Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence

When adolescents with ADHD enter adulthood, some no longer meet disorder diagnostic criteria but it is unknown if biological and cognitive abnormalities persist. We tested the hypothesis that people diagnosed with ADHD during adolescence present residual brain abnormalities both in brain structure and in working memory brain function. 83 young adults (aged 20–24 years) from the Northern Finland 1986 Birth Cohort were classified as diagnosed with ADHD in adolescence (adolescence ADHD, n = 49) or a control group (n = 34). Only one patient had received medication for ADHD. T1-weighted brain scans were acquired and processed in a voxel-based analysis using permutation-based statistics. A sub-sample of both groups (ADHD, n = 21; controls n = 23) also performed a Sternberg working memory task whilst acquiring fMRI data. Areas of structural difference were used as a region of interest to evaluate the implications that structural abnormalities found in the ADHD group might have on working memory function. There was lower grey matter volume bilaterally in adolescence ADHD participants in the caudate (p < 0.05 FWE corrected across the whole brain) at age 20–24. Working memory was poorer in adolescence ADHD participants, with associated failure to show normal load-dependent caudate activation. Young adults diagnosed with ADHD in adolescence have structural and functional deficits in the caudate associated with abnormal working memory function. These findings are not secondary to stimulant treatment, and emphasise the importance of taking a wider perspective on ADHD outcomes than simply whether or not a particular patient meets diagnostic criteria at any given point in time.     

A natural history study of adolescents and young adults with sickle cell disease as they transfer to adult care: a need for case management services

Life expectancy for adolescents with SCD now extends well into adulthood. As a result, adolescents transfer to adult care. Little empirical evidence exists to show how transfer occurs and how well the current practices now work. The aim of this study was to obtain a database on the experience of adolescents/young adults with SCD that transfer to adult care. We assessed their treatment compliance, independence, and whether they receive uninterrupted care. Data were obtained through patient and provider interviews and patient record reviews. Results indicate patients leave pediatric care without adequate transfer preparation and readiness to transfer is not the major consideration in the decision to transfer, follow-up often ceases once the patients leave pediatric care, and patients who maintain follow-up appointments are more efficient in managing their illness (self-efficacy). The model for a structured transitioning process is provided with recommendations for nurse case managers to maintain follow-up.     

Glucocerebrosidase mutations are an important risk factor for Lewy body disorders

The synucleinopathies are neurodegenerative disorders defined by inclusions composed of aberrantly fibrillized alpha-synuclein, but factors contributing to this process remain largely unknown. The authors examined the glucocerebrosidase gene in 75 autopsy specimens with different synucleinopathies and identified mutations in 23% of cases of dementia with Lewy bodies, expanding on previous findings in subjects with Parkinson disease. Mutations in this lysosomal protein may interfere with the clearance or promote aggregation of alpha-synuclein.     

Review of health research on indigenous populations in Latin America, 1995-2004

OBJECTIVE: To review health research conducted among indigenous populations in Latin America during the period 1995-2004. Material and methods. The search strategy was purposely broad to ensure the identification of all relevant studies indexed in the PubMed and Lilacs databases. RESULTS: Six-hundred ninety citations were included. One hundred fifty-nine (23.0%) papers dealt with indigenous populations in Central America and 509 (73.8%) papers with South American populations. Three hundred two (43.8%) of the studies were quantitative, 39 (5.7%) qualitative, 259 (37.5%) mainly based on laboratory work and 24 (3.5%) dealt with policy analyses. The most common researched theme was human biology with 200 (29.0 %) papers, followed by communicable diseases (150 papers, 21.7 %). CONCLUSIONS: There is a special need for policy studies in the field of indigenous health. An increased commitment to resources and capacity building will be the real challenge for indigenous health research in the nearest future.     

Attention and behavioural problems of Finnish adolescents may be related to the family environment

BACKGROUND: Adolescents' attention and behavioural problems in relation to the family environment were studied in the Northern Finland 1986 Birth Cohort. METHOD: Fifteen-year-old adolescents (N=6888) completed the Youth Self-Report (YSR) questionnaire and their parents (N=6643) completed the Strengths and Weaknesses in ADHD and Normal Behaviours (SWAN) questionnaire. The ratings were compared in relation to gender and family characteristics. RESULTS: Girls scored higher than boys on the YSR attention problems subscale (means 4.61 vs. 3.41), the rule-breaking behaviour subscale (means 4.25 vs. 3.69) and the aggressive behaviour subscale (means 7.18 vs. 5.63). Parents reported more SWAN attention problems in their sons than in their daughters. Living in an other than intact family increased YSR and SWAN attention problems and YSR behavioural problems in both genders. Adolescents living in very large families (11-19 children) had least attention and behavioural problems. CONCLUSIONS: Attention and behavioural problems seem to be common among adolescents in Finland. For both genders, living in other than intact families increases especially behavioural problems. Additionally, a very large family seems to be a protective factor against those problems.     

Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators

We report a patient with advanced Parkinson's disease (PD) who developed a recurrence of major depression with psychotic features after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. Electroconvulsive therapy (ECT) dramatically improved the depression without shifting electrode position or damaging the DBS hardware. This case suggests that ECT can be a safe and effective option for severe depression in PD patients treated with STN DBS.     

Differences in [99mTc]TRODAT-1 SPECT binding to dopamine transporters in patients with multiple system atrophy and Parkinson’s disease

Purpose Multiple system atrophy (MSA), a disorder causing autonomic dysfunction, parkinsonism, and cerebellar dysfunction, is difficult to differentiate from other movement disorders, particularly early in the course of disease. This study evaluated whether [^99mTc]TRODAT-1 binding to the dopamine transporter differentiates MSA from other movement disorders.Methods Single-photon emission computed tomographic brain scans were acquired in 25 MSA patients, 48 age-matched controls, and 130 PD patients, 3 h after the injection of 740 MBq (20 mCi) of [^99mTc]TRODAT-1. Regions of interest (ROIs) were placed manually on subregions of both basal ganglia and distribution volume ratios (DVRs) were calculated. Regional DVRs were compared between study groups in MSA patients. Students t tests were used to compare MSA patients with other study groups. Spearman correlations were used to compare DVRs with NP measures.Results Based upon various motor scores, MSA and PD patients had comparable motor impairment, and were significantly impaired compared with controls. Mean DVRs in the basal ganglia of MSA patients were significantly less than those of controls, but generally higher (p<0.05) than in PD patients. In particular, the MSA patients had significantly increased DVRs in the posterior putamen (mean 0.49±0.30) compared with PD patients (0.74±0.25).Conclusion Movement disorder patients could be differentiated from controls, but MSA and PD patients could not be easily differentiated from each other. As a group, MSA patients had significantly higher mean [^99mTc]TRODAT-1 binding, particularly in the posterior putamen, compared with PD patients and significantly lower binding compared with controls. This may reflect different pathophysiological processes of the two neurodegenerative diseases.