title: Improved functional status by comprehensive physical and psychosocial approach through right insula activation in poststroke vascular dementia.
abstract: The aim is to investigate the effect of a comprehensive physical and psychosocial approach on functional outcome and cerebral glucose metabolism in poststroke vascular dementia (PSVaD). Ten PSVaD patients participated in the study. They were diagnosed according to the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN) criteria and needed physical assistance in sit-to-stand transfer activities. Six were enrolled in a comprehensive program consisted of an individualized task-specific exercise regimen of transfer training and a psychosocial intervention program. The other 4 patients participated in the control group. The programs were undertaken over a period of 2 months. Outcomes were the scores on the Mini-Mental State Examination and the Functional Independence Measure (FIM), and on cerebral glucose metabolism determined by (18)F-fluorodeoxyglucose positron emission tomography performed before and at the end of the program. The score on the transfer mobility subscale of the FIM increased at the end of the program in all patients who received the comprehensive program. Regional glucose metabolism was increased in the right insular cortex at the end of the combined program. Control patients showed no change in FIM score or regional cerebral metabolism. A combined approach may be associated with an increase in glucose metabolism of the right insula cortex in PSVaD patients.
authors.affiliation: 1Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine , Sendai , Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Meguro
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior / Q000502:physiology; D015140:Dementia, Vascular / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18