Emergence of an imaging biomarker for amyotrophic lateral sclerosis: is the end point near?

A diagnostic and treatment biomarker for amyotrophic lateral sclerosis (ALS) remains a holy grail.1 ,2 From a neuroimaging perspective, diffusion tensor imaging (DTI) has been increasingly utilised to identify brain-related upper motor neuron changes in ALS. In particular, the corticospinal tract, anterior corpus callosum and hippocampal fractional anisotropy (FA) white matter changes have been closely linked with ALS pathology3 ,4 and associated with the underlying neuropathological spread of TAR DNA binding protein 43 (TDP-43).5 Thus, DTI emerges as an ideal neuroimaging biomarker end point for disease-modifying trials in ALS. However, most advanced trials are run on a multicentre basis, and currently it is not clear how DTI signatures across centres in ALS hold-up, in particular with varying imaging sequences and scanner variabilities

Terra incognita—cerebellar contributions to neuropsychiatric and cognitive dysfunction in behavioral variant frontotemporal dementia

Although converging evidence has positioned the human cerebellum as an important relay for intact cognitive and neuropsychiatric processing, changes in this large structure remain mostly overlooked in behavioral variant frontotemporal dementia (bvFTD), a disease which is characterized by cognitive and neuropsychiatric deficits. The present study assessed whether degeneration in specific cerebellar subregions associate with indices of cognition and neuropsychiatric performance in bvFTD. Our results demonstrate a relationship between cognitive and neuropsychiatric decline across various domains of memory, language, emotion, executive, visuospatial function, and motivation and the degree of gray matter degeneration in cerebellar lobules V–VII. Most notably, bilateral cerebellar lobule VII and the posterior vermis emerged as distinct for memory processes, the right cerebellar hemisphere underpinned emotion, and the posterior vermis was highlighted in language dysfunction in bvFTD. Based on cortico-cerebellar connectivity maps, these findings in the cerebellum are consistent with the neural connections with the cortices involved in these domains in patients with bvFTD. Overall, the present study underscores the significance of cortical-cerebellar networks associated with cognition and neuropsychiatric dysfunction in bvFTD

A study of the stress wave factor technique for nondestructive evaluation of composite materials

The acousto-ultrasonic method of nondestructive evaluation is an extremely sensitive means of assessing material response. Efforts continue to complete the understanding of this method. In order to achieve the full sensitivity of the technique, extreme care must be taken in its performance. This report provides an update of the efforts to advance the understanding of this method and to increase its application to the nondestructive evaluation of composite materials. Included are descriptions of a novel optical system that is capable of measuring in-plane and out-of-plane displacements, an IBM PC-based data acquisition system, an extensive data analysis software package, the azimuthal variation of acousto-ultrasonic behavior in graphite/epoxy laminates, and preliminary examination of processing variation in graphite-aluminum tubes

Occasional essay: upper motor neuron syndrome in amyotrophic lateral sclerosis

The diagnosis of amyotrophic lateral sclerosis (ALS) requires recognition of both lower (LMN) and upper motor neuron (UMN) dysfunction.1 However, classical UMN signs are frequently difficult to identify in ALS.2 LMN involvement is sensitively detected by electromyography (EMG)3 but, as yet, there are no generally accepted markers for monitoring UMN abnormalities,4 the neurobiology of ALS itself, and disease spread through the brain and spinal cord,.5 Full clinical assessment is therefore necessary to exclude other diagnoses and to monitor disease progression. In part, this difficulty regarding detection of UMN involvement in ALS derives from the definition of ‘the UMN syndrome’. Abnormalities of motor control in ALS require reformulation within an expanded concept of the UMN, together with the neuropathological, neuro-imaging and neurophysiological abnormalities in ALS. We review these issues here

A study of the stress wave factor technique for evaluation of composite materials

The acousto-ultrasonic approach for nondestructive evaluation provides a measurement procedure for quantifying the integrated effect of globally distributed damage characteristic of fiber reinforced composite materials. The evaluation procedure provides a stress wave factor that correlates closely with several material performance parameters. The procedure was investigated for a variety of materials including advanced composites, hybrid structure bonds, adhesive bonds, wood products, and wire rope. The research program focused primarily on development of fundamental understanding and applications advancements of acousto-ultrasonics for materials characterization. This involves characterization of materials for which detection, location, and identification of imperfections cannot at present be analyzed satisfactorily with mechanical performance prediction models. In addition to presenting definitive studies on application potentials, the understanding of the acousto-ultrasonic method as applied to advanced composites is reviewed

Characterizing sexual behavior in frontotemporal dementia

Background: Frontotemporal dementia (FTD) is characterized by a number of prominent behavioral changes. While FTD has been associated with the presence of aberrant or unusual sexual behaviors in a proportion of patients, few studies have formally investigated changes in sexual function in this disease. Objective: We aimed to systematically quantify changes in sexual behavior, including current symptoms and changes from prior diagnoses, in behavioral-variant (bvFTD) and semantic dementia (SD), compared to Alzheimer’s disease (AD). Methods: Carers of 49 dementia patients (21 bvFTD, 11 SD, 17 AD) were interviewed using the Sexual Behavior and Intimacy Questionnaire (SIQ), a survey designed to assess changes in sexual function across multiple domains including initiating, level of affection, and aberrant or unusual sexual behavior. Results: BvFTD patients show prominent hyposexual behavior including decreased affection, initiation, and response to advances by partners, and decreased frequency of sexual relations, compared to AD and to SD patients. The greatest changes in sexual behavior compared to pre-diagnoses were found in the bvFTD group with a 90–100% decrease in initiation, response, and frequency of sexual relations. Notably, aberrant or unusual sexual behavior was reported in a minority of bvFTD and SD patients and occurred in patients who also showed hyposexual behavior toward their partner. Conclusion: Overall loss of affection, reduced initiation of sexual activity, and responsiveness is an overwhelming feature of bvFTD. In contrast, aberrant or unusual sexual behavior is observed in the minority of bvFTD patients. The underlying pathophysiology of these changes likely reflects structural and functional changes in frontoinsular and limbic regions including the hypothalamus

A physical model for the acousto-ultrasonic method

A basic physical explanation, a model, and comments on NDE application of the acousto-ultrasonic (AU) method for composite materials are presented. The basis of this work is a set of experiments where a sending and a receiving piezoelectric transducer were both oriented normal to the surface, at different points, on aluminum plates, various composite plates, and a tapered aluminum plate. The purpose and basic idea is introduced. Also, general comments on the AU method are offered. A literature review is offered for areas pertinent, such as composite materials, wave propagation, ultrasonics, and the AU. Special emphasis is given to theory which is used later on and past experimental results that are important to the physical understanding of the AU method. The experimental set-up, procedure, and the ensuing analysis are described. The experimental results are presented in both a quantitative and qualitative manner. A physical understanding of experimental results based on elasticity solution is furnished. Modeling and applications of the AU method is discussed for composite material and general conclusions are stated. The physical model of the AU method for composite materials is offered, something which has been much needed and sorely lacking. This physical understanding is possible due to the extensive set of experimental measurements, also reported

Acute military psychiatric casualties from the war in Iraq

Background: The view that most military personnel evacuated from war zones are suffering from combat stress reactions, or are otherwise traumatised by the horrors of war, has an impact on all aspects of military psychiatry. Aims: To delineate the reasons for psychiatric aeromedical evacuation from Iraq from the start of build-up of UK forces in January 2003 until the end of October that year, 6 months after the end of formal hostilities. Method: A retrospective study was conducted of field and in-patient psychiatric assessments of 116 military personnel evacuated to the UK military psychiatric in-patient facility in Catterick Garrison. Results: Evacuees were mainly non-combatants (69%). A significant proportion were in reserve service (21%) and had a history of contact with mental health services (37%). Only 3% had a combat stress reaction. In over 85% of cases evacuation was for low mood attributed to separation from friends or family, or difficulties adjusting to the environment. Conclusions: These findings have implications especially for screening for suitability for deployment, and for understanding any longer-term mental health problems arising in veterans from Iraq

Dissociation of structural and functional integrities of the motor system in amyotrophic lateral sclerosis and behavioral-variant frontotemporal dementia

Background and Purpose: This study investigated the structural and functional changes in the motor system in amyotrophic lateral sclerosis (ALS; n=25) and behavioral-variant fronto-temporal dementia (bvFTD; n=17) relative to healthy controls (n=37). Methods: Structural changes were examined using a region-of-interest approach, applying voxel-based morphometry for gray-matter changes and diffusion tensor imaging for white-matter changes. Functional changes in the motor system were elucidated using threshold-tracking transcranial magnetic stimulation (TMS) measurements of upper motor-neuron excitability. Results: The structural analyses showed that in ALS there were more white-matter changes in the corticospinal and motor-cortex regions and more gray-matter changes in the cerebellum in comparison to controls. bvFTD showed substantial gray- and white-matter changes across virtually all motor-system regions compared to controls, although the brainstem was affected less than the other regions. Direct comparisons across patient groups showed that the gray- and white-matter motor-system changes inclusive of the motor cortex were greater in bvFTD than in ALS. By contrast, the functional integrity of the motor system was more adversely affected in ALS than in bvFTD, with both patient groups showing increased excitability of upper motor neurons compared to controls. Conclusions: Cross-correlation of structural and functional data further revealed a neural dissociation of different motor-system regions and tracts covarying with the TMS excitability across both patient groups. The structural and functional motor-system integrities appear to be dissociated between ALS and bvFTD, which represents useful information for the diagnosis of motor-system changes in these two disorders