The value of screening instruments in the diagnosis of poststroke dementia

Stroke is a major cause of morbidity in the industrialized world. It often results not only in physical disability, but also in significant cognitive impairment or dementia. Between 10 and 40% of patients with a recent stroke develop dementia.1-4 Although stroke was already recognized as an important cause of dementia more than one hundred years ago, research on determinants of poststroke dementia and the cognitive profile of dementia after a stroke has strongly intensified during the last decade. The diagnosis of dementia after a stroke is complex and poses clinicians for several problems. Poststroke dementia is a clinical entity with very heterogeneous cognitive disturbances, that may be characterized as cortical or subcortical, or a combination of the two. Furthermore, cognitive functioning may be hampered by the somatic symptoms that often accompany a stroke. In clinical practice, cognitive screening instruments take an important place, either to select patients who need further neuropsychological testing or as a diagnostic test in patients with obvious dementia. Most existing screening instruments that are used in a clinical setting, however, are developed to detect dementia compatible with Alzheimer’s disease and their value in detecting dementia after stroke is less well known. In this thesis, I describe and discuss the diagnosis of dementia after stroke, with emphasis on the value of screening instruments in the diagnosis of poststroke dementia. I will use the terms dementia after stroke and poststroke dementia for any type of dementia that occurs after a stroke, irrespective of its presumed cause

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

A short screening instrument for poststroke dementia : the R-CAMCOG

BACKGROUND AND PURPOSE: The CAMCOG is a feasible cognitive screening instrument for dementia in patients with a recent stroke. A major disadvantage of the CAMCOG, however, is its lengthy and relatively complex administration for screening purposes. We therefore developed the Rotterdam CAMCOG (R-CAMCOG), based on the original version. Our aim was to reduce the estimated administration time to 15 minutes or less and to retain or perhaps even improve its diagnostic accuracy. METHODS: We analyzed the item scores on the CAMCOG of 300 consecutive stroke patients, after exclusion of patients with a severe aphasia or lowered consciousness level, who were entered in the Rotterdam Stroke Databank. The diagnosis of dementia was made independent of the R-CAMCOG score, on the basis of clinical examination and neuropsychological test results. The R-CAMCOG was constructed in 3 steps. First, items with floor and ceiling effects were removed. Next, subscales with no additional diagnostic value were excluded. Finally, we removed items that did not contribute to the homogeneity of the subscales. The diagnostic accuracy of the R-CAMCOG and the original CAMCOG was determined by means of the area under the receiver operating characteristic (ROC) curve. RESULTS: In the 3 steps, the number of items was reduced from 59 to 25, divided over the subscales orientation, memory (recent, remote, and learning), perception, and abstraction. The subscale orientation did not reach significance in a logistic regression model but was included in the R-CAMCOG because of its high face validity in dementia screening. Internal validation with ROC analysis suggests that the R-CAMCOG and the CAMCOG are equally accurate in screening for poststroke dementia (area under the curve was 0.95 for both tests). CONCLUSIONS: The R-CAMCOG has overcome the disadvantages of the original CAMCOG. It is a promising, short, and easy-to-administer screening instrument for poststroke dementia. It seems to be sufficiently accurate for this purpose, but the test has yet to be validated in a separate, independent study

Multi-target mode of action of a Clerodane-type diterpenoid from Polyalthia longifolia targeting African trypanosomes.

Natural products have made remarkable contributions to drug discovery and therapy. In this work we exploited various biochemical approaches to investigate the mode of action of 16-α-hydroxycleroda-3,13 (14)-Z-dien-15,16-olide (HDK-20), which we recently isolated from Polyalthia longifolia, on Trypanosoma brucei bloodstream trypomastigotes. HDK20 at concentrations ≥ EC50 (0.4μg/ml) was trypanocidal, with its efect irreversible after only a brief exposure time (<1h). Fluorescence microscopic assessment of DNA confguration revealed severe cell cycle defects after 8h of incubation with the compound, the equivalent of a single generation time. This was accompanied by DNA fragmentation as shown by Terminal deoxynucleotidyl transferase dUTP Nick-End Labelling (TUNEL) assays. HDK-20 also induced a fast and profound depolarisation of the parasites’ mitochondrial membrane potential and depleted intracellular ATP levels of T. brucei. Overall, HDK20 showed a multi-target mechanism of action, which provides a biochemical explanation for the promising antitrypanosomatid activity in our previous report

Аксиологоческое пространство культуры

Introduction. This study was performed to assess the applicability of the WHO Maternal Near Miss Tool (MNM Tool) and the organ dysfunction criteria in a high-income country. Material and methods. The MNM tool was applied to 2552 women who died of pregnancy-related causes or sustained severe acute maternal morbidity between August 2004 and August 2006 in one of the 98 hospitals with a maternity unit in the Netherlands. Fourteen (0.6%) cases had insufficient data for application. Each case was assessed according to the three main "MNM categories" specified in the MNM tool and their subcategory criteria: five disease-, four intervention- and seven organ dysfunction-based criteria. Potentially life-threatening conditions (disease-based inclusions) and life-threatening cases (organ dysfunction-based inclusions) were differentiated according to WHO methodology. Outcomes were incidence of all (sub)categories and case-fatality rates. Results. Of the 2538 cases, 2308 (90.9%) women fulfilled disease-based, 2116 (83.4%) intervention-based and 1024 (40.3%) organ dysfunction-based criteria. Maternal death occurred in 48 women, of whom 23 (47.9%) fulfilled disease-based, 33 (68.8%) intervention-based and 31 (64.6%) organ dysfunction-based criteria. Case-fatality rates were 23/2308 (1.0%) for cases fulfilling the disease-based criteria, 33/2116 (1.6%) for intervention-based criteria and 31/1024 (3.0%) for women fulfilling the organ dysfunction-based criteria. Conclusions. In the Netherlands, where advanced laboratory and clinical monitoring are available, organ dysfunction-based criteria of the MNM tool failed to identify nearly two-thirds of sustained severe acute maternal morbidity cases and more than one-third of maternal deaths. Disease-based criteria remain important, and using only organ dysfunction-based criteria would lead to underestimating severe acute maternal morbidity

The individual components of commercial isometamidium do not possess stronger trypanocidal activity than the mixture, nor bypass isometamidium resistance

The four components present in the trypanocidal treatment Samorin, the commercially available formulation of isometamidium, were separated and purified by column chromatography. These compounds as well as the Samorin mixture and the other phenanthridine trypanocide, homidium, were tested on Trypanosoma congolense and wild type, diamidine- and isometamidium-resistant Trypanosoma brucei brucei strains using an Alamar blue drug sensitivity assay. EC50 values obtained suggest that M&B4180A (2) was the most active of the components, followed by M&B38897 (1) in all the strains tested, whereas M&B4596 (4) was inactive. Samorin was found to be significantly more active than any of the individual components alone, against T. congolense and all three T. b, brucei strains. Samorin and all its active constituents displayed reduced activity against the previously characterised isometamidium-resistant strain ISMR1

The impact of the Covid-19 crisis on socioeconomic differences in physical activity behavior:Evidence from the Lifelines COVID-19 cohort study

Covid-19 and measures to contain spreading the disease have led to changed physical activity behavior. This study aims to investigate the relationship between socioeconomic status (SES) and changes in the amount of moderate to vigorous physical activity (MVPA) during the Covid-19 crisis. Using the Dutch Lifelines Covid-19 cohort study (n = 17,749), the amount of MVPA was measured at 15 time-points between March and December 2020, and compared with the amount before the Covid19 pandemic. For SES, the population was stratified in three education and income levels. Logistic regression models were used to estimate the odds ratio (OR) and confidence interval (CI) of altered MVPA for low and high SES groups, with the middle SES category as the reference group. A clear socioeconomic gradient in changes in MVPA behavior was observed. Low educated individuals had significantly higher odds (OR = 1.14; CI: 1.03-1.27) of decreasing MVPA, while the high educated had significantly lower odds of decreased MVPA (OR = 0.84, CI: 0.79-0.90). Both low education (OR = 0.87; CI: 0.77-0.98) and low income (OR = 0.85; CI 0.78-0.92) had significantly lower odds to increase MVPA, while high education (OR = 1.21, CI: 1.12-1.30) and high income (OR = 1.17; CI: 1.07-1.28) had significantly higher odds to increase MVPA. Most findings were consistent over the full research period. Socioeconomic in-equalities in MVPA have increased during the Covid-19 pandemic, even when Covid-19 containment measures were relaxed. Our findings suggest that future public health policies need to increase efforts to improve physical activity behavior with an even larger focus on low SES groups

Automated coronary artery calcification scoring in non-gated chest CT: Agreement and reliability

Objective: To determine the agreement and reliability of fully automated coronary artery calcium (CAC) scoring in a lung cancer screening population. Materials and Methods: 1793 low-dose chest CT scans were analyzed (non-contrast-enhanced, non-gated). To establish the reference standard for CAC, first automated calcium scoring was performed using a preliminary version of a method employing coronary calcium atlas and machine learning approach. Thereafter, each scan was inspected by one of four trained raters. When needed, the raters corrected initially automaticity-identified results. In addition, an independent observer subsequently inspected manually corrected results and discarded scans with gross segmentation errors. Subsequently, fully automatic coronary calcium scoring was performed. Agatston score, CAC volume and number of calcifications were computed. Agreement was determined by calculating proportion of agreement and examining Bland-Altman plots. Reliability was determined by calculating linearly weighted kappa (κ) for Agatston strata and intraclass correlation coefficient (ICC) for continuous values. Results: 44 (2.5%) scans were excluded due to metal artifacts or gross segmentation errors. In the remaining 1749 scans, median Agatston score was 39.6 (P25-P75:0-345.9), median volume score was 60.4 mm3 (P25-P75:0-361.4) and median number of calcifications was 2 (P25-P75:0-4) for the automated scores. The k demonstrated very good reliability (0.85) for Agatston risk categories between the automated and reference scores. The Bland-Altman plots showed underestimation of calcium score values by automated quantification. Median difference was 2.5 (p25-p75:0.0-53.2) for Agatston score, 7.6 (p25-p75:0.0-94.4) for CAC volume and 1 (p25-p75:0-5) for number of calcifications. The ICC was very good for Agatston score (0.90), very good for calcium volume (0.88) and good for number of calcifications (0.64). Discussion: Fully automated coron

Orientational Defects in Ice Ih: An Interpretation of Electrical Conductivity Measurements

We present a first-principles study of the structure and energetics of Bjerrum defects in ice Ih and compare the results to experimental electrical conductivity data. While the DFT result for the activation energy is in good agreement with experiment, we find that its two components have quite different values. Aside from providing new insight into the fundamental parameters of the microscopic electrical theory of ice, our results suggest the activity of traps in doped ice in the temperature regime typically assumed to be controlled by the free migration of L defects.Comment: 4 pages, 4 Figures, 1 Tabl