White matter hyperintensities and their association with suicidality in depressed young adults

INTRODUCTION: Researchers and clinicians have increasingly recognized that biological markers may help identify patients who are at risk for suicide. The objective of this retrospective, cross-sectional study was to compare the prevalence and location of white matter hyperintensities (WMH) in young inpatients with major depressive disorder (MDD) with and without histories of suicide attempts. METHODS: T2-weighted magnetic resonance images (MRI) of 102 young psychiatric inpatients with MDD were rated for the presence of WMH. Medical charts were reviewed to ascertain history of suicide attempt, demographic and clinical variables. Fisher's Exact Tests and logistic regression modeling were used to test the association between WMH and suicidality. RESULTS: Bivariate analysis showed that the prevalence of periventricular WMH was significantly higher in subjects with past suicide attempts (Fisher's Exact Test, p=0.02). Logistic regression analyses controlling for age, sex, and several clinical risk factors supported this finding (odds ratio=5.7; 95% confidence interval: 1.6, 21.2). LIMITATIONS: Due to the retrospective, cross-sectional design of our study, we are unable to determine if the WMH preceded or followed past suicide attempts. The generalizability of our findings is limited since this group of inpatients is more severely ill than the general psychiatric population. CONCLUSIONS: The increased prevalence of periventricular WMH in young adults with MDD and a history of suicide attempt, compared to similarly depressed adults without such a history, is consistent with our findings in children and youth, and suggests there might be neurobiological in addition to psychosocial risk factors for suicide.     

Memory-for-designs test: Comparison of performance of young and old adults

Administered the Graham-Kendall MFD test to 80 normal male Ss, who ranged in age from 21 to 90 years. While no significant decline in performance occurred in Ss up to age 50, the older groups, 40 Ss 60 years and older, differed significantly in error scores from Ss 50 years and younger, p < 0.001. As older Ss were given complete neurological examinations and visual acuity was evaluated carefully, the results suggest that decline in MFD performance after the age of 60 is sufficient to suggest caution in the use of the test by present interpretation for the evaluation of brain damage in the older patient.     

Constraining eye movement when redirecting walking trajectories alters turning control in healthy young adults

Humans use a specific steering synergy, where the eyes and head lead rotation to the new direction, when executing a turn or change in direction. Increasing evidence suggests that eye movement is critical for turning control and that when the eyes are constrained, or participants have difficulties making eye movements, steering control is disrupted. The purpose of the current study was to extend previous research regarding eye movements and steering control to a functional walking and turning task. This study investigated eye, head, trunk, and pelvis kinematics of healthy young adults during a 90° redirection of walking trajectory under two visual conditions: Free Gaze (the eyes were allowed to move naturally in the environment), and Fixed Gaze (participants were required to fixate the eyes on a target in front). Results revealed significant differences in eye, head, and trunk coordination between Free Gaze and Fixed Gaze conditions (p < 0.001). During Free Gaze, the eyes led reorientation followed by the head and trunk. Intersegment timings between the eyes, head, and trunk were significantly different (p < 0.05). In contrast, during Fixed Gaze, the segments moved together with no significant differences between segment onset times. In addition, the sequence of segment rotation during Fixed Gaze suggested a bottom-up postural perturbation control strategy in place of top-down steering control seen in Free Gaze. The results of this study support the hypothesis that eye movement is critical for the release of the steering synergy for turning control.     

Short-term dietary compensation in free-living adults

Evidence suggests that compensatory behaviors operate in infants and pre-school children, such that the high variance characteristic of single eating occasions is much reduced over the day. However, the concept has not been fully explored in adults. The present within-subject, observational study investigated short-term dietary compensation patterns in fifty, weight-stable, normal weight (n=27), overweight (n=14), and obese (n=9) free-living adults (11 M, 39 F; age 30+/-11 y; BMI 26.3+/-5.9). Twenty four-hour diet recalls were obtained for 7 consecutive days, by the multi-pass technique. Each 24-h period was divided into 7 eating occasions. The coefficient of variation for energy intake was calculated for each adult, for each eating occasion, and over each 24-h period. Sub-group variability was assessed by BMI and frequency of consumption of sweetened energy-yielding beverages. The mean coefficient of variation for energy intake for the 7 eating occasions was 110.5%, compared to 28.9% for the day as a whole. Correlations between energy intakes at successive eating events were uniformly negative. No significant differences were noted in the sub-group analyses. Significantly greater variation in energy intake was noted for snacks compared to meals (P<0.0001). These data suggest that adults regulate energy intake over a 24-h period more closely than they do at individual eating occasions, similar to the pattern previously observed in children. Further studies of compensatory responses by larger sub-groups of individuals at risk for weight gain are warranted.     

Comparison of coronary heart disease risk factors in autopsied young adults from the PDAY Study with living young adults from the CARDIA study.

BACKGROUND: Disease is sometimes best studied by examination of tissue obtained from autopsied individuals. Results derived from autopsied persons are considered biased because many factors influence the decision to perform an autopsy, and variables measured postmortem may be affected by changes immediately prior to death and emergency medical treatment. METHODS: The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study measured coronary heart disease risk factors postmortem in autopsied young adults 23-34 years of age dying from external causes (accidents, homicides, suicides). The Coronary Artery Risk Development in Young Adults (CARDIA) study measured risk factors in living subjects of similar ages. RESULTS: Within sex, race, and age groups, the differences in body mass index between PDAY and CARDIA were significant but small. The prevalences of hyperglycemia/diabetes within sex, race, and age groups were similar in PDAY and CARDIA; overall, blacks in PDAY, but not in CARDIA, had a higher prevalence than whites. Serum lipoprotein concentrations were slightly and significantly higher and significantly more variable in PDAY subjects than in CARDIA subjects; the greater variability was interpreted as due primarily to emergency medical treatment. Prevalences of smoking and hypertension were substantially higher in PDAY subjects. CONCLUSIONS: Although there were statistically significant differences, the overall similarity of the risk factors in the two studies supports the validity of investigating associations of risk factors measured postmortem with anatomically determined arterial lesions in autopsied young adults dying from external causes. The greater variability in postmortem serum measurements attenuates but does not obscure associations.     

Daytime sleepiness in young adults

The daytime sleepiness of a large sample (n = 129) of healthy, young (age 18-29) adults with no sleep-wake complaints was measured and compared with that of a sample (n = 47) of older (age 30-80) healthy, normal sleeping, subjects. Each spent 8 h in the laboratory on 1 night and received the Multiple Sleep Latency Test (MSLT) the following day. Sleep latency was measured at 1000, 1200, 1400, and 1600 h. Mean sleep latency ranged from 2 to 20 min within each group, but the shape of the distribution of latency between groups was different. The mean latency of young subjects (particularly college students) was shorter than that of the older subjects, with the differences occurring between the sleepiest 80% of each distribution. Among the college students, those with higher nocturnal sleep efficiencies (the previous night) were sleepier the following day than those with lower sleep efficiencies. The relation between nocturnal sleep efficiency and daytime sleepiness suggests that the increased sleepiness of average young adults is due to mild sleep restriction.     

Comparison of respiratory syncytial virus humoral immunity and response to infection in young and elderly adults.

Little information about immunity to respiratory syncytial virus (RSV) and disease pathogenesis in elderly persons exists. Humoral immunity to RSV was assessed in 41 young, 56 healthy elderly, and 49 frail elderly adults by measuring baseline RSV specific IgG by enzyme immunoassay (EIA) and microneutralization assay (MNA) in serum. A comparison of the immune response of 11 young and 28 elderly persons with natural RSV infection was also performed. Despite significant differences in age and functional status, no decreases in RSV antibody levels by either EIA or MNA were noted in the elderly compared with the young. Mean baseline MNA titers expressed as log2 were 10.5 +/- 1.1 for the young, 10.5 +/- 1.5 for the healthy elderly, and 10.9 +/- 1.6 for the frail elderly. The frail elderly who attend a daycare had the highest RSV titers to F by EIA at 16.6 +/- 2.0, compared with 15.4 +/- 1.4 and 15.1 +/- 1.4 in the healthy elderly and young, respectively. This finding may reflect recent infection due to their communal setting or increased production of non-neutralizing antibody. The immune response of older persons to RSV infection was as vigorous as the younger subjects, with 79% having a >/=fourfold rise in MNA titers compared to 64% in the young. These data suggest that the severe clinical manifestations of RSV in the elderly are not due to a significant defect in humoral immunity.     

Comparison of pneumococcal polysaccharide and CRM197-conjugated pneumococcal oligosaccharide vaccines in young and elderly adults.

Conjugation of carbohydrate antigens to protein carriers significantly improves the immune response to many carbohydrates. In order to evaluate the potential for this approach to improve the performance of pneumococcal vaccine in the elderly, we evaluated pneumococcal polysaccharide-derived oligosaccharides conjugated to cross-reacting material 197 (CRM197) (CRM-OS) in 49 older adults over 60 years of age (median age, 66 years) and compared the results to those from 50 younger adults under age 45 (median age, 27 years). Subjects were randomly assigned to receive licensed 23-valent polysaccharide vaccine (PS) which contain 25 micrograms of polysaccharide per serotype, or 5-valent CRM-OS, which contains 10 micrograms of oligosaccharide per serotype, in double-blind fashion. Both vaccines were associated with moderate local pain on administration. Antibody responses to type 14 were seen in the majority of both younger and older subjects following administration of both CRM-OS and PS, and there was no significant improvement of responses with CRM-OS in either age group. Antibody responses in young adults to the less immunogenic type 6B were seen in only 36% of subjects receiving PS and in 56% of subjects receiving CRM-OS (P = 0.15), and the geometric mean 6B titer 1 month after vaccination was higher in CRM-OS recipients (10.9 versus 3.7 micrograms/ml; P = 0.04). However, 6B responses were poor following the administration of either vaccine to elderly adults and there was no difference between results with CRM-OS and those with PS in this age group. Relatively few subjects developed measurable mucosal immunoglobulin A responses in nasal secretions following administration of either vaccine. Revaccination of CRM-OS recipients with PS at 2 months did not result in significant additional responses to 6B or 14. Though CRM-OS is possibly more immunogenic in young adults, the formulation of the pneumococcal glycoconjugate vaccine used in this study does not appear to offer an advantage to the elderly for types 6B or 14.     

Neuropsychology of self-awareness in young adults

Disorders of self-awareness are common following cortical damage, particularly to the frontal lobes, but there have been few studies of individual differences in self-awareness in the normal population. In the current study, we explored patterns of metacognitive awareness among healthy young adults, based on discrepancies of self- and other-ratings on the Frontal Systems Behavior Scale (FrSBe; Grace and Malloy, 2002). Those who showed poor metacognitive awareness showed more frequent lapses of attention, and higher levels of everyday absentmindedness, than those who accurately appraised their own behavior or those who overestimated their own FrSBe scores. Furthermore, among those with poor metacognitive awareness, online emergent awareness correlated positively with prospective memory performance, and negatively with anxiety scores. Our results suggest that accurate self-awareness in non-neurological participants relies on efficient sustained attention functioning, supporting the role of frontal control systems in neuroanatomical models of self-awareness.     

Loneliness and attachment patterns in young adults

Loneliness is a pervasive problem for many young adults. How early attachment patterns affect later development of loneliness was investigated in a college sample. Forty-seven young adults residing in Los Angeles were screened for race, disability, age and SES and then administered an attachment history questionnaire and several measures of loneliness, including the Revised UCLA Loneliness Scale. Pearson correlations revealed a moderate to strong relationship between feeling lonely and early disrupted attachment. The results of the study are consistent with Bowlby's notion that underlying attachment disorders may affect subsequent psychological development and social behavior.     

Immobilization effects in young and older adults

This experiment compared the effects of disuse on the adductor pollicis (AP) muscle in young (YM) and old (OM) men. The AP of the YM and OM was assessed for strength (MVC), compound muscle action potential (CMAP), and volume, and then immobilized for 2 weeks. MVC decreased ~22% in the YM, and OM (P<0.001). AP volume was 4.1% (not significant) and 9.5% (P<0.05) less in the YM and OM, respectively. CMAP increased in the OM 0, 24, and 48 h post-immobilization, and did not change in the YM. However, the YM showed a greater decrease in specific force as compared to the OM. YM and OM experienced similar losses in strength, yet muscle volume loss was only significant in OM. Although OM are more susceptible to immediate losses in muscle volume, muscle activation strategies appear to preserve strength during atrophy.     

Characterization of glioblastomas in young adults

Most adult glioblastoma multiformes (GBMs) present in patients 45-70 years old; tumors occurring at the extremes of the adult age spectrum are uncommon, and seldom studied. We hypothesized that young-adult GBMs would differ from elderly-adult and from pediatric GBMs. Cases were identified from years 1997 to 2005. Demographic and histological features, MIB-1 and TP53 immunohistochemical findings and epidermal growth factor receptor (EGFR) amplification status by fluorescence in situ hybridization were compiled and correlated with survival. Twenty-eight (74%) of our 38 young-adult GBM patients had primary de novo tumors, two of which occurred in patients with cancer syndromes. Two additional GBMs were radiation-induced and eight (21%) were secondary GBMs. Seven patients were identified as long-term (>3 years) survivors. Six of 38 cases manifested unusual morphological features, including three epithelioid GBMs, one rhabdoid GBM, one gliosarcoma and one small cell GBM containing abundant, refractile, eosinophilic inclusions. MIB-1 index emerged as the most important prognosticator of survival (P < 0.005). Although there was a trend between extent of necrosis, TP53 immunohistochemical expression, and EGFR amplification status and survival, none reached statistical significance. GBMs in young adults are a more inhomogeneous tumor group than GBMs occurring in older adult patients and show features that overlap with both pediatric and adult GBMs.     

Genital-tract cancers in adolescents and young adults

In a review of the California Tumor Registry from 1950-1969, which records 1/3 of all cancer cases in California, there was an increase in the number of cancers of the vagina, corpus uteri, prostate, testis, and bladder (male) for the 10-19 year old age group. There was no increase in cancers of the vulva, ovary, cervix, breast, stomach, colon, rectum, and bladder (female). However, for the 20-24 year old age group, cancer of the vulva and testis increased from 1962-1969. The increases are compatible with other observations which indicate a possible association between stilbesterol and other cervical sites besides the vagina. There is a need for cancer surveillance to determine disease patterns and stimulate examination of existing data.     

Water turnover in children and young adults

Water homeostasis is essential for life and optimal function and considerable interest surrounds the issue of recommendations for water consumption in healthy individuals. Objective data on water turnover in free-living individuals are limited, however. The aim of the present work was to measure water turnover in children and young adults using isotopically labeled water to provide objective data on magnitude and variability in relation to body weight, fat-free mass and physical activity level. Water turnover was measured by deuterated water dilution in 91 healthy children (40 boys, 51 girls; age 5–14 years) and 109 healthy young adults (80 women, 29 men; age 18–27 years) with a wide range of body mass index (13.3–51.8 kg/m²) and percent body fat (6.1–59.3%). Total energy expenditure (TEE) and resting metabolic rate were measured by the doubly labeled water technique and indirect calorimetry, respectively. Water turnover was 1.77 ± 0.57 (SD), 1.79 ± 0.44, 2.85 ± 0.82, and 3.90 ± 0.81 L/day in girls, boys, women, and men, respectively. Water turnover indexed to body surface area did not differ significantly between girls and women but was higher in men than boys. Water turnover indexed to TEE was 0.8 mL/kcal in girls and boys and 1.0 mL/kcal in women and men. This study provides objective data on water turnover for children and young adults in a temperate climate and shows that anthropometric parameters can account for the variation between girls, boys and women but not between these groups and the more active men.