Volume 33, Issue 1 ,2011
Myotonic dystrophy (DM1) and dysphagia: The need for dysphagia management guidelines and an assessment tool
By Kori A. LaDonna, BA, PhD Candidate, Wilma J. Koopman, RN(EC), MScN, NP, and Shannon L. Venance, MD, PhD
Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic symptoms of DM1 because it may cause weight loss, aspiration pneumonias or sudden death. The purpose of this review is to describe the characteristics of DM1 that make dysphagia management problematic, and to address the need for disease-specific guidelines and a clinical tool to aid in diagnosing and managing dysphagia in this population.
Detecting cognitive impairment in clients with mild stroke or transient ischemic attack attending a stroke prevention clinic
By Gail MacKenzie, RN, MScN, Linda Gould, RPN, Sandra Ireland, RN, PhD, Kathryn LeBlanc, BsC, PhD, and Demetrios Sahlas, MSc, MD, FRCP(C)
Twenty clients diagnosed with probable transient ischemic attack (TIA) or stroke attending a stroke prevention clinic (SPC) were screened for cognitive function, as one inclusion criteria for a pilot study examining medication adherence and hypertension management. The Mini Mental State Examination (MMSE) was administered at study admission followed by a second screening within two weeks using the Montreal Cognitive Assessment (MoCA) tool. Individual scores for the MMSE and MoCA were compared. Results demonstrated that the majority (90%) of participants scored in the normal range (≥ 26) on the MMSE (M = 27.9 SD 2.15). However, more than half (55%) of participants had some degree of cognitive impairment based on MoCA scores of < 26 (M = 23.65 SD = 4.082). MoCA scores demonstrated a wider range (Range = 16) compared to the range of MMSE scores (Range = 8). MoCA scores were significantly (p = < 0.05) lower than the MMSE scores. Findings from this pilot study suggest that the MoCA test will identify more deficits in cognition among SPC clients diagnosed with cerebrovascular disease. Further investigation is underway to determine the implications of these deficits on SPC clients’ abilities to follow medication and other treatment regimens.
Key words: stroke, transient ischemic attack, prevention, cognitive testing