Sources of Bias in Common Diagnosis of Chronic Inflammatory Bowel Diseases

Aim. Causal analysis of a late diagnosis of chronic inflammatory bowel diseases (CIBD) in general medical practice.Materials and methods. We continuously sampled 80 CIBD histories (44 of ulcerative colitis, UC, and 36 of Crohn’s disease, CD) to estimate the time and nature of first complaints, primary diagnosis, time lapse between the first physician visit and diagnosis and reasons for a late diagnosis.Results. Only 63.6 % of patients with UC and 38.9 % with Crohn’s disease were correctly diagnosed during the first visit and subsequent examination. Abdominal pain in debut of CIBD was registered in 40.9 % of the UC and 75.0 % of CD patients (p < 0.01). Diarrhoea as a CIBD manifestation was significantly more common in the UC than in CD patients (88.6 and 55.5 % of cases, respectively; p < 0.01). Hematochesia was observed in 68.2 % of the UC and 22.2 % of CD cases (p < 0.01). Among the CD patients with primary symptoms, a correct follow-up diagnosis was less frequent compared to the UC patients (38.9 % of cases, p < 0.01). Only 30 patients with UC (68.2 %) and 18 patients with CD (50.0 %) had colonoscopy at a first outpatient visit. The main cause of late diagnoses in CIBD is a delayed ileocolonoscopy.Conclusions. Ileocolonoscopy should be mandatory in all patients suspected for CIBD with clinical symptoms

White matter measures correlate with essential tremor severityA pilot diffusion tensor imaging study

Background An evolving pathophysiological concept of essential tremor (ET) points to diffuse brain network involvement, which emphasizes the need to investigate white matter (WM) changes associated with motor symptoms of ET. Objectives To investigate ETrelated WM changes and WM correlates of tremor severity using tremor clinical rating scales and accelerometry. Methods Tractbased spatial statistics (TBSS) approach was utilized to compare 3 Tesla diffusion tensor imaging (DTI) data from 12 ET patients and 10 age and gendermatched healthy individuals. Clinical scales, tremor frequency and amplitude as measured by accelerometry were correlated with DTI data. Results ET patients demonstrated mean (MD) and radial diffusivity (RD) abnormalities in tracts involved in primary and associative motor functions such as bilateral corticospinal tracts, the superior longitudinal fascicles, and the corpus callosum but also in nonmotor regions including the inferior frontooccipital and longitudinal fascicles, cingulum bundles, anterior thalamic radiations, and uncinate fascicles. A combined tremor frequency and amplitude score correlated with RD and MD in extensive WM areas, which partially overlapped the regions that were associated with tremor frequency. No significant relationship was found between DTI measures and clinical rating scales scores. Conclusions The results show that ETrelated diffusion WM changes and their correlates with tremor severity are preferentially located in the primary and associative motor areas. In contrast, a relationship between WM was not detected with clinical rating scales. Accelerometry parameters may, therefore, serve as a potentially useful clinical measures that relate to WM deficits in ET.(VLID)480009

Grip Strength Is Associated With Cognitive Performance in Schizophrenia and the General Population:A UK Biobank Study of 476559 Participants

Background Handgrip strength may provide an easily-administered marker of cognitive functional status. However, further population-scale research examining relationships between grip strength and cognitive performance across multiple domains is needed. Additionally, relationships between grip strength and cognitive functioning in people with schizophrenia, who frequently experience cognitive deficits, has yet to be explored. Methods Baseline data from the UK Biobank (2007–2010) was analyzed; including 475397 individuals from the general population, and 1162 individuals with schizophrenia. Linear mixed models and generalized linear mixed models were used to assess the relationship between grip strength and 5 cognitive domains (visual memory, reaction time, reasoning, prospective memory, and number memory), controlling for age, gender, bodyweight, education, and geographical region. Results In the general population, maximal grip strength was positively and significantly related to visual memory (coefficient [coeff] = −0.1601, standard error [SE] = 0.003), reaction time (coeff = −0.0346, SE = 0.0004), reasoning (coeff = 0.2304, SE = 0.0079), number memory (coeff = 0.1616, SE = 0.0092), and prospective memory (coeff = 0.3486, SE = 0.0092: all P .1). Conclusions Grip strength is significantly associated with cognitive functioning in the general population and individuals with schizophrenia, particularly for working memory and processing speed. Future research should establish directionality, examine if grip strength also predicts functional and physical health outcomes in schizophrenia, and determine whether interventions which improve muscular strength impact on cognitive and real-world functioning

Shared vulnerability for connectome alterations across psychiatric and neurological brain disorders

Macroscale white matter pathways are the infrastructure for large-scale communication in the human brain and a prerequisite for healthy brain function. Disruptions in the brain's connectivity architecture play an important role in many psychiatric and neurological brain disorders. Here we show that connections important for global communication and network integration are particularly vulnerable to brain alterations across multiple brain disorders. We report on a cross-disorder connectome study comprising in total 1,033 patients and 1,154 matched controls across 8 psychiatric and 4 neurological disorders. We extracted disorder connectome fingerprints for each of these 12 disorders and combined them into a 'cross-disorder disconnectivity involvement map' describing the level of cross-disorder involvement of each white matter pathway of the human brain network. Network analysis revealed connections central to global network communication and integration to display high disturbance across disorders, suggesting a general cross-disorder involvement and the importance of these pathways in normal function