Outpatient management after severe stroke with dementia
https://doi.org/10.14412/2074-2711-2013-2460
Abstract
To render outpatient care to poststroke patients, particularly to those who have severe motor and/or speech disorders is an urgent problem in neurology. These patients have frequently cognitive and psychoemotional disorders that make rehabilitation much difficult. If there are no promises for functional restoration, these patients need care, prevention of restroke and complications associated with immobilization. Current methods for preventing restroke include modification of lifestyle, normalization of blood pressure, use of antithrombotic agents and statins (after prior ischemic stroke), treatment of cognitive and depressive disorders, pain syndromes, urination disorders, correct care, diet, passive and active exercises, positional treatment, and local domiciliary procedures. The use of up-to-date treatment options is now shown to substantially reduce the risk of restroke and to improve recovery of lost functions and quality of life in the patient.
About the Author
Natalia Vyacheslavovna Pizova
Department of Neurology and Medical Genetics with Course of Neurosurgery, Yaroslavl State Medical Academy, Ministry of Health of Russia
Russian Federation
Russian Federation
References
1. <div><p>Ворлоу ЧП, Деннис МС, Гейн Ж и др. Инсульт. Практическое руководство для ведения больных. Санкт-Петербург: Политехника; 1998. 629 с. [Vorlou ChP, Dennis MS, Geyn Zh i dr. Insul't. Prakticheskoe rukovodstvo dlya vedeniya bol'nykh. St-Petersburg: Politekhnika; 1998. 629 p.]</p><p>Chalmers J, Chapman N. Progress in reducing the burden of stroke. Clin Exp Pharmacol Physiol. 2001;28(12):1091–5. DOI: http://dx.doi.org/10.1046%2Fj.1440-1681.2001.03582.x.</p><p>Vanelay F. Functional outcome measures in stroke rehabilitation. Stroke. 1991;22:105–8.</p><p>Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ. Эпидемиология инсульта в России. Журнал неврологии и психиатрии. 2003;8:4–9. [Gusev EI, Skvortsova VI, Stakhovskaya LV. Epidemiologiya insul'ta v Rossii. Zhurnal nevrologii i psikhiatrii. 2003;8:4–9.]</p><p>Leys D, Pasquier F. Post-stroke dementia. San Antonio: VASCOG; 2007. 21.</p><p>Пизова НВ. Особенности когнитивных расстройств после инсульта: диагностика и терапевтические подходы. Неврология, нейропсихиатрия, психосоматика. 2013;2(S):56–61. [Pizova NV. Post-stroke cognitive impairments: diagnosis and therapeutic approaches. Neurology, Neuropsychiatry, Psychosomatics. 2013;2(S):56–61. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2360.]</p><p>Roman GC. Vascular dementia prevention: a risk factor analysis. Cerebrovasc Dis. 2005;20 Suppl 2:91–100. Epub 2005 Dec 2.</p><p>Sachdev PS. Vascular cognitive disorder. Int J Geriatr Psychiatry. 1999;14(5):402–3. DOI: http://dx.doi.org/10.1002%2F%28SICI%291099-1166%28199905%2914%3A5%3C402%3A%3AAID-GPS958%3E3.0.CO%3B2-H.</p><p>Дамулин ИВ. Сосудистая деменция. Русский медицинский журнал. 2007;15(28):2118–23. [Damulin IV. Sosudistaya dementsiya. Russkiy meditsinskiy zhurnal. 2007;15(28):2118–23.]</p><p>Hachinski V. Stroke: a global agenda (Victor and Clara Soriano Award Lecture). J Neurolog Scien. 2009;285(1):S1. DOI: http://dx.doi.org/10.1016%2FS0022-510X%2809%2970020-6.</p><p>Jaillard A, Naegele B, Trabucco-Miguel S et al. Hidden dysfunctioning in subacute stroke. Stroke. 2009;40(7):2473–9. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.108.541144.</p><p>Вербицкая СВ, Парфенов ВА. Клинический опыт применения мемантина при постинсультной деменции. Неврологический журнал. 2008;13(4):45–8. [Verbitskaya SV, Parfenov VA. Clinical experience of memantine administration in patients with post-stroke dementia. Nevrologicheskiy zhurnal. 2008;13(4):45–8.]</p><p>Henon H, Pasquier F, Leys D. Poststroke dementia. Cerebrovasc Dis. 2006;22(1):61–70. DOI: http://dx.doi.org/10.1159%2F000047642.</p><p>Serrano S, Domingo J, Rodrigez-Garcia E et al. Frequency of cognitive impairment without dementia in patients with stroke: a two-year follow-up study. Stroke. 2007;38(1):105–10. DOI: http://dx.doi.org/10.1161%2F01.STR.0000251804.13102.c0.</p><p>Srikanth VK, Quinn SJ, Donnan GA et al. Longterm cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort. Stroke. 2006;37(10):2479–83.</p><p>Leys D, Неnon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol. 2005;4(11):752–9. DOI: http://dx.doi.org/10.1016%2FS1474-4422%2805%2970221-0.</p><p>Roman GC, Tatemichi TK, Erkinjuntti T et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43(2):250–60. DOI: http://dx.doi.org/10.1212%2FWNL.43.2.250.</p><p>Sachdev PS, Brodaty Н, Valenzuela MJ et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology. 2004;62(6):912–9. DOI: http://dx.doi.org/10.1212%2F01.WNL.0000115108.65264.4B.</p><p>Катаев НГ, Корнетов НА, Катаев СГ, Левина А.Ю. Клинико-лабораторная динамика органических и депрессивных психических расстройств у постинсультных больных. Российский психиатрический журнал. 2005;4:9–12. [Kataev NG, Kornetov NA, Kataev SG, Levina A.Yu. Kliniko-laboratornaya dinamika organicheskikh i depressivnykh psikhicheskikh rasstroystv u postinsul'tnykh bol'nykh. Rossiyskiy psikhiatricheskiy zhurnal. 2005;4:9–12.]</p><p>Мищенко ВН. Постинсультная депрессия. Журнал психиатрии и медицинской психологии. 2004;2(12):81–3.</p><p>Palomaki H, Kaste M, Berg A et al. Prevention of poststroke depression: 1 year randomized placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Ncurosurg Psychiatry. I999;66:490–4.</p><p>Pantoni L, Martini M, Bartolini L. et al. Diagnosis of major depression in subcortical vascular encephalopathy. Cerebrovasc Dis. 2003;16(4):43.</p><p>Paolucci S, Antonucci G, Grasso MG. et al. Post-stroke depression, antidepressant treatment and rehabilitation results: a case-control study. Cerebrovasc Dis. 2001;12:264–71.</p><p>Paradiso S, Robinson RG. Gender differences in post-stroke depression. J Neuropsychiatry Clin Neurosci. 1998;10:41–7.</p><p>Piccinelli M, Wilkinson G. Gender differences in depression: critical review. Br J Psychiat. 2000;177(6):486–92. DOI: http://dx.doi.org/10.1192%2Fbjp.177.6.486.</p><p>Pohjiasvaara Т, Leppavuori A, Siira I et al. Frequency and clinical determinants of poststroke depression. Stroke. 1998;29(11):2311–7. DOI: http://dx.doi.org/10.1161%2F01.STR.29.11.2311.</p><p>Парфенов ВА, Вербицкая СВ. Ведение больного, перенесшего инсульт. Неврология, нейропсихиатрия, психосоматика. 2013;2(S):23–7. [Parfenov VA, Verbitskaya SV. Management of a post-stroke patient. Neurology,Neuropsychiatry, Psychosomatics. 2013;2(S):23–7. DOI:</p><p>http://dx.doi.org/10.14412/2074-2711-2013-2355.]</p><p>Legg L, Langhorne P. Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet. 2004;363:352–6.</p><p>Guidelines for management of Ischaemic Stroke of the European Stroke Organisation. 2008/2009. Available from: http://www.eso-stroke.org/recommendation.</p><p>Furie KL, Kasner SE, Adams RJ et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227–76. DOI: doi: 10.1161/STR.0b013e3181f7d043. Epub 2010 Oct 21.</p><p>Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342(3):145–3.</p><p>Lawes CM, Bennett DA, Feigin VL, Rodgers A. Blood pressure and stroke: an overview of published reviews. Stroke. 2004;35(3):776–85. DOI: http://dx.doi.org/10.1161%2F01.STR.0000116869.64771.5A.</p><p>Adams HP Jr, del Zoppo G, Alberts MJ et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–711.</p><p>Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Н.Н. Яхно. Москва: Медицина; 2005;(1):232–303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. V kn.: Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Pod red. N.N. Yakhno. Moscow: Meditsina; 2005;(1):232–303.]</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moscow: MIA; 2012. 288 p.]</p><p>Sacco RL, Adams R, Albers G et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke. 2006;(37):577–617. DOI: http://dx.doi.org/10.1161%2F01.STR.0000199147.30016.74.</p><p>Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71–86.</p><p>A randomized trial of aspirin and sulfinpyrazone in threatened stroke: the Canadian Cooperative Study Group. N Engl J Med. 1978;299(2):53–9.</p><p>Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet. 1996;348(9028):633–8.</p><p>Hylek EM, Skates SJ, Sheehan MA, Singer DE. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med. 1996;335(8):540–6. DOI: http://dx.doi.org/10.1056%2FNEJM199608223350802.</p><p>Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke: EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993;342(8882):1255–62.</p><p>Braunwald E, Antman EM, Beasley JW et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366–74.</p><p>Cannegieter S, Rosendaal F, Witzen A et al. Optimal oral anticoagulation therapy in patients with mechanical heart valves. N Eng J Med. 1995;333(1):11–7. DOI: http://dx.doi.org/10.1056%2FNEJM199507063330103.</p><p>Karapanayiotides T, Piechowski-Jozwiak B, van Melle G et al. Stroke patterns, etiology, and prognosis in patients with diabetes mellitus. Neurology. 2004;62(9):1558–62. DOI: http://dx.doi.org/10.1212%2F01.WNL.0000123252.55688.05.</p><p>Woo D, Gebel J, Miller R et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. Stroke. 1999;30(12):2517–22. DOI: http://dx.doi.org/10.1161%2F01.STR.30.12.2517.</p><p>Petty GW, Brown RD Jr, Whisnant JP et al. Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology. 1998;50(1):208–16.</p><p>Pearson TA, Blair SN, Daniels SR et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: Consensus Panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases: American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106(3):388–91.</p><p>Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–97.</p><p>Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurol. 2007;6(9):782–92.</p><p>Вахнина НВ, Захаров ВВ. Опыт применения ривастигмина (экселона) в лечении постинсультных когнитивных нарушений. Неврологический журнал. 2009;(4):42–6. [Vakhnina NV, Zakharov VV. The experience of rivastigmin (Exelon) administration for treatment of post-stroke cognitive disorders. Nevrologicheskiy zhurnal. 2009;(4):42–6.]</p><p>Левин ОС, Усольцева НИ, Юнищенко НА. Постинсультные когнитивные нарушения: механизмы развития и подходы к лечению. Трудный пациент. 2007;5(8):26–9. [Levin OS, Usol'tseva NI, Yunishchenko NA. Postinsul'tnye kognitivnye narusheniya: mekhanizmy razvitiya i podkhody k lecheniyu. Trudnyy patsient. 2007;5(8):26–9.]</p><p>Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatry. 2010;55(6):341–9.</p><p>Cummings JL, Mackell J, Kaufer D. Behavioral effects of current Alzheimer's disease treatments: a descriptive review. Alzheimers Dement. 2008;4(1):49–60. DOI: http://dx.doi.org/10.1016%2Fj.jalz.2007.10.011.</p><p>Mitchell PH, Veith RC, Becker KJ. Brief Psychosocial–Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant. Stroke. 2009;40(9):3073–8. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.109.549808.</p><p>Сашина МБ, Кадыков АС, Черникова ЛА. Постинсультные болевые синдромы. Атмосфера. Нервные болезни. 2004;3:25–7. [Sashina MB, Kadykov AS, Chernikova LA. Postinsul'tnye bolevye sindromy. Atmosfera. Nervnye bolezni. 2004;3:25–7.]</p><p>Парфенов ВА. Неврологические аспекты недержания мочи у пожилых людей. Неврология, нейропсихиатрия, психосоматика. 2013;1:34–8. [Parfenov VA. Neurological aspects of urinary incontinence in the elderly. Neurology, Neuropsychiatry, Psychosomatics. 2013;1:34–8. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2395.]</p><p>Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke - a longitudinal population-based study. Age Ageing. 2012;41(3):371–6. DOI: 10.1093/ageing/afs009. Epub 2012 Feb 8.</p><p>McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;13(5):402–6. DOI: http://dx.doi.org/10.1007%2Fs11934-012-0269-6.</p><p>Itoh Y, Yamada S, Konoeda F et al. Burden of overactive bladder symptom on quality of life in stroke patients. Neurourol Urodyn. 2012; DOI: 10.1002/nau.22336.</p><p>Воробьев ПА, Краснова ЛС, Шустов АГ и др. Клинико-экономический анализ эффективности использования подгузников MoliCare® Premium extra soft (Моликар Премиум экстра софт) для профилактики развития дерматита и пролежней у неподвижных больных с недержанием мочи. В сб.: Пролежни. Экономика и профилактика. Под ред. П.А. Воробьева, Л.С. Красновой. Москва: Ньюдиамед; 2012. С. 34–99. [Vorob'ev PA, Krasnova LS, Shustov AG i dr. Kliniko-ekonomicheskiy analiz effektivnosti ispol'zovaniya podguznikov MoliCare® Premium extra soft (Molikar Premium ekstra soft) dlya profilaktiki razvitiya dermatita i prolezhney u nepodvizhnykh bol'nykh s nederzhaniem mochi. V sb.: Prolezhni. Ekonomika i profilaktika. Pod red. P.A. Vorob'eva, L.S. Krasnovoy. Moscow: N'yudiamed; 2012. P. 34–99.]</p></div><br />
Review
For citations:
Pizova N.V. Outpatient management after severe stroke with dementia. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(4):78-83. (In Russ.) https://doi.org/10.14412/2074-2711-2013-2460
Views: 932
Email this article 