Seminars in Neurology最新文献_第9页

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness. 极端精神状态改变：意识障碍的行为评估。

IF 2 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1055/s-0044-1788807

Neha Dhadwal, Kyle Cunningham, William Pino, Stephen Hampton, David Fischer

{"title":"Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness.","authors":"Neha Dhadwal, Kyle Cunningham, William Pino, Stephen Hampton, David Fischer","doi":"10.1055/s-0044-1788807","DOIUrl":"10.1055/s-0044-1788807","url":null,"abstract":"Disorders of consciousness represent altered mental status at its most severe, comprising a continuum between coma, the vegetative state/unresponsive wakefulness syndrome, the minimally conscious state, and emergence from the minimally conscious state. Patients often transition between these levels throughout their recovery, and determining a patient's current level can be challenging, particularly in the acute care setting. Although healthcare providers have classically relied on a bedside neurological exam or the Glasgow Coma Scale to aid with assessment of consciousness, studies have identified multiple limitations of doing so. Neurobehavioral assessment measures, such as the Coma Recovery Scale-Revised, have been developed to address these shortcomings. Each behavioral metric has strengths as well as weaknesses when applied in the acute care setting. In this review, we appraise common assessment approaches, outline alternative measures for fine-tuning these assessments in the acute care setting, and highlight strategies for implementing these practices in an interdisciplinary manner.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"621-633"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacologic Treatment Strategies for Delirium in Hospitalized Adults: Past, Present, and Future. 住院成人谵妄的药物治疗策略：过去、现在和未来。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-09-23 DOI: 10.1055/s-0044-1791246

John W Devlin

引用次数: 0

The Framing and Scope of Altered Mental Status and Delirium. 精神状态改变和谵妄的定义和范围。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-11-12 DOI: 10.1055/s-0044-1790198

Catherine S W Albin, Eyal Y Kimchi

引用次数: 0

Altered Mental Status in Cancer. 癌症患者的精神状态改变。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1055/s-0044-1788806

John Y Rhee, Vihang Nakhate, Christy Soares, Zachary Tentor, Jorg Dietrich

{"title":"Altered Mental Status in Cancer.","authors":"John Y Rhee, Vihang Nakhate, Christy Soares, Zachary Tentor, Jorg Dietrich","doi":"10.1055/s-0044-1788806","DOIUrl":"10.1055/s-0044-1788806","url":null,"abstract":"Patients with cancer experience high rates of alterations in mental status. The mechanisms for altered mental status (AMS) in this population are manifold. The cancer itself may cause AMS through direct invasion of the central nervous system or as metastatic leptomeningeal spread. However, cancer patients are also vulnerable to tumor-associated complications such as seizures, cerebral edema, strokes, or cancer treatment-related complications such as infections, direct neural injury from radiation or chemotherapy, edema, or dysregulated autoimmune response from immunotherapies. Both during treatment and as sequelae, patients may suffer neurocognitive complications from chemotherapy and radiation, medications or opportunistic infections, as well as toxic-metabolic, nutritional, and endocrine complications. In this review, we describe a clinical approach to the cancer patient presenting with AMS and discuss the differential drivers of AMS in this patient population. While common etiologies of AMS in noncancer patients (toxic-metabolic or infectious encephalopathy, delirium) are also applicable to cancer patients, we additionally provide a cancer-specific differential diagnosis that warrants special consideration in the cancer patient with AMS.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"652-669"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Pathophysiology and Biomarkers of Delirium. 谵妄的病理生理学和生物标志物。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1055/s-0044-1791666

Camryn J Smith, Dasia Hodge, Fiona E Harrison, Shawniqua Williams Roberson

{"title":"The Pathophysiology and Biomarkers of Delirium.","authors":"Camryn J Smith, Dasia Hodge, Fiona E Harrison, Shawniqua Williams Roberson","doi":"10.1055/s-0044-1791666","DOIUrl":"10.1055/s-0044-1791666","url":null,"abstract":"Delirium is a major disturbance in the mental state characterized by fluctuations in arousal, deficits in attention, distorted perception, and disruptions in memory and cognitive processing. Delirium affects approximately 18% to 25% of hospital inpatients, with even higher rates observed during critical illness. To develop therapies to shorten the duration and limit the adverse effects of delirium, it is important to understand the mechanisms underlying its presentation. Neuroimaging modalities such as magnetic resonance imaging (MRI), positron emission tomography, functional MRI, and near-infrared spectroscopy point to global atrophy, white matter changes, and disruptions in cerebral blood flow, oxygenation, metabolism, and connectivity as key correlates of delirium pathogenesis. Electroencephalography demonstrates generalized slowing of normal background activity, with pathologic decreases in variability of oscillatory patterns and disruptions in functional connectivity among specific brain regions. Elevated serum biomarkers of inflammation, including interleukin-6, C-reactive protein, and S100B, suggest a role of dysregulated inflammatory processes and cellular metabolism, particularly in perioperative and sepsis-related delirium. Emerging animal models that can mimic delirium-like clinical states will reveal further insights into delirium pathophysiology. The combination of clinical and basic science methods of exploring delirium shows great promise in elucidating its underlying mechanisms and revealing potential therapeutic targets.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"720-731"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric Neuropalliative Medicine. 儿科神经姑息医学。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-01 Epub Date: 2024-08-26 DOI: 10.1055/s-0044-1788774

Talia Shear, Jori F Bogetz, Lauren Treat

{"title":"Pediatric Neuropalliative Medicine.","authors":"Talia Shear, Jori F Bogetz, Lauren Treat","doi":"10.1055/s-0044-1788774","DOIUrl":"10.1055/s-0044-1788774","url":null,"abstract":"Neurological disease in childhood has significant impacts on not only physical well-being, but also on the social, environmental, and emotional health of the child, their family, and the larger community. Pediatric neuropalliative medicine is a recently developed area of subspecialty practice that supports families affected by serious neurological illness in navigating uncertain illness trajectories, refractory symptoms, and the myriad medical decisions that arise over the life of the child. Despite their medical needs, children with neurological diseases live full, joyful, and connected lives with their families, many of whom also experience personal growth and find meaning in their caregiving. Patients and families under the care of neurologists also face many systemic and interpersonal biases, both within the health care system and in the community, and encounter frequent gaps in their home and community-based supports. This chapter summarizes what is known about pediatric neuropalliative medicine and highlights the future research, educational, and clinical innovations that are needed to build more comprehensive and well-prepared systems to address unmet needs. Particularly in the modern era of child neurology practice where disease-modifying treatments are becoming increasingly available, pediatric neuropalliative medicine is an essential area of subspecialty practice that helps to support the personhood and quality of life of the individuals affected by serious illness and their families. As medicine helps more and more children with neurological impairment survive, medical treatment must include not only treatment for the physical body, but also care and support for the complexity of human experience of living with serious illness.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"514-522"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

End-of-Life and Hospice Care in Neurologic Diseases. 神经系统疾病的临终关怀和安宁疗护。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1055/s-0044-1787809

Claudia Z Chou, Elyse A Everett, Jessica McFarlin, Usha Ramanathan

引用次数: 0

Neuropalliative Care. 神经姑息治疗。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-01 Epub Date: 2024-10-17 DOI: 10.1055/s-0044-1790587

Maisha T Robinson, Claire J Creutzfeldt

引用次数: 0

Flexibly Incorporating the Dyad into Psychosocial Intervention: Considerations for Neuropalliative Care. 在社会心理干预中灵活地融入 "家庭"：神经姑息治疗的考虑因素。

IF 2 4区医学

Seminars in Neurology Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI: 10.1055/s-0044-1791568

Evan Plys, Claire L Szapary, Ana-Maria Vranceanu

{"title":"Flexibly Incorporating the Dyad into Psychosocial Intervention: Considerations for Neuropalliative Care.","authors":"Evan Plys, Claire L Szapary, Ana-Maria Vranceanu","doi":"10.1055/s-0044-1791568","DOIUrl":"10.1055/s-0044-1791568","url":null,"abstract":"This paper reviews dyadic psychosocial intervention approaches that flexibly incorporate both dyad members despite challenges to equitable involvement due to cognitive limitations or limited availability. We provide an overview, analysis, and examples for the following dyadic intervention approaches: (1) shared interventions that involve each dyad member equitably (i.e., higher care recipient cognition, higher care-partner availability); (2) patient-focused interventions that primarily engage care recipients with early stages of neurocognitive disorders, yet include care-partners in select sessions and target dyadic and relationship needs (i.e., higher care recipient cognition, lower care-partner availability); and (3) care-partner focused interventions that primarily engage care-partners, yet still address care recipient and relationship needs (i.e., lower care recipient cognition, higher care-partner availability). In our review, we propose a flexible definition of dyadic psychosocial intervention that considers the continuum of individuals' involvement, measurement, content, and conceptual background. We conclude with a discussion of implications for neuropalliative care.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"559-566"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Communication in Neuropalliative Care. 神经姑息治疗中的沟通

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1055/s-0044-1787791

Jessica Besbris, Jessica Baker, Neha M Kramer

引用次数: 0