Subjective memory complaints in the elderly: a sign of cognitive impairment?

OBJECTIVES:

Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial.

METHODS:

Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting “probable cognitive impairment” underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus.

RESULTS:

A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or “cognitively impaired not demented”. Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%.

CONCLUSION:

Subjective memory complaints are an indicator for cognitive impairment screening.     

Target selection in eye–hand coordination: Do we reach to where we look or do we look to where we reach?

During a goal-directed movement of the hand to a visual target the controlling nervous system depends on information provided by the visual system. This suggests that a coupling between these two systems is crucial. In a choice condition with two or more equivalent objects present at the same time the question arises whether we (a) reach for the object we have selected to look at or (b) look to the object we have selected to grasp. Therefore, we examined the preference of human subjects selecting the left or the right target and its correlation to the action to be performed (eye-, arm- or coordinated eye–arm movement) as well as the horizontal position of the target. Two targets were presented at the same distance to the left and right of a fixation point and the stimulus onset asynchrony (SOA) was adjusted until both targets were selected equally often. This balanced SOA was then taken as a quantitative measure of selection preference. We compared these preferences at three horizontal positions for the different movement types (eye, arm, both). The preferences of the ‘arm’ and ‘coordinated eye–arm’ movement types were correlated more strongly than the preferences of the other movement types. Thus, we look to where we have already selected to grasp. These findings provide evidence that in a coordinated movement of eyes and arm the control of gaze is a means to an end, namely a tool to conduct the arm movement properly.     

A closer look at treatment resistant depression: is it due to a bipolar diathesis?

BACKGROUND: Treatment resistant depression is a common clinical problem. Studies have shown that a large number of patients with depression do not have a satisfactory clinical outcome in spite of adequate trials of antidepressant drugs. In this study, we investigated demographic and clinical characteristics, diagnostic subtypes, and illness outcome of patients with resistant depression and a history of escape of response to adequate trials of at least two antidepressants for a previous episode. METHOD: Sixty-one patients who were seen consecutively at a mood disorders clinic with the diagnosis of "unipolar" treatment resistant depression, and followed up for at least one year, were interviewed using the Structured Clinical Interview for DSM-IV. Prospectively collected data including the occurrence of episodes of hypomania, and supplemental information from family members on illness course were also used for purposes of diagnostic re-evaluation. RESULTS: At intake, 35% of the patients were diagnosed as having a bipolar disorder. At follow-up, there was a 59% prevalence of bipolar disorder. Of the patients with major depressive disorder, 52% were subsequently classified as having bipolar spectrum disorder. The most important finding was that 80% of patients were found to show evidence of bipolarity. Moreover, the most common change in medication was a switch to mood stabilizers. CGI ratings showed significant improvement in functioning from the time of initial consultation. LIMITATIONS: This was a naturalistic study, and the data were collected in a non-blind fashion. CONCLUSIONS: The findings suggest that the majority of cases of unipolar treatment resistant depression, occurring in the context of loss of antidepressant response, have a bipolar diathesis.     

Do children need a longer time to shed SARS-CoV-2 in stool than adults?

SARS-CoV-2 can be shed in the stool of patients in the recovery phase. Children show a longer shedding time than adults. We analyzed the possible causes of this finding and recommend that a negative stool sample be included in a patient's discharge criteria.     

Why look in the brain for answers to temporomandibular disorder pain?

Temporomandibular disorder (TMD) patients often exhibit widespread clinical pain, as well as greater sensitivity to experimental pain than pain-free controls, suggesting a role of central pathophysiologic mechanisms in TMD. Moreover, TMD is more prevalent among women, which may be related to the higher sensitivity of women to experimental pain. Women also exhibit greater temporal summation of heat pain compared to men. Temporal summation, the increase in pain intensity upon repetitive noxious stimulation of constant intensity, at a high frequency is centrally mediated. Thus, greater temporal summation in women indicates that their central nociceptive processing is upregulated compared to men. Recent studies in our research center sought further evidence for upregulation of central nociceptive processing in females compared to males and in TMD patients compared to healthy controls, assessing group differences in temporal summation of mechanically evoked pain, and aftersensations following repetitive noxious stimulation. Sixteen series of 10 repetitive, sharp, mechanical stimuli were applied to the fingers of 25 female TMD patients, 25 healthy women, and 25 healthy men, with a computer-controlled small probe. All subjects rated the pain intensity or the unpleasantness evoked by the 1st, 5th and 10th stimulus in the series, and the aftersensations 15 s and 1 min after the last stimulus on visual-analog scales. TMD patients exhibited greater temporal summation of pain and unpleasantness, stronger aftersensations, and more frequent painful aftersensations than controls. Healthy females showed greater temporal summation of pain intensity and unpleasantness, higher intensity and unpleasantness of aftersensations, and more frequent painful aftersensations than males. Greater temporal summation of pain and aftersensations from digital stimulation of TMD patients than controls suggest a generalized hyperexcitability of the central nociceptive system in this patient group. Such hyperexcitability may contribute to the development and/or maintenance of chronic TMD pain. Moreover, greater temporal summation of pain and aftersensations in healthy females than males indicate that their central processing of nociceptive input may be more easily upregulated into pathological hyperexcitability, possibly accounting for the predominance of TMD among women.     

Pericellular lacunae in the diagnosis of metastatic carcinoma in effusions: Is this a useful sign?

The presence of pericellular lacunae has been cited as a useful criterion in distinguishing between benign and malignant effusions from body cavities. This study assessed the presence of pericellular lacunae in 75 specimens of malignant and 38 specimens of benign effusions. In a large number of cases, lacunae could not be assessed reliably because of technical and artifactual reasons. Pericellular lacunae were detected around the majority of the cell clusters in only 4 of the malignant and 2 of the benign cases. In our material, peri-cellular lacunae were not a useful criterion for the diagnosis of malignancy in body cavity fluids. Diagn Cytopathol 1996;15:193–196. © 1996 Wiley-Liss, Inc.     

Oesophagitis in children: reflux or allergy?

The prevalence of eosinophilic oesophagitis appears to be increasing in many countries, sometimes rapidly, although this may be partly due to increased disease recognition. Histological methods of assessment and diagnostic criteria vary considerably between major clinical centres. Oesophagitis with over 20 intraepithelial eosinophils per high power field is more likely to be due to allergy than gastro-oesophageal reflux induced acid-peptic mucosal injury. Typical eosinophilic oesophagitis shows involvement of the entire oesophagus, with basal cell proliferation occupying more than 50% of the thickness of the surface epithelium, and high numbers of intraepithelial eosinophils, sometimes concentrated on the surface or as contiguous clusters. Ulceration and prominent neutrophils are atypical and should suggest an alternative or co-existent disease. On endoscopy, the oesophagus may display the typical 'corrugated' mucosal appearance. Clinically, dysphagia or food impaction are the most characteristic symptoms. There is a strong association with other atopic diseases, especially asthma and eczema. To date no evidence has emerged of an increased malignancy risk. Patients with eosinophilic oesophagitis typically fail to respond to acid suppressive medications but respond well to either elemental/elimination diets or aerosolised swallowed corticosteroids. Long-term uncontrolled oesophageal eosinophilic inflammation may lead to progressive subepithelial fibrosis, potentially resulting in strictures or oesophageal narrowing.     

Asthma: an increasing problem in children?

The study of asthma trend, nonhospitalized and hospitalized cases, and factors correlated with asthma admissions were carried out at Queen Sirikit National Institute of Child Health (Children's Hospital) between 1986-1995. Asthma OPD visits had increased significantly (r = 0.9039, p < 0.001). The age distribution of the cases are 0-2, 2-5, 5-10 and > 10 years old group. The number of visits in 0-2 and 2-5 years groups were significantly increased (r = 0.908, p = 0.000, r = 0.904, p = 0.000), while in 5-10 and >10 years old groups were not (r = 0.054, p = 0.137, r = -0.565, p = 0.089). Although the OPD visits were increasing, there was a decreasing trend in the age-adjusted percentage of admissions (r = -0.798, p = 0.006). The percentage of admissions was significantly decreased in 0-2, 2-5, and >10 years old groups (r = -0.881, p = 0.001, r = -0.632, p = 0.05, r = -0.815, p = 0.004, respectively). The correlation with the environment was observed (r = 0.915, p < 0.001). There was no correlation with allergic diseases in the family (r = 0.2825, p = 0.4). The 2,312 admission charts (86.69% of total IPD cases) were reviewed and there were 1,855 cases of true asthma. Almost 70% of cases were in the under-five age group and the male to female ratio was 1.3:1. The increasing trend in steroid use was observed (r = 0.693, p = 0.026), while the use of antibiotics was unchanged (r = 0.068, p = 0.852). The percentage of admissions began to decline in 1989 when the aerosolized beta-2 agonists were introduced in the hospital and declined further in 1991 when increased use of aerosolized therapy and prophylactic drugs was observed. Better patient education and regular follow-up care during the past five years are believed to be one of the major contributions to this reduction in admissions.     

Street children in Nairobi: Hakuna Matata?

In many Third World countries there is a large population of street children. The causes of this phenomenon are diverse; for example, rapid urbanization, worsening economic trends, and rampant population growth. This study reveals the range of difficulties that plague projects for street children in Nairobi, Kenya. The data were collected by means of semi-structured interviews. In total, seven projects were visited and 68 street children were interviewed. Recommendations to improve assistance to and care of street children in Nairobi are presented. © 1999 John Wiley & Sons, Inc.     

Motor function in children with autism: Why is this relevant to psychologists?

Over the last decade, researchers have continued to make breakthroughs in understanding the clinical significance of motor symptoms in neurodevelopmental disorders, in particular, autism. With funding now available for assessment and therapy via the Federal Government's “Helping Children with Autism” initiative, there is an increased need for clinicians to have access to the latest research evidence which may both inform, and expedite the diagnostic process to ensure that this most vulnerable population is referred for timely interventions and therapies. This paper focuses on the importance of neuromotor impairment to the clinical conceptualisation of autism. There are three key ways in which motor function may be useful for improving our clinical and neurobiological understanding of autism: (a) as a quantifiable and pervasive feature of autism that may reflect a diagnostic marker; (b) as an endophenotype, for the identification of underlying genetic loci of impairment; and (c) as a potential “proxy” marker of degree and nature of social‐communicative impairment. With the impending move towards neurobiological models of psychological disorder classification, motor as well as cognitive symptoms are beginning to matter to psychologists.     

Proteomics of exhaled breath condensate: a realistic approach in children with asthma?

Cite this as: E. Dompeling and Q. Jöbsis, Clinical & Experimental Allergy, 2011 (41) 299–301.