摘要:

BACKGROUND–Improvements in health care over the last 50 years have lengthened average life expectancy significantly, resulting in considerable growth of the population over 65 years of age. With increased age, however, comes an increased risk for Alzheimer’s disease (AD), and the prevalence of AD is predicted to reach epidemic proportions by the later half of the 21st century. The prevalence of cerebrovascular disease also increases with age, and recent evidence suggests that cerebrovascular risk factors such as hypertension and hypercholesterolemia also increase an individual’s risk for AD, suggesting a potential interaction between these two very common disorders. The potential impact of cerebrovascular disease on general cognitive health is not yet well understood, but is now being actively explored and clarified.REVIEW SUMMARY–Cerebrovascular disease may manifest itself in many ways, and this review begins by discussing the possible spectrum of brain injury associated with common cerebrovascular risk factors. The prominent role of brain imaging to detect clinically silent cerebrovascular disease is recognized and reviewed. The neuropsychological consequences of cerebrovascular disease across the cognitive spectrum is also reviewed, including potential mechanisms by which cerebrovascular disease may interact with AD to increase the expression or hasten the progression of dementia.CONCLUSIONS–Cerebrovascular risk factors, common to the elderly, lead to pernicious brain injury and subtle cognitive impairment that most probably places the individual at greater lifetime risk for dementia. The cause of dementia among individuals with cerebrovascular disease, however, remains AD. Recognition of the potential role of cerebrovascular disease as an independent risk factor for AD offers the possibility of primary prevention through treatment of well-recognized risk factors and deserves further study. In the meantime, clinicians presented with an individual suffering from a slowly progressive dementia and findings of clinically silent cerebrovascular brain injury should recognize the potential role of cerebrovascular disease in the dementia process but not ignore the likely overwhelming effects of AD and treat appropriately.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–A majority of people in the United States use alternative or complementary therapy at some point in their lives, and acupuncture is among the most frequently used modalities. Many United States medical schools offer courses in alternative medicine, and a growing number of insurers offer coverage for alternative therapies. This paper critically reviews our current knowledge about the safety and efficacy of acupuncture for neurologic conditions.REVIEW SUMMARY–Acupuncture is a safe procedure when performed by trained professionals. Complications from acupuncture are rare and mainly related to negligence of sterile technique. Studies of the therapeutic value of acupuncture are fraught with challenging methodologic problems, including the choice of a placebo, a suitable control treatment, and the technique of stimulation applied. Clinical trials of the use of acupuncture for pain syndromes (headache, neck, and back pain), stroke rehabilitation, Parkinson’s disease, multiple sclerosis, and substance abuse are reviewed.CONCLUSIONS–Based on the current literature, no definitive recommendation can be made regarding the efficacy of acupuncture for common pain syndromes including headache, and neck and back pain. Better quality clinical trials fail to demonstrate efficacy for the use of acupuncture as part of a rehabilitation program following stroke or as a treatment for drug addiction. Acupuncture may have a role in the treatment of sleep disturbance associated with Parkinson’s disease but was not efficacious for the primary symptoms of either Parkinson’s disease or multiple sclerosis. In light of increasing public interest and use of alternative therapies, this review may be helpful in promoting more discussion between patients and physicians about the use of acupuncture.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology.REVIEW SUMMARY–First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists’ relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes.CONCLUSIONS–Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–This study retrospectively compared the effectiveness of vagus nerve stimulation (VNS) therapy among a constant cohort of patients in the patient outcome registry, which systematically monitors outcomes of patients receiving VNS therapy. Patients in the study had pharmacoresistant seizures for 6 years or less (early treatment group) or more than 6 years (late treatment group) before initiation of VNS therapy, and results are provided after both 3 and 12 months.REVIEW SUMMARY–Of 405 patients, 51 were in the early and 354 in the late treatment groups. Median age at onset of seizures was 7 years in the early and 4.5 years in the late treatment group. Seizure reduction of 100% was reported in 7.8% (early) and 3.7% (late) patients at 3 months and 11.8% (early) and 4.5% (late) at 12 months (P= 0.033). Reductions in seizure frequency greater than or equal to 90% for early and late treatment groups were similar: 11.8% (early) and 11.0% (late) at 3 months and 23.5% (early) and 17.0% (late) at 12 months.CONCLUSIONS–Patients treated earlier with VNS therapy were twice as likely to report no seizures as patients who had seizures for more than 6 years before they received VNS therapy. The effectiveness of VNS therapy should be assessed among other patients with pharmacoresistant seizures and lesser cumulative seizure loads.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID