Investigating quality of life in adults with epilepsy and psychogenic non epileptic seizures

Objective This longitudinal study examined QOL in individuals with psychogenic non-epileptic seizures (PNES) and epilepsy and investigated factors associated with QOL and change in QOL from admission to discharge at a specialist epilepsy centre. Methods Fifty-five patients with epilepsy and 23 patients with PNES who attended the William Quarrier Scottish Epilepsy Centre (SEC) between March 1st 2019 and March 31st 2020 were included. Participants completed self-report measures in the week prior to or on the day of their admission to the SEC and again on the day of discharge. Results There was no significant difference between QOL scores in the PNES and epilepsy groups. Psychological distress at admission was found to be a significant predictor of QOL scores (at admission). In the epilepsy group, psychological distress accounted for 37.1% of the variance in QOLIE-31 admission scores in model one (p<.0001). Sleep Condition Indicator scores (SCI) (p=.001) and cognition scores as measured by the EpiTrack cognitive assessment (p=.167) accounted for a further 16.9% of the variance (p=.003) in model two. EpiTrack scores did not contribute significantly to the variance associated with QOLIE-31 scores. In the PNES group psychological distress accounted for 30.5% of the variance in QOLIE-31 admission scores in model one (p=.014). SCI (p=.605) and EpiTrack scores (p=.003) accounted for a further 31.5% of the variance in model two (p=.011). SCI scores did not contribute significantly to the variance associated with QOLIE-31. QOL was improved at discharge in the PNES group (t(17) = -4.187; p=0.001), psychological distress change scores accounted for 56.6% of the variance in QOLIE-31 change scores in model one (p <.0001). QOL was also improved at discharge in the epilepsy group (t(35) = -5.875, P=0.001), psychological distress change scores accounted for 59.4% of the variance in QOLIE-31 change scores in model one. In model two of both groups, the SCI scores and EpiTrack scores did not contribute to the variance associated with QOL change scores. Conclusion Psychological distress is a good predictor of QOL in both patient groups. Assessment and management of anxiety and depression symptoms in both groups may enhance QOL. SCI scores made a significant contribution to the variance in QOL in the epilepsy group and EpiTrack Scores made a significant contribution to the QOL scores in the PNES group. Future research may examine the effect of sleep strategies on QOL scores and study the effect of change in cognitive scores following AED reduction on QOL

Quantitative T1 and T2 MRI signal characteristics in the human brain: different patterns of MR contrasts in normal ageing

OBJECTIVE: The objective of this study was to examine age-dependent changes in both T(1)-weighted and T(2)-weighted image contrasts and spin-echo T(2) relaxation time in the human brain during healthy ageing. METHODS: A total of 37 participants between the ages of 49 and 87 years old were scanned with a 3 Tesla system, using T(1)-weighted, T(2) weighted and quantitative spin-echo T(2) imaging. Contrast between image intensities and T(2) values was calculated for various regions, including between individual hippocampal subfields. RESULTS: The T(1) contrast-to-noise (CNR) and gray:white signal intensity ratio (GWR) did not change in the hippocampus, but it declined in the cingulate cortex with age. In contrast, T(2) CNR and GWR declined in both brain regions. T(2) relaxation time was almost constant in gray matter and most (but not all) hippocampal subfields, but increased substantially in white matter, pointing to an age effect on water relaxation in white matter. CONCLUSIONS: Changes in T(1) and T(2) MR characteristics influence the appearance of brain images in later life and should be considered in image analyses of aged subjects. It is speculated that alterations at the cell biology level, with concomitant alterations to the local magnetic environment, reduce dephasing and subsequently prolong spin-echo T(2) through reduced diffusion effects in later life. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10334-016-0573-0) contains supplementary material, which is available to authorized users

Quantitative T2 mapping of white matter:applications for ageing and cognitive decline

In MRI, the coherence lifetime T2 is sensitive to the magnetic environment imposed by tissue microstructure and biochemistry in vivo. Here we explore the possibility that the use of T2 relaxometry may provide information complementary to that provided by diffusion tensor imaging (DTI) in ageing of healthy controls (HC), Alzheimer’s disease (AD) and mild cognitive impairment (MCI). T2 and diffusion MRI metrics were quantified in HC and patients with MCI and mild AD using multi-echo MRI and DTI. We used tract-based spatial statistics (TBSS) to evaluate quantitative MRI parameters in white matter (WM). A prolonged T2 in WM was associated with AD, and able to distinguish AD from MCI, and AD from HC. Shorter WM T2 was associated with better cognition and younger age in general. In no case was a reduction in T2 associated with poorer cognition. We also applied principal component analysis, showing that WM volume changes independently of  T2, MRI diffusion indices and cognitive performance indices. Our data add to the evidence that age-related and AD-related decline in cognition is in part attributable to WM tissue state, and much less to WM quantity. These observations suggest that WM is involved in AD pathology, and that T2 relaxometry is a potential imaging modality for detecting and characterising WM in cognitive decline and dementia

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Emerging evidence suggests that dopamine may modulate learning and memory with important implications for understanding the neurobiology of memory and future therapeutic targeting. An influential hypothesis posits that dopamine biases reinforcement learning. More recent data also suggest an influence during both consolidation and retrieval. Eighteen Parkinson’s disease patients learned through feedback ON or OFF medication with memory tested 24 hours later ON or OFF medication (4 conditions, within-subjects design with matched healthy control group). Patients OFF medication during learning decreased in memory accuracy over the following 24 hours. In contrast to previous studies, however, dopaminergic medication during learning and testing did not affect expression of positive or negative reinforcement. Two further experiments were run without the 24-hour delay, but they too failed to reproduce effects of dopaminergic medication on reinforcement learning. While supportive of a dopaminergic role in consolidation, this study failed to replicate previous findings on reinforcement learning

Dopamine and Consolidation of Episodic Memory:Timing Is Everything

Memory consolidation underpins adaptive behavior and dopaminergic networks may be critical for prolonged, selective information storage. To understand the time course of the dopaminergic contribution to memory consolidation in humans, here we investigate the effect of dopaminergic medication on recall and recognition in the short and longer term in Parkinson disease (PD). Fifteen people with PD were each tested on or off dopaminergic medication during learning/early consolidation (Day 1) and/or late consolidation (Day 2). Fifteen age-matched healthy participants were tested only once. On Day 1 participants learned new information, and early episodic memory was tested after 30 min. Then on Day 2, recall and recognition were retested after a 24-hr delay. Participants on medication on Day 1 recalled less information at 30 min and 24 hr. In contrast, patients on medication on Day 2 (8–24 hr after learning) recalled more information at 24 hr than those off medication. Although recognition sensitivity was unaffected by medication, response bias was dependent on dopaminergic state: Medication during learning induced a more liberal bias 24 hr later, whereas patients off medication during learning were more conservative responders 24 hr later. We use computational modeling to propose possible mechanisms for this change in response bias. In summary, dopaminergic medication in PD patients during learning impairs early consolidation of episodic memory and makes delayed responses more liberal, but enhances late memory consolidation presumably through a dopamine-dependent consolidation pathway that may be active during sleep