A comparison of life satisfaction and mood in nursing home residents and community-dwelling elders

This study compared life satisfaction and mood in a sample of 138 cognitively intact and ambulatory elders, including 70 who lived in nursing homes and 68 who lived independently in the community. Community-dwelling elders reported greater life satisfaction, and scored higher on the Vigor-Activity subscale of the Profile of Mood States (POMS) than those who lived in a nursing home. Nursing home residents scored higher on the Depression-Dejection, Tension-Anxiety, and Confusion-Bewilderment subscales of the POMS. No between group differences were shown on the Anger-Hostility and Fatigue-Inertia subscales of the POMS. The diminished life satisfaction and high depression found in the nursing home residents hold immediate implications for professionals who work in this area.

Computerised cognitive assessment of concussed Australian Rules footballers

BACKGROUND

"Paper and pencil" neuropsychological tests play an important role in the management of sports related concussions. They provide objective information on the athlete's cognitive function and thus facilitate decisions on safe return to sport. It has been proposed that computerised cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established.

OBJECTIVES

To measure cognitive impairment after concussion in a case series of concussed Australian Rules footballers, using both computerised and paper and pencil neuropsychological tests. To investigate the role of computerised cognitive tests in the assessment and follow up of sports related concussions.

METHODS

Baseline measures on the Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT), and a simple reaction time (SRT) test from a computerised cognitive test battery (CogState) were obtained in 240 players. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls.

RESULTS

Six concussions were observed over a period of nine weeks. At the follow up, DSST and TMT scores did not significantly differ from baseline scores in both control and concussed groups. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. This was in contrast with a decrease in response variability and no change in latency on follow up of the control players (p<0.02).

CONCLUSION

Increased variability in response time may be an important cognitive deficit after concussion. This has implications for consistency of an athlete's performance after injury, as well as for tests used in clinical assessment and follow up of head injuries.

Uraemia suppresses central dopaminergic metabolism and impairs motor activity in rats

OBJECTIVE

Uraemia often provokes various neurological disorders, such as mental changes, malperception, confusion, seizures and coma. Since changes in neurotransmissions induce neurological symptoms, we investigated changes in the monoamine metabolism and motor activity in uraemic rats.

DESIGN

Prospective, randomised, controlled animal study.

SUBJECTS

Male Wistar rats.

INTERVENTIONS

Acute renal failure was induced by occlusion of bilateral renal arteries for 60 min, and the motor activity and brain monoamine turnover were examined 48 h later. The brain monoamine turnover was evaluated by the depletion of norepinephrine (NE) and dopamine (DA) induced by alpha-methyl-p-tyrosine (alpha-MT), or the accumulation of 5-hydroxyindoleacetic acid (5-HIAA) induced by probenecid.

MEASUREMENTS AND RESULTS

Marked damage in renal function was found in animals subjected to renal ischaemia 48 h after the operation. The motor activity of the uraemic rats was impaired. The turnover of DA in the striatum, mesencephalon and hypothalamus was decreased in these rats. The turnover of NE and 5-hydroxytryptamine (5-HT) was unchanged in all regions examined.

CONCLUSIONS

Suppression of the central DA turnover appears to be involved in the impairment of motor activity in uraemic rats.

Diffusion-weighted magnetic resonance in cerebral venous thrombosis

BACKGROUND

Cerebral venous thrombosis (CVT) is a cause of stroke with obscure pathophysiologic properties that differ from arterial stroke. Its main mechanisms of pathophysiology are the breakdown of the blood-brain barrier and the coexistence of cytotoxic and vasogenic edema. However, conventional magnetic resonance imaging (MRI) cannot differentiate between vasogenic and cytotoxic edema.

OBJECTIVES

To describe the diffusion-weighted imaging (DWI) findings and characterize the clinical applications of DWI in CVT.

SETTING

A tertiary referral center, neurology department.

DESIGN AND METHODS

From November 1998 to March 2001, 14 patients (5 men, 9 women; mean age, 43 +/- 10 years) with CVT underwent DWI, conventional MRI, MR venography, or conventional cerebral angiography. Abnormal findings on DWI and conventional MRI indicated the necessity of MR venography and conventional angiography to confirm the diagnosis of CVT. Apparent diffusion coefficient (ADC) values were measured in all of the abnormal lesions with visual inspection of DWI and T2-weighted echo planar imaging.

RESULTS

Findings on DWI were grouped according to 3 patterns: (1) Heterogeneous signal intensity (SI) (10 patients) showed mixed bright high SI and low SI and the corresponding ADC values were inversely correlated to the DWI SI. The areas of prominent low SI on DWI were reversed with adequate treatment on follow-up MRI in 1 patient. (2) Multifocal high SI (3 patients) was similar to that observed in acute arterial stroke. The corresponding ADC values were decreased and DWI was performed in the acute stages. (3) Intravascular clot with high SI was found with (1 patient, also in heterogeneous SI group) or without (1 patient) parenchymal lesions. In 1 patient, DWI demonstrated T2-negative and fluid attenuated inversion recovery-negative lesions without correlative symptoms.

CONCLUSIONS

These data suggest that DWI with ADC maps can be used to discriminate between types of edema for tissue viability and to provide information about stages and diagnostic clues in CVT.

Magnetic resonance imaging detection of a lesion compatible with central pontine myelinolysis in a pregnant patient with recurrent vomiting and confusion

The authors report a patient who presented with unexplained confusion. She was 15 weeks pregnant and had been having recurrent vomiting for several weeks. This was felt to possibly represent hyperemesis gravidarum, but she had several other possible contributing factors. Her serum sodium was 146 mmol/L, and her potassium was 2.6 mmol/L. She was alert but had disorientation, visual hallucinations, memory impairment, and confabulation despite being a college graduate with no history of illicit drug use or excessive alcohol consumption. Her initial magnetic resonance imaging (MRI) brain scan was interpreted as being normal. However, her follow-up MRI brain scan revealed typical findings of central pontine myelinolysis, which correlated with hyperreflexia and positive Babinski reflexes. This patient illustrates the constellation of signs and symptoms that can be seen with a demyelinating lesion of the pons. In addition, our case illustrates how this MRI scan finding can be quite nonspecific but may help to explain the clinical findings.

De novo absence status of late onset following withdrawal of lorazepam: a case report

The aim of this report is to describe the clinical and electroencephalographic findings seen in an elderly woman without previous history of seizures who developed a nonconvulsive generalized status epilepticus following acute withdrawal of lorazepam. Scalp video-EEG monitoring was obtained using the standard 10/20 system of electrode placement. Cognitive and speech functions were specifically tested during the evaluation. Continuous irregular rhythmic generalized 2.0-2.5 Hz sharp-and-slow wave complexes intermixed with spikes and polyspikes more prominent over the frontocentral areas were seen on the EEG. This epileptic activity was continuous and unmodified by sensory stimulation and eyes opening and closing. Intravenous injection of diazepam caused a rapid normalization of the EEG with disappearance of the clinical manifestations. De novo absence status is a specific epileptic condition that should be suspected in all elderly subjects on chronic treatment with psychotropic drugs presenting in a confusional state. An urgent EEG is essential to confirm the diagnosis.

Memory impairment and spatial disorientation following a left retrosplenial lesion

We treated a patient in whom a left retrosplenial lesion resulted in memory impairment and spatial disorientation. A 31 year old, right handed man was admitted to our hospital after the sudden onset of headache. He was alert, attentive and cooperative, and showed no motor or sensory deficits. Although intelligence was preserved, memory was obviously deficient. The patient proceeded in wrong directions after he left his hospital room and subsequently his home. Neuroimaging revealed a subcortical hematoma in the left cingulate isthmus, while single-photon emission computed tomography demonstrated decreased perfusion in the splenium and left parietal lobe.

Assessment of delirium in advanced cancer: the use of the bedside confusion scale

We conducted a prospective assessment of 50 consecutive admissions to an acute palliative medicine unit, using the bedside confusion scale (BSCS). Information including age, gender, diagnosis, and the presence or absence of brain metastasis was collected. Possible predisposing factors for delirium were recorded. Forty-one of 50 consecutive admissions were screened. There were 18 men and 23 women with a median age of 65 years (average: 60-75). The most common diagnoses among all were lung and breast cancer. Thirteen patients were delirious (BSCS score of > or = 2), 10 borderline (BSCS score = 1), and 21 normal (BSCS score = 0). Brain metastases and drugs appeared to be the most common predisposing factors of delirium. Forty percent of those that were delirious received haloperidol as symptomatic treatment. The BSCS is simple, portable, valid, quick, and easy to use by any medical team member. Delirium is common in hospitalized patients with advanced cancer.

Nonconvulsive status epilepticus in peritoneal dialysis patients

This report describes nonconvulsive status epilepticus (NCSE) in four patients with end-stage renal disease (ESRD) on peritoneal dialysis therapy. All patients presented with acute confusion or stuporous state without clinical motor seizures. Three patients had active systemic infections and were being administered antibiotics. Diagnoses were confirmed in all cases by electroencephalogram (EEG), which showed characteristic diffuse sharp waves and spikes. The EEG appearance improved after anticonvulsant therapy. All patients had satisfactory control of their electrical seizure activity and made varying degrees of mental recovery. To our knowledge, this is the first reported series of NCSE in patients with ESRD on peritoneal dialysis therapy. It shows NCSE as a differential diagnosis for acute confusion. We emphasize the need for nephrologists to consider NCSE as a differential diagnosis for uremic encephalopathy.

G-transition effects and their implications

G-transition effects are defined as the spectrum of physiological and psychophysical effects induced by rapid changes in gravitoinertial forces, alternating between hypogravity (<1 Gz) and hypergravity (>1 Gz) and vice versa. They appear to involve the cardiovascular and spatial orientation systems. This note attempts to briefly review past and current research efforts on the consequences of G-transitions and to examine potential confounding Coriolis-induced bias in both ground-based and inflight research. A brief review of current evidence of vestibular influence on orthostatic compensation and their implications for G tolerance is presented. The effects of roll-induced hypogravity on subsequent G tolerance and possible misperception of attitude during roll rotation are discussed. An integrated approach is recommended for future research on acceleration and disorientation.

Lassa fever encephalopathy: Lassa virus in cerebrospinal fluid but not in serum

The pathogenesis of neurologic complications of Lassa fever is poorly understood. A Nigerian patient had fever, disorientation, seizures, and blood-brain barrier dysfunction, and Lassa virus was found in cerebrospinal fluid (CSF) but not in serum. The concentration of Lassa virus RNA in CSF corresponded to 1 x 10(3) pfu/mL, as determined by a quantitative real-time polymerase chain reaction assay. To characterize the Lassa virus in CSF, the 3.5-kb S RNA was sequenced. In the S RNA coding sequences, the CSF strain differed between 20% and 24.6% from all known prototype strains. These data suggest that Lassa virus or specific Lassa virus strains can persist in the central nervous system and thus contribute to neuropathogenesis. Lassa virus infection should be considered in West African patients or in travelers returning from this area who present only with fever and neurologic signs.

Hypercalcaemia of malignancy: an undiagnosed and undertreated disease

BACKGROUND

Hypercalcaemia of malignancy, a relatively frequent phenomenon, seems to be insufficiently recognized and treated. Its symptoms are not specific, but they affect the quality of life.

METHODS

A prospective study to analyse the influence of symptoms caused by hypercalcaemia on the decision of the admitting physician, the motivation for treatment, and the effect of the treatment on the given symptoms in hospitalized patients with oncologic disease in progression, where confounding causes of similar symptoms such as cerebral metastasis, radiotherapy, treatment with opioids, etc., were excluded.

RESULTS

A total of 71 patients, mean age 65 + 11 years, fulfilled the strict inclusion criteria. About 42% were hospitalized because of symptoms caused by hypercalcaemia, but none of the medical reports mentioned hypercalcaemia as reason for hospitalization. Specific antihypercalcaemic therapy was given to only 37% of patients, and only 25% got an adequate rehydratation. Antihypercalcaemic treatment was guided by the severity of hypercalcaemia (>3.00 mmol L(-1)), not by the symptoms. Polyuria-polydipsia, nausea-vomiting and constipation were correlated with hypercalcaemia. These symptoms, as well as confusion-stupor and bone pains improved significantly when calcaemia was normalized. Patients with calcaemia normalized returned home most frequently (P < 0.03).

CONCLUSIONS

Malignant hypercalcaemia remains mostly undiagnosed in medical praxis. Specific treatment occurs in too small fractions of the patients. As the normalization of calcaemia significantly improves the symptoms because of hypercalcaemia and the quality of life, rapid rehydration and specific calcium lowering treatments should be part of palliative measures in all patients with malignant hypercalcaemia.

[Symptoms reported by mobile cellular telephone users]

A survey study, using questionnaire, was conducted in 161 students and workers in a French engineering school on symptoms experienced during use of digital cellular phones. A significant increase in concentration difficulty (p < 0.05) was reported by users of 1800-MHz (DCS) cellular phones compared to 900-MHz (GSM) phone users. In users of cellular phones, women significantly (p < 0.05) complained more often of sleep disturbance than men. This sex difference for sleep complaint is not observed between women and men non-users of cellular phone. The use of both cellular phones and VDT significantly (p < 0.05) increased concentration difficulty. Digital cellular phone users also significantly (p < 0.05) more often complained of discomfort, warmth, and picking on the ear during phone conversation in relation with calling duration per day and number of calls per day. The complaint of warmth on the ear might be a signal to users for stopping the call.

[Initial deficits in Alzheimer's disease: 3 practical examples]

INTRODUCTION

The aim of the first studies to determine the neuropsychological features of Alzheimer's disease (AD) were based on the concept of the disease as an homogeneous entity. However, clinical observations and the most recent research studies have demonstrated that Alzheimer's disease may present several other neuropsychological deficits on its clinical onset.

DEVELOPMENT

in the initial process of cognitive function loss, memory deficits are seen as a consequence of hippocampal degeneration; however, a great interindividual variability is observed in the appearance of other cortical deficits. In addiction, new advances in epidemiology, neurochemistry and neuropathology support the idea that AD represents a neuropsychologically heterogeneous disorder. In AD three different subgroups have been established: patients with initial deficits in visuospatial abilities, patients with a major deterioration of linguistic abilities, and a third group with altered visuospatial and linguistic abilities. The most sensitive neuropsychological tests capable of distinguish among these differences were The Boston Naming Test (BNT) and the copy of a drawing. These results have been confirmed with single photon emission computed tomography (SPECT) images, and has been observed that patients with a pattern of a elevated right-hemispheric deterioration presented also a higher right-hipofunctionality. At the same time, patients with an elevated linguistic deficit showed a higher hipofunctionality image in the left hemisphere.

CONCLUSIONS

In this work we present three patients from a prospective study in course, who have similar background, education, gender and disease evolution, but with an onset of the illness corresponding to each of the patterns previously described All three patients were explored with an extense neuropsychological battery of tests specially chosen for this study.