Anosmia in dementia is associated with Lewy bodies rather than Alzheimer's pathology

OBJECTIVES: To assess olfactory function of patients with dementia. Odour detection ability is impaired in clinical Parkinson's disease. Evidence of impaired detection in patients with clinically diagnosed Alzheimer's disease is inconsistent. No studies of olfaction have been neuropathologically validated. METHODS: The olfactory function of 92 patients with dementia and 94 controls was assessed using a simple bedside test as part of the Oxford Project To Investigate Memory and Ageing (OPTIMA). Neuropathological assessment was made of cortical Lewy bodies and substantia nigra (SN) cell counts and of Alzheimer's disease in all 92 patients, 22 of whom had SN Lewy bodies and 43 of whom had only Alzheimer's disease. RESULTS: Patients with Lewy bodies were more likely to be anosmic than those with Alzheimer's disease or controls. Patients with Alzheimer's disease were not more likely to be anosmic than controls. Nor was anosmia associated with degree of neurofibrillary tangles, as assessed by Braak stage. Among subjects with Lewy bodies, overall cortical Lewy body scores and Lewy body density in the cingulate were higher in those who were anosmic. Consensus clinical criteria for dementia with Lewy bodies had a sensitivity of 64% and specificity of 89%. In the absence of definite Alzheimer's disease, the criteria had sensitivity of 100%. In patients with definite Alzheimer's disease, anosmia was slightly more sensitive (55%) than the consensus criteria (33%). However, the addition of anosmia to the consensus criteria did not improve their overall performance. CONCLUSION: Dementia with Lewy bodies is associated with impaired odour detection. Misdiagnosis may have accounted for some previous reports of impaired odour detection in Alzheimer's disease. Simple but more sensitive tests of anosmia are required if they are to be clinically useful in identifying patients with dementia with Lewy bodies.     

Sleep duration rather than sleep timing is associated with obesity in adolescents

ObjectiveIn this study, we investigated differences in sleep patterns between obese and non-obese adolescents, and determined which sleep-related parameters were associated with a risk of adolescent obesity.MethodsIn this cross-sectional study, we evaluated 22,906 adolescents between 12 and 18 years of age (mean 15.2 ± 1.7 years; male 50.9%). Self-report questionnaires were used to assess body mass index (BMI) and sleep habits. Obesity was defined as a BMI-for-age ≥ 95th percentile. Weekend catch-up sleep (CUS) duration was calculated as the sleep duration on free days minus sleep duration on school days. We estimated mid-sleep time on free days corrected for oversleep on free days (MSFsc) and social jet lag. Then, we performed multivariate analysis for adolescent obesity and BMI, respectively.ResultsThe prevalence of obesity was 6.0%. The average sleep duration (P = 0.017) and weekend CUS duration (P < 0.001) of obese adolescents were shorter than those of non-obese adolescents. However, there was no significant difference in MSFsc or social jet lag by the obesity status. After adjustment, obesity was significantly associated with short average sleep duration (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86–0.96) and short weekend CUS duration (OR 0.92, 95% CI 0.89–0.95). Similarly, BMI was inversely correlated with average sleep duration (B = −0.15, 95% CI -0.19 to −0.11) and weekend CUS duration (B = −0.09, 95% CI -0.11 to −0.06).ConclusionsOur observations suggest that short sleep duration, rather than late MSFsc or social jet lag, was associated with adolescent obesity.     

Perceived rather than actual overweight is associated with mental health problems in adolescence

Background: Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear.

Aims: The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disorders among adolescents.

Methods: Data were collected by two similar school surveys in all Finnish-speaking secondary schools in Tampere (population 200,000) in the academic years 2002–2003 and 2012–2013. A total of 2775 acceptable responses were received. All the analyses were carried out separately for girls and boys. Mean age of the respondents was 15.6 years.

Results: In multivariate analyses perceived overweight, not actual weight, was significantly associated with higher risk of self-reported depression (OR: 4.3, 95% CI: 2.9–6.3, p?p?p?=?.001) and self-reported social phobia (OR: 2.4, 95% CI: 1.0–5.6, p?=?.05) in boys.

Conclusion: Perceived overweight rather than actual weight status is associated with both internalizing and externalizing mental health problems in adolescents.     

Bipolar sensation seeking is associated with a propensity to abuse rather than to temperamental characteristics.

OBJECTIVE: As some temperament profiles may be markers of genetic vulnerability traits, we aimed to compare sensation seeking in euthymic bipolar patients and in controls. METHODS: One hundred ninety-four patients fulfilling DSM-IV diagnostic criteria for bipolar disorders (BP), 81% of whom presented type I BP, and 95 controls were included in this study. Euthymia was assessed using both the MADRS and Bech mania scales. Subjects were evaluated using the French abbreviated form of Zuckerman's Sensation Seeking Scale (SSS), which provide a total score (TS) and four subscores: Thrill and Adventure Seeking (TAS), Experience Seeking (ES), Disinhibition (Dis), and Boredom Susceptibility (BS). RESULTS: SSS total score differed significantly between men (17.2 +/- 0.5) and women (15.3 +/- 0.6) (P = 0.02) and all the subscores were negatively correlated with age. On adjustment for sex and age, we found that bipolar patients had a high Dis score (P = 0.003). However, if the same analysis was performed with a lifetime history of alcohol abuse or dependence as a covariable, no such difference was found (P = 0.436). The SSS demonstrated a high degree of test-retest reliability (ICC = 0.91). CONCLUSION: These results suggest that sensation seeking assessed with the SSS is not a temperament characteristic associated with bipolar disorders but is instead linked to a tendency towards alcohol abuse.     

Recovered memory experience in a nonclinical sample is associated with dissociation rather than with aversive experiences

Different hypotheses exist for the relationship among trauma, dissociation, and recovered memory. According to one view, recovered memory results from dissociation that a survivor adopts as a defense mechanism during a traumatizing event to avoid emotional pain. From this perspective, trauma is a necessary antecedent to relate dissociative symptoms with recovered memory. Another view emphasizes the characteristics of the victim, such as fantasy proneness and atypical cognitive operations. This alternate view holds that trauma is not necessary in relating dissociation to recovered memory. We tested these two hypotheses, measuring recovered memory, dissociative symptoms, childhood interpersonal adversity, and fantasy proneness in a nonclinical sample of college students. Our results showed a significant correlation between recovered memory and dissociative symptoms; the correlation cannot be accounted for by childhood interpersonal adversity, fantasy proneness, or absorption. Recovered events can be negative, neutral, or even positive. Trauma is not necessary in relating recovered memory to dissociative symptoms.     

Brain prolyl oligopeptidase activity is associated with neuronal damage rather than beta-amyloid accumulation.

Prolyl oligopeptidase (POP) have been suggested to participate in the pathogenesis of Alzheimer's disease (AD). In this study the activity of POP is evaluated in AD patients and in transgenic mice with substantial deposits of beta-amyloid (Abeta). In AD cases, the POP activity displayed a significant negative correlation with the scores of senile/neuritic plaques and neurofibrillary tangles but not with Abeta-load. The transgenic mice with high levels of Abeta did not have altered POP activity compared to wild type mice. Based on our results, the low POP activity in AD seems to be associated with neuronal degeneration rather than to Abeta accumulation.     

Assessment of psychiatric patients' competency to give informed consent: legal safeguard of civil right to autonomous decision-making

Amendment of the Mental Health and Welfare Law in Japan will limit admission for medical care and protection only for those individuals who are incapable of giving consent to admission. This is a first in the history of the Japanese mental health legislation. By reviewing the law and psychiatric literature, it is argued that: (i) informed consent is a legal transaction that embodies the idea of an individual's right to autonomous decision-making in medical settings; (ii) health professionals have a duty to protect those individuals who cannot decide medical matters because of lack of capacity to do so; (iii) some patients are marginally incompetent so assessment of their competency is essential in protecting patients' civil rights; (iv) in order for a competency assessment to be reliable (and hence fair) the method should be psychometrically sound; (v) at the same time, in order for a competency assessment to be valid, the structure of a competency assessment should match the patient's psychological, cultural, and social background; and (vi) because informed consent is a process rather than a cross-sectional event, a competency assessment should be performed in everyday practice. The use of a brief and semistructured interview to assess patients' competency to give informed consent may meet all of the requirements described.     

Quality of life outcome is associated with cessation rather than reduction of psychogenic nonepileptic seizures

The outcome of psychogenic nonepileptic seizures (NES) is usually judged by recurrence of spells, but functional outcome or quality of life (QOL) is less well described. We tested the hypothesis that a decrease in NES recurrence yields corresponding improvement in QOL. Patients with NES were diagnosed with continuous video-EEG. We determined spell rate and QOL through a telephone interview at least six months after diagnosis. Thirty subjects consented to a follow-up interview (mean 17.4+/-1.5 months between diagnosis and interview). The rate of NES per week decreased significantly, and 10/30 (33%) had complete resolution. QOL, measured by the QOLIE-10 scale, did not improve proportionately with reduction in NES. However, subjects who reported a cessation of NES noted a significantly better total QOLIE-10 score (20.7+/-2.2) than those with continuing NES (27.4+/-1.6, P=0.02 by unpaired t test). Cessation rather than reduction of NES is associated with better QOL outcome.     

Sleep disturbances: Core symptoms of major depressive disorder rather than associated or comorbid disorders

Depression is increasingly prevalent in Western countries. It has severe consequences and is associated with increased rates of disability, morbidity, and mortality. Despite numerous therapeutic options, a great number of depressed patients do not achieve full remission. In addition, despite good short-term outcomes, long-term therapeutic results remain disappointing and associated with a poor prognosis, raising significant concern in terms of public health. Impaired sleep – especially insomnia – may be at least partly responsible for this problem. Very close relationships between major depressive disorder (MDD) and sleep disorders have been observed. In particular, residual symptoms of sleep disturbance in a remitted patient may predict a relapse of the disease. However, most currently available antidepressants do not always take into consideration the sleep disturbances of depressed patients; some agents long used in clinical practice even appear to worsen them by their sleep-inhibiting properties. But some other new medications were shown to relieve early sleep disturbance in addition to alleviating other depression-related symptoms. This positive impact should promote compliance with medication and psychological treatments, and increase daytime performance and overall functioning. Complete remission of MDD appears therefore to depend on the relief of sleep disturbances, a core symptom of MDD that should be taken into consideration and treated early in depressed patients.     

The Hopkins Competency Assessment Test: a brief method for evaluating patients' capacity to give informed consent.

The Hopkins Competency Assessment Test (HCAT), a brief instrument for evaluating the competency of patients to give informed consent or write advance directives, consists of a short essay and a questionnaire for determining patients' understanding of the essay. In a study to validate the instrument, 41 medical and psychiatric inpatients answered the questionnaire after reading the essay while bearing it read aloud. A forensic psychiatrist who was blind to the HCAT scores later examined the patients for competency. A subject's number of correct answers to the HCAT questionnaire was an accurate indicator of clinical competency as assessed by the psychiatrist. The results suggest that the HCAT is a useful tool for rapidly screening patients for competency to make treatment decisions.     

Perisomatic thalamic axotomy after diffuse traumatic brain injury is associated with atrophy rather than cell death

Morbidity and mortality associated with traumatic brain injury (TBI) stem from diffuse axonal injury (DAI) throughout subcortical and brainstem white matter and subcortical nuclei. After midline fluid percussion brain injury, DAI in the thalamus includes perisomatic axotomy and resembles human post-traumatic pathology where the degree of morbidity correlates with thalamic damage. After axotomy, acute somatic perturbations resolve and appear compatible with cell survival; however, the long-term fate of neurons in an area with perisomatic axotomy is unknown. From brain-injured and uninjured rats at 1, 7 and 28 days after injury (injury, n = 5/group; sham, n = 4), alternate sections were immunostained for amyloid precursor protein (APP) to detect perisomatic axotomy or Giemsa stained for quantification of neuronal number, neuronal density, regional volume, and neuronal nuclear volume using design-based stereology. One day postinjury, APP-immunoreactive axons were identified consistently within the perisomatic domains of thalamic neurons of the ventral basal complex. Bilateral systematic-random quantification of the ventral basal complex indicated a significant reduction in neuronal density (number per mm, but not number alone) at 1 week after injury, compared with sham and 1 day postinjury. Furthermore, by 1 day and persisting through 1 week after injury, the mean neuronal nuclear volume was atrophied significantly compared with sham. Therefore, diffuse TBI results in early perisomatic axonal injury followed by neuronal atrophy in the ventral basal complex, without gross degeneration. Enduring atrophy in thalamic relays could underlie circuit disruption responsible for post-traumatic morbidity.     

Trauma exposure rather than posttraumatic stress disorder is associated with reduced baseline plasma neuropeptide-Y levels.

BACKGROUND: Exposure to uncontrollable stress reduces baseline plasma neuropeptide-Y levels in animals. We previously reported that baseline plasma neuropeptide-Y levels, as well as neuropeptide-Y responses to yohimbine, were lower in combat veterans with posttraumatic stress disorder, but we were unable to determine whether this was attributable to posttraumatic stress disorder or trauma exposure. The current report addresses this issue. METHODS: A) Baseline plasma neuropeptide-Y levels were measured in 8 healthy combat veterans compared to 18 combat veterans with posttraumatic stress disorder and 8 healthy nontraumatized subjects; and B) Baseline plasma neuropeptide-Y levels, trauma exposure, and posttraumatic stress disorder symptoms were assessed in 41 active military personnel. RESULTS: Plasma neuropeptide-Y was negatively associated with trauma exposure but not posttraumatic stress disorder symptoms in active duty personnel. Baseline neuropeptide-Y was reduced in combat veterans with and without posttraumatic stress disorder. CONCLUSIONS: Trauma exposure rather than posttraumatic stress disorder is associated with reduced baseline plasma neuropeptide-Y levels. Future studies must determine if neuropeptide-Y reactivity differentiates trauma-exposed individuals with and without posttraumatic stress disorder.