Does the radiologically isolated syndrome exist? A dual-task cost pilot study

Simultaneous performance of motor and cognitive tasks may compete for common brain network resources in aging or patients with some neurological diseases, suggesting the occurrence of a cognitive-motor interference. While this phenomenon has been well described for multiple sclerosis (MS) patients, it never has been tested on asymptomatic subject with magnetic resonance imaging (MRI) findings suggestive of demyelinating disease (i.e., radiologically isolated syndrome: RIS). In this pilot study, 10 RIS subjects and 10 sex/age-matched healthy controls were tested by means of static posturography under eyes opened (single-task trial) and while performing two different cognitive tasks (semantic modified word list generation for first dual-task trial and phonemic semantic modified word list generation for second dual-task trial), to estimate the dual-task cost (DTC) of standing balance. In our sample, under cognitive interference (without any substantial differences between semantic and phonemic modified word list generation), the RIS group showed significance differences in CoP (center of pressure) total sway area, ellipse eccentricity, CoP sway path length, CoP median sway velocity along the AP (anteroposterior) axis and along the ML (mediolateral) axis, reflecting a higher negative DTC respect to healthy subjects (which have simply shown a statistical trend, failing to reach a significance, in some trials). The phenomenon of cognitive-motor interference might be unmasked by a dual-task posturography in RIS subjects, too. We hypothesize that this approach could be useful to early reveal the presence of a demyelinating disease and to reach a MS diagnosis in subjects otherwise classified as RIS.     

Does olanzapine have antidepressant properties? A retrospective preliminary study

Objective: Mood‐stabilizing agents are ideally conceptualized as possessing antimanic and antidepressant properties. While research on olanzapine's antimanic effects is growing, data on its possible antidepressant properties are limited. We sought to determine if olanzapine is effective in the add‐on treatment of major affective disorders, particularly depressive symptoms, in a naturalistic setting.

Methods: All charts of patients meeting DSM‐IV criteria for bipolar disorder or unipolar major depressive disorder treated with olanzapine in a private psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impression Scale for Improvement (CGI‐I).

Results: Olanzapine was moderately effective in 6/10 (60%) patients. Side‐effects were present in 8/10 (80%), most commonly weight gain.

Conclusions: Olanzapine appears to be moderately effective in open add‐on treatment in patients with mainly depressive symptoms. Accumulating evidence suggests that olanzapine, and atypical antipsychotics in general, possess mild to moderate adjunctive antidepressant properties.     

Does graded activity increase activity? A case study of chronic fatigue syndrome

The reliance on self-report outcome measures in clinical trials of graded activity-oriented cognitive-behavior therapy in chronic fatigue syndrome (CFS) makes it difficult to draw definitive conclusions about actual behavioral change. The participant in this case study was a 52-year-old married male with CFS who was working full-time. Outcome measures included a step counter to objectively measure physical activity as well as a daily diary measure of exercise activity and in vivo ratings of perceived energy, fatigue, and affect. The following psychometric instruments were also used: the CFS Symptom Inventory, the SF-36, the Beck Depression Inventory, and the Beck Anxiety Inventory. The 26-session graded activity intervention involved gradual increases in physical activity. From baseline to treatment termination, the patient's self-reported increase in walk time from 0 to 155 min a week contrasted with a surprising 10.6% decrease in mean weekly step counts. The final follow-up assessment revealed a “much improved” global rating, substantial increases in patient-recorded walk time and weight lifting intensity, yet a relatively modest increment in weekly step counts. It appeared that improvement was associated with mood-enhancing, stress-reducing activities that were substituted for stress-exacerbating activities.     

Does age predict outcome in stroke rehabilitation? A study of 878 Chinese subjects

BACKGROUND: The predicting value of age on stroke rehabilitation has been controversial. There is a lack of large-scale studies in the Chinese population to examine the effect of age on stroke rehabilitation outcomes. This study examines the predictors of a good outcome after rehabilitation in Chinese stroke patients with special attention to age as a factor. PATIENTS AND METHODS: This retrospective cohort study includes stroke patients receiving a standard inpatient multidisciplinary rehabilitation program in a neuro-rehabilitation ward of a convalescence hospital in Hong Kong from January 2000 to December 2003. Functional independence measure (FIM) >or=90 was used to define a good outcome. Multivariate regression analysis was used to assess the independent predictors of a good outcome. RESULTS: There were important differences in clinical characteristics and complications of stroke among patients of three age groups: <65, >or=65 and <80, and >or=80 years. The total FIM scores both upon admission and at discharge were lower in the older age groups. No significant difference was observed in the changes in FIM scores across these age groups. Age was not an independent predictor for a good outcome. FIM upon admission was an independent predictor for a good outcome (discharge FIM >or=90) in all patients and in individual age groups. Having employment before stroke was a predictor for good outcome in all patients. Living at home prior to stroke was a predictor for the total population and the >or=65 and <80 years group. The length of stay predicted a good outcome in the group >or=80 years. CONCLUSIONS: Admission functional status, employment and living at home before stroke but not age per se are predictors of a good outcome following stroke rehabilitation. As older patients show comparable improvement during rehabilitation, intensive rehabilitation should not be withheld in stroke patients simply because of advanced age.     

Does genotype predict phenotype in Rett syndrome?

Mutations in the X-linked gene encoding the methyl-CpG binding protein MeCP2 are the primary cause of classic and atypical Rett syndrome and have recently been shown to contribute to other neurodevelopmental disorders of varying severity. To determine whether there are molecular correlates to the phenotypic heterogeneity, numerous groups have performed genotype-phenotype correlation studies. These studies have yielded conflicting results, in part because they used different criteria for determining severity and classifying mutations. Evolution of the phenotype with age and variable expressivity arising from individual variability in X-chromosome inactivation patterns are among other reasons the findings varied. Nonetheless, evidence of differences in the phenotypic consequences of specific types of mutations is emerging. This review analyzes the available literature and makes recommendations for future studies.     

Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation

Purpose

To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.

Methods

Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome’s prevalence in their country, etiology, diagnosis, suicide risk, and treatment.

Results

Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.

Conclusions

Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.     

Does apolipoprotein A1 predict microstructural changes in subgenual cingulum in early Parkinson?

Higher plasma cholesterol levels are associated with lower Parkinson’s disease (PD) risk. Apolipoprotein A-1 (ApoA-1) is a surface marker of brain HDL-like particles associated with the time of PD onset. Clinical correlates of serum Apolipoprotein A1 levels with structural brain connectivity in PD-related disorders remains unclear. Here, we applied a novel diffusion-weighted imaging approach [Diffusion Magnetic Resonance Imaging (MRI) Connectometry] to explore the association between ApoA-1 and structural brain connectivity in PD. Participants involved in this research were recruited from Parkinson’s Progression Markers Initiative (PPMI). Diffusion MRI connectometry was conducted using a multiple regression against apoA-1 for 36 patients with DTI measurements available in the baseline visit. Fiber results of the connectometry were then reconstructed for each patient, and diffusion parameters were extracted and regressed against apoA-1 levels. Connectometry results revealed the subgenual cingulum to be associated with ApoA-1, with different FDR yields. This result was further supported by significant negative correlation of Quantitative Anisotropic (QA) of left subgenual cingulum (Pearson’s coefficient = ?0.398, p = 0.020) and Generalized Fractional Anisotropic (GFA) of right subgenual cingulum (Pearson’s coefficient ?0.457, p = 0.007) with plasma apoA-1 levels, in a multiple regression model with age and sex. The subgenual cingulum encompasses fibers from the anterior cingulate cortex and anterior thalamus. These structures are involved in PD-associated psychosis and executive cognitive decline. We demonstrated for the first time that apoA-1, as a blood marker, can predict microstructural changes in white matter regions in PD patients with undisturbed cognition and mild motor disability.     

Is MCI really just early dementia? A systematic review of conversion studies

OBJECTIVES: Older people commonly present with memory loss although on assessment are not found to have a full dementia complex. Previous studies have suggested however that people with subjective and objective cognitive loss are at higher risk of dementia. We aimed to determine from the literature the rate of conversion from mild cognitive impairment to dementia. METHODS: Systematic review of MedLine, PsychLit and EmBase. RESULTS: We identified 19 longitudinal studies published between 1991 and 2001 that addressed conversion of mild cognitive impairment to dementia. Overall the rate of conversion was 10% but with large differences between studies. The single biggest variable accounting for between study heterogeneity was source of subjects, with self-selected clinic attenders having the highest conversion rate. The most important factor accounting for heterogeneity within studies was cognitive testing, with poor performance predicting conversion with a high degree of accuracy. CONCLUSIONS: These data strongly support the notion that subjective and objective evidence of cognitive decline is not normal and predicts conversion to dementia. The more stringent the measures of both variables the better the prediction of conversion. Mild cognitive impairment, appropriately diagnosed, is a good measure with which to select subjects for disease modification studies.     

Does hippocampal atrophy on MRI predict cognitive decline? A prospective follow-up study

Objectives. To investigate whether the presence of hippocampal atrophy (HCA) on MRI in Alzheimer's disease (AD) leads to a more rapid decline in cognitive function. To investigate whether cognitively unimpaired controls and depressed subjects with HCA are at higher risk than those without HCA of developing dementia. Design. A prospective follow-up of subjects from a previously reported MRI study. Setting. Melbourne, Australia. Participants. Five controls with HCA and five age-matched controls without HCA, seven depressed subjects with HCA and seven without HCA, and 12 subjects with clinically diagnosed probable AD with HCA and 12 without HCA were studied. They were followed up at approximately 2 years with repeat cognitive testing, blind to initial diagnosis and MRI result. Measures. HCA was rated by two radiologists blind to cognitive test score results. Cognitive assessment was by the Cambridge Cognitive Examination (CAMCOG). Results. No significant differences in rate of cognitive decline, mortality or progression to dementia were found between subjects with or without HCA. Conclusions. HCA was not found to be a predictor of subsequent cognitive decline in this series. © 1997 John Wiley & Sons, Ltd.     

Does a carpal tunnel syndrome predict an underlying disease?

Carpal tunnel syndrome (CTS) may be the presenting symptom of an underlying disease such as diabetes mellitus, hypothyroidism or connective tissue disease (CTD). It was investigated whether additional blood tests (glucose level, thyroid-stimulating hormone level and erythrocyte sedimentation rate) are useful to detect diabetes mellitus, hypothyroidism or CTD in patients with CTS who have not been diagnosed with these diseases before. A group of 516 consecutive patients electromyographically diagnosed with CTS without known diabetes mellitus, hypothyroidism or CTD underwent blood tests and were followed up for incident diabetes mellitus, hypothyroidism or CTD to investigate whether these additional blood tests are useful to detect these diseases in patients with CTS. In our CTS population, only two patients were newly diagnosed with diabetes mellitus, two with hypothyroidism and none with CTD. In general, systematic screening for incident diabetes mellitus, hypothyroidism and CTD through additional blood tests seems to be of little additional value in otherwise typical cases of CTS.     

Neuromuscular electrical stimulation in early rehabilitation of Guillain-Barré syndrome: A pilot study

Introduction: In Guillain-Barré syndrome (GBS), patients often develop muscle atrophy from denervation and immobilization. We, therefore, conducted a pilot study of neuromuscular electrical stimulation (NMES) to evaluate feasibility, safety, and effect on muscle wasting in the early phase of GBS. Methods: Seventeen patients were randomized to receive 20 min of muscle fiber stimulation followed by 40 min of NMES of the right or left quadriceps muscle with the untreated side as control. Cross-sectional area (CSA) of the muscle measured by ultrasound and isometric knee extensor strength were the primary and secondary outcome measures. Results: No treatment related adverse effects were recorded. Change in CSA was -0.25 cm² (confidence interval [CI], -0.93–0.42) on the stimulated side versus -0.60 cm² (CI, -1.32–0.11) on the nonstimulated side (P = 0.08). No effect was observed on muscle strength. Conclusions: NMES seems safe and feasible in the early phase of GBS. Further studies are needed to explore effect on muscle function. Muscle Nerve 59:481–484, 2019     

Does neuropsychological performance impact on real-life functional achievements in obsessive-compulsive disorder? A preliminary study

Objective: We investigated the association between neuropsychological performance and real-life functioning in obsessive-compulsive disorder (OCD). As a secondary aim, we investigated the association between neuropsychological performance and self-reported quality of life (QoL).

Methods: We retrospectively selected 68 of 240 inpatients with OCD, who had been hospitalised for a 4-week psychiatric rehabilitation programme. We used clinical information recorded in the patients’ electronic medical records. We considered the following variables: neuropsychological performance (verbal/visual memory, sustained attention, visual-constructive ability, and language fluency; in a sub-sample of 37 subjects, divided attention, working memory, and attentional shifting were also available); real-life functional achievements (social/vocational outcomes and independent living); subjectively reported QoL (WHOQOL-BREF); obsessive-compulsive (OC) symptoms severity (DY-BOCS).

Results: We found significant associations between poorer neuropsychological performance and poorer achievements in independent living and vocational outcomes. Among the different neuropsychological tests, we found significant associations between language fluency/executive processing and independent living, and between divided attention, attentional shifting, working memory and vocational outcome. We found no significant associations between neuropsychological performance and subjectively reported QoL. OC symptoms severity was not associated with real-life functional achievements.

Conclusions: Our preliminary results suggest that poorer neuropsychological performance may be associated with impaired real-life functioning in subjects with OCD.