Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia

Noncognitive behavioral and psychiatric disturbances are common in dementia and help in the clinical differentiation of the various subtypes. We studied the frequency of neuropsychiatric disturbances, their relationship to dementia severity and compared these disturbances in Alzheimer's disease (AD), vascular dementia (VaD) and frontotemporal dementia (FTD) using the 12-item Neuropsychiatric Inventory (NPI). A total of 98 patients (AD-44, VaD-31, FTD-23) were evaluated. All subjects were community dwelling at the time of evaluation. The three groups were comparable on global dementia severity and functional ability. All patients had clinically significant scores on the NPI with apathy, irritability and agitation being very common (>90% of patients). AD and VaD patients in Clinical Dementia Rating (CDR) stage 2 had significantly higher scores on the total NPI, agitation and disinhibition subscales compared to those in CDR stage 1. Mean scores in the domains of aberrant motor behavior, disinhibition and appetite/eating behavior differentiated FTD from AD and VaD. Neuropsychiatric disturbances in dementia appear to be universal with agitation, disinhibition and irritability being more frequent in the later stages. In this cohort disinhibition, aberrant motor behavior and appetite/eating disturbances could reliably differentiate AD and VaD from FTD. There were no significant differences between the neuropsychiatric profiles of AD and VaD.     

Efficacy of dichloroacetate as a lactate-lowering drug

Dichloroacetate (DCA) decreases blood, cerebral spinal fluid, and intracellular lactate concentrations by activating the mitochondrial pyruvate dehydrogenase enzyme complex. The authors reviewed the efficacy of this investigational drug in the treatment of acquired or congenital forms of lactic acidosis from data in 40 English-language publications. The hypolactatemic effect of DCA occurs over a broad range of pretreatment lactate concentrations and is directly related to the baseline lactate level. The maximum lactate-lowering effect of the drug is dependent on its dose but independent of time following its administration. Recent clinical studies of acquired lactic acidosis suggest that DCA could be rapidly effective in reducing this risk factor of mortality in patients with mild hyperlactatemeia.     

Effect of acute and chronic conditions of over-crowding on free choice ethanol intake in rats

Male albino rats of Wistar strain were exposed to overcrowding stress in two different groups for a period of seven days. One group of rats was kept under stress for six hours per day (acute stressed group) and the other group rats was kept under stress continuously (chronic stressed group). The effect of these acute and chronic stresses on voluntary alcohol (2% w/v) intake was monitored during the 7 days of stress exposure, and ethanol preference and total ethanol intake in terms of g/kg body weight were also studied. A significant increase in ethanol preference and ethanol intake was observed in one-day and 7 days chronic stressed group. No significant increase in ethanol intake was observed in acute stress. Thus a short lasting stressor may not increase ethanol-drinking behavior, whereas when animals were exposed to more intense stressor continuously for 7 days, an increase in voluntary drinking behavior may be seen.     

Combination therapy of donepezil and vitamin E in Alzheimer disease

A retrospective chart review was performed on 130 patients from the Ohio State University Memory Disorders Clinic to examine the long-term effects of combination therapy with donepezil and vitamin E on patients with Alzheimer disease. Subjects were included if they met National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer disease, had taken at least 5 mg donepezil and at least 1000 U vitamin E daily, had at least a 1-year follow-up while continuing these medications, and had a Mini-Mental State Examination score of 10-24. The Mini-Mental State Examination was then recorded annually thereafter. These data were compared with the Consortium to Establish a Registry for Alzheimer's Disease database for patients collected prior to the availability of these treatment options. Patients declined at a significantly lower rate as compared with the Consortium to Establish a Registry for Alzheimer's Disease data. The long-term combination therapy of donepezil and vitamin E appears beneficial for patients with Alzheimer disease. Future prospective studies would be needed to compare combination treatment to vitamin E and donepezil alone.     

A new sensitive and selective spectrophotometric method for the determination of catechol derivatives and its pharmaceutical preparations

A sensitive and simple spectrophotometric method for the estimation of certain catechol derivatives like pyrocatechol (PCL), dopamine hydrochloride (DPH), levodopa (LDP), methyl dopa (MDP) and adrenaline (ADH) in either pure form or in its pharmaceutical formulation is described. The method is based on the interaction of diazotised p-nitro aniline (DPNA) with catechol derivatives in presence of molybdate ions in acidic medium. Absorbance of the resulting red complex is measured at 500-510 nm, respectively, and is stable for 2-10 h. The method is highly reproducible and specific for these selected catechol derivatives. The common excipients used as additives in pharmaceuticals and phenol, hydroquinone, resorcinol, pyrogallol and phloroglucinol do not interfere in the proposed method. Analytical data for determination of the pure compound is presented together with the application of the proposed method to the analysis of some pharmaceutical formulations. The results compare favourably with those of official and reported methods.     

Valvular heart disease in Antiphospholipid antibody syndrome: Isolated Tricuspid stenosis

Antiphospholipid antibody syndrome (APLS) is a rare disorder characterized by a hypercoagulable state. Manifestations include arterial or venous thrombosis, recurrent fetal wastage, coronary artery disease, valvular heart disease, dilated cardiomyopathy, pulmonary artery hypertension, and intracardiac thrombus. Most commonly mitral valve is affected followed by aortic and then tricuspid valve. In this report, a rare case of spontaneous aortic thrombosis with tricuspid stenosis uncomplicated by other valve lesions is presented with clinical and echocardiographic studies and computed tomographic images.     

Impact of Presence of Children on Indoor Tobacco Restrictions in Households of Urban and Rural Adult Tobacco Users

Objectives

Secondhand smoke exposure in children is changing as a result of new public policy and electronic nicotine products (e-cigarettes). We examined factors related to self-imposed indoor household tobacco restrictions, with emphasis on children in the household and associations with combustible and noncombustible product use.