Severe adolescent head injury: Implications for transition into adult life

This report describes the outcomes of 28 children who had severe head injuries between 13–18 years of age. All were unconscious at least 24 hours and have been followed at least 2 years after injury. At present, their ages range from 18 to 27 years. Their educational achievements, social activities, marital status, functional independence, and employment at follow-up are described.     

Distribution of tangles and threads in the cerebral cortex in progressive supranuclear palsy

Recent studies have described silver- and tau-positive glia and threads in the degenerating lesions of progressive supranuclear palsy. In this study, Gallyas-Braak silver impregnation and several immunohistochemical techniques were employed to examine the distribution of tangles, abnormal glia and threads in the cerebral cortex of nine cases of progressive supranuclear palsy. In addition to neurofibrillary tangles, argentophilic glia and threads were impregnated exclusively by GaIIyas-Braak technique. This technique demonstrated two types of glia profiles: tightly coiled intra-cytoplasmic profiles surrounding nuclei (coiled profiles) and thorn-like profiles with radial ramifications (thorn-like profiles). Thorn-like profiles are possibly in astrocytes and were detected in the cerebral cortex, while coiled profiles are possibly in oligodendroglia and were detected both in the cerebral cortex and subcortical white matter. Topographically, many neurofibrillary tangles were constantly seen in the frontal cortex and in the pre-central gyrus. Numerous neurofibrillary tangles were detected in the entorhinal cortex of the two brains. Argentophilic glia and threads were also frequent both in the frontal cortex and the precentral gyrus: however, they were more frequent in the pre-central gyrus that in the frontal cortex in four of the eight cases examined. In two brains, argentophilic threads were distributed widely in the cerebral cortex and white matter except for the temporal cortex. In immunohistochemical studies, argentophilic glia and threads were mostly positive for Tau 2, and a small number of them were weakly positive for ubiquitin and paired helical filament protein. The immunoproperties of these abnormal glia and threads seemed to be virtually identical to those of neurofibrillary tangles. These findings indicate that cytoskeletal abnormalities related with abnormal tau proteins may occur concordantly both in neuronal and glial cells, especially in the pre-central gyrus. Cytoskeletal abnormalities occurring in the sub-cortical nuclei may be involved in the primary motor cortex.     

Leukoaraiosis and stroke outcome

We studied the influence of leukoaraiosis on the prognosis of stroke for the first year after onset. Three hundred and seventy consecutive stroke subjects were observed for 1 year. Data were collected prospectively in a questionnaire constructed in accordance with the Stroke Data Bank and analyzed using SPSS. Leukoaraiosis was observed in 17.6% of subjects. Subjects with leukoaraiosis were older than subjects without leukoaraiosis. Cerebrovascular risk factors were similar in both groups. During the first 30 days, the fatality rate of both groups was similar. However, at 1 year, the fatality rate in subjects with leukoaraiosis was higher. Stroke Severity, Weakness Score, and the Barthel Modified Activities for Daily Living score did not differ between groups at 30 days or 1 year. At both 30 days and 1 year, the MMSE score was lower in subjects with leukoaraiosis. Leukoaraiosis did not predict stroke recurrence within 1 year. Leukoaraiosis in stroke patients is an adverse predictor of cognitive functioning at 30 days and at 1 year and is an adverse predictor of survival at 1 year.     

Ethnic Differences in Singapore's Dementia Prevalence: The Stroke,Parkinson's Disease,Epilepsy, and Dementia in Singapore Study

OBJECTIVES: To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians. DESIGN: A two‐phase, cross‐sectional study of randomly selected population from central Singapore with disproportionate race stratification. SETTING: Community‐based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers. PARTICIPANTS: Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate). MEASUREMENTS: The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders—Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke—Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively. RESULTS: The overall age‐ and race‐standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10–1.45). Prevalence (in 5‐year age bands) was 0.08% (50–54), 0.08% (55–59), 0.44% (60–64), 1.16% (65–69), 1.84% (70–74), 3.26% (75–79), 8.35% (80–84), and 16.42% (≥85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese. CONCLUSION: Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.     

Dissociation of Visual and Auditory Language Comprehension Capacity in Aphasia

Visual language comprehension capacity was compared with auditory language comprehension capacity in 26 aphasic subjects. The Token Test was used for both modalities. By the means of the difference in scores on the two tests three groups were separated, that is (1) a group with no essential difference between the two capacities, (2) a group with superior reading capacity and (3) a group with superior auditory capacity. Particular attention was directed to the second group. Seven subjects showed this type of dissociated comprehension. The group was found to be heterogeneous in their linguistic characteristics, The clinical type of aphasia included not only Wer-nicke's aphasia but also Broca's aphasia. A possible psychological explanation underlying this phenomenon was attempted. Anatomical correlation was also attempted. The hypothesis of sparing the left inferior parietal lobe is proposed as an explanation of why visual comprehension was better preserved than auditory comprehension.     

阻塞性睡眠呼吸暂停临床亚型的潜在类别以及对不同类别首次持续气道正压通气治疗反应的分析研究

背景　阻塞性睡眠呼吸暂停（OSA）具有高度异质性，不同临床亚型提示不同的临床特点。本研究团队前期研究发现不同OSA临床亚型在初次持续气道正压通气（CPAP）治疗上存在显著差异性，但目前国内外缺乏相关研究。目的　使用潜在类别分析探索OSA患者中存在的临床亚型，分析不同临床亚型诊断夜（首次CPAP治疗前）睡眠特征和对首次CPAP治疗反应的差异。方法　回顾性分析了2011年1月-2016年12月在唐都医院睡眠中心进行首次CPAP治疗的491例OSA患者的临床资料。将22种临床症状（入睡困难、多醒、早醒、打鼾、憋气、突然憋醒、梦魇、梦话、尿床、睡眠中肢体抽动、晨起头痛、头昏、焦虑、情绪低落、思维困难、注意力不集中、头脑不清、反应迟钝、工作能力减退、心悸、疲劳乏力、白日嗜睡）纳入潜在类别分析模型。比较不同临床亚型症状分布特点、诊断夜的睡眠特征以及首次CPAP治疗反应的差异性。结果　临床亚型数目为4时，模型拟合最佳，分为类别1 “呼吸中断伴白日嗜睡组”143例（29.1%），类别2 “症状轻微组”189例（38.5%），类别3 “日间功能严重受损组”64例（13.0%）和类别4 “合并失眠组”95例（19.3%）。类别2 “症状轻微组”年龄更小，男性比例更高，而类别4 “合并失眠组”正好相反。不同临床亚型除外憋气症状，其余临床症状占比比较，差异均有统计学意义（P<0.05）。不同临床亚型OSA患者诊断夜的睡眠潜伏期（SL）、N1%、N2%、N3%、快速眼动睡眠期占总睡眠时期的比例（REM%）比较，差异均有统计学意义（P<0.05）。不同临床亚型OSA患者接受首次CPAP治疗后的总睡眠时间（TST）、睡眠效率（SE）、N1%、N2%、N3%、REM%、入睡后清醒时间（WASO）、氧饱和度下降指数（ODI）、血氧饱和度（SpO2）<90%的时间、最低SpO2（LSpO2）、整夜平均SpO2比较，差异均有统计学意义（P<0.05）。结论　通过潜在类别分析，可以将OSA的临床症状分为4种临床亚型，且4种临床亚型首次CPAP治疗反应存在统计学差异。这些发现强调了识别一系列OSA临床症状，进行个体化治疗的必要性。     

Multi-task learning based structured sparse canonical correlation analysis for brain imaging genetics

The advances in technologies for acquiring brain imaging and high-throughput genetic data allow the researcher to access a large amount of multi-modal data. Although the sparse canonical correlation analysis is a powerful bi-multivariate association analysis technique for feature selection, we are still facing major challenges in integrating multi-modal imaging genetic data and yielding biologically meaningful interpretation of imaging genetic findings. In this study, we propose a novel multi-task learning based structured sparse canonical correlation analysis (MTS2CCA) to deliver interpretable results and improve integration in imaging genetics studies. We perform comparative studies with state-of-the-art competing methods on both simulation and real imaging genetic data. On the simulation data, our proposed model has achieved the best performance in terms of canonical correlation coefficients, estimation accuracy, and feature selection accuracy. On the real imaging genetic data, our proposed model has revealed promising features of single-nucleotide polymorphisms and brain regions related to sleep. The identified features can be used to improve clinical score prediction using promising imaging genetic biomarkers. An interesting future direction is to apply our model to additional neurological or psychiatric cohorts such as patients with Alzheimer’s or Parkinson’s disease to demonstrate the generalizability of our method.