Somatosensory phenomena in Huntington's disease

Sensory symptons are generally not associated with Huntington's disease (HD). We describe two patients with HD who had painful sompatosensory symptons. One patient also had auditory hallucinations. No other cause was found for these symptoms. Both patients also had significant depression and one patient committed suicide. Somatosensory symptons may be a marker for depression in HD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50396/1/870030411_ftp.pd

The Use of Web 2.0 Technologies to Support Continuing Medical Education

Physicians in the U.S. often turn to medical specialty societies as a primary source of the continuing education credits they need to maintain licensure and certification. In recent years, these requirements have been increased. Many physicians prefer live educational activities, but the cost of producing these events is prohibitive given the reduction in funding available to many societies. In this project, the author addressed this problem by developing a handbook for use by medical society members serving as volunteer faculty for continuing medical education (CME) activities. This handbook outlines a number of online tools, making use of the interactive qualities of web 2.0 technologies that require minimal cost and have been demonstrated to support adult learning. By using these tools, activity planners can create online CME activities that are cost-effective and provide the interaction desired by participants in live events

Analytical performance and clinical utility of the INNOTEST (R) PHOSPHO-TAU(181P) assay for discrimination between Alzheimer's disease and dementia with Lewy bodies

Background: Total tau (T-tau) and beta-amyloid((1-42)) (A beta(1-42)) levels in cerebrospinal fluid (CSF) can differentiate Alzheimer's disease (AD) from normal aging or depressive pseudo-dementia. Differential diagnosis from dementia with Lewy bodies (DLB) in clinical settings is difficult. Methods: The analytical performance of the INNOTEST (R) PHOSPHO-TAU((181P)) assay was validated in terms of selectivity, sensitivity, specificity, precision, robustness, and stability. Clinical utility of the assay alone, or combined with T-tau and AP1-421 for discrimination of AD (n=94) from patients suffering from DLB (n=60) or from age-matched control subjects (CS) (n=60) was assessed in a multicenter study. Results: CSF concentrations of tau phosphorylated at threonine 181 (P-tau(181P)) in AD was significantly higher than in DLB and CS. Discriminant analysis, a classification tree, and logistic regression showed that P-tau(181P) was the most statistically significant single variable of the three biomarkers for discrimination between AD and DLB. Conclusions: P-tau(181P) quantification is a robust and reliable assay that may be useful in discriminating AD from DLB

Influences of state anxiety on gaze behavior and stepping accuracy in older adults during adaptive locomotion

This article is available open access through the publisher’s website at the link below. Copyright © The Authors 2011.OBJECTIVES: Older adults deemed to be at a high risk of falling transfer their gaze from a stepping target earlier than their low-risk counterparts. The extent of premature gaze transfer increases with task complexity and is associated with a decline in stepping accuracy. This study tests the hypothesis that increased anxiety about upcoming obstacles is associated with (a) premature transfers of gaze toward obstacles (i.e., looking away from a target box prior to completing the step on it in order to fixate future constraints in the walkway) and (b) reduced stepping accuracy on the target in older adults. METHODS: High-risk (9) and low-risk (8) older adult participants walked a 10-m pathway containing a stepping target area followed by various arrangements of obstacles, which varied with each trial. Anxiety, eye movements, and movement kinematics were measured. RESULTS: Progressively increasing task complexity resulted in associated statistically significant increases in measures of anxiety, extent of early gaze transfer, and stepping inaccuracies in the high-risk group. DISCUSSION: These results provide evidence that increased anxiety about environmental hazards is related to suboptimal visual sampling behavior which, in turn, negatively influences stepping performance, potentially contributing to increased falls risk in older adults.Biotechnology and Biological Sciences Research Counci

Gene-Environment Interaction of Body Mass Index and Apolipoprotein E ε4 Allele on Cognitive Decline

Genetic variation alone may not account for common chronic disease susceptibility. Rather, an interaction between genetic and environmental factors may clarify the underlying disease mechanism. Hence, we tested whether BMI modified the genetic association of the Apolipoprotein E (APOE) ε4 allele with cognitive decline. The data came from a longitudinal population-based sample of 4,055 participants interviewed at 3-year intervals from 1993 to 2012. Cognitive function was assessed using a standardized global cognitive score and BMI was assessed at baseline and classified as normal, overweight, and obese. There were 1,374 (34%) participants with the ε4 allele. In normal BMI participants, cognitive decline was 0.048-unit per without the ε4 allele, and increased by an additional 0.031-unit per year with the ε4 allele. In overweight participants, cognitive decline was 0.038-unit per year without the ε4 allele, and increased by an additional 0.026-unit per year with the ε4 allele. Finally, in obese participants, cognitive decline was 0.038- unit per year without the ε4 allele, and increased by an additional 0.014-unit per year with the ε4 allele. The association of ε4 allele with cognitive decline was significantly lower in obese participants compared to normal BMI participants (p=0.003), thereby suggesting significant gene-environment interaction on cognitive decline

Mere Exposure Alters Category Learning of Novel Objects

We investigated how mere exposure to complex objects with correlated or uncorrelated object features affects later category learning of new objects not seen during exposure. Correlations among pre-exposed object dimensions influenced later category learning. Unlike other published studies, the collection of pre-exposed objects provided no information regarding the categories to be learned, ruling out unsupervised or incidental category learning during pre-exposure. Instead, results are interpreted with respect to statistical learning mechanisms, providing one of the first demonstrations of how statistical learning can influence visual object learning

Functioning and disability in multiple sclerosis from the patient perspective

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives

Associations of centrally acting ACE inhibitors with cognitive decline and survival in Alzheimer’s disease

BACKGROUND: Cognitive improvement has been reported in patients receiving centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs). AIMS: To compare cognitive decline and survival after diagnosis of Alzheimer's disease between people receiving C-ACEIs, non-centrally acting angiotensin-converting enzyme inhibitors (NC-ACEIs), and neither. METHOD: Routine Mini-Mental State Examination (MMSE) scores were extracted in 5260 patients receiving acetylcholinesterase inhibitors and analysed against C-/NC-ACEI exposure at the time of Alzheimer's disease diagnosis. RESULTS: In the 9 months after Alzheimer's disease diagnosis, MMSE scores significantly increased by 0.72 and 0.19 points per year in patients on C-ACEIs and neither respectively, but deteriorated by 0.61 points per year in those on NC-ACEIs. There were no significant group differences in score trajectories from 9 to 36 months and no differences in survival. CONCLUSIONS: In people with Alzheimer's disease receiving acetylcholinesterase inhibitors, those also taking C-ACEIs had stronger initial improvement in cognitive function, but there was no evidence of longer-lasting influence on dementia progression. DECLARATION OF INTEREST: R.S. has received research funding from Pfizer, Lundbeck, Roche, Janssen and GlaxoSmithKline. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license

Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores

© 2018 International Society for HemodialysisIntroduction: Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression. Methods: In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea. Findings: Seven hundred and one HD patients were studied; 63.6% male, mean age 64.1 ± 16.6 years, 33.5% diabetic. About 24.1% recovered in 1 hour were more likely to be female, have high self-reported Beck depression inventory-II scores, a past medical history of depression, and be living without a partner. Longer recovery times were also associated with very low postdialysis systolic blood pressures (<100 mmHg), and higher body weight. However, the model predicted only 18% of the variation in recovery times. We found no association between recovery times and short-term mortality risk. Discussion: Prolonged postdialysis recovery times are associated with higher self-reported depression scores, and very low postdialysis blood pressure. Future studies investigating changes in dialysis practice and recovery times will need to target strategies to prevent intradialytic hypotension and adjust for patient psychological status.Peer reviewedFinal Accepted Versio