[Symptomatic causes of restless legs syndrome.]

Restless legs syndrome (RLS) is characterized by discomfort and paresthesias in the legs with urge to move the legs, worsening of the symptoms with the rest or inactivity, present or exacerbation in the evening or night and partial or total relief with movement. The diagnosis is primarily clinical. RLS is idiopathic, with family history in 40-60% of the cases, or symptomatic associated conditions such as iron deficiency, uremia, pregnancy, Parkinson's disease, neuropathy or myelopathy. Although the pathophysiology of RLS remains unknown, it has been implicated a central dopaminergic dysfunction. In the last years it has increased the interest and has been published several papers about RLS, that make significant contributions to the current understanding of the syndrome. The aim of this paper is to review the cur-rent advances in the field of RLS, with special emphasis on symptomatic causes of the syndrome, from both epidemiological and pathophysiological points of view.

International study on the psychometric attributes of the non-motor symptoms scale in Parkinson disease

BACKGROUND

Nonmotor symptoms (NMS) have a great impact on patients with Parkinson disease (PD). The Non-Motor Symptoms Scale (NMSS) is an instrument specifically designed for the comprehensive assessment of NMS in patients with PD. NMSS psychometric properties have been tested in this study.

METHODS

Data were collected in 12 centers across 10 countries in America, Asia, and Europe. In addition to the NMSS, the following measures were applied: Scales for Outcomes in Parkinson's Disease (SCOPA)-Motor, SCOPA-Psychiatric Complications (SCOPA-PC), SCOPA-Cognition, Hoehn and Yahr Staging (HY), Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), SCOPA-Autonomic, Parkinson's Disease Sleep Scale (PDSS), Parkinson's Disease Questionnaire-39 items (PDQ-39), and EuroQol-5 dimensions (EQ-5D). NMSS acceptability, reliability, validity, and precision were analyzed.

RESULTS

Four hundred eleven patients with PD, 61.3% men, were recruited. The mean age was 64.5 +/- 9.9 years, and mean disease duration was 8.1 +/- 5.7 years. The NMSS score was 57.1 +/- 44.0 points. The scale was free of floor or ceiling effects. For domains, the Cronbach alpha coefficient ranged from 0.44 to 0.85. The intraclass correlation coefficient (0.90 for the total score, 0.67-0.91 for domains) and Lin concordance coefficient (0.88) suggested satisfactory reproducibility. The NMSS total score correlated significantly with SCOPA-Autonomic, PDQ-39, and EQ-5D (r(S) = 0.57-0.70). Association was close between NMSS domains and the corresponding SCOPA-Autonomic domains (r(S) = 0.51-0.65) and also with scales measuring related constructs (PDSS, SCOPA-PC) (all p < 0.0001). The NMSS total score was higher for women (p < 0.02) and for increasing disease duration, HY, and CISI-PD severity level (p < 0.001). The SEM was 13.91 for total score and 1.71 to 4.73 for domains.

CONCLUSION

The Non-Motor Symptoms Scale is an acceptable, reproducible, valid, and precise assessment instrument for nonmotor symptoms in Parkinson disease.

Cerebellar magnetic stimulation decreases levodopa-induced dyskinesias in Parkinson disease

BACKGROUND

The neural mechanisms and the circuitry involved in levodopa-induced dyskinesia (LID) are still partially obscure. LID can be considered the consequence of an abnormal pattern or code of activity that originates and is conveyed from the basal ganglia to the thalamus and the cortical motor areas. However, not only striatothalamocortical motor circuits but also other interconnected pathways could be implicated in its pathogenesis.

METHODS

In a series of experiments, we applied repetitive transcranial magnetic stimulation (rTMS) over the lateral cerebellum in a group of patients with advanced Parkinson disease, to investigate whether modulation of cerebellothalamocortical circuits by means of rTMS may result in a modification of a dyskinetic state induced by levodopa ingestion.

RESULTS

We found that a single session of cerebellar continuous theta burst stimulation (cTBS) was capable of transiently reducing LID. In the same patients, we observed that cerebellar cTBS changed the profile of activation of intracortical circuits in the contralateral primary motor cortex. Cerebellar cTBS reduced short intracortical inhibition and increased long intracortical inhibition, inducing a cortical reorganization that is associated with a reduction of LID. Furthermore, in another experiment, we observed that a 2-week course of bilateral cerebellar cTBS induced persistent clinical beneficial effects, reducing peak-dose LID for up to 4 weeks after the end of the daily stimulation period.

CONCLUSIONS

Our study demonstrates that cerebellar continuous theta burst stimulation has an antidyskinetic effect in Parkinson disease patients with levodopa-induced dyskinesia, possibly due to modulation of cerebellothalamocortical pathways.

Autosomal-dominant GTPCH1-deficient DRD: clinical characteristics and long-term outcome of 34 patients

BACKGROUND

An autosomal dominantly inherited defect in the GCH1 gene that encodes guanosine triphosphate cyclohydrolase 1 (GTPCH1) is the most common cause of dopa-responsive dystonia (DRD). A classic phenotype of young-onset lower-limb dystonia, diurnal fluctuations and excellent response to levodopa has been well recognised in association with GCH1 mutations, and rare atypical presentations have been reported. However, a number of clinical issues remain unresolved including phenotypic variability, long-term response to levodopa and associated non-motor symptoms, and there are limited data on long-term follow-up of genetically proven cases.

METHODS

A detailed clinical evaluation of 34 patients (19 women, 15 men), with confirmed mutations in the GCH1 gene, is presented.

RESULTS AND CONCLUSIONS

The classic phenotype was most frequent (n = 23), with female predominance (F:M = 16:7), and early onset (mean 4.5 years) with involvement of legs. However, a surprisingly large number of patients developed craniocervical dystonia, with spasmodic dysphonia being the predominant symptom in two subjects. A subset of patients, mainly men, presented with either a young-onset (mean 6.8 years) mild DRD variant not requiring treatment (n = 4), or with an adult-onset (mean 37 years) Parkinson disease-like phenotype (n = 4). Two siblings were severely affected with early hypotonia and delay in motor development, associated with compound heterozygous GCH1 gene mutations. The study also describes a number of supplementary features including restless-legs-like symptoms, influence of female sex hormones, predominance of tremor or parkinsonism in adult-onset cases, initial reverse reaction to levodopa, recurrent episodes of depressive disorder and specific levodopa-resistant symptoms (writer's cramp, dysphonia, truncal dystonia). Levodopa was used effectively and safely in 20 pregnancies, and did not cause any fetal abnormalities.

Olfaction in patients with suspected parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs)

BACKGROUND

Positron emission tomography and single photon emission computed tomography scanning have 87-94% sensitivity and 80-100% specificity to differentiate patients with Parkinson's disease (PD) from control subjects and patients with essential (ET) or atypical tremor. More than 10% of patients diagnosed as early PD can have scans without evidence of dopaminergic deficiency (SWEDDs). This study investigated whether smell tests can help identify possible cases with SWEDDs.

METHODS

The 40 item University of Pennsylvania Smell Test (UPSIT) was used to evaluate the sense of smell in 21 SWEDDs patients. Twenty-six ET patients, 16 patients with a diagnosis of idiopathic adult onset dystonia (D), 191 non-demented PD patients and 136 control subjects were also tested. Multiple regression analyses were used to compare the mean UPSIT score in the SWEDDs group with the other four groups (ET, D, PD and controls) after adjusting for the effects of relevant covariates.

RESULTS

The mean UPSIT score for the SWEDDs group was greater than in the PD group (p<0.001) and not different from the mean UPSIT in the control (p = 0.7), ET (p = 0.4) or D (p = 0.9) groups. Smell tests indicated a high probability of PD in only 23.8% of SWEDDs as opposed to 85.3% of PD patients.

CONCLUSIONS

In a patient with suspected PD, a high PD probability on smell testing favours the diagnosis of PD, and a low PD probability strengthens the indication for dopamine transporter imaging.

[Neuroprotection in Parkinson's disease: analysis though group of experts' methodology]

INTRODUCTION

Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far.

METHOD

A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested.

RESULTS

Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect.

CONCLUSIONS

The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.

[Apolipoprotein E4 in dementia with Lewy bodies]

INTRODUCTION

There is a strong association between the e4 allele of apolipoprotein E (APOE) and Alzheimer's disease (AD). This converts this allele into a risk factor for the development of AD. The association between APOE4 and dementia with Lewy bodies (DLB) is under discussion. In DLB, the presence of APOE4 has been related with a greater amount of senile plaques and neurofibrillary tangles.

METHOD

This is a case-control study in which the APOE genotype was determined using the modified PCR technique of Wenham in 306 patients with diagnosis of probably AD, NINCDS-ADRDA criteria, 58 cases of probably DLB, McKeith et al. consensus criteria (1996), all of them with SPECT with pathological 123I-FP-CIT and 80 normal controls (NC) having similar age and gender distribution.

RESULTS

The frequency of alleles was: DLB group epsilon4: 16%; epsilon3: 75%; epsilon2: 9%; AD: epsilon4: 32%; epsilon3: 67%; epsilon2: 1%; and in the normal control group: epsilon4: 12%; epsilon3: 83%; epsilon2: 5%. The percentage of alleles in both genders was similar in the three groups.

CONCLUSIONS

APOE4 percentage in DLB group (16%) was lower than in AD group (32%), and similar to the control group (12%). Considering that the presence of morphopathological Alzheimer type alterations in DBL, essentially neurofibrillary tangles, is inversely correlated with the presence of Parkinsonian signs, this group may represent pure forms of the disease, although the lack of neuropathological demonstration does not make it possible to confirm this hypothesis.

[Urinary symptoms and urodynamic findings in Parkinson's disease]

INTRODUCTION

Urinary symptoms in Parkinson's disease (PD) are minor but disabling. We have analyzed correlation of urinary symptoms with motor symptoms, duration and severity of PD and urodynamic abnormalities observed. Response to treatment with tolterodine was also assessed.

METHODS

PD male patients with a score in IPSS questionnaire over 7 and female patients with a score in IU-4 scale over 5 were included in the study. Intensity of neurological symptoms (UPDRS score), seriousness of PD (Hohen-Yahr stage), urodynamic parameters, and urinary sediment were analyzed in each patient. Abdominal ultrasonography and rectal examination were performed in males to exclude obstructive prostatic pathology. Patients without evidence of urinary flow obstruction were treated with tolterodine.

RESULTS

Three out of the 19 patients were excluded because of abnormal urinary sediment and the rest (n = 16) were included. Urinary symptoms correlated with rigidity severity (p < 0.01) and years of evolution of PD (p < 0.01). Rigidity (p < 0.01) was the neurological sign with the highest UPDRS motor scale score. Overactive bladder was present in 13 cases (81.2%) and 4 of them had urinary flow obstruction. Clinical improvement in nine patients treated with tolterodine was mild (33%).

CONCLUSIONS

Urinary symptoms correlate with rigidity severity and with years of evolution of PD. The use of both the urinary questionnaire and urodynamic study allow us to identify the type of bladder dysfunction and select the patients who would benefit the most from anticholinergics. Tolterodine reduced miccional urgency and frequency in PD, but was ineffective on urinary incontinence.

Meat quality and fatty acid composition of pasture-finished beef steers fed barley and soybeans

The effect of supplemention on the performance, carcass characteristics, meat quality, and fatty acid composition of pasture-finished cattle was studied. Thirty-two steers were assigned to four treatments in a randomized block design. Treatments were: totally mixed ration (TMR) [confinement-fed total mixed ration (60% grass silage, 40% rolled barley], pasture only (rotationally grazed temperate mixed pasture); pasture plus barley (the same pasture plus 4.5 kg DM hd-1 d-1 rolled barley) and pasture plus soybeans (the same pasture plus 1.8 kg DM hd-1 d-1 whole roasted soybeans). Steers were slaughtered after 105 d on test. Tissue samples were collected at slaughter for analysis of meat quality and fatty acid content. Dry matter (DM) intakes were greater for TMR-fed cattle (P < 0.05). Among the pasture-fed cattle those fed barley (P < 0.05) consumed more total DM than those given pasture alone. Rates of BW gain were higher for TMR-fed steers than those fed pasture only (P < 0.05). Carcass weights and dressing percentage were similar across all treatments. Feeding barley or soybeans on pasture increased backfat thickness (P < 0.05), but the pasture-only cattle had greater loin eye area (P < 0.05). Pasture-only beef had more thaw drip loss (P < 0.05) and less cooking drip loss (P < 0.05) than TMR-fed beef. Evaporative cooking losses were greater in beef from unsupplemented pasture than from barley- or soybean-supplemented pasture (P < 0.05). Pasture-only beef had 25% more polyunsaturated fatty acids and 37% greater cis-9, trans-11 conjugated linoleic acid (CLA) concentrations in longisimus thoracis (l. thoracis) tissue than TMR-fed beef (P < 0.05). Among pasture-fed cattle, soybean supplementation increased C18:2 concentration by 34% (P < 0.05), while barley reduced C18:3 concentration by 8% (P < 0.05) in l. thoracis tissue. Soybean supplementation increased cis-9, trans-11 CLA concentration by 30% (P < 0.05) in l. thoracis tissue over pasture only. Beef finished on pasture has higher levels of beneficial fatty acids than TMR-fed beef, with few differences in meat quality. Supplementation on pasture improves animal performance, but barley has some negative effects on beneficial fatty acids in meat. Key words: Pasture, steers, fatty acids, conjugated linoleic acid

Motor system inhibition in dopa-responsive dystonia and its modulation by treatment

Dopa-responsive dystonia (DRD) causes dystonia–parkinsonism, which is abolished by levodopa. The authors assessed short intracortical inhibition and facilitation, silent period, blink reflex recovery cycle, and reciprocal inhibition in seven patients with DRD on and off treatment. Short intracortical inhibition and blink reflex recovery cycle were reduced, but increased with treatment. Silent period was normal on and off treatment. Third phase of reciprocal inhibition was reduced on and off treatment. A discrete pattern of motor inhibitory dysfunction occurs in DRD.

Dopaminergic drugs restore facilitatory premotor-motor interactions in Parkinson disease

OBJECTIVE

To explore the impact of dopaminergic therapy on facilitatory premotor-motor interactions in patients with Parkinson disease (PD).

METHODS

Ten patients with PD and 10 age-matched healthy volunteers received repetitive transcranial magnetic stimulation (rTMS) over the left dorsal premotor cortex (5 Hz, 1,500 stimuli, 90% of active motor threshold). Patients were studied while "on" and "off" medication. Motor evoked potentials (MEPs) were recorded from the right first dorsal interosseus muscle before and after rTMS to quantify changes in motor cortical excitability. The after-effects of rTMS on motor function were assessed using the Unified Parkinson's Disease Rating Scale and the kinematics of ballistic wrist flexions.

RESULTS

MEPs evoked from the ipsilateral motor cortex were increased after premotor rTMS in relaxed normal subjects, consistent with an increase in motor cortex excitability. In patients with PD, the effect of premotor rTMS was modified by medication. When patients were in a practically defined "off" state, premotor rTMS had no effect on MEPs, whereas when they were in the "on" state, premotor rTMS facilitated MEPs. Premotor rTMS had no effect on clinical parkinsonian symptoms or motor performance of ballistic wrist movements, regardless of whether patients were in the "on" or "off" state.

CONCLUSIONS

In Parkinson disease, the ability of premotor-motor connections to increase motor cortical excitability is defective but restored to normal by dopaminergic medication. Dopamine deficiency in the basal ganglia may affect the way that frontal motor areas interact with each other.

The epsilon-sarcoglycan gene in myoclonic syndromes

Mutations in the epsilon-sarcoglycan gene (SGCE) are associated with familial myoclonus dystonia, but the full spectrum of the phenotype may not be fully defined. We screened 58 individuals with a range of myoclonic/dystonic syndromes for SGCE mutations. We found mutations (three of them novel) in six (21%) of the 29 patients with essential myoclonus and myoclonic dystonia, but did not find mutations in the 29 patients with other phenotypes.

Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone

We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxon's test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications ( p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.

Influence of canola oil on the fatty acid profile in goats’ milk

Four Alpine does were used in a 4 × 4 Latin square design to determine the effects of feeding canola oil at four levels: 0, 2, 4 and 6% on milk fatty acid profile. The sum of C12:0 + C14:0 + C16:0 (hypercholesterolemic fatty acids) decreased linearly and C18:0 + C18:1: C16:0 (indicator of cholesterolemic tendency of fat source) increased linearly (P < 0.01) with increased canola oil intake. Key words: Goat, milk, fatty acids, canola oil

[Spontaneous cerebral calcium embolism]

INTRODUCTION

Calcium embolism is an uncommon cause of stroke which may not be diagnosed in cases which do not involve cardiac surgery or catheterization. The emboli may come from cardiac valves or calcified atheroma of the aortic or carotid arteries.

CASE REPORTS

Two patients with cerebral infarcts secondary to spontaneous calcium embolism confirmed by neuro imaging. In both cases on CT scans there were dense points corresponding to calcified material within the middle cerebral artery or one of its branches. In the first case migration of the calcified point following the course of the artery was observed.

CONCLUSIONS

Cranial CAT scans are essential for diagnosis of calcium embolism. Migration of the calcified point confirms the diagnosis. It is still not clear whether valve replacement is necessary in these patients and treatment with antiaggregants and/or anticoagulants is controversial.

Statuslike SUNCT in two young women

OBJECTIVE

To describe the statuslike pattern of SUNCT (short-lasting unilateral neuralgiform pain with conjunctival injection and tearing) in two young women.

BACKGROUND

SUNCT syndrome is a rare condition characterized by a short-lasting periocular pain associated with marked autonomic symptoms. Twenty-five cases have been reported in the literature with a high preponderance of males and a mean age of 51 years. The frequency of episodes shows a wide variability, not just among individuals but also in the same patient, and a statuslike pattern of almost continuous attacks has been described.

METHODS

We report the cases of two young women (aged 26 and 23 years) with typical SUNCT features who suffered bouts of up to 60 paroxysms of pain per hour. Paraclinical investigations showed no abnormalities.

CONCLUSIONS

Although unusual, paroxysms in SUNCT may overlap into a clinical status. A strong relationship with hormonal changes was noted in one patient. In both cases, the pain was refractory to treatment with indomethacin, carbamazepine, and hypnotics, and only intravenous methylprednisolone with oral carbamazepine may have been partially effective in one case.

Quality of life in children with Crohn's disease: a pilot study

BACKGROUND

Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88-item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation.

METHODS

The questionnaire covered six domains of health-related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects.

RESULTS

Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16.

CONCLUSIONS

In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health-related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health-related quality of life.

Quality of life of parents and siblings of children with inflammatory bowel disease

BACKGROUND

Few investigators have reported on the quality of life of family members of children with inflammatory bowel disease. Psychological symptoms have been reported in parents and siblings, but the problems that which give rise to these symptoms are seldom examined. In this pilot study, some of the issues that affect the quality of life of parents and siblings of children with inflammatory bowel disease were examined.

METHODS

Focus group meetings were held separately with 20 parents and 7 siblings of children with inflammatory bowel disease. The participants were encouraged to identify voluntarily problems related to the disease that affected their lives, and the discussions were tape recorded. Each participant subsequently wrote down the three most important concerns.

RESULTS

Thirteen (65%) parents were very concerned about the effect of the disease on the child's future jobs, marriage, independence) and 11 (55%) were worried about problems the ill child was encountering at school. Other issues of most concern to parents included side effects of medication (n = 7), limited job prospects (n = 3), persistent feelings of guilt (n = 3), and restricted family lifestyle (n = 1 ). Most siblings (57%) were concerned about their parents' keeping information about the illness from them, and three (43%) of them were also concerned about others bullying the ill child at school. Other issues of concern to siblings included fear about the disease and treatment (n = 3), parents overprotecting the ill child, and feelings of jealousy (n = 1).

CONCLUSION

Families of children with inflammatory bowel disease experience many problems that may affect their quality of life. Resources should be made available to help families with these concerns.

Nutritional evaluation of ensilage made from intercropped corn and sunflowers

The feeding value of sunflower–corn silage relative to that of corn silage as the only forage fed lactating cows was established using 12 lactating Holstein cows in an experiment with a 2 × 2 Latin square design. Treatment periods were 5 wk and there was no changeover period between treatments. A constant grain intake to milk yield ratio of 1:4 was maintained. The comparison was based on dry matter (DM) intake, milk yield and composition, body-weight change, rumen pH and molar proportions of volatile fatty acids and plasma metabolites. The sunflower–corn silage was lower in DM content (25.4 vs. 29.2%), but higher in protein (11.5 vs. 8.0%), acid detergent fiber (33.2 vs. 29.2%), fat (8.1 vs. 2.1%) and total ash (10.6 vs. 4.9%). Silage DM intake was the same for both silages, but milk yield was significantly greater (P < 0.05) (32.7 vs. 31.2 kg d−1) for cows fed sunflower–corn silage. However, both milk fat (3.19 vs. 3.87%) and milk protein (3.04 vs. 3.26%) were lower (P < 0.05) for cows fed sunflower–corn silage, resulting in a higher (P < 0.05) fat-corrected milk yield (30.5 vs. 28.4 kg d−1) for the cows fed corn silage. Type of silage fed did not alter rumen pH, but the molar percentage of acetic acid was higher (P < 0.05) and the molar percentages of isovaleric and valeric acids were lower when sunflower–corn silage was fed. The feeding of sunflower–corn silage resulted in a significant increase (P < 0.05) in plasma urea nitrogen (10.60 vs. 7.53 mg 100−1), cholesterol (7.36 vs. 5.63 mmol L−1) and triglyceride (0.20 vs. 0.18 mmol L−1). Plasma levels of methionine (29.9 vs. 18.5 mmol mL−1) and valine (208.0 vs. 191.0 N mol mL−1) were greater for cows fed the sunflower–corn silage. It was concluded from this study that intercropped sunflower–corn harvested and preserved as silage is an acceptable source of forage for lactating cows, but when fed as the only source of forage it may have a negative impact on milk composition. Key words: lactating cows, sunflower–corn silage, milk yield, milk composition

The effects of mood changes and antidepressants on the cognitive capacity of elderly depressed patients

Seventy-eight nondemented elderly depressed patients underwent an extensive battery of cognitive tests both before and after seven weeks of treatment with nortriptyline, phenelzine, or placebo. Clinical and cognitive evaluations of the patients were under double-blind conditions. Response to treatment did not appear to significantly affect cognitive capacity; neither did treatment with an active substance as compared to placebo. In addition, the baseline level of cognitive functioning did not appear related to whether a patient responded to treatment. The authors conclude that under optimal conditions neither antidepressant produces measurable changes in the cognitive capacity of nondemented elderly patients.

Clinical predictors of response to antidepressants in elderly patients

A group of 42 patients, ages 55 and above, suffering from major depression were examined in an attempt to isolate clinical variables that would predict response to antidepressants. These patients were part of a placebo-controlled, double-blind study and were given either nortriptyline or phenelzine for 5-7 weeks. There was no significant difference in response rates between patients subclassified as endogenous or nonendogenous by either RDC or Newcastle criteria. No difference in response rates was found between the DSM-III melancholic and nonmelancholic subtypes. Neither drug preferentially treated a subtype. None of the 21 variables representing symptoms, demographic traits, or characteristics of the depressive illness were found to be significant predictors of antidepressant response.