Cognitive change on the repeatable battery of neuropsychological status (RBANS) in parkinson's disease with and without bilateral subthalamic nucleus deep brain stimulation surgery

Cognitive change following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in those with Parkinson's disease (PD) has led to equivocal results. The current study applied a standardized regression-based (SRB) method based on 20 medically managed PD patients and 20 STN DBS PD surgical patients who were administered the Repeatable Battery of Neuropsychological Status (RBANS). Of the medically managed PD participants, 94% remained stable compared to 73% of the DBS group. In the DBS group cognitive change was noted on the Total scale and the Immediate Memory Index. A secondary analysis also revealed reliable change on several subtest scores. Although preliminary, the current study provides change parameters for post DBS surgery on this brief battery.     

Normative Adjustments to the D-KEFS Trail Making Test: Corrections for Education and Vocabulary Level

The Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test (TMT), a modification of the original TMT, was created to isolate set-shifting (Letter–Number Switching) from other component skills. This was accomplished by including four baseline conditions (Visual Scanning, Number Sequencing, Letter Sequencing, and Motor Speed) and by placing equal numbers of stimuli in the three sequencing conditions. Given that some studies with the original TMT demonstrated a significant effect of education and intellectual functioning on performance, we utilized the D-KEFS national standardization sample to examine the effects of education and vocabulary level—i.e., Vocabulary subtest from the Wechsler Abbreviated Scale of Intelligence (WASI)—on the D-KEFS TMT. The results indicate a significant effect of these variables on each D-KEFS TMT condition. Normative tables for education- and vocabulary-adjusted scaled scores based on the database from the D-KEFS national normative study were generated.     

Conducting neuropsychological assessment with transgender individuals

Abstract

Objective: The purpose of this paper is to provide an overview of helpful clinical practices when working with transgender adult individuals. Method: While the number of openly transgender individuals appears to be growing with society’s increased acceptance and awareness, many neuropsychologists have had few opportunities to gain experience with this patient population. In this article, we review the existing literature as it relates to clinical neuropsychological practice. Results: We describe important terminology, ideals for creating an environment of respect, and how existing clinical guidelines for transgender individuals may apply to neuropsychology. In addition, we review the primary steps in the assessment process and provide a set of principles and recommendations for conducting neuropsychological assessments with transgender patients. Conclusions: There is a paucity of guidance in the field for working with transgender individuals. This article represents a step forward in the dialog and we look forward to future research that develops appropriate normative information, increases understanding of psychosocial factors, and better appreciates the range of hormonal influences for transgender individuals.     

QTc-Prolongation in Posterior Circulation Stroke

Background and Purpose

To evaluate the relationship between infarct location and QTc-prolongation in patients with posterior circulation strokes.

Methods

Admission electrocardiograms (ECG) of 131 patients among a prospective sample of 407 consecutive adult patients in the New England Medical Center Posterior Circulation Registry were retrospectively analyzed. The QT interval (ms) was measured and corrected using Bazett’s formula (QTc_Bazett) as well as linear regression functions (QTc_Linear). QTc_Bazett > 440 ms and QTc_Linear ≥ 450 ms for men (≥460 ms for women) were considered prolonged. Multivariable linear and logistic regression analyses were used to identify independent predictors of the QTc.

Results

Overall, 34 % of patients had a prolonged QTc_Bazett and 7 % had a prolonged QTc_Linear noted on the admission ECG. There was a significant association between temporal lobe infarction and QTc_Bazett and QTc_Linear (p < 0.001 for both) in multivariable linear regression analyses adjusting for demographics, ECG parameters, and preadmission medication use. In multivariable logistic regression analysis, temporal lobe infarction emerged as an independent predictor of prolonged QTc_Bazett (p = 0.009) and QTc_Linear (p = 0.008), respectively. Sensitivity analyses excluding patients with transient ischemic attack yielded similar results. Exploratory analyses indicated that patients with temporal lobe infarction had worse functional 30-day outcomes in multivariable logistic regression (p = 0.022). However, there was no significant association between QTc and 30-day functional outcome.

Conclusions

QTc-prolongation is common after posterior circulation stroke and associated with temporal lobe infarction. Prospective studies are needed to confirm these preliminary findings and to examine potential long-term consequences.     

Neuroimaging in hyperkinetic children and adults: an overview

The application of brain imaging techniques to children with Attention Deficit/Hyperactivity Disorders is reviewed, stressing methodological aspects. Findings are still provisional, but suggest minor structural changes in frontal and candate areas, especially on the right side. Functional studies suggest reduced activation in these and other areas. The techniques do not yet contribute to individual diagnosis.     

Dual delivery of chlorhexidine and platelet-derived growth factor-BB for enhanced wound healing and infection control

Wound treatment can require molecules that both enhance healing and control infection. As in many biomedical applications, the options for therapeutic molecules may include both hydrophilic and hydrophobic molecules. The goal of this study was to investigate a polymer system for drug delivery that simultaneously delivers platelet-derived growth factor (PDGF)-BB, a hydrophilic protein known to promote wound healing, and chlorhexidine (CHX), a hydrophobic antimicrobial agent for infection treatment. Poly(lactic-co-glycolic acid) (PLGA) microspheres were prepared using different polymer formulations in a double emulsion process. CHX encapsulation efficiency was 19.6 ± 0.8% and 28.9 ± 1.5% for PLGA 50:50 and 85:15, respectively. The presence of CHX significantly increased PDGF-BB encapsulation efficiency relative to PDGF-BB alone. Both molecules could be released for up to 50 days and exhibited bioactivity for greater than 3 (PLGA 85:15) or 8 (PLGA 50:50) weeks using in vitro bacteria and cellular assays. An infected wound model was used to evaluate the system in vivo. Wounds treated with the dual delivery system showed decreased levels of infection and increased healing. Vascular analysis of wound tissues also showed higher levels of mature vasculature with the delivery of PDGF-BB. In conclusion, we have evaluated a drug delivery system for simultaneous delivery of hydrophobic and hydrophilic molecules and have shown that this system can improve healing and reduce bacteria levels in an infected wound model. This system could be applied to other therapeutic applications where sustained delivery of hydrophobic and hydrophilic molecules is required.     

Bilateral Bifid Mandibular Condyles

The bifid mandibular condyle is, in and of itself, a most uncommon anatomic occurrence. The observation of bilateral bifid mandibular condyles is, in fact, rare. Hrdlicka¹ first described three cases of this bilateral phenomenon in 1941 in the American Journal of Physical Anthropology. Since then, there have been no known reported cases of bilateral bifid mandibular condyles.

This paper reports a case of documented bilateral bifid mandibular condyles diagnosed in a young woman undergoing routine temporomandibular joint evaluation following a trauma to the face.