Biomedical subjects

Domenico De Angelis

Publications and source records attributed to Domenico De Angelis.

6 recordsLinked to original sources

PubMed2006

Is sex a prognostic factor in stroke rehabilitation? A matched comparison.

BACKGROUND AND PURPOSE: We sought to assess the specific influence of sex on rehabilitation results. METHODS: A case-control study in 440 consecutive patients with sequelae of first ischemic stroke were enrolled in 2 subgroups (males and females) and matched for severity of stroke (evaluated by means of the Canadian Neurological Scale), age (within 1 year), and onset-admission interval (within 3 days). Functional data, evaluated by means of the Barthel Index and the Rivermead Mobility Index, were compared between subgroups. Logistic regressions were used to clarify the role of sex in affecting global autonomy and mobility. RESULTS: After rehabilitation treatment, a sex-related difference was observed essentially in the higher levels of response. Indeed, more men than women reached independence in both stair climbing and activities of daily living (ADL), with a higher response and effectiveness on mobility. In multivariate analyses, male patients had a 3 times higher probability than female patients of good autonomy in both stair climbing and ADL (odds ratio [OR]=3.22; 95% CI, 1.67 to 6.18 and OR=2.92; 95% CI, 1.63 to 5.42, respectively). Conversely, female patients had a higher risk of walking with a cane (OR=1.69; 95%, CI 1.04 to 2.76) or of partial autonomy with respect to ADL (OR=1.90; 95% CI, 1.25 to 2.91). No significant difference was found for the other functional parameters. CONCLUSIONS: Female sex is a mildly unfavorable prognostic factor in rehabilitation results after stroke.

Aged↗

PubMed2005

Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. A matched comparison.

BACKGROUND: Aphasia is considered a risk factor for disability after stroke. The aim of this study was to assess the specific influence of aphasia on rehabilitation results. METHOD: A case-control study in consecutive left brain-damaged stroke inpatients, enrolled in three homogeneous subgroups [nonaphasic (NA) patients, aphasic with comprehension deficit (CD), and without comprehension deficit (NCD)] matched for age and onset-admission interval. Rehabilitation results (gain, efficiency, effectiveness of treatment, percentage and odds ratio of dropouts and of each degree of therapeutic response, assessed by Barthel Index and Rivermead Mobility Index) were compared among the subgroups. RESULTS: Two hundred and forty patients with sequelae of a first stroke were enrolled. CD patients, as compared with NCD and NA ones, had a significantly more severe basal neurological and functional status at admission, minor effectiveness on ADL and mobility, a higher percentage of low responders on ADL and urinary incontinence at discharge, and a risk of low therapeutic response on ADL nearly 4 times higher than the other patients (OR = 4.22, 95% CI = 1.90-9.38). The rehabilitative behavior between NCD and NA was similar. However, all subgroups (NA, CD and NCD) showed a significant improvement (p < 0.001) between their basal and discharge score, both on BI and RMI. CONCLUSIONS: Comprehension language deficit was confirmed to be a strong negative rehabilitation prognostic factor despite the speech therapy done by all CD patients.

Aged↗

PubMed2003

Functional outcome of ischemic and hemorrhagic stroke patients after inpatient rehabilitation: a matched comparison.

BACKGROUND AND PURPOSE: The goal of this study was to assess the specific influence of stroke etiology on rehabilitation results. METHODS: This was a case-control study of 270 inpatients with sequelae of first stroke who were enrolled in homogeneous subgroups and matched for stroke severity, basal disability, age (within 1 year), sex, and onset admission interval (within 3 days) who were different only in terms of stroke origin, infarction versus hemorrhage. We compared the groups' length of stay, efficiency and effectiveness of treatment, and percentage of low and high responder patients. Odds ratios of dropouts and of low and high therapeutic response were also quantified. RESULTS: Compared with ischemic patients, hemorrhagic patients had significantly higher Canadian Neurological Scale and Rivermead Mobility Index scores at discharge; higher effectiveness and efficiency on the Canadian Neurological Scale, Barthel Index, and Rivermead Mobility Index; and a higher percentage of high responders on the Barthel Index. Hemorrhagic patients showed a probability of a high therapeutic response on the Barthel Index that was approximately 2.5 times greater than that of ischemic patients (odds ratio, 2.48; 95% confidence interval, 1.19 to 5.20; accuracy on prediction, 87.06%). CONCLUSIONS: The results of this study provide further evidence of better functional prognosis in stroke survivors with hemorrhagic stroke.

Aged↗

PubMed2003

Aging and stroke rehabilitation. a case-comparison study.

The aim of this study was to assess the specific influence of age on basal functional status and rehabilitation results. We conducted a case-comparison study on 150 stroke inpatients. They were enrolled in homogeneous subgroups, matched for severity of stroke (measured by Canadian Neurological Scale - CNS) and onset admission interval (within 3 days) and divided into five subgroups according to age: or=85 years. Even when severity of stroke was the same, increasing age was associated with greater disability in activities of daily living (ADL) and mobility, minor results of rehabilitation treatment and shorter length of stay. Patients >or=85 years were nearly ten times as likely to show a low response in ADL (OR = 9.28, 95% CI = 2.89-29.76) and nearly six times in mobility (OR = 6.13, 95% CI = 2.18-17.25) than younger patients. However, rehabilitation treatment was efficacious also in patients >or=85 years, with effectiveness of treatment 27.96% on ADL and 18.64% on mobility. On one hand our results confirm the unfavorable influence of age on functional outcome and on the other that inpatient rehabilitation is substantially effective also for very old patients, although less than for younger ones.

Activities of Daily Living↗

PubMed2002

Predictors of cognitive level and depression severity are different in patients with left and right hemispheric stroke within the first year of illness.

Causes of cognitive impairment after stroke are not yet clear because a large number of sociodemographic and clinical variables complicate the understanding of the phenomenon. We aim to evaluate sociodemographic and clinical predictors of cognitive level and depression in subjects with different lesion laterality. We assessed 153 right (n = 87) and left (n = 66) unilateral first-ever stroke patients within the first year of illness with the Structured Clinical Interview for DSM-IV-Patient Edition, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the State Trait Anger Expression Inventory, the Barthel Index, and the Mini Mental State Examination (MMSE). Sociodemographic variables were also measured. Sixty-two (41 %) patients suffered from Major Depression (MDD), and 26 (17 %) suffered from Minor Depression (MIND). An univariate analysis of variance showed that MMSE scores were different throughout the groups of left and right stroke patients with MDD, MIND and without depression. Left stroke patients with MDD were more cognitively impaired than all the other groups. This result was valid after controlling for the effect of lesion location on cognitive level difference between the groups. A series of stepwise multiple regression analyses indicated that depression severity was a predictor of cognitive level and vice-versa in left hemispheric stroke patients only. Moreover, educational level in right hemispheric stroke patients and state-anger and number of regions affected in left hemispheric stroke patients were other predictors of cognitive level. The study confirms the hypothesis that predictors of cognitive level and depression severity are different in subjects with different laterality of lesion and that MDD is associated with cognitive impairment in left stroke patients.

Age Factors↗

PubMedDate not supplied

New developments on drug treatment rehabilitation.

Increasing interest has been directed to role of pharmaceuticals in the recovery of cerebrovascular events. However, only few scientific studies are available to date, and further research is needed. Amphetamine is the most extensively studied drug shown to promote recovery of function, although clinical data have lead to conflicting results. Other psychostimulants drugs have been proposed, as levodopa or methylphenidate, even if published data are still few. Recently, two studies have been published about the positive role of cholinesterase inhibitor donepezil on stroke recovery. However, such data must still be confirmed by randomized controlled trials. Antidepressant drugs have shown to be effective not only in improving depressive symptoms in stroke patients, but also in decreasing, although partially, the negative impact of poststroke depression on functional outcome. Serotoninergic agents may have a role in improving stroke recovery, in a fashion that is not dependent on their primary antidepressant activity. Last, it is important to be aware that certain drugs as clonidine, prazosin, dopamine receptor antagonists, benzodiazepines, phenytoin, and phenobarbital could have a detrimental effect on the poststroke recovery.

Antidepressive Agents↗