Development of a rat model for glioma-related epilepsy

Seizures are common in patients with high-grade gliomas (30–60%) and approximately 15–30% of glioblastoma (GB) patients develop drug-resistant epilepsy. Reliable animal models are needed to develop adequate treatments for glioma-related epilepsy. Therefore, fifteen rats were inoculated with F98 GB cells (GB group) and four rats with vehicle only (control group) in the right entorhinal cortex. MRI was performed to visualize tumor presence. A subset of seven GB and two control rats were implanted with recording electrodes to determine the occurrence of epileptic seizures with video-EEG recording over multiple days. In a subset of rats, tumor size and expression of tumor markers were investigated with histology or mRNA in situ hybridization. Tumors were visible on MRI six days post-inoculation. Time-dependent changes in tumor morphology and size were visible on MRI. Epileptic seizures were detected in all GB rats monitored with video-EEG. Twenty-one days after inoculation, rats were euthanized based on signs of discomfort and pain. This study describes, for the first time, reproducible tumor growth and spontaneous seizures upon inoculation of F98 cells in the rat entorhinal cortex. The development of this new model of GB-related epilepsy may be valuable to design new therapies against tumor growth and associated epileptic seizures

Dual task performance of working memory and postural control in major depressive disorder

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Cognitive and fine motor function in depressed elderly patients

Introduction Psychomotor retardation (PR) is one of the core features in depression (DSM-IV-TR, APA, 2000). In elderly depressed patients, the question whether these patients show less pronounced PR, because aging in itself causes slowing (Cerella et al., 1993) has been answered bij research showing that PR in depression is different from age related slowing (Bonin-Guillaume S. et al., 2008). On the other hand, more pronounced PR in geriatric depression has been hypothesised, because of an -at least- additive effect of age and depression (Pier et al., 2004). In this study, the effects of escitalopram treatment on depression and psychomotor symptoms in the elderly will be evaluated. Objective Primary: to confirm a beneficial effect of escitalopram on depressive symptoms and on cognition and motor retardation in elderly depressed patients. Secondary: to assess the timeframe in which different aspects of the depressive disease get better; cognitive impairment could resolve faster compared to the core depressive symptoms. Methods To investigate this, we compared a group of 20 non-demented late-life depressive elderly to a matched control group of healthy elderly to whom a battery of tests (Geriatric Depression Scale GDS, State and Trait Anxiety Scale STAI, Mini Mental State Examination MMSE, Widlöcher PRS, computerized simple and complex figure copying tasks CL CC, Fitts, Symbol Digit Substitution Test SDST, Strooptest, Trailmaking A & B TMTA TMTB and Wisconsin Card Sorting Test WCST) with questionnaires as well as neuropsychological and fine motor skill-tests was administered. A computerized method of recording and analyzing writing and drawing behavior was used. For this purpose, subjects were asked to copy figures from a computer screen with use of a special pressure-sensitive pen and a digitizer (Maarse et al., 1988). After 2, 6 and 12 weeks, that same battery was administered as a follow up to both groups, with the depressive group receiving treatment with escitalopram 5-20 mg (open label flexible dose study) during the 12 weeks interval. Results Preliminary data about the comparison of the controls and the depressed elderly, more specifically the effect of depression on cognition and motor skills in later life will be presented. Central hypothesis: psychomotor retardation in normal aging is qualitatively different from that associated with depression. In general, an overall motorslowing effect of aging can be observed. In depression, however, the cognitive factor of impairment in the psychomotor retardation is much stronger. In elderly with major depression there is a reciprocal negative influence of agerelated motorslowing and the cognitive factor of impairment. The cognitive factor of psychomotor retardation in old age is essentially a limited short-term memorycapacity and an impaired set-shifting in the executive function (DLPFC). In depressives, updating is the most important deficit in the executive function (posterior parietal cortex and caudate of the superior frontal sulcus). Depressive deficits cause a disturbance in compensatory mechanisms of normal aging. This can be translated in the following subhypotheses: • In general, both geriatric depressed patients and healthy elderly are psychomotorically slower. • Yet, geriatric depressed patients show more psychomotor retardation than healthy elderly. Operationally: Both groups show age related slowing in copying complex figures. Yet, automated processes go off slower with the depressed elderly in comparison with the healthy elderly. Initiation time and reinspection time remain unaffected with healthy elderly copying 'concepts'. Initiation time and reinspection time become longer, however, when copying random patterns. With depressives in general, initiation time and reinspection time are dependent on the degree of abstraction of the pattern to be copied (Pier et al., 2004). Differences in short term memory, updating behavior, integration of automated processes and motor adjustments are apparent.status: publishe

Is ECT safe in the presence of an intracranial metallic object? Case report and review of the literature

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Care for suicidal older people: current clinical–ethical considerations

This article opens by reviewing the state of the knowledge on the most current worldwide facts about suicide in older people. Next, a number of values that have a role in this problem are considered. Having a clear and current understanding of suicide and of the related self‐held and social values forms the framework for a number of clinical–ethical recommendations for care practice. An important aspect of caring for older people with suicidal tendencies is to determine whether their primary care fosters self‐esteem and affirms their dignity. In addition to providing a timely and appropriate diagnosis and treatment of suicidality, the caregiver is responsible for helping the patient to cope with stressful conditions, and for treating the patient with respect and consideration, thereby supporting the patient's dignity and giving the patient a reason to live. Paying attention to these central points will foster caring contact with suicidal older people

ECT-Related Anxiety: A Systematic Review

BACKGROUND: A significant proportion of electroconvulsive therapy (ECT)-treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is underexposed in the scientific literature. OBJECTIVES: We aimed to review the prevalence and specific subjects of ECT-related anxiety and therapeutic interventions to reduce it. METHODS: We performed a computerized search (EMBASE, MEDLINE, and PsycINFO) for articles meeting the following inclusion criteria: (1) qualitative (interview) studies, quantitative (questionnaire) studies, or experimental (interventional) studies that (2) report on anxiety that is related to a planned, ongoing, or past ECT treatment. RESULTS: Of 1160 search results, 31 articles were included. Electroconvulsive therapy-related anxiety is estimated to be present in 14% to 75% of patients and is most often linked to worries about memory impairment or brain damage. Only a few interventions (chlorpromazine, meprobamate, propofol, a talking-through technique, an information leaflet, and animal-assisted therapy) have been proposed to reduce patients' ECT-related anxiety. CONCLUSIONS: Electroconvulsive therapy-related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management. Most studies are of a low methodological quality and suffer from significant limitations, thereby hampering generalized conclusions. Given the clinical importance of ECT-related anxiety, further study on its nature and evolution through the course of treatment and on anxiety-reducing interventions is warranted.status: publishe

The Clinical Practice of Assessing Cognitive Function in Adults Receiving Electroconvulsive Therapy: Whom Are We Missing?

Cognition can be affected by electroconvulsive therapy (ECT). Good clinical practice includes neuropsychological assessment, although this is seldom a part of routine clinical practice. It looks like a substantial part of patients fail to complete cognitive assessments. This constitutes a problem in the generalizability of published clinical research on cognitive side effects. Most studies of ECT-related cognitive adverse effects do not discuss this important issue of so-called cognitive test nonparticipants. Recent findings suggest that cognitive test nonparticipants are more severely ill, and probably more vulnerable to cognitive side effects.status: publishe

Psychomotor retardation in elderly untreated depressed patients

Background: Psychomotor retardation (PR) is one of the core features in depression according to DSM V1, but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating psychomotor retardation in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. Methods: A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of psychomotor retardation and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method (GLM) multivariate analysis of variance to compare the clinical, cognitive and psychomotor outcomes of the two groups. Results: Patients performed worse on all clinical, cognitive and psychomotor retardation measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. Limitations: due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. Conclusion: With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression.status: publishe