Two nap sleep test: an easy objective sleepiness test

The two nap sleep test (TNST) was developed and its usefulness for detecting sleepiness in long-distance drivers has been reported. This study's authors attempted to apply the TNST as a clinical test of sleepiness. A normal control group (n = 29), an obstructive sleep apnea syndrome (OSAS) group (n = 9), and another sleep disorder group (n = 6) participated. As a result of polysomnography, the sleep latency and sleep time did not differ among the groups. In contrast, the frequency of micro-arousal and movement arousal was significantly higher in the OSAS group than in the other groups. The TNST is thought to be useful for evaluating disturbance of sleep maintenance.     

Using reaction time to assess patients with unilateral neglect and extinction

Brain damage often results in visual defects and/or higher order visuo-spatial disorders including the syndromes of unilateral neglect and extinction. These syndromes and their associated behavioral sequelae are described along with several standard assessments and methods for behaviorally quantifying such deficits. In particular, the advantages of the reaction time measures commonly used by cognitive neuroscientists are surveyed. In order to illustrate how reaction time measures can be used to examine the subtleties of visuo-spatial deficits, several reaction time studies that have been conducted in patients with neglect and/or extinction are discussed. These studies stand as an example of how reaction time measures can contribute to both clinical and experimental neuropsychology.     

The spoon test: a valid and reliable bedside test to assess sudomotor function

Objective

To establish the validity of bedside sudomotor tests in a controlled prospective study.

Methods

Five different tests were used to assess presence of sweating at seven bilaterally symmetrical body loci, namely, examination with the unaided eye, visualization with light reflection, magnification with an ophthalmoscope, palpation of skin for slickness, and gliding the back of a spoon over the skin to detect friction. Sensitivity and specificity of these bedside tests were compared with the thermoregulatory sweat test in 130 subjects with generalized body sweating and 16 patients with complete anhidrosis.

Results

The spoon test was more sensitive in detecting sweating than the other four bedside tests, demonstrating sensitivity of about 86% at the neck, 58% at the chest, and 51% at the forehead. Specificity of the spoon test was almost 100% at all body sites except at the chest (81%) and the neck (50%).

Interpretation

With caveats related to methodology, the spoon test is a clinically practical and useful bedside screening test for the assessment of sweating, especially at the forehead and chest.

     

Instruments to assess decision-making capacity: an overview

OBJECTIVE: The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice. METHODS: The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability. RESULTS: The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability. CONCLUSIONS: Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.     

Visuo-spatial neglect: a new copying test to assess perceptual parsing

A new copying test has been devised to explore different forms of perceptuo-motor impairment in visuo-spatial neglect. The stimuli are constructed so that one hypercomplex figure can be transformed into two complex figures by deletion of part of the original drawing. Task performance by five patients with left neglect after right hemisphere damage is reported. Their copies illustrate the varied spatial reference frames within which visual neglect can be manifest.     

Real time polymerase chain reaction: a new powerful tool for the diagnosis of neurobrucellosis

BACKGROUND/METHODS: We compared the diagnostic yield of a real time polymerase chain reaction (PCR) assay in cerebrospinal fluid (CSF) samples with conventional microbiological techniques for the diagnosis of neurobrucellosis. Following amplification of a 223 bp sequence specific for Brucella genus, melting curve analysis was performed to verify the specificity of the PCR products. RESULTS: All six patients with neurobrucellosis (three meningitis and three meningoencephalitis) had a positive real time PCR assay, whereas CSF cultures and Wright seroagglutination tests were positive in only two and four cases, respectively. Brucella specific amplicons were easily demonstrated by their characteristic melting temperature in all the real time PCR assays. CONCLUSION: LightCycler based real time PCR assay in CSF samples is more rapid and sensitive than conventional microbiological tests. This technique could be useful for the rapid diagnosis of neurobrucellosis.     

Skin conductance reaction (SCR)-habituation test, a tool to detect anxiolytic activity. Its justification by the correlation between SCR-habituation test activities and specific binding potencies in benzodiazepines

Correlation between specific binding potencies "in vitro" of several benzodiazepines and activities in SCR-habituation test is very satisfactory. As the SCR-habituation test might be considered as an elementary model of anxiety state, the test is suggested to be used as an intermediate psychopharmacological tool before clinical study. SCR-magnitude test exhibits no correlation of this kind proving that sedative activity is of a different mechanism.     

The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis

Background

The BRadykinesia Akinesia INcordination (BRAIN) test is an online keyboard-tapping test previously validated as a sensitive tool for detecting signs of Parkinson’s disease.

Objectives

To determine whether the BRAIN test can measure disability in MS and identify the presence of pyramidal or cerebellar dysfunction.

Methods

Kinesia scores (KS, number of key taps in 30 s), akinesia times (AT, mean dwell time on each key) and incoordination scores (IS, variance of travelling time between keys) were calculated in 39 MS patients. These were correlated against the Expanded Disability Status Scale (EDSS) scores, pyramidal and cerebellar functional system scores and 9-hole peg test scores.

Results

EDSS correlated with KS (r = ? 0.594, p < 0.001), AT (r = 0.464, p = 0.003) and IS (r = 0.423, p = 0.007). 9-HPT scores strongly correlated with KS (r = 0.926, p < 0.001). Pyramidal scores correlated with KS (r = ? 0.517, p < 0.001). Cerebellar scores correlated with KS (r = ? 0.665, p < 0.001), AT (r = 0.567, p < 0.001) and IS (r = 0.546, p = 0.007). Receiver operating characteristic curves demonstrate that KS can distinguish between the presence or absence of pyramidal and cerebellar dysfunction with area under curve 0.840 (p < 0.001) and 0.829 (p < 0.001), respectively.

Conclusions

The BRAIN test can remotely measure disability in MS. Specific scores differ according to the presence and severity of pyramidal or extrapyramidal dysfunction. It demonstrates huge potential in monitoring disease progression in clinical trials.

     

Saccadic foraging: reduced reaction time to informative targets

The study of saccadic reaction times has revealed a great deal about the neural mechanisms underlying neural decision, in terms of Bayesian factors such as prior probability and information supply. In addition, recent work has shown that saccades are faster to visual targets associated with conventional monetary or food rewards. However, because the purpose of saccades is to acquire information, it could be argued that this is an unnatural situation: the most natural and fundamental reward is the amount of information supplied by a target. Here, we report the results of a study investigating the hypothesis that a saccade to a target whose colour provides information about the location of a subsequent target is faster than to one that does not. We show that the latencies of saccades to a location that provides reliable information about the location of a future target are indeed shorter, their distributions being shifted in a way that implies that the rate of rise of the underlying decision signal is increased. In a race between alternative targets, this means that expected information will be an important factor in deciding where to look, so that ‘foraging’ saccades are more likely to be made to useful targets.     

The 5-HT(2C) receptor agonist WAY-163909 decreases impulsivity in the 5-choice serial reaction time test

Increased impulsivity is observed across a number of neuropsychiatric and neurodegenerative diseases. Preclinical evidence has demonstrated that antagonism of the serotonin 5-HT(2C) receptor may act to increase impulsivity, leading to the hypothesis that an agonist may exert reciprocal effects and attenuate impulsive behavior. The 5-HT(2C) agonist, WAY-163909, was evaluated in the present paper using a variable stimulus duration and inter-trial interval manipulation in the 5-choice serial reaction time test designed to increase impulsivity and decrease attention. WAY-163909 treatment selectively and dose-dependently decreased impulsivity suggesting that agonism of the 5-HT(2C) receptor may be useful for modulating impulsivity in disease states where impulsivity is a pathological feature.     

The Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ): an instrument to assess outcomes of schizophrenia care

Advances in treatment technologies and development of evidence-based standards of care demand better methods for routine assessment of outcomes for schizophrenia in systems of care. This article describes the development and psychometrics of a new instrument to assess outcomes of routine care for persons with schizophrenia in service systems. Candidate items for the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ) were drawn from existing measures. Domains covered include disease outcomes (symptoms, subjective medication effects, substance abuse), functional status, health status, quality of life, and public safety. A sample of 1,584 patients with schizophrenia or schizoaffective disorder who were recruited into a large prospective, naturalistic study on the course of treatment for schizophrenia completed the SCAP-HQ at baseline and 1 year later (n = 434), providing data for factor analysis, assessment of internal consistency, convergent validity, and responsiveness to change. A subsample of 121 patients completed a test-retest protocol. Fifteen scales were derived by factor analysis from 55 outcome items on the SCAP-HQ. These factors covered psychiatric symptoms, life satisfaction, instrumental activities of daily living, health-related disability, subjective medication side effects, vitality, legal problems, social relations, mental health-related disability, suicidality, drug and alcohol use, daily activities, victimization, violence, and employment. For most scales, standard psychometric parameters, including internal consistency and test-retest reliability, convergent validity, and responsiveness to change, were acceptable for application to large sample evaluations of care systems. This new measure represents an advance in the development of outcome measures for schizophrenia for use in large-scale studies of routine care.     

Evaluation of brain perfusion SPECT using an easy Z-score imaging system (eZIS) as an adjunct to early-diagnosis of neurodegenerative diseases

The eZIS allows computer-assisted statistical analysis of brain perfusion SPECT images. We evaluated the diagnostic value of brain perfusion SPECT using eZIS in patients with various neurodegenerative diseases at a very early stage, within one year from onset.

Methods

SPECT using eZIS was performed for patients with Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD,), idiopathic Parkinson disease (PD) and vascular Parkinsonism (VP), multiple systemic atrophy of the cerebellar type (MSA-C), cortical cerebellar atrophy (CCA) and amyotrophic lateral sclerosis (ALS).

Results

Decreased rCBF was observed in the posterior cingulate cortex, precuneus and parietal cortex in AD; in the frontal gyrus and insula in FTD; in the occipital lobe, precuneus gyrus and posterior cingulate cortex in DLB; in the striatum and the thalamus in VP; in the cerebellum in CCA; in the cerebellum and pons in MSA-C and in the frontal cortex including the central sulcus in ALS. Increased rCBF in the striatum, thalamus and cerebellar dentate nuclei were observed in PD.

Conclusions

A specific rCBF pattern was observed for each disease using eZIS analysis, consistent with previous reports. Our results showed eZIS can be easily used as an adjunct to early-diagnosis of neurodegenerative diseases in any hospital.     

Level of uncertainty and brain damage: a reaction time test of attention for clinical use

The goal of this study was to search for effects of aging on visual reaction-time task designed to evidence subtle attentional disturbances in brain-injured subjects. Experiment I showed that the speed of response was affected by the level of task complexity (simple versus two-choice versus four-choice reaction times, with a forced response), irrespective of age. A main effect of age and effects of the responding finger and/or of the spatial location of the stimulus also emerged. Experiment II showed that the complexity effect was not an artifact resulting from the order of the conditions, and Exp. III, by means of a go/no-go procedure, showed that the effect of the location of the stimulus in Exp. I was due to central cognitive operations dealing with the choice of the response finger rather than with visuospatial operations about the stimulus.