Vascular Syndrome c (1994)

Wagner MT, Cushman LA. Functional significance of the subcortical vascular syndrome in the rehabilitative setting. Arch Phys Med Rehabil 1994:75: 193-7. The purpose of this study was to examine the effect of cortical versus subcortical and right versus left hemi- spheric vascular lesion site on rehabilitative functional status. Seventy patients were prospectively studied. A 2 Y 2 ANOVA showed significant group differences with the cortical group being more impaired on both the initial admission and discharge Functional Independence Measure (FIM) scores (F = 14.2, p <: .0004 and F = 12.2, p < .0009, respectively). Analysis of the component FIM profile showed that the cortical group was relatively more impaired on measures of self-care, language, and social cognition, but not sphincter control or ambulation status. This general pattern also was similar at discharge with the exception of self-care. Left hemispheric lesion site was a strong predictor of language-related deficits. In addition, a Chi-square analysis showed that the cortical group had a greater frequency of unsafe behaviors requiring physical restraints. The implication of cortical versus subcortical lesion site was discussed relative to rehabilitative treatment planning. ID 1994 by the American Congress of Rehabilitation Medicine and the American Academy qf Physicnl Medicine and Rehabilitation In recent literature, subcortical lesion site has been impli- cated in dementias with unique neurocognitive deficits. which can be contrasted with the cortical dementias. For ex- ample. McHugh and Folstein' characterized the mental im- pairment of Huntington's chorea as an insidious. subtle, intel- lectual deterioration without aphasia. alexia, agnosia. or amnesia. Albert. Feldman, and Willis' depicted four character- istic features of progressive supranuclear palsy. which in- cluded forgetfulness, slowness of thought processes. altered personality with apathy or depression, and impaired ability to process acquired knowledge. Cummings and Benson' noted that subcortical dementias involve brain structures such as the basal ganglia. white matter, and/or brainstem structures, and are associated with neurocognitive disturbances in arousal. attention, retrieval. mood. and motor programming. The study of subcortical dementias has been conducted primarily with patients who have suffered nonvascular neu- rological events. The neurocognitive deficits of Huntington's or Parkinson's disease have been contrasted with Alzhei- mer's disease. and have shown marked differences in explicit memory performance. Patients with Alzheimer's disease who are severely impaired on tasks of immediate recall. with free recall equally as impaired as recognition recall, also have a high rate of intrusion errors.J-h Patients with subcort- cal dementia. on the other hand, demonstrate immediate free recall deficits. but show superior retention in recognition recall tasks.'. Though the research is more sparse in the patient popula- tion suffering from vascular events. subcortical lesions have been shown to produce aphasic syndromes.',' Subcortical vascular drmentias have been characterired by impairments in attention, memory, and mental control with slowed verbal and motor responsiveness.' Brandt. Folntein. and Folstein have reported that the qualitative differences in cortical and subcortical dementias are so robust as to be distinguishable on brief mental status examination me,lsures with 83% accu- racy. Despite much attention in the basic :,ciences and some applied literature regarding cortical versut. subcortical neuro- cognitive syndromes, little is known about the functional significance of cortical versus subcortical lesion site in the vascular population. It was hypothesized that lesion site would differentially affect functional statu5. Therefore. the major purpose of this study was to determine the impact of everyday functional skill deficit performance as a function of lesion site on the cortical/subcortical itxis. I,eft versus right hemispheric lesion site also was examined