Background Cognitive impairment is an important aspect for stroke survivors. Little data are available about the frequency and risk factors of post-stroke dementia in Egypt. Objectives The aim of this study is to evaluate the frequency and predictors of post-stroke dementia and its impact on outcome. Methods A total of 380 patients with acute stroke were included. Patients were subjected to demographic data collection, neurological examination, and assessment of vascular risk factors. Furthermore, assessment of stroke severity by Barthel Index was done. After 6 months, patients were assessed for outcome and development of post-stroke dementia. Results Post-stroke dementia was detected in 20.8% of patient. It was recorded more in old ages, illiterates, unmarried, unemployed, and those with recurrent stroke and with cerebral infarction (significantly with cardio-embolic). Conclusion Post-stroke dementia is high in Egypt, especially in those with illiteracy, atrial fibrillation, brain atrophy, severe strokes, and those presented with hemiplegia, sphincter affection, abnormal gait, and psychotic features. Assessment for post-stroke dementia should be done during follow up of stroke patients.

Background. Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in parkinson's disease. Late-onset (tardive syndromes) movement disorders typically manifest three months or later (this varies) after the exposure to antipsychotic drugs, and unfortunately have no satisfactory medical treatment. The aim of this study was to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on drug induced tardive syndromes. Material and Methods: Twenty patients with Tardive syndromes were allocated to receive real or sham rTMS. Each patient received 2000 rTMS pulses (20 Hz at 100% rMT) over the hand motor area area for 10 consecutive days. The Abnormal involuntary movement scale (AIMS), and cortical excitability of all patients were measured before, and immediately after the 10 sessions,. Results. At baseline, there was no significant difference between the groups in age, sex distribution, duration of illness, and treatment. The offending antipsychotic drugs that induced TS and the current treatment were similar in both groups, and no significant differences in clinical rating scale and their subitems nor in cortical excitability between groups. However, there was a significant improvement in the AIMS score (pre versus post sessions with p= 00001) in the real rTMS group compared with the sham group (P = 0.03). A repeated-measures ANOVA that showed a significant Time (pre, post session) × Group (real vs sham) interaction (P = .0001). The same trends were observed in the clinical subscales with significant improvement in real group and no effect the sham group. There were no significant changes in cortical excitability in either group. Conclusion. This is the first clinical trial study of bilateral hemispheric rTMS in patients with tardive syndromes. Bilateral hemispheric high frequency rTMS might be a feasible treatment for tardive syndromes resistant to medical treatment; further multicenter studies are needed to confirm this result.-American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision (DSM-IV-TR). Washington, DC., American Psychiatric Association, 2000.

Objectives: It has recently been suggested that drug induced Tardive Syndromes (TS) might be due to maladaptive plasticity which increases motor excitability in cerebral cortex and basal ganglia. In order to test this hypothesis we performed the first measurements of cortical excitability in TS. Methods: Motor cortex excitability was examined using transcranial magnetic stimulation (TMS) in 22 TS patients and compared with that in 20 age and sex-matched healthy individuals. Resting and active motor threshold (RMT, AMT) and input-output curves (I/O curves) assessed corticospinal excitability. The duration of the contralateral silent period (cSP) at a range of stimulation intensities and ipsilateral silent period (iSP) were used as measures of inhibition.Results: There were no significant differences in RMT and AMT between patients and controls, although the input-output curves were significantly steeper in patients. The cSP (at different stimulus intensities) and iSP were both longer in the patients compared to the control group. But most of this difference could be accounted for by increased recruitment of motor evoked potentials (MEPs) in patients. Conclusion:TS is characterized by hyperexcitability of corticospinal output that might contribute to the lack of selectivity in muscle recruitment and contribute to excess involuntary movement. The findings are opposite to those in naturally-occurring hyperkinesia such as Sydenham's and Huntington's chorea suggesting a fundamental difference in the pathophysiology.