Communication and cognitive impairments and healthcare decision-making in MND: A narrative review

Rationale: Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred healthcare relies on the sharing of information and a mutual understanding of the person’s needs and preferences. Decision-making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. Objective: To identify the reported impact of communication and/or cognitive impairment on patient and carer involvement in healthcare decision-making in MND. Methods: A review and synthesis of studies addressing issues of communication impairment and/or cognitive impairment in relation to decision-making focussed on MND was conducted. Articles were excluded if they were reviews, case studies, conference papers or commentaries. To be included studies needed to address issues of communication impairment or cognitive impairment specifically in relation to decision-making. Relevant data was extracted verbatim and subjected to content analysis to support the narrative summary. Results: Seventy-six articles were identified and 35 articles screened. Six articles met inclusion criteria each describing examples of decision-making in MND. There was limited data related to communication and/or cognitive impairment and the impact these impairments may have on decision-making despite recognition that many people with MND may lose verbal communication or develop subtle cognitive impairments. The literature is primarily from the perspective of others. Conclusion: This review highlights that the current body of literature exploring decision-making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on healthcare decision-making. Extant literature focuses on interventions (namely ventilation and gastrostomy), the broad process of decision-making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study

Humour processing in frontotemporal lobar degeneration: A behavioural and neuroanatomical analysis.

Humour is a complex cognitive and emotional construct that is vulnerable in neurodegenerative diseases, notably the frontotemporal lobar degenerations. However, humour processing in these diseases has been little studied. Here we assessed humour processing in patients with behavioural variant frontotemporal dementia (n = 22, mean age 67 years, four female) and semantic dementia (n = 11, mean age 67 years, five female) relative to healthy individuals (n = 21, mean age 66 years, 11 female), using a joint cognitive and neuroanatomical approach. We created a novel neuropsychological test requiring a decision about the humorous intent of nonverbal cartoons, in which we manipulated orthogonally humour content and familiarity of depicted scenarios. Structural neuroanatomical correlates of humour detection were assessed using voxel-based morphometry. Assessing performance in a signal detection framework and after adjusting for standard measures of cognitive function, both patient groups showed impaired accuracy of humour detection in familiar and novel scenarios relative to healthy older controls (p < .001). Patient groups showed similar overall performance profiles; however the behavioural variant frontotemporal dementia group alone showed a significant advantage for detection of humour in familiar relative to novel scenarios (p = .045), suggesting that the behavioural variant syndrome may lead to particular difficulty decoding novel situations for humour, while semantic dementia produces a more general deficit of humour detection that extends to stock comedic situations. Humour detection accuracy was associated with grey matter volume in a distributed network including temporo-parietal junctional and anterior superior temporal cortices, with predominantly left-sided correlates of processing humour in familiar scenarios and right-sided correlates of processing novel humour. The findings quantify deficits of core cognitive operations underpinning humour processing in frontotemporal lobar degenerations and suggest a candidate brain substrate in cortical hub regions processing incongruity and semantic associations. Humour is a promising candidate tool with which to assess complex social signal processing in neurodegenerative disease

Inversion, Hydration and Diuresis during Extracorporeal Shock Wave Lithotripsy: Does It Improve the Stone-Free Rate for Lower Pole Stone Clearance?

Objective:It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. Patients and Methods: In this prospective, non-randomized study, we included 100 Patients with lower calyceal calculi Results: Clinical outcomes were available in 90 Patients. Follow-up at 3 months showed that 83.3% of the Patients belonging to the study group were rendered stone free, whereas 71.5% were stone free in the control (p \u3e 0.05). Complications were minimal and not statistically significant. Conclusions: Forced diuresis and inversion therapy is very well tolerated, however, the stone-free rate was not significantly improved

Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: A pilot randomized clinical trial

<div><p>Background</p><p>The current lack of pharmacological treatments for cannabis use disorder (CUD) warrants novel approaches and further investigation of promising pharmacotherapy. We previously showed that nabiximols (27 mg/ml Δ⁹-tetrahydrocannabinol (THC)/ 25 mg/ml cannabidiol (CBD), Sativex^®) can decrease cannabis withdrawal symptoms. Here, we assessed in a pilot study the tolerability and safety of self-titrated nabiximols vs. placebo among 40 treatment-seeking cannabis-dependent participants.</p><p>Methods</p><p>Subjects participated in a double blind randomized clinical trial, with as-needed nabiximols up to 113.4 mg THC/105 mg CBD or placebo daily for 12 weeks, concurrently with Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/CBT). Primary outcome measures were tolerability and abstinence, secondary outcome measures were days and amount of cannabis use, withdrawal, and craving scores. Participants received up to CDN$ 855 in compensation for their time.</p><p>Results</p><p>Medication was well tolerated and no serious adverse events (SAEs) were observed. Rates of adverse events did not differ between treatment arms (F_1,39 = 0.205, NS). There was no significant change in abstinence rates at trial end. Participants were not able to differentiate between subjective effects associated with nabiximols or placebo treatments (F_1,40 = 0.585, NS). Cannabis use was reduced in the nabiximols (70.5%) and placebo groups (42.6%). Nabiximols reduced cannabis craving but no significant differences between the nabiximols and placebo groups were observed on withdrawal scores.</p><p>Conclusions</p><p>Nabiximols in combination with MET/CBT was well tolerated and allowed for reduction of cannabis use. Future clinical trials should explore the potential of high doses of nabiximols for cannabis dependence.</p></div

Cannabinoids of interest in urine were quantified using two-dimensional gas chromatography-mass spectrometry (2D-GCMS).

<p>Table represents creatinine-normalized mean urine Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-THC (THCCOOH), cannabidiol (CBD) and cannabinol (CBN) concentrations for nabiximols and placebo groups.</p

Study medication rates/effects in cannabis use.

<p>Circles (white placebo, black nabiximols) represent mean (+SEM). In a) self-titrated medication (sprays/day) as reported in the smoking diary. In b) total average cannabis intake (g) per week as reported in the timeline followback (TLFB) (week 0) and smoking diary (weeks 1–12). In c) mean percentage of days using cannabis (nabiximols n = 20–13, placebo n = 20–14).</p

Consort flow diagram.

<p>Diagram shows the number of participants at each stage of the study.</p