Aivoverenkiertohäiriöön (AVH) sairastuneen henkilön toimintakyvyn arviointi

TOIMIA-suositusTämä suositus korvaa 24.1.2011 julkaistusta suosituksesta ”Kantanen M, Paltamaa J, Peurala S. Suositus aivoverenkiertohäiriö (AVH)- ja MS -kuntoutujan liikkumisen ja osallistumisen arviointiin” AVH:n sairastuneen henkilön toimintakyvyn arviointiin kohdistuvan osuuden

Longitudinal Changes in Total Brain Volume in Schizophrenia:Relation to Symptom Severity, Cognition and Antipsychotic Medication

Studies show evidence of longitudinal brain volume decreases in schizophrenia. We studied brain volume changes and their relation to symptom severity, level of function, cognition, and antipsychotic medication in participants with schizophrenia and control participants from a general population based birth cohort sample in a relatively long follow-up period of almost a decade. All members of the Northern Finland Birth Cohort 1966 with any psychotic disorder and a random sample not having psychosis were invited for a MRI brain scan, and clinical and cognitive assessment during 1999-2001 at the age of 33-35 years. A follow-up was conducted 9 years later during 2008-2010. Brain scans at both time points were obtained from 33 participants with schizophrenia and 71 control participants. Regression models were used to examine whether brain volume changes predicted clinical and cognitive changes over time, and whether antipsychotic medication predicted brain volume changes. The mean annual whole brain volume reduction was 0.69% in schizophrenia, and 0.49% in controls (p = 0.003, adjusted for gender, educational level, alcohol use and weight gain). The brain volume reduction in schizophrenia patients was found especially in the temporal lobe and periventricular area. Symptom severity, functioning level, and decline in cognition were not associated with brain volume reduction in schizophrenia. The amount of antipsychotic medication (dose years of equivalent to 100 mg daily chlorpromazine) over the follow-up period predicted brain volume loss (p = 0.003 adjusted for symptom level, alcohol use and weight gain). In this population based sample, brain volume reduction continues in schizophrenia patients after the onset of illness, and antipsychotic medications may contribute to these reductions

Mean brain edge movement (reduction) by brain region in schizophrenia and during the 9-year follow-up time.

<p>Note: *p-values from group comparison adjusted for sex.</p

Linear regression analysis of the association between annual brain volume reduction and amount of antipsychotic medication (log dose years of daily equivalent of 100 mg chlorpromazine separately in typical, atypical and any antipsychotics) during the 9-year follow-up time.

a<p>unadjusted model. All betas are standardised.</p>b<p>adjusted for mean total PANSS, logarithm of alcohol use and weight change.</p>c<p>adjusted for change in total PANSS, logarithm of alcohol use and weight change.</p>d<p>adjusted for mean SOFAS, logarithm of alcohol use and weight change.</p>e<p>adjusted for change in SOFAS, logarithm of alcohol use and weight change.</p

Clinical characteristics of participants with schizophrenia.

a<p>PANSS, Positive and Negative Syndrome Scale, assessment of the PANSS in the baseline and 9 year follow-up are not completely comparable (please see text in methods).</p>b<p>Social and Occupational Functioning Assessment Scale.</p>c<p>Equivalent to 100 mg daily chlorpromazine during the 9-year follow-up.</p

Sociodemographic background and handedness in the schizophrenia and control groups.

<p>Sociodemographic background and handedness in the schizophrenia and control groups.</p

Scatter blot of annual brain volume change in schizophrenia and control groups.

<p>Scatter blot of annual brain volume change in schizophrenia and control groups.</p

Linear regression between dose years (equivalent to daily 100 mg chlorpromazine) of antipsychotic medication and annual change in brain volume (%) in participants with schizophrenia (beta = −0.50, t = −3.23, p = 0.003).

<p>1000 mg chlorpromazine daily for a duration of 9 years equals 90 dose years.</p

Mean of the annual change of total brain volume (%) during the 9-year follow-up period in participants with schizophrenia and control participants.

<p>SD  =  Standard Deviation.</p><p>Q₁  =  first quartile, Q₃  =  third quartile.</p>a<p>Independent samples t-test.</p>b<p>Adjusted for sex.</p>c<p>Adjusted for sex, educational level, logarithm of the alcohol use (g/day) and weight change (kg).</p