ACTIGRAPHIC EVIDENCE FOR NIGHT-TIME HYPERKINESIA IN PARKINSON’S DISEASE

Parkinson's disease is a common motor disorder that not only leads to motor symptoms but also autonomic dysregulation, mental changes, sensory disturbances, and sleep disorders such as increased daytime sleepiness and sleep fragmentation. The aim of this study was to find out how the daytime and night-time motor activity levels in individuals without motor disorders differ from patients with Parkinson's disease. Daytime and night-time motor activity levels in 17 PD patients and 69 controls were measured for three consecutive days and nights via actigraphy, a method of continuous long-term assessment of activity levels. A ratio between night-time and daytime motor activity was calculated. PD patients had a 1.5–2-fold lower daytime motor activity but also showed 1.5–2-fold higher motor activity at night time. Older controls showed a lower daytime but similar night-time motor activity when compared to younger controls. A ratio of night-time to daytime motor activity could clearly distinguish controls and patients. The possibility to distinguish patients and controls by the ratio of night-time to daytime motor activity is worth further investigation.     

EFFICACY OF MICROELECTRODE-GUIDED, POSTEROVENTRAL, UNILATERAL AND BILATERAL PALLIDOTOMY IN THE TREATMENT OF PARKINSON′S DISEASE

Objective: To investigate the short- and long-term efficacy of microelectrode-guided, posteroventral pallidotomy (PVP) in a large cohort of patients with advanced Parkinson's disease (PD). Background.: Advances in motor physiology, neuroimaging and neurosurgery have led to increased use of unilateral and bilateral PVP to treat patients with PD, particularly those with severe, medically intractable disease. Results from a prospective follow-up of a large series of patients are needed to establish the long-term efficacy and safety of PVP. Methods: We followed 101 consecutive patients who underwent PVP procedures performed at our center and returned for at least one post operative evaluation after 3 months. All had standardized clinical evaluations within 1 week before surgery and every 3 to 6 months after surgery. Data were collected during ′on′ and practically defined ′off periods for the Unified Parkinson′s Disease Rating Scale (UPDRS), Hoehn and Yahr stage, Schwab and England Activities of Daily Living (ADL) scale, and movement and reaction time. In addition, the severity and anatomic distribution of dyskinesia, neuropsychological status, average percent of ′on′ time with and without dyskinesia, and clinical global impression were assessed during a longitudinal follow-up. Results.: Eighty-nine patients (46 men) underwent unilateral PVP while 12 patients (6 men) had staged bilateral PVP. At 3 months after unilateral or staged bilateral PVP, 84 of the 101 patients reported marked or moderate improvement in their parkinsonian symptoms. Postoperative UPDRS mean total motor score improved in the 'off state by 35.5% and the mean ADL score by 33.7% (p＜0.001). Rigidity, b radykinesia, and tremor scores also markedly improved after PVP, particularly on the contralateral side. Levodopa-induced dyskinesia was markedly reduced while daily 'on′ time increased by 34.5% (p＜0.001). Seven patients had transient peri-operative complications including confusion, expressive aphasia, pneumonia, and visual changes. Improvements in parkinsonian symptoms were maintained in both ‘off’ and ‘on’ states in 67 patients at 12 months after PVP and in 46 patients who were followed for a mean period of 26.3 months. Patients who underwent staged bilateral PVP benefited further from the second procedure. Five of 12 patients experienced some adverse event. Conclusion.: Based on this large series of patients with extended follow-up, we conclude that PVP is an effective and relatively safe treatment for medically resistant PD, especially for dopa-induced dyskinesia, tremor, rigidity, and bradykinesia. Motor fluctuations also improved. Benefits are most noticeable on the side contralateral to the PVP. Clinical improvement has been sustained for longer than 2 years.     

INFLUENCES OF PATIENTS’ AND THERAPISTS’ INTERPERSONAL PROBLEMS AND THERAPEUTIC ALLIANCE ON OUTCOME IN PSYCHOTHERAPY

Abstract

The aim of this study was to investigate the importance of therapists’ and patients’ interpersonal problems as well as the impact of the therapeutic alliance on symptomatic outcome in psychotherapy. Of interest were direct effects of interpersonal problems, represented through the dimensions of affiliation and control, as well as possible interaction effects between patient and therapist variables on outcome. Further hypotheses referred to therapist differences in the predictive impact of the therapeutic alliance for outcome. Outcome ratings of 1,513 psychotherapy inpatients treated by 31 psychodynamically oriented individual psychotherapists were studied. Therapists’ and patients’ interpersonal dispositions were assessed with the Inventory of Interpersonal Problems, and patients answered standardized outcome measures before and after therapy and retrospectively evaluated the therapeutic alliance at discharge. The results indicate that dominant patients profited better from their therapy and that therapists’ interpersonal disposition did not have a direct influence on outcome. The influence of the therapeutic alliance on outcome varied among the therapists. The general positive effect of therapeutic alliance on outcome was stronger for less affiliative therapists. Limitations of the study and implications of the results are discussed.     

CORRELATIVE STUDY OF THE COGNITIVE IMPAIRMENT,REGIONAL CEREBRAL BLOOD FLOW,AND ELECTROENCEPHALOGRAM ABNORMALITIES IN CHILDREN WITH DOWN’S SYNDROME

The aim of this study was to investigate possible correlations of the cognitive impairment with abnormalities of regional cerebral blood flow and electroencephalogram in children with (Down's Syndrome) DS. Nine patients with DS were evaluated by single photon emission computed tomography (SPECT) in combination with clinical findings, electroencephalography (EEG), and magnetic resonance imaging (MRI). In cases with IQs below 40, there were one or more findings of abnormal EEG/MRI and brain perfusion SPECT. In 6 cases (66.7%) EEG findings were normal, but 3 (33.3%) had abnormal EEG findings. Perfusion abnormalities were most pronounced in the fronto-parieto-temporal region in the form of hypoperfusion (n = 5) and in the right hemisphere (n = 5) than the left hemisphere (n = 1). These findings suggest that the children with DS had varying levels of structural, perfusion, and electrophysiological abnormalities in the brain and these abnormalities were reflected by measurable alterations of the cognitive functions.     

THE RESEARCH ON MECHANISMS OF AMYLOID- β PROTEIN INDUCING ALZHEIMER'S DISEASE IN RAT AND EFFECTS OF NIMODIPINE TREATMENT

0bjective In order to clarify the mechanism of the neurotoxics of Aβ, we studied the effects on the rCBF, extra-cellular amino acid (EAA), apoptosis and Bcl-2 protein expression, and their relationship with learning and memory deficiency. Methods Aβ was injected into NBM in rats to establish the AD model, learning and memory abilities were observed by Y-maze. The rCBF was measured by hydrogen clearance method. The EAA was detected by microdialysis in vivo with HPLC. The apoptosis and Bc1-2 protein expression was examined by flow cytometry. The male SD rats were divided into three groups: the model group was injected Aβ (10 μ g) into NBM of the rat. The control group was injected NaC1 (0.9%) in the same way. The treatment group was made with intraperitoneal injections of Nimodipine for 2 weeks after A β injections. Results The administration of Aβ into rat′s NBM could lead to the loss of learning and memory abilities. It was found that in frontal cortex and hippocampus, the rCBF decrease, however, with no trend of progressive decline. On the other hand, the levels of EAA increased, especially glutamate. Furthermore, A β significantly induced neurons apoptosis of frontal cortex and hippocampi cell, and upregulated the expression of the bcl-2. The Nimodipine might entirely improve rCBF of AD rats nearly to normal level, lessen the release of EAA and augment restrain neurotransmission. It might reduce the apoptosis partly, but it couldn't improve the learning and memory disorders completely. Conclusion The results implied that the neurotoxic effect of Aβ exists multi-mechanism.     

GENERAL PSYCHIATRISTS AND THEIR PATIENTS’ CHILDREN: ASSESSMENT AND PREVENTION

  General psychiatrists frequently treat adult patients with Major Depressive Disorder. Ordinarily, these psychiatrists focus solely on the treatment of their adult patients. However, new data suggest that treatment efforts might be doubly rewarded if psychiatrists tended to the children of these patients as well. This article reviews the literature on children whose parents have Major Depressive Disorder, and on preventive interventions for their children. We also review challenges to funding interventions of this sort based on systematic interviews of public and private insurance providers. We suggest a new standard of care for depressed patients: reliable screening of the patients’ children for both risk of disorder and resilience as well as referral of these children, where indicated, for prevention services. We review obstacles to this standard of care: the professional reluctance of general psychiatrists to work with children and the lack of screening and preventive services for these children in most practice settings.     

SPECIFIC MECHANISM FOR BLOOD INFLOW STIMULATION IN BRAIN AREA PRONE TO ALZHEIMER’S DISEASE LESIONS

The present study describes the specific two-stage mechanism that intensifies blood supply to the brain area comprising amygdala, hippocampus, olfactory bulb, entorhinal cortex, and neocortex (AHBC). Cholinergic neurons from the nuclei of basal forebrain induce vasodilatory effect through release of acetylcholine. In physiological aging the efficacy of this neuronal system declines, while intensive formation of amyloidogenic peptides starts. These peptides at low, picomolar concentrations activate alpha7 nicotinic acetylcholine receptors, thus enhancing angiogenesis and in so doing restoring blood supply to the AHBC area.     

MYASTHENIA GRAVIS ACCOMPANIED BY THYMOMAS NOT RELATED TO FOAMY VIRUS GENOME IN BELARUSIAN’S PATIENTS

The spectrum and features of neurological disorders have been changed due to the Chernobyl catastrophe in the Republic of Belarus. More recently neurologists in Belarus have noted a significant increase in the frequency of myasthenia gravis (MG) with concomitant rise in the thymomas. There is some evidence suggesting that retroviruses play a key role in the development and pathogenesis of autoimmune diseases. This study analyzed thymomas from 45 MG patients from the Republic of Belarus by using PCR and primers for two regions of FV—gag and bel-2 genes. The results showed that none of the varied thymuses from the 45 MG patients contained FV genome. No relationship can be confirmed between FV and this disease and the results suggest that no pathological link between FV and MG exists.     

CAN FRONTOTEMPORAL DEMENTIA AND ALZHEIMER'S DISEASE BE DIFFERENTIATED USING A BRIEF BATTERY OF TESTS?

Objective. To compare the performance of patients with frontotemporal dementia (FTD) and Alzheimer's disease (AD) on a range of simple neuropsychological tests. Design. A battery of neuropsychological tests easily applied at the bedside, consisting of traditional tests of memory, attention and executive function, were given together with tests of motor sequencing and examination of frontal release signs. In addition, we devised a theoretically motivated test of dual attention—a story with distraction which also contained a ‘social dilemma’. Setting. Specialist memory and cognitive disorders clinic. Patients. 12 patients with FTD and 12 patients with AD, matched for overall level of dementia on the Mini-Mental State Examination, were selected. Results. In general, the difference in results between FTD and AD patients was small. However, a composite score derived from the presence of a grasp and pout reflex, the number of perseverations during category fluency for animals and response to the social dilemma within the two stories produced a sensitivity of 83.3% and specificity of 91.6%. There was also a highly significant difference between patients with FTD and AD in scores achieved on the Clinical Dementia Rating Scale reflecting the marked change in behaviour that patients with FTD suffer, even at a stage when memory functions are well preserved. Conclusion. Traditional neuropsychological tests were poor at differentiating cases of FTD and AD; however, a composite (SIFTD) score appears potentially useful but requires prospective validation. Better methods of assessing the changes in comportment that characterize the early stages of FTD are required. © 1997 by John Wiley & Sons, Ltd.     

BEHAVIORAL AND NEUROCHEMICAL EFFECTS OF THE INTRAHIPPOCAMPAL CO-INJECTION OF ß-AMYLOID PROTEIN1-40 AND IBOTENIC ACID IN RATS

The authors investigated the effects of bilateral intrahippocampal co-injection of Aβ1-40 (4 µg for each side) with ibotenic acid (Ibo, 2 µg for each side) on rats' performance in the open field behavior, Y-maze, and passive avoidance task, and also examined some neurochemical changes in hippocampus two weeks after the co-injection. The results showed that the co-injection of Aβ1-40 with Ibo induced a decrease in exploratory activity and a significant decline in learning-memory ability of the tested rats (p <. 01). The neurochemistry changes induced by the co-injection included a significant decreased in membrane fluidity of hippocampal mitochondria (p <. 01), a significant decrease in the activity of SOD (p <. 01), and a remarkable increase in the content of MDA (p <. 01). These results suggest that the co-injection of Aβ1-40 with Ibo may induce an increase of hippocampal damage by peroxidation, and a serious learning and memory impairment of the rats. The results also suggest that the co-injection of Aβ1-40 with Ibo may provide a useful animal model for Alzheimer's disease (AD) research.     

IS THERE ANY DIFFERENCE IN THE EFFECTS OF QI THERAPY (EXTERNAL QIGONG) WITH AND WITHOUT TOUCHING? A PILOT STUDY

The aim of this study was to evaluate differences in the effects of Qi therapy without touching or with touching on anxiety, mood, neurohormones, and cellular immune function. Twenty-four healthy male subjects were randomly assigned to either QTN (n = 12) or QTT (n = 12). They received Qi therapy (external Qigong) without touching (QTN) or with touching (QTT). Nonparametric statistical tests revealed no significant differences between the effects of QTN and QTT (all p > .05). Separate Wilcox signed rank tests for each intervention revealed significant effects on anxiety, alertness, depression, fatigue, tension, cortisol levels, and NK cell cytotoxicity for both QTN and QTT, and on neutrophil function for QTN only. These findings suggest that there are few differences between the effects of QTN and QTT. However, the reproducibility of the findings should be tested with multiple sessions, and long-term follow-up tests.     

IMPACT OF DIFFERENT INJURY SITES IN S-D RATS’ OCULOMOTOR NERVES

目的：研究不同部位损伤对Sprague-Dawley(以下简称S-D)大鼠动眼神经功能修复的影响及可能机制。方法：经幕下和眶上裂切断和修复动眼神经,术后通过前庭眼反射评估眼外肌在垂直、水平方向的恢复程度,经右侧上直肌注射HRP逆行追踪中脑动眼神经核团内神经元分布,动眼神经组织学、解剖学研究。结果：经眶上裂干预动眼神经的实验组大鼠新生神经纤维对眼外肌支配的特异性较高,其眼外肌功能恢复程度明显优于经幕下干预动眼神经的实验组大鼠。结论：动眼神经损伤部位距离眼外肌越近,最终的神经功能恢复水平就越好,其机理可能与再生神经纤维通过损伤部位时的迷行程度有关。