Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES.

PURPOSE: Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements. METHODS: In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR. RESULTS: Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P < .001); and depression score predicted exit mental health status (R = 0.523, P < .001). CONCLUSIONS: Anxiety and executive dysfunction persisted post-TIA/MNDS. Although promising for secondary prevention post-TIA/MNDS, CCR was not independently associated with psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.

Executive dysfunction in patients with transient ischemic attack and minor stroke.

BACKGROUND AND OBJECTIVE: A considerable number of patients with transient ischemic attack suffer from cognitive impairment, even after recovery of focal neurological deficits. In particular, executive functions such as working memory, abstraction, reasoning, verbal fluency and cognitive flexibility are impaired in these patients. The purpose of the present study was to explore the nature and prevalence of cognitive impairment in a series of patients with transient ischemic attack and minor stroke. MATERIALS AND METHODS: We included 140 patients (61% women) who presented with a focal cerebral ischemic event lasting less than 24h in the Urgent TIA outpatient clinic. All patients underwent a brief battery of neuropsychological tests, consisting of the Mini Mental State Examination (MMSE), Neurobehavioral Cognitive Status Examination-Judgment Subtest, Clock Drawing Test and Trail Making Test. RESULTS: A majority of patients (57%) were impaired on one or more of these neuropsychological tests. Nearly one-third of individuals were impaired on two or more tests. Cognitive impairment was most frequently observed on the Trail Making Test Part A (31% of patients) and Part B (40%). The Trail Making Test examines executive functions, as it requires cognitive flexibility, ability to maintain a complex response set and speed of processing. By contrast, only 5% of patients were impaired on the MMSE, a widely used neuropsychological test insensitive to executive dysfunction. CONCLUSIONS: Our results highlight the limitations of the MMSE as an independent cognitive screening instrument for patients with TIAs and minor stroke and the high prevalence of executive dysfunction in these patients.

Victoria Symptom Validity Test scores of patients with profound memory impairment: nonlitigants case studies.

Victoria Symptom Validity Test (VSVT) scores from six nonlitigants with neurological illness accompanied by dense anterograde amnesia or severe memory impairment are presented. All of these patients obtained perfect or near perfect scores on the VSVT. These data add to the literature suggesting that the VSVT is insensitive to genuine neurologically-based memory impairment and provide an additional floor-level clinical benchmark against which to compare the performance of litigants.

A longitudinal study of the effects of seizure symptoms on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical interpretation.

This study investigated whether the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items reflecting seizure symptoms spuriously inflate MMPI-2 scores in persons with epilepsy. In a repeated measures prospective design, patients with epilepsy completed the MMPI-2 prior to epilepsy surgery and again two years later when they were either seizure-free or not seizure-free. Compared to baseline scores, only seizure-free patients showed a decline in endorsement of seizure items, and only on one scale, Hypochondriasis (Hs). Clinical profiles were not meaningfully different when readministered when seizures were no longer present. Moreover, profiles generated by individuals with and without seizures were not significantly different. We conclude the MMPI-2 is a valid test in an epilepsy population, as seizure content did not alter its clinical interpretation. In using the MMPI-2 in patients with epilepsy, a modest correction on the Hs and Schizophrenia (Sc) scales is warranted in selected cases. In MMPI-2 research, assessing both statistical and clinical significance is recommended.