Subcortical connections of normotopic and heterotopic neurons in sensory and motor cortices of the tish mutant rat

Orthograde and retrograde tracers were used to examine subcortical connections of neurons in the neurological mutant tish rat. This animal exhibits bilateral heterotopia similar to those observed in epileptic humans with subcortical band heterotopia. Terminal varicosities were labeled in the striatum, thalamus, brainstem, and spinal cord following injections of the anterograde tracer biotinylated dextran amine (BDA) into the heterotopic cortex. The general topography of corticothalamic projections was evaluated by injecting the retrograde tracer Fluoro-Gold (FG) into ventral thalamic nuclei. Retrograde labeling of small-to-medium sized neurons was observed in layer VI of topographically restricted portions of the normotopic cortex. Similar appearing cells were labeled in the neighboring portions of the underlying heterotopia; however, these neurons did not display characteristic lamination or radial orientation. Thalamocortical terminals labeled by injecting BDA into the ventroposterolateral nucleus (VPL) were observed primarily in layer IV of the medial aspect of the normotopic somatosensory cortex. In contrast, a radial column of terminals was present in the underlying heterotopia. Typical barrel labeling was found in the lateral aspect of the normotopic somatosensory cortex after injecting the ventroposteromedial nucleus (VPM), whereas more diffuse patches of labeling were observed in the underlying heterotopia. Heterotopic neurons in the tish cortex, thus, exhibit characteristic features of subcortical connectivity. Both normotopic and heterotopic neurons in the tish brain project to appropriate subcortical sites and establish bidirectional topographic connections with the thalamus. These results suggest that primary sensory-motor information is represented in a parallel manner in the normotopic and heterotopic cortices of the tish rat. J. Comp. Neurol. 395:29–42, 1998. © 1998 Wiley-Liss, Inc.     

The Expanded Disability Status Scale Score and Demographic Indexes Are Correlated with the Severity of Cognitive Impairment in Multiple Sclerosis Patients

Background and PurposeCognitive impairment (CI) is a common symptom of multiple sclerosis (MS). Although demographic and clinical factors contribute to MS-dependent CI, previous findings have been inconsistent. This study aimed to identify the cognitive domains that are impaired in MS patients, and to determine the impacts of the Expanded Disability Status Scale (EDSS) score and other clinical and demographic factors on them domains.MethodsThis study enrolled 115 MS patients. Cognitive performance was assessed using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. CI severity was assessed based on the number of impaired tasks in the MACFIMS battery, with impairment in two or more tasks defined as CI cases. Correlation analysis was used to determine whether factors including current age, age at disease onset, EDSS score, disease duration, relapse rate, and education level affect the severity of CI.ResultsThe scores on the Paced Auditory Serial Addition Test and Delis-Kaplan Executive Function System were the most and least affected, respectively. EDSS score (r=0.438, p<0.001), current age (r=0.393, p<0.001), and disease duration (r=0.486, p<0.001) were positively correlated with CI severity, whereas education level (r=−0.527, p<0.001) had a negative correlation with CI severity, and age at disease onset and relapse rate were not correlated with CI severity (r=0.150 and p=0.107, and r=0.052 and p=0.530, respectively). However, all variables (except EDSS score) significantly predicted CI severity in a multiple regression model (p<0.001, r=0.668).ConclusionsInformation processing speed and working memory were the most commonly affected cognitive domains in the present MS patients. CI severity had strong positive correlations with current age, EDSS score, and disease duration, and a negative correlation with education level. The relapse rate and age at disease onset were not correlated with CI severity.     

Cognitive impairment following chemotherapy for breast cancer: The impact of practice effect on results

Chemotherapy-Related Cognitive Impairment (CRCI) can be an adverse effect in women treated for breast cancer. Some longitudinal studies reported deficits in attention, memory, and executive function following treatment, but other studies did not find cognitive changes. It is known that practice effects (PE) on repeated assessments with cognitive tests contribute to the discrepancies in these results, but its influence on scores has not been systematically explored. The present study examines the impact of PE on retest scores in a group of women with breast cancer treated with chemotherapy and evaluated longitudinally.

Method: 51 women with breast cancer treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide with or without taxanes were assessed after surgery but before chemotherapy (T1), post-chemotherapy (T2), and at one year after T2 (T3). Longitudinal changes on cognitive performance were analyzed twice: when retest scores were not corrected for PE and when correction for PE was applied to T2 and T3 scores.

Results: When PE was not corrected, progressive improvement over time in measures of memory and divided attention at T2 and T3 was observed. In contrast, when PE was corrected, worsening was found in measures of memory, fluency, executive function, and attention at T2 and in attention and executive function at T3. Results after correction for PE are in line with previous longitudinal studies that report cognitive impairment after treatment with chemotherapy for breast cancer.

Conclusion: Accounting for PE is recommended to identify true change on cognition through treatment with chemotherapy for breast cancer.     

The Brief Assessment of Family Functioning Scale (BAFFS): a three-item version of the General Functioning Scale of the Family Assessment Device

The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.     

The need for a consensus in the use of assessment tools for Alzheimer's disease: the Feasibility Study (assessment tools for dementia in Alzheimer Centres across Europe), a European Alzheimer's Disease Consortium's (EADC) survey

AIMS: To ensure that all Alzheimer centres across Europe are capable of using a similar method of data collection. Information about the patient assessment tools used by each participating centre was obtained and normal clinical practice in each EADC centre was documented by collecting data from routine new patient consultation. METHODS: Twenty new consecutive patients with objective memory impairment were recruited in each Alzheimer centre over 6 months. Each patient consultation was carried out according to routine clinical practice. Patient data were recorded using the anonymous patient protocol (demographic, diagnosis, MMSE score, patient assessment scales, and most prominent behavioural problem). Information about neuropsychological assessment tools used in each centre was take to account to harmonise research practice for future multicentre collaboration. RESULTS: Seven hundred and four patients from 36 memory clinics in 13 countries across Europe participated in the study. [M:F ratio 0.67. Mean age 75.4 SD 9.3 (51-102) Mean MMSE 21 SD 6 (0-30)] Five hundred and fifty-five patients had a clinical diagnosis of dementia [Alzheimer's disease (68.5%), vascular dementia (10.3%), frontal lobe dementia (5.6%), Lewy body dementia (4.1%), mixed dementia (5.6%)]. Duration of symptoms: 0-6 months 6.5%; 6-12 months 16.1%; 1-2 years 30.5%; 2-5 years 46.9%. Assessment scales used: Clinical Dementia Rating (CDR) 48.9%, Reisberg's Global Deterioration Scale (GDS) 38.6%, ADL/IADL (Lawton and Brody, 1969) 37.5%, Neuropsychological Inventory (NPI) 28.6%, Geriatric Depression Scale 22%, ADL (Katz et al., 1963) 19.2%, ADAS-Cog 14.9%, Cornell Scale for Depression 12.9%, Grober and Bushke Selective Reminding Test 11.5%, ADCS/ADL 7.7%. 64.8% of the patients experienced behavioural symptoms: apathy 13.6%; anxiety 12.8%; dysphoria 9.9%; irritability 7.8%; agitation 5.5%; hallucinations 3.6%; delusions 3.6%, sleep disorder 2.4%; desinhibition 2%. CONCLUSIONS: The most common type of cognitive decline was Alzheimer's disease followed by mild cognitive impairment and vascular dementia. CDR, GDS Reisberg, and ADL/IADL were used widely (40-50%). The NPI, geriatric depression scale and ADL (Katz, 1963) were only used in 20% of the centres. We verified large differences in the tools use in the EADC centres to evaluate patients with dementia across Europe. There is a need for a consensus in the use of assessment tools for dementia in Alzheimer's centres in Europe.     

Brief Report: Quantifying the Impact of Autism Coverage on Private Insurance Premiums

Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation.     

Brief Report: Impact of Child Problem Behaviors and Parental Broad Autism Phenotype Traits on Substance Use Among Parents of Children with ASD

Using data from the Simons Simplex Collection, the present study examined the impact of child externalizing behavior and parental broad autism phenotype traits on substance use among parents of children with autism spectrum disorder (n = 2,388). For both fathers and mothers, child externalizing behaviors predicted tobacco use (OR = 1.01 and OR = 1.02, respectively), whereas rigidity increased risk of tobacco use for fathers (OR = 1.29) but not mothers. Additionally, among mothers, child externalizing behaviors increased risk of illegal substance use (OR = 1.04), whereas maternal rigidity decreased risk of alcohol use (OR = .83). Collectively, results suggest that child externalizing behaviors and parental rigidity may have differing impacts on the types of substances used by parents.     

Neuropsychological Advances in Child and Adolescent Mental Health: The Decade of the Brain

As the 'decade of the brain' comes to a close, it is clear that the field of neuropsychology has made many vital contributions to evaluation, treatment, and research issues in child and adolescent health care. In the study of brain-behaviour relationships, the neuropsychologist plays a unique role. The practice of child neuropsychology is differentiated from adult work because developmental and environmental influences have a significant impact on practice. The various goals of the child neuropsychologist may include psychoeducational and neuropsychological assessment, the exploration of brain-behaviour relationships, consultation with a variety of professionals ranging from teachers to neurologists, and rehabilitation training. Advances in medical treatment have contributed to an expanding population of children and adolescents with neurological and/or neuropsychiatric concerns. New research in this field has also provided evidence of disordered or dysfunctional neurological systems in a number of childhood disorders and psychiatric conditions. This paper reviews some contributions that neuropsychology has made to the health care of children and adolescents in the past decade.     

Risk and benefit in the surgery of epilepsy: Complications and positive results on seizures tendency and intellectual function

ABSTRACT— A review of complications in a series of 560 consecutive craniotomies for surgery of epilepsy shows the mortality to be nil and the morbidity very low. Results on the seizure tendency for temporal resections are presented with emphasis on extent and modalities of removal. In this series the success/failure ratio was in the order of 80/20%. Patients with-right sided removal tend to do better than those with left-sided operations. Removal of the hippocampal formation appears to significantly improve the results. Patients studied with intracerebral electrodes tend as a group to do better than those operated without depth electrodes. Anterior temporal resection is usually followed by a significant increase in intellectual function when measured one year after surgery.     

Brief Report: Sociometric Status and Behavioral Characteristics of Peer Nominated Buddies for a Child with Autism

We examined social and behavioral correlates of children selected by their peers to serve as peer buddies for an unfamiliar child with autism (CWA). Participants were 293 children from two public elementary schools who completed social status, behavioral, and peer buddy nomination measures. Peer buddy nominations for a CWA were related to: (a) perceived unpopularity; (b) being viewed as helpful and smart; and (c) lacking influence regarding popularity within the classroom. In contrast, peer buddy nominations for a typical boy were related to being viewed as popular, helpful, and self-confident. Students may select a social niche for CWA based on principles of peer homophily. Limitations and suggestions for future research are discussed.     

Brief Report: Effects of Pressure Vest Usage on Engagement and Problem Behaviors of a Young Child with Developmental Delays

The purpose of this study was to examine the effects of wearing a pressure vest for a young boy with developmental delays. An A-B-A withdrawal design was used to examine the relation between wearing the pressure vest and child behaviors during a preschool art activity. Although the data showed moderate variability, no systematic differences were found in child engagement when the vest was worn and when the vest was not worn and problem behavior increased when the vest was being worn. These results are discussed in the context of the study limitations. Implications for future research are provided.     

110例癫癎患者停药与预后的相关分析

目的:通过对临床已获控制并停药的癫癎患者进行分析,总结并探讨癫癎预后的有关因素。方法:回顾性分析110例临床已获控制并停药患者的临床资料。结果:患者的性别与发病年龄、治疗时间均无显著性差异(P>0.05);患者的发病年龄、病程、发作类型、发作频率、影像学检查正常与否与治疗时间有显著性差异(P<0.05);而有无既往史或家族史与治疗时间无显著性差异(P> 0.05)。结论:患者发病年龄、病程、发作类型、发作频率、影像学检查正常与否影响总的治疗时间,且发作类型与停药后的复发可能密切相关。达控时间是影响癫癎预后最为重要的因素。     

Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample

Objectives: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures.

Method: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older.

Results: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores.

Conclusion: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.