Validation of the Italian version of Parkinson’s Disease-Cognitive Rating Scale (PD-CRS)

Cognitive impairment (CI) is a frequent feature associated with both early and advanced stages of Parkinson’s disease (PD). An evaluation of cognitive functions is relevant to identify those parkinsonians at risk of developing dementia. In the present study, the Italian version of Parkinson’s Disease-Cognitive Rating Scale (PD-CRS) assessing fronto-subcortical and cortical cognitive functions in PD was validated in 387 parkinsonians and was used to test the empirical validity of the item 1.1 (cognitive impairment) of the Italian version of MDS-UPDRS as screening tool for CI in PD. PD-CRS was free from floor and ceiling effect. The mean PD-CRS score was 76.1 (mean cortical score, 24.5 ± 4.6; mean subcortical score, 51.5 ± 17.5). The internal consistency was satisfactory (α = 0.89); corrected item-total correlation was 0.570 (naming) to 0.696 (working memory). The correlation between PD-CRS and part I–IV of MDS-UPDRS was weak. The low agreement between classification of PD sample into patients with mild cognitive impairment (PD-MCI), dementia (PD-D) and normal cognition (PD-NC) according to scores of item 1.1 and classification according to cutoff scores of PD-CRS for PD-MCI, PD-D and PD-NC indicated a poor empirical validity of item 1.1 of MDS-UPDRS as cognitive screening tool for CI in PD (Κ = 0.114; weighted Κ = 0.17; SE of Κ = 0.038; 95 % confidence interval from 0.040 to 0.1895). The Italian version of PD-CRS is an easy, consistent and valid tool for assessment of the cognitive cortical and subcortical impairments in PD.     

Le poumon est une cible de la dermatomyosite de l’enfant

Juvenile dermatomyositis is the leading cause of chronic idiopathic inflammatory myopathy of auto-immune origin in children. Lung involvement in inflammatory myopathies is well described in adults, involving mostly interstitial lung disease, aspiration pneumonia and alveolar hypoventilation. We propose to describe its specificities in children. Pulmonary involvement may be asymptomatic and therefore must be systematically screened for. In case of clinical or functional respiratory abnormality, a chest computed tomographic (CT) scan is necessary. In children, a decrease of respiratory muscle strength seems common and should be systematically and specifically searched for by non-invasive and reproducible tests (sniff test). Interstitial lung disease usually associates restrictive functional defect, impairment of carbon monoxide diffusion and interstitial lung disease on CT scan. As in adults, the first-line treatment of juvenile dermatomyositis is based on corticosteroids. Corticosteroid resistant forms require corticosteroid bolus or adjuvant immunosuppressive drugs (methotrexate or cyclosporine). There is no consensus in pediatrics for the treatment of diffuse interstitial lung disease. Complications of treatment, including prolonged steroid therapy, are frequent and therefore a careful assessment of the treatments risk-benefit ratio is necessary, especially in growing children.     

Comparison between rapid and mixed maxillary expansion through an assessment of dento-skeletal effects on posteroanterior cephalometry

Background

The aim of this study is to compare the dento-skeletal effects of rapid maxillary expansion (RME) and mixed maxillary expansion (MME), assessed on posteroanterior (PA) cephalograms.

Methods

Treatment groups consisted of 42 patients; mean age in RME group (n = 21,13 female and 8 male subjects) was 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1 and mean age in MME group (n = 21, 12 female and 9 male patients) was 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. Seventeen bilateral anatomic landmarks, 16 linear (12 skeletal and 4 dental) and 4 angular measurements were assessed for each patient at T0 and T1. Data from the two groups were compared using independent sample t test (p < 0.05).

Results

At T0, the groups were similar for all examined variables (p > 0.05). Significant and equal increase of lateronasal and maxillary and upper and lower molar widths (p < 0. 01) occurred in both groups at T1. Significant but different increases were observed for maxillary incisal, upper left first molar-lateroorbitale, and maxillary first molar angles (p < 0.001 vs. p < 0.05). Significant increases were reported for upper inter-incisal width apex (p < 0.001) and upper right first molar-lateroorbitale angle (p < 0.05) only in the RME group. At T1, differences in maxillary incisal angle (p < 0.05), upper left first molar-lateroorbitale, and maxillary first molar angles (p < 0.001) were noted.

Conclusions

RME and MME were both effective to increase skeletal transverse dimensions by opening mid-palatal suture in growing patients, while MME was associated with minor dental side effects than RME.     

Prevalence and Clinical Aspects of Mild Cognitive Impairment in Parkinson's Disease: A Meta-Analysis

Mild cognitive impairment associated with Parkinson's disease (PD) is a risk factor for the development of dementia. Despite the importance of early identification of mild cognitive impairment in PD, its prevalence and clinical correlates are still debated. The present meta-analysis provides a robust estimate of prevalence rate of mild cognitive impairment in PD according to the Movement Disorder Society clinical criteria and to explore the differences between PD patients with and without mild cognitive impairment in demographic, clinical, and neuropsychiatric features. A systematic literature search was performed up to April 2019 using PsycInfo (PROQUEST), PubMed, and Scopus. From 4706 titles and abstracts, 41 studies were selected (n = 7053 patients). Pooled mild cognitive impairment prevalence was 40% on a total sample of 7053 PD patients (95% confidence interval = 36–44; Q = 490.14, P < 0.0001; I² = 91.84%) with a higher frequency for the multiple domain subtype (31%; 95% confidence interval = 23–41, Q = 93.24; P < 0.0001; I² = 92.49%). Meta-regression analysis revealed that stage of PD moderate prevalence estimates of mild cognitive impairment (β = 2.80; P = 0.008). Mild cognitive impairment in PD was associated with older age, lower education, longer disease duration, higher levodopa equivalent daily dose, more severe motor symptoms, and postural instability/gait difficulty motor subtype, poorer quality of life, higher levels of apathy, and depression. The present meta-analysis indicated that mild cognitive impairment in PD is a frequent cognitive status deserving to be early detected by means of standardized cognitive assessments in clinical practice. © 2019 International Parkinson and Movement Disorder Society     

Sexual function after resection for rectal cancer

Major rectal operation, that is, abdominoperineal or anterior resection, for cancer frequently damages the autonomic pelvic nerve supply with resultant sexual dysfunction. The anatomic characteristics and function of the autonomic nervous system in the pelvis has been reviewed. Sexual function after rectal excision for cancer was studied in 25 male patients who were less than 60 years of age and exhibited normal sexual activity preoperatively. Of nine patients who had abdominoperineal resection, four were impotent and two reported no ejaculation with normal potency postoperatively. Of 4 patients who had high anterior resection, only 1 reported no ejaculation, whereas of 12 patients with low anterior resection, 4 were impotent and 3 reported no ejaculation. A higher incidence of sexual dysfunction was noted after abdominoperineal resection compared with after anterior resection (66 percent and 50 percent, respectively). However, the incidence after low and very low anterior resection was comparable with that after abdominoperineal resection (58 percent and 66 percent, respectively). Advanced patient age and very low resection were the two main factors effecting sexual dysfunction after major rectal operation. Although we believe that careful operative technique might reduce the incidence of sexual disturbances attributable to sympathetic fiber damage, avoidance of parasympathetic damage during operation cannot be accomplished because the most likely site of injury, namely the periprostatic plexus, is usually within the operative field, the exception being cases in which the tumor is small, thus allowing preservation of the rectoprostatic fascia.     

Potentially Inappropriate Medications and Functional Decline in Elderly Hospitalized Patients

OBJECTIVES: To verify whether the use of potentially inappropriate medications (PIMs) is associated with loss of independence in elderly in-patients by promoting adverse drug reactions (ADRs).
DESIGN: Prospective observational study.
PARTICIPANTS: Five hundred six patients aged 65 and older admitted to 11 acute care medical wards.
MEASUREMENTS: In-hospital loss of one or more activities of daily living (ADLs) and three or more ADLs. PIMs were identified according to diagnosis-independent Beers criteria and ascertained by study physicians based on daily review of medical and nurse records. The relationship between risk factors and outcomes was assessed using logistic regression.
RESULTS: Overall, 104 patients (20.6%) were taking at least one PIM at the time of admission (baseline users), and 49 (9.7%) were newly prescribed at least one PIM during their hospital stay. The loss of one or more ADLs occurred in 9.6% of baseline users, 16.3% of new users, and 8.5% of nonusers ( P =.21) and that of three or more ADLs in 7.7% of baseline users, 12.2% of new users, and 4.8% of nonusers ( P =.10). The lack of association was confirmed after correction for potential confounders, including ADRs. The occurrence of ADRs was strongly associated with both outcomes (odds ratio (OR)=7.80, 95% confidence interval (CI)=3.53–17.3 for the loss of ≥1 ADLs; OR=3.98, 95% CI=1.50–10.5 for the loss of ≥3 ADLs), but PIMs caused only six of 106 ADRs.
CONCLUSIONS: ADRs to any drugs more than the use of PIMs might be associated with functional decline in elderly hospitalized patients, but because the power of this study was too limited to definitively exclude a direct relationship between PIMs and functional decline, this merits further investigation.     

Short interval intracortical facilitation correlates with the degree of disability in multiple sclerosis

BackgroundThe Expanded Disability Status Scale (EDSS) is the most widely used measure of disability in MS, however because of its limitations surrogate markers of clinical disability progression are of high interest. Transcranial magnetic stimulation (TMS) measures of demyelination and cortical excitability correlate with disability levels in MS.ObjectiveAim of this study was testing whether paired pulse (pp) TMS represents a reliable surrogate marker to measure clinical disability in MS.MethodsppTMS measures of intracortical synaptic transmission such as short interval intracortical inhibition (SICI), long interval intracortical inhibition (LICI), short interval intracortical facilitation (SICF) and intracortical facilitation (ICF) were collected from 74 patients affected by MS. Correlation of EDSS scores with ppTMS measures was analyzed.ResultsEDSS scores correlated with patient’s age, disease duration, Motor Evoked Potentials latency and thresholds and SICF measures but not with age of onset, SICI, ICF and LICI.ConclusionsThese findings support a possible use of SICF and MEP latency as surrogate markers of disability in MS. Further research is warranted to determine the role of SICF in the follow up of disease progression and to validate its use as an endpoint in multiple sclerosis clinical trials.     

Burden of acute stroke and hospital resources in the Campania region of Italy

We examined all the official hospital records referring to admissions for acute stroke (AS) (DRG 14) from January 1 to December 31, 1996 in Campania (Italy), a large region with 10% of the Italian population. Related healthcare burden and available resources were evaluated. During the study period, a total of 9,003 discharges were reported. We counted 11 neurological care units (NCU) committed to emergency in the region, with 230 hospital beds. The 4,890 admissions in NCU represented 54.3% of the total AS hospitalizations per year. A large number of strokes (45.7%) had no access to specialist assistance and were hospitalized mainly in general wards with a mean hospital stay of 12.7 days, compared with 9.5 days in NCU (p < 0.01). In our region, the number of hospital beds available for neurological emergencies do not meet the demand.     

Parietal cortex integrates contextual and saliency signals during the encoding of natural scenes in working memory

The Brief presentation of a complex scene entails that only a few objects can be selected, processed indepth, and stored in memory. Both low‐level sensory salience and high‐level context‐related factors (e.g., the conceptual match/mismatch between objects and scene context) contribute to this selection process, but how the interplay between these factors affects memory encoding is largely unexplored. Here, during fMRI we presented participants with pictures of everyday scenes. After a short retention interval, participants judged the position of a target object extracted from the initial scene. The target object could be either congruent or incongruent with the context of the scene, and could be located in a region of the image with maximal or minimal salience. Behaviourally, we found a reduced impact of saliency on visuospatial working memory performance when the target was out‐of‐context. Encoding‐related fMRI results showed that context–congruent targets activated dorsoparietal regions, while context–incongruent targets de‐activated the ventroparietal cortex. Saliency modulated activity both in dorsal and ventral regions, with larger context‐related effects for salient targets. These findings demonstrate the joint contribution of knowledge‐based and saliency‐driven attention for memory encoding, highlighting a dissociation between dorsal and ventral parietal regions. Hum Brain Mapp 36:5003–5017, 2015. © 2015 Wiley Periodicals, Inc .