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Emotional disturbance in CADASIL: its impact on quality of life and caregiver burden.
[cadasil]
Recurrent
strokes
and
cognitive
dysfunction
are
the
major
symptoms
of
cerebral
autosomal
dominant
arteriopathy
with
subcortical
infarcts
and
leukoencephalopathy
(
CADASIL
)
.
However
,
emotional
disturbances
in
CADASIL
patients
are
incompletely
understood
.
The
aim
of
this
study
was
to
investigate
emotional
disturbances
in
CADASIL
and
their
impact
on
the
patients
'
quality
of
life
(
QOL
)
and
caregiver
burden
.
From
54
patients
who
were
diagnosed
as
CADASIL
between
January
2000
and
August
2012
in
the
Asan
Medical
Center
,
Seoul
,
Korea
,
23
patients
were
enrolled
in
this
study
.
The
Montgomery
-
Asberg
Depression
Rating
Scale
was
used
for
the
assessment
of
depressive
emotional
disturbances
(
DED
)
.
For
nondepressive
emotional
disturbances
(
NDED
)
,
the
criteria
of
Kim
and
Choi-
Kwon
[
Neurology
2000
;
54
:
1805
-
1810
]
were
used
for
emotional
incontinence
(
excessive
/
inappropriate
expression
of
laughing
or
crying
)
,
and
the
modified
Spielberger
Trait
Anger
Scale
was
used
for
anger
proneness
(
excessive
/
inappropriate
expression
of
anger
)
.
Patients
'
QOL
and
caregiver
burden
were
assessed
with
stroke
-
specific
emotional
QOL
and
the
Sense
of
Competence
Questionnaire
(
SCQ
)
,
respectively
.
Functional
disability
was
assessed
by
the
modified
Rankin
scale
(
mRS
)
,
and
white
matter
ischemic
changes
and
microbleeds
were
analyzed
using
brain
magnetic
resonance
images
.
Twelve
patients
(
52
.
2
%
)
had
various
emotional
disturbances
including
DED
(
n
=
10
,
43
.
5
%
)
and
NDED
(
n
=
7
,
30
.
4
%
)
.
The
presence
of
any
emotional
disturbances
was
associated
with
thalamic
(
p
=
0
.
012
)
and
cortical
(
p
=
0
.
037
)
microbleeds
,
mRS
(
p
=
0
.
001
)
,
cognitive
impairment
(
p
=
0
.
002
)
,
patients
'
low
QOL
(
p
=
0
.
009
)
and
increased
caregiver
burden
(
p
=
0
.
002
)
.
DED
was
associated
with
multiple
(
≥
10
)
microbleeds
(
p
=
0
.
039
)
,
cognitive
impairment
(
p
=
0
.
030
)
and
mRS
(
p
=
0
.
030
)
,
and
negatively
influenced
all
domains
of
patients
'
QOL
and
caregiver
burden
.
NDED
was
associated
with
cortical
microbleeds
(
p
=
0
.
017
)
and
mRS
(
p
=
0
.
014
)
.
Unlike
DED
,
NDED
was
not
associated
with
patients
'
poor
QOL
,
except
for
thinking
domain
,
but
was
significantly
related
to
total
SCQ
and
subscales
1
and
2
of
SCQ
(
p
=
0
.
012
)
.
More
than
half
the
CADASIL
patients
had
emotional
disturbances
,
either
DED
or
NDED
.
Both
are
associated
with
patients
'
poor
QOL
and
increased
caregiver
burden
,
the
former
more
markedly
than
the
latter
.
Considering
that
CADASIL
is
a
progressive
disease
with
deteriorating
patients
'
QOL
,
physicians
have
to
pay
more
attention
to
emotional
problems
in
CADASIL
patients
.
Treatment
strategies
should
be
investigated
in
this
regard
to
improve
patients
'
QOL
and
reduce
caregiver
burden
.
Diseases
Validation
Diseases presenting
"increased caregiver burden"
symptom
cadasil
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