Cost-effectiveness of a collaborative dementia care management—Results of a cluster-randomized controlled trial

IntroductionThe purpose of this study was to determine the cost-effectiveness of collaborative dementia care management (DCM).MethodsThe cost-effectiveness analysis was based on the data of 444 patients of a cluster-randomized, controlled trial, conceptualized to evaluate a collaborative DCM that aimed to optimize treatment and care in dementia. Health-care resource use, costs, quality-adjusted life years (QALYs), and incremental cost per QALY gained were measured over a 24-month time horizon.ResultsDCM increased QALYs (+0.05) and decreased costs (?569€) due to a lower hospitalization and a delayed institutionalization (7 months) compared with usual care. The probability of DCM being cost-effective was 88% at willingness-to-pay thresholds of 40,000€ per QALY gained and higher in patients living alone compared to those not living alone (96% vs. 26%).DiscussionDCM is likely to be a cost-effective strategy in treating dementia and thus beneficial for public health-care payers and patients, especially for those living alone.     

Towards a prevention of dementia?

Many studies have shown that high blood pressure and, to a lesser extent, other vascular risk factors could be the target of interventions aiming to reduce the incidence of dementia. Two large controlled trials have demonstrated that blood pressure lowering drugs have a significant effect on the risk of dementia including Alzheimer's disease. On another hand, large epidemiological studies have shown associations between different vascular factors and dementia. Overall, these data suggest that interventions aiming to reduce the level of vascular risk factors might prevent dementia. The expected benefit of these interventions could be estimated from data provided by epidemiological studies, but large population-based controlled studies are needed to demonstrate the efficacy of preventive interventions.     

The interface of positive psychology with a psychology of loss: a brave new world?

In this paper, it is argued that a psychology of loss can help to illuminate one of the central themes of positive psychology: That is, showcasing those human skills that emphasize human strengths and optimal functioning. However, the interface of positive psychology and a psychology of loss also contains a definite paradox. Loss is not an intrinsically positive event that will necessarily build human strength. Yet, the experience of loss can become a profound means for showcasing human strengths and potential. We also caution that a positive psychology, in its quest to focus on the more uplifting qualities of the human experience, must also realize that suffering and loss is inherent to the human condition.     

Retinal vein occlusion: a form of venous thrombosis or a complication of atherosclerosis? A meta-analysis of thrombophilic factors

Previous studies have shown an increased risk of retinal vein occlusion (RVO) in patients with hypertension, hypercholesterolemia and diabetes mellitus. Literature on the association between thrombophilic factors and RVO consists of small studies and case reports. The objective was to determine the relationship between thrombophilic risk factors and RVO. Thrombophilic risk factors analyzed were hyperhomocysteinemia, MTHFR gene mutation, factor V Leiden mutation, protein C and S deficiency, antithrombin deficiency, prothrombin gene mutation, anticardiolipin antibodies and lupus anticoagulant. For all currently known thrombophilic risk factors odds ratios for RVO were calculated as estimates of relative risk. The odds ratios were 8.9 (95% CI 5.7 - 13.7) for hyperhomocysteinemia, 3.9 (95% CI 2.3 - 6.7) for anticardiolipin antibodies, 1.2 (95% CI 0.9 - 1.6) for MTHFR, 1.5 (95% CI 1.0 - 2.2) for factor V Leiden mutation and 1.6 (95% CI 0.8 - 3.2) for prothrombin gene mutation. In conclusion, regarding thrombophilic risk factors and RVO there is only evidence for an association with hyperhomocysteinemia and anticardiolipin antibodies, factors that are known as risk factors for venous thrombosis as well as for arterial vascular disease. The minor effect of factor V Leiden mutation and the protrombin gene mutation (risk factors for venous thrombosis only) suggests that atherosclerosis might be an important factor in the development of CRVO.     

'Theory of Mind' I: a theory of knowledge?

Objective: 'Theory of mind' is a cognitive notion introduced by Simon Baron-Cohen and colleagues to explain certain deficits in autistic disorders. It has, however, been extended beyond this, and applied more broadly. It proposes a means of knowing the mind of others, and suggests that this means fails in autism. The epistemological basis of 'theory of mind' will be examined critically, not just in terms of its endeavour as a theory of knowledge, but also in regard to the principles that underlie it. Conclusions: The proponents of 'theory of mind' eschew the rich field of psychological and phenomenological research, privileging only the biological sciences into which they endeavour to place their theorizations. In doing this, they fail to recognize the epistemological problems involved. This leads to the theory remaining hamstrung by the very Cartesian ontological problems that it seeks to avoid. For some, 'theory of mind' is but an artefact of the cognitive approach that it employs. It is argued that these difficulties are compounded by the failure of 'theory of mind' to take account of the place of language in the interpersonal encounters it attempts to describe.     

Is a plum a memory problem? Longitudinal study of the reversal of concreteness effect in a patient with semantic dementia

The concreteness effect, which refers to the typically superior performance for concrete concepts compared to abstract ones, is a robust phenomenon that has been observed in normal and brain-damaged subjects in a number of cognitive domains. Reversal of this effect was also reported in a few neuropsychological studies, mainly in patients with semantic dementia (SD). In this article, we report the first longitudinal single-case study of a patient with SD, SC, who performed better for abstract than concrete concepts in various comprehension and production tasks. For concrete concepts, SC showed no category-specific deficit but was impaired in tasks exploring access to stored structural knowledge and semantic perceptual attributes. With the course of the disease, the semantic system progressively declined and the reversal of the concreteness effect, as well as the dissociation between perceptual and non-perceptual knowledge, vanished. We discuss the results and their implications for theoretical propositions of concreteness effect as well as theoretical models of semantic memory. We suggest that the reversal of concreteness in SC is a direct result of the degradation of visual feature knowledge, sustained by anatomical structures affected early in SD. With the time course of the disease, the atrophy extends to adjacent regions and the dissociation between abstract and concrete concepts was no longer observed.     

PDGFR-β as a positive regulator of tissue repair in a mouse model of focal cerebral ischemia

Although platelet-derived growth factors (PDGFs) and receptors (PDGFRs) are abundantly expressed in the central nervous system, their functions largely remain elusive. We investigated the role of PDGFR-β in tissue responses and functional recovery after photothrombolic middle cerebral artery occlusion (MCAO). In the normal adult mouse brain, PDGFR-β was mainly localized in neurons and in pericyte/vascular smooth muscle cells (PC/vSMCs). From 3 to 28 days after MCAO, postnatally induced systemic PDGFR-β knockout mice (Esr-KO) exhibited the delayed recovery of body weight and behavior, and larger infarction volume than controls. In Esr-KO, PC/vSMC coverage was decreased and vascular leakage of infused fluorescent-labeled albumin was extensive within the ischemic lesion, but not in the uninjured cerebral cortex. Angiogenesis levels were comparable between Esr-KO and controls. In another PDGFR-β conditional KO mouse (Nestin-KO), PDGFR-β was deleted in neurons and astrocytes from embryonic day 10.5, but was preserved in PC/vSMCs. After MCAO, vascular leakage and infarction volume in Nestin-KO were worse than controls, but partly improved compared with Esr-KO. Astroglial scar formation in both Esr-KO and Nestin-KO was similarly reduced compared with controls after MCAO. These data suggested that PDGFR-β signaling is crucial for neuroprotection, endogenous tissue repair, and functional recovery after stroke by targeting neurons, PC/vSMCs, and astrocytes.     

Is panic disorder a distinct diagnostic entity? A critical review of the borders of a syndrome

The evidence supporting the existence of panic disorder as a distinct clinical entity is critically examined, as are the current criteria for panic disorder in DSM-III. It is argued that the current definition of a panic attack is imprecise and that the borders and overlap of panic disorder with other psychiatric disorders raise broader questions as to what is meant by a distinct psychiatric disorder. DSM-III "panic disorder" defines an ideal type that may be more relevant for research purposes than clinical. In defining fairly homogeneous "pure" cases, it overlooks the prevalence and importance of atypical "mixed" and subsyndromal cases.