RESUMEN
The Alzheimer's Disease Assessment Scale (ADAS) has assumed a primary role in assessment of treatment responses in large-scale multicenter trials of drugs being evaluated for treatment of dementia in elderly patients. Data from 280 patients with Alzheimer's disease were analyzed to evaluate factor structure and reliability. Results confirm the presence of three primary factors interpreted as mental status, verbal fluency, and praxis. The presence of a large general factor underlying those more specific dimensions also supports the utility of the composite ADAS cognitive score that has been used as a primary outcome measure in previous drug trials. Test-retest reliability of the factor scores were calculated to be 0.83, 0.78, and 0.87. Test-retest reliability of the composite ADAS cognitive score was 0.90. Statistics useful for estimation of sample sizes for future multicenter trials are provided.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/tratamiento farmacológico , Inhibidores de la Colinesterasa/uso terapéutico , Pruebas Neuropsicológicas , Anciano , Humanos , Reproducibilidad de los ResultadosRESUMEN
The SKT (Syndrom Kurztest) has been used in the assessment of treatment responses in numerous clinical trials for treatment of dementia in German-speaking Europe. Data from 265 patients with mild to moderate Alzheimer's disease in a study conducted in the U.S. were analyzed to evaluate factor structure, common and specific subtest content, reliability, and concurrent validity. Results confirm the presence of two primary factors of memory and attention. Test-retest reliability of the factor scores was estimated to be .75 and .93. Test-retest reliability of the composite SKT total score was .90. The correlations between the SKT memory and attention factor scores and the MMSE and ADAS measurements of dementia also support validity with regard to the broader construct of cognitive dysfunction.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Anciano , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/psicología , Atención/efectos de los fármacos , Método Doble Ciego , Humanos , Indoles/uso terapéutico , Recuerdo Mental/efectos de los fármacos , Psicometría , Piridinas/uso terapéutico , Valores de ReferenciaRESUMEN
The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.
Asunto(s)
Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/terapia , Antifibrinolíticos/uso terapéutico , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Estudios Prospectivos , Distribución Aleatoria , Recurrencia , Rotura Espontánea , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/mortalidad , Hemorragia Subaracnoidea/cirugía , Factores de TiempoRESUMEN
Antifibrinolytic therapy was used in 1,114 patients who had aneurysmal subarachnoid hemorrhage (SAH) and who were treated by the 13 institutions of the Cooperative Aneurysm Study. Patients were started on treatment within one week after SAH was diagnosed, and therapy was discontinued 14 days after the ictus. Rebleeding occurred in 10% of the treated patients. Overall mortality among the treated patients during the two weeks following hemorrhage was 10.7%. Though some minor and a few major side effects occurred, serious complications of therapy were infrequent.
Asunto(s)
Aminocaproatos/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/tratamiento farmacológico , Ácido Tranexámico/uso terapéutico , Adolescente , Adulto , Anciano , Aminocaproatos/efectos adversos , Niño , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/mortalidad , Ácido Tranexámico/efectos adversosAsunto(s)
Reposo en Cama , Aneurisma Intracraneal/terapia , Hemorragia Subaracnoidea/terapia , Adulto , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia , Rotura Espontánea/complicaciones , Rotura Espontánea/terapia , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/mortalidadRESUMEN
Three weeks of regulated bed rest was one of four treatments evaluated in the Cooperative Aneurysm Study. A total of 187 patients with a recently ruptured intracranial aneurysm had subarachnoid hemorrhage confirmed by lumbar puncture. A group of 124 patients were assigned to treatment within 7 days after the bleed, 49 between 8 and 21 days, and 14 between 22 days and 92 days. During the mean follow-up interval of 6.5 years, mortality was 55.1%. A proved rebleed was the cause of death in 34.2%, progressive deterioration from aneurysm rupture in 8.0%, and a suspected rebleed in 4.8%. A total of 47.1% died of causes related directly to the cerebral effects of the ruptured aneurysm.
Asunto(s)
Aneurisma Intracraneal/terapia , Hemorragia Subaracnoidea/terapia , Adolescente , Adulto , Anciano , Reposo en Cama , Arteria Carótida Interna , Niño , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/mortalidad , Masculino , Persona de Mediana Edad , Hemorragia Subaracnoidea/etiologíaRESUMEN
Unusual findings at autopsy prompted this case report of a patient with the syndrome of alexia without agraphia. The expected disconnection of the left angular gyrus from both visual cortices was not found at postmortem examination. Multiple cerebral metastases were identified, but none were present in the presumed pathways connecting the left occipital lobe and the left angular gyrus.
Asunto(s)
Encéfalo/patología , Dislexia Adquirida/patología , Hemianopsia/patología , Autopsia , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/patología , Dislexia Adquirida/complicaciones , Dislexia Adquirida/etiología , Hemianopsia/complicaciones , Hemianopsia/etiología , Hemiplejía/complicaciones , Hemiplejía/etiología , Humanos , Masculino , Melanoma/complicaciones , Melanoma/patología , Persona de Mediana EdadRESUMEN
In this cooperative study among 13 institutions, 502 patients were treated with antifibrinolytic medication (epsilon-aminocaproic acid or tranexamic acid) within a 14-day period following rupture of an intracranial aneurysm. Mortality at the end of 14 days was 11.6%; proved rebleed rate was 12.7%. Patients with an internal carotid or anterior cerebral aneurysm had the highest mortality and rebleed rate. Most rebleeds occurred between the sixth and eleventh days following the initial bleed. Significantly higher mortality was reported among patients with cerebral vasospasm, yet rebleed rate was no different among those patients with or without vasospasm. The same pattern was observed among patients with a mean blood pressure value above and below 110 mm Hg. We conclude that antifibrinolytic therapy provides beneficial treatment to patients with recent onset subarachnoid hemorrhage (SAH) following rupture of an intracranial aneurysm.