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(11)C-PIB-PET for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI).
CONCLUSIONS: Although the good sensitivity achieved in some included studies is promising for the value of (11)C-PIB-PET, given the heterogeneity in the conduct and interpretation of the test and the lack of defined thresholds for determination of test positivity, we cannot recommend its routine use in clinical practice.(11)C-PIB-PET biomarker is a high cost investigation, therefore it is important to clearly demonstrate its accuracy and standardise the process of the (11)C-PIB diagnostic modality prior to it being widely used. PMID: 25052054 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 23, 2014 Category: Journals (General) Authors: Zhang S, Smailagic N, Hyde C, Noel-Storr AH, Takwoingi Y, McShane R, Feng J Tags: Cochrane Database Syst Rev Source Type: research

Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting).
CONCLUSIONS: This review concluded that the data available were too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy. Large scale randomised trials of routine shunting versus selective shunting are required. No method of monitoring in selective shunting has been shown to produce better outcomes. PMID: 24956204 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 23, 2014 Category: Journals (General) Authors: Chongruksut W, Vaniyapong T, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Plasma and cerebrospinal fluid amyloid beta for the diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI).
CONCLUSIONS: The proposed diagnostic criteria for prodromal dementia and MCI due to Alzheimer's disease, although still being debated, would be fulfilled where there is both core clinical and cognitive criteria and a single biomarker abnormality. From our review, the measure of abnormally low CSF Aß levels has very little diagnostic benefit with likelihood ratios suggesting only marginal clinical utility. The quality of reports was also poor, and thresholds and length of follow-up were inconsistent. We conclude that when applied to a population of patients with MCI, CSF Aß levels cannot be recommended as an accurate test...
Source: Cochrane Database of Systematic Reviews - June 10, 2014 Category: Journals (General) Authors: Ritchie C, Smailagic N, Noel-Storr AH, Takwoingi Y, Flicker L, Mason SE, McShane R Tags: Cochrane Database Syst Rev Source Type: research

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within community dwelling populations.
CONCLUSIONS: Published data suggest that if using the IQCODE for community dwelling older adults, the 16 item IQCODE may be preferable to the traditional scale due to lesser test burden and no obvious difference in accuracy. Although IQCODE test accuracy is in a range that many would consider 'reasonable', in the context of community or population settings the use of the IQCODE alone would result in substantial misdiagnosis and false reassurance. Across the included studies there were issues with heterogeneity, several potential biases and suboptimal reporting quality. PMID: 24719028 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 10, 2014 Category: Journals (General) Authors: Quinn TJ, Fearon P, Noel-Storr AH, Young C, McShane R, Stott DJ Tags: Cochrane Database Syst Rev Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

Rehabilitation for improving automobile driving after stroke.
CONCLUSIONS: There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after stroke. We found limited evidence that the use of a driving simulator may be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we were unable to find any RCTs that evaluated on-road driving lessons as an intervention. At present, it is unclear which impairments that influence driving ability after stroke are amenable to rehabilitation, and whether the contextual or remedial approaches, or a combination of both, are more...
Source: Cochrane Database of Systematic Reviews - February 25, 2014 Category: Journals (General) Authors: George S, Crotty M, Gelinas I, Devos H Tags: Cochrane Database Syst Rev Source Type: research

Treadmill training and body weight support for walking after stroke.
CONCLUSIONS: Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of d...
Source: Cochrane Database of Systematic Reviews - January 23, 2014 Category: Journals (General) Authors: Mehrholz J, Pohl M, Elsner B Tags: Cochrane Database Syst Rev Source Type: research

Management of faecal incontinence and constipation in adults with central neurological diseases.
CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol l...
Source: Cochrane Database of Systematic Reviews - January 13, 2014 Category: Journals (General) Authors: Coggrave M, Norton C, Cody JD Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in patients with stroke or transient ischaemic attack.
CONCLUSIONS: PPAR-γ agonists were demonstrated to reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and improve insulin sensitivity and the stabilisation of carotid plaques. There is evidence of limited quality that they are well-tolerated. However, the conclusions should be interpreted with caution considering the small number and the quality of the included studies. In future, well-designed, double-blind RCTs with large samples are required to test the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular ev...
Source: Cochrane Database of Systematic Reviews - January 8, 2014 Category: Journals (General) Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Management of faecal incontinence and constipation in adults with central neurological diseases.
CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol l...
Source: Cochrane Database of Systematic Reviews - December 18, 2013 Category: Journals (General) Authors: Coggrave M, Norton C Tags: Cochrane Database Syst Rev Source Type: research

Telerehabilitation services for stroke.
CONCLUSIONS: We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach. PMID: 24338496 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 16, 2013 Category: Journals (General) Authors: Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving function and activities of daily living in patients after stroke.
CONCLUSIONS: At the moment, evidence of very low to low quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance and function after stroke. Future research should investigate the effects of tDCS on lower limb function and should address methodological issues by routinely reporting data on adverse events and dropouts and allocation concealment, and by performing intention-to-treat analyses. PMID: 24234980 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 15, 2013 Category: Journals (General) Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.
CONCLUSIONS: The STOP trial demonstrated a significantly reduced risk of stroke in participants with abnormal transcranial Doppler ultrasonography velocities receiving regular blood transfusions. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. The degree of risk must be balanced against the burden of chronic transfusions. The combination of hydroxyurea and phlebotomy is not as effective as "standard" transfusion and chelation in preventing secondary stroke and iron overload. Ongoing multicentre trials are investigating the use of chronic transfusion t...
Source: Cochrane Database of Systematic Reviews - November 14, 2013 Category: Journals (General) Authors: Wang WC, Dwan K Tags: Cochrane Database Syst Rev Source Type: research

Physical fitness training for stroke patients.
CONCLUSIONS: The effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke and this may be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-t...
Source: Cochrane Database of Systematic Reviews - October 21, 2013 Category: Journals (General) Authors: Saunders DH, Sanderson M, Brazzelli M, Greig CA, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters.
CONCLUSIONS: We found no significant effects of systemic treatments compared with no intervention in preventing (a)symptomatic VTE in paediatric oncology patients with CVCs. However, this could be a result of the low number of included participants, which resulted in low power. In one CCT, which compared one systemic treatment with another systemic treatment, we identified a significant reduction in symptomatic VTE with the addition of LMWH to AT supplementation.All studies investigated the prevalence of major and/or minor bleeding episodes, and none found a significant difference between study groups. None of the studies ...
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Schoot RA, Kremer LC, van de Wetering MD, van Ommen CH Tags: Cochrane Database Syst Rev Source Type: research

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