Over the first year after stroke, participants reported that the process of community reintegration was marked by ongoing changes in their goals. Formal and informal caregivers need to work with stroke survivors living in the community to facilitate realistic and achievable goal setting. Tools which identify meaningful activities should also be incorporated to provide stroke survivors with the opportunity to contribute and engage with others in the community.

Objective: To investigate patterns of in vivo white matter tract change using diffusion tensor imaging (DTI), we conducted a cross-sectional study of dementia with Lewy bodies (DLB) in comparison with Alzheimer disease (AD) and normal aging. Methods:The study included 106 subjects (35 with DLB, 36 with AD, and 35 elderly controls) who underwent clinical and neuropsychological assessment and diffusion tensor MRI. We used tract-based spatial statistics to investigate patterns of reduced fractional anisotropy (FA) and increased mean diffusivity (MD) across the entire white matter tract skeleton and also investigated correlations with clinical features. Results:Areas of reduced FA in subjects with DLB vs controls were found primarily in parietooccipital white matter tracts; in AD, the changes were much more diffuse. DLB was also associated with reduced FA in the pons and left thalamus, in comparison with AD. The pattern of MD increase was diffuse in AD and DLB. We found an association between DTI parameters and impaired episodic memory, letter fluency, and severity of motor parkinsonism in DLB. Conclusions:Despite a similar level of dementia severity, patterns of DTI changes in AD and DLB differed significantly. The selective involvement of the visual association areas and subcortical structures and the significant clinical correlations highlight the potential importance of white matter tract change in the pathogenesis of DLB. DTI may be a useful technique to investigate early and possible preclinical changes in DLB and warrants further investigation. Neurology Dementia with Lewy bodies (DLB) is a common form of neurodegenerative dementia in older people, second to Alzheimer disease (AD). The separation between AD and DLB clinically remains a challenge. We therefore need to establish in vivo biomarkers that can distinguish the differing pathologies and their contribution to the clinical features of the conditions. Diffusion tensor imaging (DTI) utilizes the anisotropic nature of diffusion in neuronal white matter tracts.1 With neuronal degeneration, the mean diffusivity (MD) increases with the loss of structural barriers that normally restrict diffusion, and diffusion becomes less directionally oriented, which is associated with a reduction in fractional anisotropy (FA). 2Previous studies investigating the DTI changes in DLB have used conventional region of interest (ROI) or voxel-based morphometry (VBM) methods.3-8 Some studies found widespread FA changes in comparison with healthy controls, 3,7 whereas others have found very little

There is insufficient evidence to be able to say whether or not physical activity programs are beneficial for people with dementia.

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