Clinical usefulness of cognitive evoked potentials to assess cognitive deficits in cerebrovascular diseases

Background: The aim of the present study is to evaluate the clinical applicability and usefulness of cognitive evoked potentials (CEP) to identify a cognitive deficit in patients with cerebrovascular diseases (CVD). Methods: The P3 latencies, amplitudes and latency to amplitude ratios (LAR) of CEP were measured in 25 healthy control subjects and 35 inpatients with CVD. The association of CEP with variables including age, sex, mini‐mental state examination (MMSE) score, CVD types, loci of hemiplegic limbs, duration, education, brief psychiatric rating scale (BPRS), instrumental activities of daily living (IADL) and daily living function assessment (DLFA) was also analyzed. Results: (i) The P3 latencies (447.87 ± 113.06 msec) and LAR (65.83 ± 43.25) were prolonged in CVD (P < 0.05), while the amplitudes (8.18 ± 2.51 µV ) were not changed; (ii) the P3 latencies (537.31 ± 101.14msec) and LAR (94.89 ± 46.44 in CVD with a MMSE score <24 were prolonged, and the amplitudes (6.45 ± 1.98 µV ) were reduced (P < 0.05, respectively); (iii) the BPRS, IADL and DLFA in CVD with a MMSE score <24 were different from MMSE ≥24 (P < 0.05); (iv) there was no difference in CEP between CVD caused by infaction and hemorrhage; (v) the P3 latencies were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA. The amplitudes were correlated positively with MMSE and DLFA, while negatively with age, BPRS and IADL. The LAR were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA; and (vi) on analyzing association of CEP with variables in CVD with MMSE <24, the P3 latencies were correlated positively with BPRS and DLFA, while negatively with MMSE and DLFA. The amplitudes were positively correlated with age. The LAR were positively correlated with IADL. Conclusions: The P3 latencies and LAR of CEP seemed to be useful clinical measures to assess cognitive disorders in CVD as well as in vascular dementia.     

Early detection of childhood autism: a review of screening instruments and rating scales

Summary The detection and diagnosis of autism may be delayed until middle childhood, 3–4 years after its onset. This is more likely in high-functioning autism and in cases of co-morbidity with mental retardation. Such delays have serious effects on children and their families as well as on the provision of clinical and educational resources. In addition to greater awareness among professionals and to the development of comprehensive services, early detection could be facilitated by screening for early signs and symptoms of autism. The instruments that have been developed to rate autistic behaviours, particularly in pre-school children, are reviewed in this paper. Although the majority of these observational or informant-based measures were not initially designed for screening purposes, previous research findings from their application could be useful in the future development of such a screening instrument. Relevant research findings are discussed and suggestions are made for further evaluation in appropriate populations.     

Effect of Intravesical Prostatic Protrusion on the Characteristics of Lower Urinary Tract Symptom Change after 12‐Week Drug Medication: A Prospective Analysis

Objectives: The aim of this study was to identify whether intravesical prostatic protrusion (IPP) is related to the characteristics of voiding symptoms improvement after drug treatment in benign prostatic hyperplasia patients. Methods: Ninety male patients with more than 30 g prostate volume were prospectively enrolled. All patients were evaluated with International Prostate Symptoms Score (IPSS), uroflowmetry, postvoid residual urine (PVR), prostate volume and IPP measurement by transrectal ultrasound. Treatment response was evaluated again by IPSS after 12 weeks of medication. We evaluated the correlation of IPP and IPSS, quality of life (QoL) score, maximum urinary flow rate (Qmax) and PVR, and compared IPPS and IPSS subscale score change between the IPP and non‐IPP groups. Results: IPP was significantly correlated with total IPSS, voiding/storage symptom subscore and PVR. IPP was inversely correlated with Qmax. IPP showed a significant correlation with storage symptoms after an adjustment of prostate volume. After 12 weeks of medication, the IPP group showed persistently high storage symptoms than the non‐IPP group. Conclusion: BPH patients with IPP showed less improvement of storage symptoms after 12 weeks of medication. This study suggests that IPP may be a possible cause of intractable storage symptoms in early treatment.     

Prolonged Atrium Electromechanical Interval Is Associated with Stroke in Patients with Atrial Fibrillation After Catheter Ablation

Electromechanical Interval and Strokes After Ablations of AF . Introduction: Atrial fibrillation (AF) is associated with increased risk of embolic stroke. Catheter ablation of AF provides an effective therapy for patients with symptomatic and drug‐refractory AF. The aim of this study was to evaluate whether the atrial electromechanical interval is useful in identifying patients at risk of stroke after successful catheter ablation. Methods and Results: A total of 279 AF patients who received catheter ablation and showed no evidence of recurrences were enrolled. Electromechanical interval (PA–PDI) was determined as the time interval from the initiation of P wave deflection to the peak of mitral inflow A wave on pulse wave Doppler imaging. The PA–PDI interval was measured for each patient after the 3‐month blanking period of catheter ablation. The clinical endpoint was the occurrence of ischemic stroke. During the follow‐up of 46.5 ± 17.2 months, 6 patients suffered from ischemic strokes. Patients with strokes had higher CHA₂DS₂–VASc scores and longer PA–PDI intervals (138.7 ± 12.4 ms vs 161.2 ± 7.7 ms, P value < 0.001) compared to those without strokes. At a cutoff point of 150 ms identified by ROC curve, the positive and negative predictive values of the PA–PDI interval to predict stroke were 86.7% and 100%, respectively. The PA–PDI interval improved the predictive performance of the CHA₂DS₂–VASc score, and the area under the ROC curve increased from 0.75 to 0.85. Conclusions: Our results suggest that the PA–PDI interval is a useful tool to identify patients with high risk of stroke after successful catheter ablation of AF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 375‐380, April 2013)