Wiener klinische Wochenschrift / Assessment of individual cognitive changes after deep brain stimulation surgery in Parkinsons disease using the Neuropsychological Test Battery Vienna short version

Long-term therapy of Parkinsons disease with LDOPA is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinsons patients, 24 patients with mild cognitive impairment (MCI) and 12 healthy controls using the Neuropsychological Test Battery Vienna short version (NTBV-short) for cognitive outcome 12 months after the first examination. Reliable change index methodology was used. Roughly 10% of DBS patients showed cognitive decline mainly affecting the domains attention and executive functioning (phonemic fluency). Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.(VLID)355129

Screening for Specific Language Impairment in Preschool Children : Evaluating a Screening Procedure Including the Token Test

Specific language impairment (SLI) comprises impairments in receptive and/or expressive language. Aim of this study was to evaluate a screening for SLI. 61 children with SLI (SLI-children, age-range 46 years) and 61 matched typically developing controls were tested for receptive language ability (Token TestTT) and for intelligence (Wechsler Preschool-and-Primary-Scale-of-IntelligenceWPPSI). Group differences were analyzed using t tests, as well as direct and stepwise discriminant analyses. The predictive value of the WPPSI with respect to TT performance was analyzed using regression analyses. SLI-children performed significantly worse on both TT and WPPSI (p.0001). The TT alone yielded an overall classification rate of 79%, the TT and the WPPSI together yielded an overall classification rate of 80%. TT performance was significantly predicted by verbal intelligence in SLI-children and nonverbal intelligence in controls whilst WPPSI subtest arithmetic was predictive in both groups. Without further research, the Token Test cannot be seen as a valid and sufficient tool for the screening of SLI in preschool children but rather as a tool for the assessment of more general intellectual capacities. SLI-children at this age already show impairments typically associated with SLI which indicates the necessity of early developmental support or training. Token Test performance is possibly an indicator for a more general developmental factor rather than an exclusive indicator for language difficulties.(VLID)355665

Wanted : a better cut-off value for the Epworth Sleepiness Scale

Background Excessive daytime sleepiness (EDS) is the main complaint in many neurological sleep disorders, such as idiopathic hypersomnia, narcolepsy, or obstructive sleep apnea/hypopnea syndrome (OSAS). The validity of the Epworth Sleepiness Scale (ESS) as a screening tool for EDS remains controversial. We therefore investigated (1) the interrelation of the ESS total score and the mean sleep latency (MSL) during the multiple sleep latency test (MSLT) and (2) the diagnostic accuracy of the ESS total score to detect EDS in patients with the chief complaint of subjective EDS. Methods A total of 94 patients (48 males) with subjective EDS were included in this study. Regression analyses and ROC curve analyses were carried out to assess the predictive value of the ESS score for MSL. Results The ESS score significantly predicted a shortened MSL (p=0.01, =0.29). After dichotomizing into two groups, the ESS score predicted MSL only in patients with hypersomnia or narcolepsy (p=0.01, =0.33), but not in patients with other clinical diagnoses (e.g. OSAS; p=0.36, =0.15). The ROC curve analyses indicated an optimal ESS cut-off value of 16 with a sensitivity of 70%; however, specificity remained unsatisfactory (55.6%). Conclusions Our results suggest that the predictive value of the ESS score in patients with subjective EDS is low and patient subgroup-specific (superior in hypersomnia/narcolepsy vs. other diagnoses) and that the commonly used cut-off of 11 points may be insufficient for clinical practice.(VLID)358379

Iodinated contrast agents in patients with myasthenia gravis : a retrospective cohort study

Currently, it has not been satisfactorily established, whether modern low-osmolality iodinated contrast agents (ICAs) used in computed tomography (CT) studies are a risk factor for exacerbation of myasthenic symptoms. The rate of acute adverse events as well as delayed clinical worsening up to 30 days were analyzed in 73 patients with confirmed myasthenia gravis (MG) who underwent contrast-enhanced CT studies and compared to 52 patients who underwent unenhanced CT studies. One acute adverse event was documented. 12.3% of MG patients experienced a delayed exacerbation of symptoms after ICA administration. The rate of delayed severe exacerbation was higher in the contrast-enhanced group. Alternative causes for the exacerbation of MG-related symptoms were more likely than ICA administration in all cases. ICA administration for CT studies in MG patients should not be withheld if indicated, but patients particularly those with concomitant acute diseases should be carefully monitored for exacerbation of symptoms.(VLID)354446

Early dysfunctions of fronto-parietal praxis networks in Parkinsons disease

In Parkinsons disease (PD) the prevalence of apraxia increases with disease severity implying that patients in early stages may already have subclinical deficits. The aim of this exploratory fMRI study was to investigate if subclinical aberrations of the praxis network are already present in patients with early PD. In previous functional imaging literature only data on basal motor functions in PD exists. Thirteen patients with mild parkinsonian symptoms and without clinically diagnosed apraxia and 14 healthy controls entered this study. During fMRI participants performed a pantomime task in which they imitated the use of visually presented objects. Patients were measured ON and OFF dopaminergic therapy to evaluate a potential medication effect on praxis abilities and related brain functions. Although none of the patients was apraxic according to De Renzi ideomotor scores (range 6272), patients OFF showed significantly lower praxis scores than controls. Patients exhibited significant hyperactivation in left fronto-parietal core areas of the praxis network. Frontal activations were clearly dominant in patients and were correlated with lower individual praxis scores. We conclude that early PD patients already show characteristic signs of praxis network dysfunctions and rely on specific hyperactivations to avoid clinically evident apraxic symptoms. Subclinical apraxic deficits were shown to correlate with an activation shift from left parietal to left frontal areas implying a prospective individual imaging marker for incipient apraxia.(VLID)353391

Self-reported and informant-reported memory functioning and awareness in patients with mild cognitive impairment and Alzheimers disease

Grundlagen Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist ein wichtiger Faktor für eine angemessene Behandlung von Patienten mit leichter kognitiver Beeinträchtigung (MCI) und Alzheimer-Krankheit (AD). Ziel der vorliegenden Studie war herauszufinden (i) ob subjektive Gedächtnisleistung und objektive Gedächtnisleistung assoziiert sind, (ii) ob sich die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung mit der Zeit verändert und (iii) ob die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ein Prädiktor für die Entwicklung einer Demenz ist. Methodik Vierunddreißig Patienten mit MCI, die Hilfe in einer universitären Gedächtnisambulanz suchten, wurden in die Studie eingeschlossen. Alle Teilnehmer wurden einer ausführlichen neuropsychologischen Untersuchung unterzogen. Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung wurde durch Berechnung der Differenzwerte zwischen Patient und Informant Bewertung auf einem 16-Punkt-Fragebogen hinsichtlich Gedächtnisbeschwerden im täglichen Leben erhalten. Eine Kontrolluntersuchung wurde nach einer mittleren Nachbeobachtungszeit von 24 Monaten durchgeführt. Ergebnisse Die Analyse zeigte, dass die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung relativ stabil über die Zeit blieb. Selbst berichtete Gedächtnisbeschwerden korrelierten mit der episodischen Gedächtnisleistung zu Beginn der Studie und mit der Leistung bei einer Sprachaufgabe bei der Nachuntersuchung. Wiederholungsprüfungen angezeigt Rückgang des Bewusstseins. Der prädiktive Wert der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung in Bezug auf die Demenzentwicklung war gering. Schlussfolgerungen Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist mit episodischer Gedächtnis-Funktion verknüpft und nimmt mit Abnahme der kognitiven Fähigkeiten ab. Weitere Studien zur Vorhersagekraft der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung sollten eine größere Patientenstichprobe umfassen.Awareness of subjective memory is an important factor for adequate treatment of patients with mild cognitive impairment (MCI) and Alzheimers disease (AD). This study served to find out whether awareness of subjective memory complies with objective performance, if differences in awareness are observed longitudinally and whether decrease of awareness can serve as a predictor of AD in MCI patients. Methods Thirty-four patients with MCI seeking help in a memory outpatient clinic were included. All participants underwent thorough neuropsychological examination. Awareness of subjective memory was obtained by calculating difference scores between patient and informant ratings on a 16-item questionnaire concerning complaints about loss of memory in every-day life. Retesting was performed after a mean follow-up period of 24 months. Results Whole group analyses showed that awareness remained relatively stable across time. Self-reported memory complaints correlated with episodic memory at baseline and with performance on a language task at follow-up. Retests displayed decrease of awareness. At group level differences in awareness between both times of assessment were not significant for MCI and MCI patients converting to mild AD at follow-up. The predictive value of awareness was low. Conclusions Awareness of subjective memory deficit is linked to episodic memory function and decreases with decline of cognitive ability. Further studies evaluating predictive power of awareness of subjective memory should include a larger patient sample.(VLID)347208