amount of change in tractography measurements correlated with patients' long-term outcome. Acute tractography measurements were able to predict patients' learning and memory performance; chronic measurements also determined performance on processing speed and executive function.
Conclusions: Diffusion tensor tractography is a valuable tool for identifying structural connectivity changes occurring between the acute and chronic stages of traumatic brain injury and for predicting patients' long-term outcome.
- Received December 13, 2010.
- Accepted March 22, 2011.
Wednesday, August 3, 2011
Blast-induced phenotypic switching in cerebral vasospasm
- Patrick W. Alford1,
- Borna E. Dabiri,
- Josue A. Goss,
- Matthew A. Hemphill,
- Mark D. Brigham, and
- Kevin Kit Parker2
+ Author Affiliations
1. Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, Harvard School of Engineering and Applied Science, Pierce Hall #321, 29 Oxford Street, Cambridge, MA 021381. Edited* by Robert Langer, Massachusetts Institute of Technology, Cambridge, MA, and approved June 20, 2011 (received for review April 14, 2011)
Abstract
Vasospasm of the cerebrovasculature is a common manifestation of blast-induced traumatic brain injury (bTBI) reported among combat casualties in the conflicts in Afghanistan and Iraq. Cerebral vasospasm occurs more frequently, and with earlier onset, in bTBI patients than in patients with other TBI injury modes, such as blunt force trauma. Though vasospasm is usually associated with the presence of subarachnoid hemorrhage (SAH), SAH is not required for vasospasm in bTBI, which suggests that the unique mechanics of blast injury could potentiate vasospasm onset, accounting for the increased incidence. Here, using theoretical and in vitro models, we show that a single rapid mechanical insult can induce vascular hypercontractility and remodeling, indicative of vasospasm initiation. We employed high-velocity stretching of engineered arterial lamellae to simulate the mechanical forces of a blast pulse on the vasculature. An hour after a simulated blast, injured tissues displayed altered intracellular calcium dynamics leading to hypersensitivity to contractile stimulus with endothelin-1. One day after simulated blast, tissues exhibited blast force dependent prolonged hypercontraction and vascular smooth muscle phenotype switching, indicative of remodeling. These results suggest that an acute, blast-like injury is sufficient to induce a hypercontraction-induced genetic switch that potentiates vascular remodeling, and cerebral vasospasm, in bTBI patients.
Thursday, July 7, 2011
Widespread Tau and Amyloid-Beta Pathology Many Years After a Single Traumatic Brain Injury in Humans.
Brain Pathol. 2011 Jun 29;
Authors: Johnson VE, Stewart W, Smith DH
Whilst a history of single traumatic brain injury (TBI) is associated with the later development of syndromes of cognitive impairment, such as Alzheimer's disease (AD), the long-term pathology evolving after single TBI is poorly understood. However, a progressive tauopathy, chronic traumatic encephalopathy, is described in selected cohorts with a history of repetitive concussive / mild head injury. Here, post-mortem brains from long-term survivors of just a single TBI (1 to 47 years survival; n = 39) versus uninjured, age-matched controls (n = 47) were examined for neurofibrillary tangles (NFTs) and amyloid-β (Aβ) plaques using immunohistochemistry and thioflavin-S staining. Detailed maps of findings permitted classification of pathology using semi-quantitative scoring systems.NFTs were exceptionally rare in young, uninjured controls, yet were abundant and widely distributed in approximately one third of TBI cases. In addition, Aβ-plaques were found in a greater density following TBI versus controls. Moreover, thioflavin-S staining revealed that while all plaque-positive control cases displayed predominantly diffuse plaques, 64% of plaque-positive TBI cases, displayed predominantly thioflavin-S positive plaques or a mixed thioflavin-S positive / diffuse pattern. These data demonstrate widespread NFT and Aβ plaque pathologies are present in a proportion of patients following a single TBI, suggesting that some individuals who experience a single TBI may develop long-term neuropathological changes akin to those found in neurodegenerative disease.
PMID: 21714827 [PubMed - as supplied by publisher]
Assessment and treatment of common persistent sequelae following blast induced mild traumatic brain injury.
NeuroRehabilitation. 2011 Jan 1;28(4):309-20
Authors: Schultz BA, Cifu DX, McNamee S, Nichols M, Carne W
The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.
PMID: 21725164 [PubMed - in process]
Optic radiation injury following traumatic epidural hematoma: Diffusion tensor imaging study.
NeuroRehabilitation. 2011 Jan 1;28(4):383-7
Authors: Kwon HG, Jang SH
Little is known about optic radiation (OR) injury in patients with traumatic brain injury (TBI). We report on a patient who showed an OR injury on diffusion tensor imaging (DTI) following traumatic epidural hematoma (EDH). A 38 year-old man with TBI and 7 age-matched normal subjects were enrolled in this study. The patient had fallen down stairs while in an alcohol intoxicated state. He underwent a craniotomy following diagnosis of traumatic EDH in the left temporo-parietal lobe on brain CT. He complained of right bilateral homonymous hemianopsia, which was confirmed on the Humphrey visual field test. No lesion on the left OR was observed during brain MRI. We were not able to reconstruct the fiber tractography for the left OR in this patient. We found that the left OR had been injured most severely around the midportion between the lateral geniculate body and occipital pole. We determined that DTI would be a useful technique for detection of an OR injury in patients with TBI. Therefore, we believe that DTI should be performed along with conventional brain MRI for patients with visual field defects following TBI.
PMID: 21725172 [PubMed - in process]
Friday, July 1, 2011
Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008
Abstract
Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.
Objective
To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008.
Data Sources
PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication,executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms:rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles.
Study Selection
One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies.