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1.
Yhojan Rodríguez Manuel Rojas Carolina Ramírez-Santana Yeny Acosta-Ampudia Diana M. Monsalve Juan-Manuel Anaya 《Clinical autonomic research》2018,28(2):211-214
Purpose
To determine if autonomic symptoms are associated with previous Zika virus infection.Methods
Case–control study including 35 patients with Zika virus infection without evidence of neurological disease and 105 controls. Symptoms of autonomic dysfunction were assessed with the composite autonomic symptom scale 31 (COMPASS-31).Results
Patients with previous Zika virus infection had significantly higher COMPASS-31 score than controls regardless of age and sex (p = 0.007). The main drivers for the higher scores where orthostatic intolerance (p = 0.003), secretomotor (p = 0.04) and bladder symptoms (p < 0.001).Conclusion
Zika virus infection is associated with autonomic dysfunction. The mechanisms remain to be elucidated.2.
Paul N. Pfeiffer Marcia Valenstein Dara Ganoczy Jennifer Henry Steven K. Dobscha John D. Piette 《Social psychiatry and psychiatric epidemiology》2017,52(2):183-191
Background
Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes.Aims
Pilot tests a post-hospital monitoring and enhanced support program for depression.Method
48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence.Results
Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was ?7.9 (p < 0.05) according to the Patient Health Questionnaire and ?11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of ?3.5 (p < 0.05) and ?1.7 (p > 0.10), respectively.Conclusions
Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.3.
David D. Kim Donna J. Lang Darren E. R. Warburton Melissa L. Woodward Randall F. White Alasdair M. Barr William G. Honer Ric M. Procyshyn 《Clinical autonomic research》2017,27(6):407-410
Purpose
To explore the relationship between antipsychotic-associated antagonism of alpha2-adrenergic receptors and resting heart rate in individuals with schizophrenia.Methods
Thirty-one inpatients treated with antipsychotics were included in this exploratory analysis. Antipsychotic doses were converted to haloperidol equivalents for alpha2-adrenergic receptor antagonism. Resting heart rate was measured with the patient in the seated upright posture.Results
After controlling for confounding variables, the relationship between alpha2-adrenergic receptor antagonism and resting heart rate demonstrated a positive linear effect (P = 0.002) as well as a nonlinear effect that accounted for an additional 14% of the variability in resting heart rate (P = 0.005).Conclusion
The observed inverted-U relationship between alpha2-adrenergic receptor antagonism and resting heart rate can possibly be attributed to an altered response of beta1-adrenergic receptors to increased norepinephrine release. Further investigations are required to confirm this exploratory finding, taking into account additional variables that include other receptors which either directly or indirectly influence heart rate.ClinicalTrials.gov Identifier
NCT01392885.4.
Jinhua Zheng Xinglong Yang Yalan Chen Quanzhen Zhao Sijia Tian Hongyan Huang Yanming Xu 《Clinical autonomic research》2017,27(2):103-106
Purpose
To compare the order of presentation of bladder and motor symptoms between multiple system atrophy phenotypes.Methods
Medical records were retrospectively reviewed in 144 patients.Results
Bladder symptoms occurred either before or within 12 months after onset of motor symptoms in significantly more patients with the cerebellar phenotype than the parkinsonian phenotype (80 vs. 53%, p = 0.003); similar results were observed for urinary incontinence (79 vs. 45%, p = 0.001).Conclusions
Urinary dysfunction is more likely to appear either before or shortly after motor symptoms in the cerebellar phenotype than in the parkinsonian phenotype.5.
Ari J. Elliot Nicholas A. Turiano Benjamin P. Chapman 《Annals of behavioral medicine》2017,51(2):240-250
Background
Socioeconomic health disparities research may benefit from further consideration of dispositional factors potentially modifying risk associated with low socioeconomic status, including that indexed by systemic inflammation.Purpose
This study was conducted to investigate interactions of SES and the Five-Factor Model (FFM) personality traits in predicting circulating concentrations of the inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP).Method
Using a sample of middle-aged and older adults from the Midlife in the United States Survey (MIDUS) biomarker project (N = 978), linear regression models tested interactions of each FFM trait with a composite measure of SES in predicting IL-6 and CRP, as well as the explanatory role of medical morbidity, measures of adiposity, and health behaviors.Results
SES interacted with conscientiousness to predict levels of IL-6 (interaction b = .03, p = .002) and CRP (interaction b = .04, p = .014) and with neuroticism to predict IL-6 (interaction b = ?.03, p = .004). Socioeconomic gradients in both markers were smaller at higher levels of conscientiousness. Conversely, the socioeconomic gradient in IL-6 was larger at higher levels of neuroticism. Viewed from the perspective of SES as the moderator, neuroticism was positively related to IL-6 at low levels of SES but negatively related at high SES. Interactions of SES with both conscientiousness and neuroticism were attenuated upon adjustment for measures of adiposity.Conclusions
Conscientiousness may buffer, and neuroticism amplify, excess inflammatory risk associated with low SES, in part through relationships with adiposity. Neuroticism may be associated with lower levels of inflammation at high levels of SES.6.
Kirsten Hauber Albert Eduard Boon Robert Vermeiren 《Child and adolescent psychiatry and mental health》2017,11(1):58
Objective
To examine changes in personality disorders and symptomology and the relation between personality disorder variables and treatment outcomes in an adolescent sample during partial residential mentalization based treatment.Methods
In a sample of 62 (out of 115) adolescents treated for personality disorders, assessment was done pre- and post-treatment using the Structured Clinical Interview for DSM personality disorders and the Symptom Check List 90.Results
Significant reductions in personality disorder traits (t = 8.36, p = .000) and symptoms (t = 5.95, p = .000) were found. During pre-treatment, 91.8% (n = 56) of the patients had one or more personality disorders, compared to 35.4% (n = 22) at post-treatment. Symptom reduction was not related to pre-treatment personality disorder variables.Conclusion
During intensive psychotherapy, personality disorders and symptoms may diminish. Future studies should evaluate whether the outcomes obtained are the result of the treatment given or other factors.7.
Roger C. McIntosh 《Clinical autonomic research》2016,26(4):287-294
Background
Heart rate variability (HRV) has been used to assess autonomic dysfunction since the beginning of the HIV epidemic. Although autonomic failure was commonly detected in HIV and AIDS patients prior to the advent of antiretroviral therapy (ART), the effect of HIV on HRV in the current era of widespread ART availability is more ambiguous.Methods
A systematic search and review was conducted on cross-sectional observational and case–control studies published in the era of ART (1996–2015) that compared HRV between HIV + individuals treated with ART and HIV ? controls. Eight out of the 20 studies identified, enrolling a total of 292 HIV + adults (mean age 38.7 years) and 201 HIV seronegative controls (mean age 35.1 years), were included in a meta-analysis based on stringent methodological criteria.Results
At rest, individuals with HIV showed lower HRV in the time (g) = ?0.72, 95 % CI (?1.03 to ?0.42) and low-frequency (LF) domain (g) = ?0.51, (?0.81 to ?0.21); markers of lower parasympathetic tone in the time (g) = ?0.55, (?0.85 to ?0.25) and high-frequency (HF) domain (g) = ?0.42, (?0.71 to ?0.12); and higher LF:HF ratio (g) = 0.46, (0.12–0.86) in the frequency domain, suggestive of parasympathetic withdrawal.Conclusion
This meta-analysis confirmed, within a relatively young cohort of HIV + adults on ART, a general reduction in autonomic function with a shift toward sympathetic dominance. This shift may predispose HIV patients to early and elevated risk of arrhythmias, cardiac events, and accelerated HIV disease progression.8.
Marlene N. Silva David Sánchez-Oliva Jennifer Brunet Geoffrey C. Williams Pedro J. Teixeira Antonio L. Palmeira 《Annals of behavioral medicine》2017,51(5):707-717
Background
Research into the factors associated with the use of different motivational strategies by exercise professionals is of empirical and practical utility.Purpose
Grounded in self-determination theory, this study sought to analyze putative antecedents, mediators, and work-related well- and ill-being consequences of two types of motivational strategies reported by exercise professionals.Methods
Participants were 366 exercise professionals (193 males; experience = 7.7 ± 5.8 years). Questionnaires assessing psychological need satisfaction frustration, self-determined work motivation, motivational strategies (need-supportive vs. controlling), emotional exhaustion, and personal accomplishment were completed online. Path analysis was used to test the hypothesized model.Results
Model with good fit [χ 2 (5) = 9.174, p> .05; CFI = .984; TLI = .936; RMSEA = .048; SRMR = .022] showed need satisfaction as positively associated with supportive strategies and personal accomplishment (β between .267 and .399) and negatively with emotional exhaustion (β = ?.145). Need frustration was negatively associated with work motivation and personal accomplishment (β = ?.315; ?.176), and positively with controlling strategies and emotional exhaustion (β = .195; .226). Furthermore, supportive strategies and work motivation were positively associated with personal accomplishment (β = .134; .184), whereas controlling strategies were positively associated with emotional exhaustion (β = .178).Conclusions
Findings have theoretical implications, providing evidence of need satisfaction and frustration as being differently associated with work-related motivation, type of strategies used, and work-related emotional outcomes. Practical implications convey the importance of these variables in relation to the standard of motivational strategies provided and their role on work-related well- and ill-being indicators.9.
Barbara H. Brumbach Wendy C. Birmingham Watcharaporn Boonyasiriwat Scott Walters Anita Y. Kinney 《Annals of behavioral medicine》2017,51(5):694-706
Background
Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies.Purpose
We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk.Methods
Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention.Results
Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08.Conclusion
Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions.Trial Registration Number
ClinicalTrials.gov, NCT01274143.10.
Yongfeng Yang Hongyan Yu Wenqiang Li Bing Liu Hongxing Zhang Shuang Ding Yanli Lu Tianzi Jiang 《Behavioral and brain functions : BBF》2018,14(1):1
Background
Schizophrenia (SZ) is a complex polygenic psychiatric disorder caused in part by abnormal dopamine levels. Cerebral dopamine neurotrophic factor (CDNF) 2 is known to protect and repair the dopaminergic system. Dopamine dysfunction is one of the pathogenesis of SZ. However, the relationship between CDNF2 and SZ has not been previously investigated. We speculated that CDNF2 may be a susceptibility factor for SZ.Methods
To address this issue, we carried out a study to investigate the association between CDNF2 and SZ in the total sample 1371 (670 SZ patients and 701 healthy controls) Han Chinese population. Stage 1 included 528 SZ patients and 528 healthy controls; and stage 2 included 142 SZ patients and 173 healthy controls. The allele and genotype frequencies of five single nucleotide polymorphisms (rs2577074, rs2577075, rs2249810, rs6506891, and rs2118343) of CDNF2 were compared between patients and controls.Results
We found a significant association in allele and genotype frequencies between the two groups at rs2249810 (χ2 = 4.38 and 6.45, respectively; P = 0.03 and 0.04, respectively). An association was also observed in males at rs2249810 (χ2 = 8.76; P = 0.03). Haplotype TGATC differed between SZ and controls in stage 2 samples (χ2 = 6.38; P = 0.01), and rs2118343 genotypes were associated with negative factor scores (F = 4.396; P = 0.01).Conclusions
These results suggest that rs2249810 and haplotype TGATC of CDNF2 are an SZ susceptibility locus and factor, respectively, and that rs2118343 genotypes are associated with negative symptoms of SZ in the Han Chinese population.11.
Liza S. Rovniak Lan Kong Melbourne F. Hovell Ding Ding James F. Sallis Chester A. Ray Jennifer L. Kraschnewski Stephen A. Matthews Elizabeth Kiser Vernon M. Chinchilli Daniel R. George Christopher N. Sciamanna 《Annals of behavioral medicine》2016,50(6):885-897
Background
Social networks can influence physical activity, but little is known about how best to engineer online and in-person social networks to increase activity.Purpose
The purpose of this study was to conduct a randomized trial based on the Social Networks for Activity Promotion model to assess the incremental contributions of different procedures for building social networks on objectively measured outcomes.Methods
Physically inactive adults (n = 308, age, 50.3 (SD = 8.3) years, 38.3 % male, 83.4 % overweight/obese) were randomized to one of three groups. The Promotion group evaluated the effects of weekly emailed tips emphasizing social network interactions for walking (e.g., encouragement, informational support); the Activity group evaluated the incremental effect of adding an evidence-based online fitness walking intervention to the weekly tips; and the Social Networks group evaluated the additional incremental effect of providing access to an online networking site for walking as well as prompting walking/activity across diverse settings. The primary outcome was mean change in accelerometer-measured moderate-to-vigorous physical activity (MVPA), assessed at 3 and 9 months from baseline.Results
Participants increased their MVPA by 21.0 min/week, 95 % CI [5.9, 36.1], p = .005, at 3 months, and this change was sustained at 9 months, with no between-group differences.Conclusions
Although the structure of procedures for targeting social networks varied across intervention groups, the functional effect of these procedures on physical activity was similar. Future research should evaluate if more powerful reinforcers improve the effects of social network interventions.Trial Registration Number
The trial was registered with the ClinicalTrials.gov (NCT01142804).12.
Jennifer Fillo Stephanie Brooks Holliday Amy DeSantis Anne Germain Daniel J. Buysse Karen A. Matthews Wendy M. Troxel 《Annals of behavioral medicine》2017,51(6):879-889
Background
Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias.Purpose
The purpose of the study was to examine associations between relationship functioning and sleep in military couples. This is the first research to examine associations between observed relationship behaviors and subjective and polysomnographically measured sleep in a sample at-risk for both sleep and relationship problems.Methods
The sample included 35 military veterans and their spouses/partners. Marital functioning was coded from a videotaped conflict interaction. Analyses focused on behavioral codes of hostility and relationship-enhancing attributions. Sleep was assessed via self-report and in-home polysomnography.Results
Greater hostility was associated with poorer sleep efficiency for oneself (b = ?0.195, p = .013). In contrast, greater relationship-enhancing attributions were associated with higher percentages of stage N3 sleep (b = 0.239, p = .028). Partners’ hostility was also positively associated with higher percentages of stage N3 sleep (b = 0.272, p = .010). Neither hostility nor relationship-enhancing attributions was associated with self-reported sleep quality, percentage of REM sleep, or total sleep time.Conclusions
Both partners’ positive and negative behaviors during conflict interactions were related to sleep quality. These findings highlight the role that effective communication and conflict resolution skills may play in shaping not only the marital health of veterans and their spouses but also the physical health of both partners as well. Understanding the links between relationship functioning and sleep may be important targets of intervention in the aftermath of war.13.
Objective
To assess the effects of PR-fampridine on cognitive functioning, fatigue and depression in patients with multiple sclerosis (PwMS).Methods
Thirty-two PwMS were included in this trial. Cognitive performance was assessed in an open-label and randomized double-blind, placebo-controlled study design using a comprehensive neuropsychological test battery as well as questionnaires examining depression and fatigue.Results
We found significant improvements in cognitive measures assessing alertness (tonic alertness, p = 0.0244 and phasic alertness, p = 0.0428), psychomotor speed (p = 0.0140) as well as verbal fluency (p = 0.0002) during open-label treatment with PR-fampridine. These effects of performance were paralleled by patients’ perception of reduced fatigue (physical, p = 0.0131; cognitive, p = 0.0225; total, p = 0.0126). Fampridine-induced improvements in phasic alertness (p = 0.0010) and measures of fatigue (physical, p = 0.0014; cognitive, p = 0.0003; total, p = 0.0005) were confirmed during randomized, double-blind, placebo-controlled assessment in the second year. In addition, we found positive effects of PR-fampridine on depressive symptoms (p = 0.0049). We demonstrated persisting beneficial effects of PR-fampridine on fatigue in PwMS over a period of more than 2 years. Drug responsiveness regarding cognitive performance and fatigue was not limited to walking responders.Conclusions
Our data demonstrate significant positive effects of treatment with PR-fampridine over 2 years on different cognitive domains as well as fatigue and depression in a cohort of PwMS. These findings imply that PR-fampridine should be considered as symptomatic treatment improving aspects of cognition, fatigue and depression in PwMS.14.
Francis Vergunst Jorun Rugkåsa Constantinos Koshiaris Judit Simon Tom Burns 《Social psychiatry and psychiatric epidemiology》2017,52(11):1375-1384
Purpose
Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients’ social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients’ long-term social outcomes.Methods
A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health.Results
No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = ?0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives.Conclusions
CTO duration was not associated with improvements in patients’ social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.15.
Carsten Friedrich André O. von Bueren Larissa Kolevatova Christian Bernreuther Tobias Grob Diego Sepulveda-Falla Leander van den Boom Manfred Westphal Ronald Simon Markus Glatzel 《Child's nervous system》2016,32(2):281-290
Purpose
The aim of this study was to investigate the epidermal growth factor receptor (EGFR) status in ependymoma specimens, as there is a need for new prognostic and druggable targets in this disease.Methods
Ependymomas (WHO grade II, n = 40; WHO grade III, n = 15) located spinal (n = 35), infratentorial (n = 14), and supratentorial (n = 6) of 53 patients with a median age of 40 (range, 2–79) years were analyzed for Ki-67, p53, and EGFR expression by immunohistochemistry using a tissue microarray and for EGFR gene copy number alterations/mutations. Results were correlated to clinical data.Results
EGFR overexpression was found in 30/60 % of ependymomas depending on the antibody used and was more pronounced in WHO grade III. High EGFR gene copy number gains were found in 6 (11 %) ependymomas with half of them being amplifications. EGFR amplified ependymomas displayed an EGFR overexpression with both antibodies in two of three cases. A missense mutation in exon 20 of EGFR (S768I) was detected in one amplified case.Conclusions
EGFR is frequently overexpressed in ependymomas. Other mechanisms than amplification of the EGFR gene appear to contribute to EGFR overexpression in most cases. EGFR mutations may be present in a small subset of ependymomas.16.
Ruchira M. Jha David O. Okonkwo Benjamin E. Zusman Seo-Young Park Jessica Wallisch Philip E. Empey Lori A. Shutter Robert S. B. Clark 《Neurocritical care》2017,26(2):213-224
Objective
Cerebral edema (CE) in traumatic brain injury (TBI) is the consequence of multiple underlying mechanisms and is associated with unfavorable outcomes. Genetic variability in these pathways likely explains some of the clinical heterogeneity observed in edema development. A role for sulfonylurea receptor-1 (Sur1) in CE is supported. However, there are no prior studies examining the effect of genetic variability in the Sur1 gene (ABCC8) on the development of CE. We hypothesize that ABCC8 single nucleotide polymorphisms (SNPs) are predictive of CE.Methods
DNA was extracted from 385 patients. SNPs in ABCC8 were genotyped using the Human Core Exome v1.2 (Illumina). CE measurements included acute CT edema, mean and peak intracranial pressure (ICP), and need for decompressive craniotomy.Results
Fourteen SNPs with minor allele frequency >0.2 were identified. Four SNPS rs2283261, rs3819521, rs2283258, and rs1799857 were associated with CE measures. In multiple regression models, homozygote-variant genotypes in rs2283261, rs3819521, and rs2283258 had increased odds of CT edema (OR 2.45, p = 0.007; OR 2.95, p = 0.025; OR 3.00, p = 0.013), had higher mean (β = 3.13, p = 0.000; β = 2.95, p = 0.005; β = 3.20, p = 0.008), and peak ICP (β = 8.00, p = 0.001; β = 7.64, p = 0.007; β = 6.89, p = 0.034). The homozygote wild-type genotype of rs1799857 had decreased odds of decompressive craniotomy (OR 0.47, p = 0.004).Conclusions
This is the first report assessing the impact of ABCC8 genetic variability on CE development in TBI. Minor allele ABCC8 SNP genotypes had increased risk of CE, while major SNP alleles were protective—potentially suggesting an evolutionary advantage. These findings could guide risk stratification, treatment responders, and the development of novel targeted or gene-based therapies against CE in TBI and other neurological disorders.17.
Background
Inpatient video-EEG monitoring (VEM) can contribute to the diagnosis and treatment in many of the monitored patients. Most admissions to VEM are elective and are scheduled ahead before the monitoring session.Purpose
To retrospectively evaluate the yield of non-elective VEM sessions.Methods
We retrospectively reviewed the VEM recordings and medical records of all the patients admitted to our one-bed VEM unit from June 2007 to June 2015. A VEM session was diagnostic when a seizure, an event or previously unreported interictal epileptiform discharges were recorded.Results
The study group included 304 adults aged 18–92 years (mean 40.4 ± 17.4 years), 181 (59%) women. The diagnostic yield of non-elective and elective VEM session was similar (66 and 69%, respectively). In non-elective VEM, fewer patients had known epilepsy (p = 0.0001), session duration was shorter (p = 0.0001), and seizures and interictal epileptiform discharges were recorded less frequently compared to elective VEM (p = 0.005 and p = 0.0001, respectively).Conclusion
Non-elective VEM can provide useful information in patients admitted to the neurology department with recent neurological or behavioral events. A timely and correct diagnosis in these patients can potentially reduce unnecessary use of antiepileptic drugs in patients with psychogenic nonepileptic seizures and the morbidity and mortality associated with undiagnosed seizures.18.
Alessandro Putzu Silvia Valtorta Giuseppe Di Grigoli Matthias Haenggi Sara Belloli Antonio Malgaroli Marco Gemma Giovanni Landoni Luigi Beretta Rosa Maria Moresco 《Neurocritical care》2018,28(3):370-378
Background
Cardiac arrest is an important cause of morbidity and mortality. Brain injury severity and prognosis of cardiac arrest patients are related to the cerebral areas affected. To this aim, we evaluated the variability and the distribution of brain glucose metabolism after cardiac arrest and resuscitation in an adult rat model.Methods
Ten rats underwent 8-min cardiac arrest, induced with a mixture of potassium and esmolol, and resuscitation, performed with chest compressions and epinephrine. Eight sham animals received anesthesia and experimental procedures identical to the ischemic group except cardiac arrest induction. Brain metabolism was assessed using [18F]FDG autoradiography and small animal-dedicated positron emission tomography.Results
The absolute glucose metabolism measured with [18F]FDG autoradiography 2 h after cardiac arrest and resuscitation was lower in the frontal, parietal, occipital, and temporal cortices of cardiac arrest animals, showing, respectively, a 36% (p = 0.006), 32% (p = 0.016), 36% (p = 0.009), and 32% (p = 0.013) decrease compared to sham group. Striatum, hippocampus, thalamus, brainstem, and cerebellum showed no significant changes. Relative regional metabolism indicated a redistribution of metabolism from cortical area to brainstem and cerebellum.Conclusions
Our data suggest that cerebral regions have different susceptibility to moderate global ischemia in terms of glucose metabolism. The neocortex showed a higher sensibility to hypoxia–ischemia than other regions. Other subcortical regions, in particular brainstem and cerebellum, showed no significant change compared to non-ischemic rats.19.
Objective
Caregiver burden is a recognised consequence of caring for a patient with neurodegeneration. Amyotrophic lateral sclerosis (ALS) differs from other neurodegenerations by its rapid progression and impairment of motor, cognitive, and behavioural function, which contribute to caregiver burden. However, longitudinal factors that determine the extent of caregiver burden, and in particular the impact of psychological distress among caregivers, have not been fully established.Methods
Patients with ALS (n = 85) and their primary caregivers (n = 85) completed three serial evaluations. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The Edinburgh Cognitive-Behavioural ALS Screen (ECAS) was used to determine cognitive function in patients. The ALS Functional Rating Scale (ALSFRS-R) measured disease progression.Results
Using the ZBI, caregivers were categorised as high or low burden. In the low burden group, anxiety scores from the HADS predicted caregiver burden (r = 0.410, F = 3.73, p = 0.033), whereas the depression sub-score from the HADS was predictive of caregiver burden in the high burden group (r = 0.501, F = 5.87, p = 0.006) for cross-sectional analyses. Longitudinally, an elevated score on the HADS at Time 1 was the largest predictor of caregiver burden across serial assessments.Conclusion
In a patient cohort with relatively preserved cognitive function (65%), anxiety and depression at Time 1, as measured by the HADS, were the best predictors of caregiver burden at Time 3. This observation provides a mechanism by which caregiver burden can be identified by health-care professionals and a stepped care programme of intervention initiated.20.