Margareta Lindberg

Intracranial aneurysms and heredity

The occurrence of intracranial aneurysms (IAs) in the families of 579 consecutive patients with subarachnoid hemorrhage (SAH), of whom 485 had verified IAs, was studied retrospectively. IAs occurred in the families of 6.7% of the IA patients, but only 0.4% of their siblings had IAs. However, there were differences between the familial and nonfamilial IA patients, indicating that the familial patients are a specific small subpopulation of IA patients. The familial patients were younger, often had multiple aneurysms, and had aneurysms frequently located on arteries other than those in the nonfamilial group.

Impact of thalamic deep brain stimulation on disability and health-related quality of life in patients with essential tremor

Objectives: To evaluate the impact of thalamic deep brain stimulation (DBS) on disability and health-related quality of life in patients with essential tremor. Methods: Twenty seven consecutive patients were evaluated prospectively, before surgery and at a mean of 12 months (range 6–26) after thalamic DBS. Assessment tools included the Fahn-Tolosa-Marìn tremor rating scale (TRS), activities of daily living (ADL) taxonomy, Nottingham health profile (NHP) and the visual analogue scale (VAS) for measuring impact of disease on life. Additional information on the side effects of, and expectations from surgery was obtained by interview. Results: Thalamic DBS improved the ability of the patients in eating, drinking, writing, home maintenance, hobbies, and participation in society. Activities of daily life requiring bimanual skills were less improved. The emotional condition of the patients was positively affected and the negative impact of the disease on life as a whole, and on social life was decreased. Seventy per cent of the patients considered that the surgical treatment met their expectations. Conclusions: After thalamic DBS, health-related quality of life including disability in ADL and social life were improved in patients with essential tremor.

Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery

Objectives – To investigate eventual differences between women and men with Parkinsons disease (PD) before and after surgery, with respect to clinical status, disability and health‐related quality of life (HRQoL).

Verbal Memory Function after Subarachnoid Haemorrhage Determined by the Localisation of the Ruptured Aneurysm

A total of 219 patients who had suffered from subarachnoid haemorrhage (SAH) were given a set of memory tests. The tests comprised immediate free recall (indexing long-term memory, LTM, and short-term memory, STM), final free recall (LTM) and final cued recall (LTM) of words as well as a digit-span test (an index of working memory, WM). STM was highly sensitive to brain damage caused by SAH whereas WM was not. Localisation of the ruptured aneurysm, angiographic vasospasm or mass effect did not have any selective influence on the SAH groups STM or WM. The final free recall test was the most sensitive measure of LTM whereas the LTM part of the immediate free recall test was the least sensitive. LTM impairment was most pronounced for patients with ruptured left anterior communicating artery aneurysms or for patients with angiographic vasospasm or mass effect. It is suggested that, in the SAH patients, a passive phonological short-term store is impaired, but the active maintenance rehearsal mechanism is intact. For patients with LTM dysfunction, deeper, more elaborate, active processing is disrupted, hindering efficient long-term storage.

Co-existence of abdominal aortic aneurysms and intracranial aneurysms

SummaryThe occurrence of abdominal aortic aneurysms (AAAs) and intracranial aneurysms (IAs) in the same patient and in the same family was studied among 89 patients with AAAs and 485 patients with IAs. Among the AAA-patients two had IAs themselves and five had IAs in the family, whereas three IA-patients had AAAs themselves and eight had AAAs in the family. Moreover, one of the patients with both AAA and IA had a blood relative with AAA, and in six of the families with both types of aneurysms there were more than two subjects with aneurysms. The results indicate, that AAAs and IAs may have a common aetiologic factor.

Does the ADL part of the unified Parkinson's disease rating scale measure ADL? An evaluation in patients after pallidotomy and thalamic deep brain stimulation

We evaluated the impact of pallidotomy and thalamic deep brain stimulation (DBS) on disability of patients with advanced Parkinsons disease and investigated whether the activities of daily living (ADL) section of the Unified Parkinsons Disease Rating Scale (UPDRS) measures disability in everyday life. Nineteen patients who had pallidotomy and 14 patients who had thalamic DBS were followed for a mean of 11 months. Evaluation tools included the UPDRS as well as a generic ADL scale, called ADL taxonomy. The 13 items belonging to the ADL part of the UPDRS were classified into two categories according to whether the items described a disability or impairment. The total scores of the UPDRS Part II (ADL) were ameliorated in both the pallidotomy and the thalamic DBS groups. When analysing separately the scores from the two categories of the ADL part of the UPDRS, i.e., disability and impairment, only patients who underwent pallidotomy showed improvement in disability‐related items. These findings were confirmed when evaluating the patients with the ADL taxonomy. The ADL part of the UPDRS contains a mixture of impairment‐ and disability‐related items. This mixture may confound results when evaluating the impact of surgery on ADL.

Self-reported prevalence of disability after subarachnoid haemorrhage, with special emphasis on return to leisure and work

The prevalences of motor and language impairments and of disabilities in activities of daily living (ADL), leisure and work were investigated in a consecutive series (n = 296) of long-term survivors of subarachnoid haemorrhage (SAH). Motor and language impairments were present in 17 and 20%, respectively. The majority reported independence in self-care (91%) and instrumental (80%) ADL, but among the self-care independent, 23% reported need of personal assistance. Leisure disability occurred in 48% and vocational disability in 40%. Hence, disabilities are more common after SAH than is indicated by occurrences of motor and language impairments. It is concluded that the discrepancy between the prevalences of impairments and of disabilities may be to a great extent caused by coping difficulties in relation to socio-demographic and geographic circumstances. The findings indicate a need for rehabilitative follow-up for virtually all SAH-patients.

Subarachnoid blood on CT and memory dysfunctions in aneurysmal subarachnoid hemorrhage

Ninety patients with a previous subarachnoid haemorrhage (SAH) were given a set of memory tests comprising immediate free recall of words (indexing long‐term memory, LTM, and short‐term memory, STM), final free recall of words (indexing LTM), final cued recall of words (indexing LTM), and a digit span test (indexing working memory, WM). Patients with a large amount of blood on CT, carried out within 72 h of the bleed, showed LTM as well as STM dysfunction, whereas patients with a small amount of subarachnoid blood evidenced only STM dysfunction. Patients with the ruptured aneurysm located on the anterior cerebral artery, however, constituted an exception with dysfunction of both LTM and STM together with intact WM, independent of the amount of subarachnoid blood. Also, patients with internal carotid artery or middle cerebral artery aneurysms and large volume SAH displayed LTM dysfunction, but differed concerning STM, the former showing intact STM and the latter showing STM dysfunction. Thus, it appears, that the combined information from factors such as the amount of subarachnoid blood and the location of the ruptured aneurysm is of vital importance for explaining the different patterns of memory dysfunctions after SAH.

Quality of Life after Subarachnoid Haemorrhage, and its Relationship to Impairments, Disabilities and Depression

This investigation addresses the subjectively experienced Quality of Life (QoL) in long-term survivors (n104) of subarachnoid haemorrhage (SAH). QoL in terms of increase/no—negligible change/decrease was related to prevalence of impairments, disabilities and to occurrence of depression. The perceived QoL had increased for 14% of the sample, was unaltered for 48% and had decreased for 38%. Impairments were neither significantly related to QoL nor to depression. Decreased QoL appeared mainly to reflect decreased ability to socialise while depression was closely associated with disabilities in numerous instrumental activities of daily living, particularly within the domestic and social sphere, and also with work- and leisure disabilities.

Stories of Rediscovering Agency Home-Based Occupational Therapy for People With Severe Psychiatric Disability

As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim with this study was to understand how participants made sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of “rediscovering agency,” referring to occupational and identity transformations. A parallel outcome study has shown positive results for participants, and by using narrative inquiry we contribute with a deeper understanding of the meaning making of their transformations and mechanisms of the intervention; i.e., hope, extended value of reaching goals, reentering the majority world, transparency of process, and attunement to the individual. The findings support the use of the ELR intervention.