The combination of cognitive testing and an informant questionnaire in screening for dementia

Aim: A cognitive test and an informant report questionnaire were used together to investigate whether their combined use could improve the accuracy of detecting dementia in a memory clinic, compared with either test used alone. METHOD: The subjects were 323 patients assessed at a memory clinic. The Mini-Mental State Examination and the short form of the Informant Questionnaire on Cognitive Decline in the Elderly were used. A method of combining the test scores developed by Mackinnon and Mulligan [Am J Psychiatry 1998; 155: 1529-35] was used. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria. RESULTS: Logistic regression analysis showed that the combination of the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly produced a slightly more accurate prediction of dementia caseness than either test used alone. Using receiver operating characteristic analysis the performance of the combination of the tests according to a weighted sum rule was compared with the performance of either test used alone. This way of combining the tests resulted in a more accurate screening for dementia than when the Informant Questionnaire on Cognitive Decline in the Elderly was used alone. The area under the receiver operating characteristic curve for the Mini-Mental State Examination combined with the Informant Questionnaire on Cognitive Decline in the Elderly was 0.89 compared with 0.82 for the Informant Questionnaire on Cognitive Decline in the Elderly alone (chi-square = 10.63; P = 0.0011). However, there was no improvement in screening performance when the combination of Mini-Mental State Examination and Informant Questionnaire on Cognitive Decline in the Elderly was compared with the Mini-Mental State Examination used alone (area under the receiver operating characteristic curve = 0.89 versus 0.86; chi-square = 3.54; P = 0.060). CONCLUSION: The combination of cognitive testing and an informant report according to a weighted sum rule in this population did not result in any advantage over the use of the Mini-Mental State Examination alone. The mixed results of this study contrast with those of Mackinnon and Mulligan.     

Argyrophilic nuclear organizer regions in nasopharyngeal carcinoma and paraneoplastic epithelia

BACKGROUND: Nucleolar organizer regions (NORs), which are loops of DNA containing ribosomal RNA genes, have been shown to correlate with cell proliferation and malignant transformation. The diagnostic value of silver staining NORs (AgNORs) in preneoplastic epithelia and nasopharyngeal carcinoma (NPC) by the quantitative assessment of AgNORs proteins is evaluated. METHODS: Silver-staining of NORs was applied to 70 paraffin sections of NPC biopsy specimens, including 29 samples of the adjacent normal glandular epithelia (GE), 19 hyperplastic/dysplastic columnar epithelia (CE) in the adjacent mucosa, 10 hyperplastic/dysplastic squamous epithelia (SE) in the adjacent mucosa, 54 differentiated nonkeratinizing carcinoma (DC), and 16 undifferentiated carcinoma (UC). The morphometric features of AgNORs in preneoplastic epithelia and cancer cells were analyzed by image cytometric analysis and then compared. RESULTS: The AgNOR count, mean AgNOR area, and AgNOR area-count ratio increased significantly from GE to CE to DC or UC. The mean nuclear area, AgNOR area, and AgNOR area-count ratio increased significantly from GE to SE to UC, whereas overlapping AgNOR values were observed between SE and DC. UC had significantly higher values than DC in mean nuclear area, AgNOR area, and AgNOR area-count ratio. CONCLUSIONS: The morphometric analysis of AgNORs reflected cell proliferative activity and histologic differentiation of tumor rather than malignant transformation in different nasopharyngeal epithelia and NPC. AgNOR area and AgNOR area-count ratio are the most valuable features for differential diagnosis of normal, preneoplastic, and cancer cells.     

Use of pulse oximeter for determining distal perfusion in neonates &; infants with suspected vascular compromise

Conclusion The use of a pulse oximeter, which is readily available in the ICU, can be of immense benefit to determine the status of distal limb perfusion in neonates and children who are suspected of having a vascular compromise, and the pulsations cannot be appreciated due to the presence of limb edema. Limb warmth and capillary filling are the primary indicators of vascularity but may be misleading in some patients. The presence of poor quality tracings or absent tracings is a definite indicator of significant ischemia. The use of a pulse oximeter, for determination of oxygen saturation, was declared by Severinghaus and Astrup to be “arguably the most significant technologic advance ever made in monitoring the well being of patients during anaesthesia, recovery and critical care. Perhaps the use of the pulse oximeter for determination of distal perfusion can further augment the statement. Editor Note The authors are to be congratulated for their observations which are clinically relevant. However we urge them to continue their study and obtain meaningful data, with proper statistical analysis. For the time being these observations may be considered preliminary.     

Acceptability of oesophagogastroduodenoscopy without intravenous sedation: patients' versus endoscopist's perception with special reference to older patients

Objective::This study was undertaken to compare (1) patients'' perception of discomfort with the endoscopist''s perception of patients'' discomfort for the unsedated OGD, (2) tolerability between older (⩾75 years) and younger (<75 years) patients. Design and subjects::A total of 130 consecutive patients attending a day case endoscopy unit were recruited for the study. The patients and endoscopist recorded their assessment using a visual analogue scale (VAS). The results were analysed using non-parametric tests. Thirty patients were excluded from the study based on exclusion criteria. Sixty three (57%) patients were aged ⩾75 years and 37 (43%) were <75 years. Results::A significant difference was noted between patients'' perception of the discomfort and the endoscopist''s assessment of the patient''s discomfort as suggested by the overall higher VAS scores for patients (median 4.9, SD 2.6) than those of the endoscopist (median 2.2, SD 1.2), giving a significant difference in median VAS score of 3.4 (p<0.001). Older and younger patients had similar scores, with median (SD) VAS scores of 4.8 (2.5) for ⩾75 years and 4.9 (2.8) for <75 years. The endoscopist''s median scores for these two groups were 2.2 (1.2) and 2.1 (1.3), respectively. Conclusions::Patients'' discomfort during OGD performed without sedation was greatly underestimated by the endoscopist. There was no significant difference in acceptability between old and the young patients.     

Neuropsychiatric non-motor aspects of Parkinson's disease

Parkinson's disease is often recognised as a motor disease characterised by rest tremor, rigidity, bradykinesia, and postural disturbances. However, there are several non-motor aspects of the disease that are of at least equal importance in the management of patients with Parkinson's disease. They include depression, cognitive impairment, anxiety, and psychosis among others. It is important to recognise them, as they are common and they contribute significantly to patients' morbidity, quality of life, and institutionalisation to long term care homes. In addition to the disease duration and severity, other factors including drugs may contribute to their occurrence. Pathogenesis of these aspects is not fully understood, though there has been a significant increase in the knowledge in recent years. Management of these aspects involves a multidisciplinary approach.