Neuropsychiatric differences between Parkinson's disease with dementia and Alzheimer's disease

OBJECTIVE: To compare the profile of neuropsychiatric symptoms in patients with Parkinson's disease with dementia (PDD) and patients with Alzheimer's disease (AD). DESIGN: Cross-sectional survey of a population-based sample of patients with PDD and AD patients matched for age, sex, and Mini-Mental State Examination (MMSE) score. METHOD: Patients were diagnosed according to published criteria for PD and AD. The diagnosis of dementia in PD was made according to DSM-III-R, and was based on clinical interview of the patient and a relative, psychometric testing (including MMSE, Dementia Rating Scale and tests assessing memory, executive functions and visuospatial functioning) and physical examination. The Neuropsychiatric Inventory (NPI) was administered to all patients. RESULTS: One or more psychiatric symptoms was reported in 95% of AD and 83% of PDD patients. Hallucinations were more severe in PD patients, while aberrant motor behavior, agitation, disinhibition, irritability, euphoria, and apathy were more severe in AD. In PDD, apathy was more common in mild Hoehn and Yahr stages, while delusions increased with more severe motor and cognitive disturbances. In PDD, only delusions correlated with the MMSE score. CONCLUSIONS: Neuropsychiatric symptoms are common and severe in patients with PDD, with important implications for the management of these patients. AD and PDD patients have different neuropsychiatric profiles, suggesting different underlying mechanisms. Cognitive impairment, psychopathology, and motor features progress independently in PDD patients Copyright 2001 John Wiley & Sons, Ltd.     

Trapezius muscle activity, neck and shoulder pain, and subjective experiences during monotonous work in women

The electromyographic (EMG) activity patterns of 18 female supermarket employees reporting neck and shoulder pain were compared with those of 6 of their female colleagues reporting no pain when doing cash-register work. It was found that the EMG activity of the trapezius muscle tended to show a lack of low and high levels among pain subjects, and that the time the trapezius muscle was at rest was longer in the group reporting no pain. In the non-dominant side, the muscle rest time was significantly longer (P < 0.05) in the group reporting no pain, and this group also showed a larger EMG activity difference between the dominant and non-dominant sides, indicating a less static bilateral muscle activation. Self-reports of negative experiences (stressed, exhausted and tense) were somewhat higher in the group reporting pain, while positive experiences during work (concentrated, stimulated and happy) appeared to be similar in the two groups of supermarket employees. Accepted: 8 June 2000     

Nasal Symptoms Are Associated with School Performance in Adolescents

Children with asthma and allergy have higher school absence rates than others, but little is known about their school performance. In a study of 9538 adolescents, nasal symptoms severe enough to affect daily activity were associated with low-grade sum, particularly in adolescents using anti-allergy medication.     

Long-term follow-up of “sex change” in 13 male-to-female transsexuals

Thirteen male-to-female transsexuals were investigated in an intensive interview study. The follow-up period varied between 6 and 25 years, with an average of 12 years. Surgical outcome was disappointing, and only one-third of the patients where a vaginal construction was carried out had a functioning vagina. The importance of patient cooperation postoperatively is pointed out and reasons for noncooperation are discussed. The generally held view of transsexuals as hypo- or asexual is questionned. In this study, one-third of the patients were very active sexually both before and after radical genital surgery. More than half of these castrated and estrogen-treated former males experienced orgasm, but only one-third were judged as having a fair or good sexual adjustment after sex reassignment. The possibility of unsuccessful surgical results must continue to be an important part of presurgery reality orientation both in doctors and patients. One striking finding is that overall sexual adjustment is often unchanged by genital surgery. Psychosocial adjustment showed a slight improvement after surgery. However, the majority of patients (eight) were judged to be unchanged. Repentance was chosen as the most crucial single outcome variable. One patient had officially requested reversal of sex change and another three were judged as repenting surgery in more indirect ways. Thus for a total of four individuals (30%), sex reassignment was considered retrospectively to be a mistake. Despite their returning to a male social role after surgery, however, two of the repenting patients were judged as fairly well adjusted from a psychosocial point of view.     

Phase I study of intraperitoneal carboplatin as adjuvant therapy in early ovarian cancer

Early stage poor-risk ovarian cancer patients are at considerable risk for recurrent disease. Adjuvant radio- or chemotherapy has been found to improve disease-free and overall survival. Carboplatin, a second generation platinum, is documented comparable in efficacy to cisplatin in patients with advanced ovarian cancer. The toxicity profile is different from that of cisplatin. Dose-limiting toxicity is myelosuppression. The incidence and grade of renal and neurological toxicity is much lower compared with cisplatin, as is nausea and vomiting. Carboplatin given intraperitoneally (ip) is shown to have a favorable theoretical therapeutic advantage compared with iv administration since the peak peritoneal cavity/peak plasma concentration ratio is 18. Patients with early stage ovarian cancer seem suitable for carboplatin ip treatment. The study was designed to find the maximal tolerated dose (MTD). Three new patients were given two courses at each dose level. The MTD found was confirmed with further patients. Carboplatin was given in 2 liters of glucose via a subcutaneous implantable port without removal of fluid from the cavity. The starting dose was 300 mg/m2. Dose-limiting toxicity was thrombocytopenia and leukopenia. Leukocyte and platelet counts were reconstituted within 28 days in all cases. One case of severe but transient nephrotoxicity was observed. MTD was determined to 500 mg/m2.     

Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD) – A microdialysis study

The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash associated disorders (WAD) appear to involve both peripheral and central components, but the specific contribution of alterations in muscle is not clear. Female patients with WAD and involvement of trapezius (N=22) and female controls (N=20; CON) were studied during an experiment compromised of rest (baseline), 20min repetitive low‐force exercise and 120min recovery. Their interstitial concentrations of serotonin (5‐HT), glutamate, lactate, pyruvate, potassium, interleukin‐6 (IL‐6), and blood flow were determined in the trapezius muscle using a microdialysis technique. Pressure pain thresholds (PPT) over trapezius and tibialis anterior muscles were also assessed. In WAD, we found signs of generalized hypersensitivity according to PPT. The WAD group had significantly higher interstitial [IL‐6] and [5‐HT] in the trapezius than the CON. [Pyruvate] was overall significantly lower in WAD, and with lactate it showed another time‐pattern throughout the test. In the multivariate regression analysis of pain intensity [5‐HT] was the strongest regressor and positively correlated with pain intensity in WAD. In addition, blood flow, [pyruvate], and [potassium] influenced the pain intensity in a complex time dependent way. These findings may indicate that peripheral nociceptive processes are activated in WAD with generalized hypersensitivity for pressure and they are not identical with those reported in chronic work‐related trapezius myalgia, which could indicate different pain mechanisms.