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Ramírez-Salazar SA, MacRae C, Feany MB, Miller M, Yang HS, Meadows ME, McGinnis SM, Silbersweig D, Gale SA, Daffner KR. Case Study 6: The Diagnostic Challenge of a 75-Year-Old Man Who Had, Then Didn't Have, Then Did Have Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2023; 35:325-332. [PMID: 37840261 DOI: 10.1176/appi.neuropsych.20230097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Sergio A Ramírez-Salazar
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Cassie MacRae
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Mel B Feany
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Michael Miller
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Hyun-Sik Yang
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Mary-Ellen Meadows
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Scott M McGinnis
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - David Silbersweig
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Seth A Gale
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Kirk R Daffner
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
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Affiliation(s)
- Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mary-Ellen Meadows
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Hickman TT, Shuman ME, Johnson TA, Yang F, Rice RR, Rice IM, Chung EH, Wiemann R, Tinl M, Iracheta C, Chen G, Flynn P, Mondello MB, Thompson J, Meadows ME, Carroll RS, Yang HW, Xing H, Pilgrim D, Chiocca EA, Dunn IF, Golby AJ, Johnson MD. Association between shunt-responsive idiopathic normal pressure hydrocephalus and alcohol. J Neurosurg 2016; 127:240-248. [PMID: 27689463 DOI: 10.3171/2016.6.jns16496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventriculomegaly, gait difficulty, incontinence, and dementia. The symptoms can be ameliorated by CSF drainage. The object of this study was to identify factors associated with shunt-responsive iNPH. METHODS The authors reviewed the medical records of 529 patients who underwent shunt placement for iNPH at their institution between July 2001 and March 2015. Variables associated with shunt-responsive iNPH were identified using bivariate and multivariate analyses. Detailed alcohol consumption information was obtained for 328 patients and was used to examine the relationship between alcohol and shunt-responsive iNPH. A computerized patient registry from 2 academic medical centers was queried to determine the prevalence of alcohol abuse among 1665 iNPH patients. RESULTS Bivariate analysis identified associations between shunt-responsive iNPH and gait difficulty (OR 4.59, 95% CI 2.32-9.09; p < 0.0001), dementia (OR 1.79, 95% CI 1.14-2.80; p = 0.01), incontinence (OR 1.77, 95% CI 1.13-2.76; p = 0.01), and alcohol use (OR 1.98, 95% CI 1.23-3.16; p = 0.03). Borderline significance was observed for hyperlipidemia (OR 1.56, 95% CI 0.99-2.45; p = 0.054), a family history of hyperlipidemia (OR 3.09, 95% CI 0.93-10.26, p = 0.054), and diabetes (OR 1.83, 95% CI 0.96-3.51; p = 0.064). Multivariate analysis identified associations with gait difficulty (OR 3.98, 95% CI 1.81-8.77; p = 0.0006) and alcohol (OR 1.94, 95% CI 1.10-3.39; p = 0.04). Increased alcohol intake correlated with greater improvement after CSF drainage. Alcohol abuse was 2.5 times more prevalent among iNPH patients than matched controls. CONCLUSIONS Alcohol consumption is associated with the development of shunt-responsive iNPH.
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Affiliation(s)
- Thu-Trang Hickman
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Matthew E Shuman
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Tatyana A Johnson
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Felix Yang
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Rebecca R Rice
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Isaac M Rice
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Esther H Chung
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Robert Wiemann
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Megan Tinl
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Rehabilitation Services, Brigham and Women's Hospital; and
| | - Christine Iracheta
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Rehabilitation Services, Brigham and Women's Hospital; and
| | - Grace Chen
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Rehabilitation Services, Brigham and Women's Hospital; and
| | - Patricia Flynn
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Rehabilitation Services, Brigham and Women's Hospital; and
| | - Mary Beth Mondello
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Jillian Thompson
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Mary-Ellen Meadows
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rona S Carroll
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Hong Wei Yang
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Hongyan Xing
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - David Pilgrim
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.,Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Antonio Chiocca
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Ian F Dunn
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Alexandra J Golby
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
| | - Mark D Johnson
- Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School
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Fischer DB, Perez DL, Prasad S, Rigolo L, O'Donnell L, Acar D, Meadows ME, Baslet G, Boes AD, Golby AJ, Dworetzky BA. Right inferior longitudinal fasciculus lesions disrupt visual-emotional integration. Soc Cogn Affect Neurosci 2016; 11:945-51. [PMID: 26940563 DOI: 10.1093/scan/nsw011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 01/28/2016] [Indexed: 11/14/2022] Open
Abstract
The mechanism by which the brain integrates visual and emotional information remains incompletely understood, and can be studied through focal lesions that selectively disrupt this process. To date, three reported cases of visual hypoemotionality, a vision-specific form of derealization, have resulted from lesions of the temporo-occipital junction. We present a fourth case of this rare phenomenon, and investigate the role of the inferior longitudinal fasciculus (ILF) in the underlying pathophysiology. A 50-year-old right-handed male was found to have a right medial temporal lobe tumor following new-onset seizures. Interstitial laser ablation of the lesion was complicated by a right temporo-parieto-occipital intraparenchymal hemorrhage. The patient subsequently experienced emotional estrangement from visual stimuli. A lesion overlap analysis was conducted to assess involvement of the ILF by this patient's lesion and those of the three previously described cases, and diffusion tensor imaging was acquired in our case to further investigate ILF disruption. All four lesions specifically overlapped with the expected trajectory of the right ILF, and diminished structural integrity of the right ILF was observed in our case. These findings implicate the ILF in visual hypoemotionality, suggesting that the ILF is critical for integrating visual information with its emotional content.
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Affiliation(s)
- David B Fischer
- Harvard Medical School, Boston, MA 02115, USA, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,
| | - David L Perez
- Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA and Department of Psychiatry
| | | | - Laura Rigolo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lauren O'Donnell
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | - Aaron D Boes
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA, Department of Neurology and
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Nelson AP, Roper BL, Slomine BS, Morrison C, Greher MR, Janusz J, Larson JC, Meadows ME, Ready RE, Rivera Mindt M, Whiteside DM, Willment K, Wodushek TR. Official Position of the American Academy of Clinical Neuropsychology (AACN): Guidelines for Practicum Training in Clinical Neuropsychology. Clin Neuropsychol 2016; 29:879-904. [DOI: 10.1080/13854046.2015.1117658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chang G, Meadows ME, Smallwood JA, Antin JH, Orav EJ. Cognitive and other predictors of change in quality of life one year after treatment for chronic myelogenous leukemia or myelodysplastic syndrome. J Neuropsychiatry Clin Neurosci 2015; 26:249-57. [PMID: 24817387 DOI: 10.1176/appi.neuropsych.12070177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of cognitive function in quality of life is important among the growing numbers of survivors after cancer treatment. The authors conducted a prospective cohort study of 106 adults evaluated 5.6 months (median) after diagnosis and 77 of 83 (93%) survivors 12 months later with neuropsychological assessments yielding information about simple reaction time to stimuli and other aspects of cognitive function and with two quality of life measures. The two most consistent predictors of change in quality of life were baseline quality of life ratings and simple reaction time. This novel finding about simple reaction time warrants further confirmation.
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Meadows ME, Chang G, Jones JA, Antin JR, Orav EJ. Predictors of neuropsychological change in patients with chronic myelogenous leukemia and myelodysplastic syndrome. Arch Clin Neuropsychol 2013; 28:363-74. [PMID: 23391504 PMCID: PMC3656510 DOI: 10.1093/arclin/acs141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2012] [Indexed: 11/14/2022] Open
Abstract
This study examined the course of neuropsychological functioning in patients with chronic myelogeous leukemia (n = 91) or myelodysplastic syndrome (n = 15) who underwent standard treatment for their disease or allogeneic hematopoietic stem cell transplantation (HSCT) at baseline, 12 months, and 18 months post-treatment. At baseline, 23% of the participants (n = 75) in the longitudinal sample had Z-scores on at least one of the neuropsychological tests that were <1.4. Participants in the study showed improvement over baseline at the 12 and 18 months assessments. The average Z-scores for the six cognitive domains in the longitudinal data set over the course of the study ranged from -0.89 to 0.59. Significant predictors of change in neuropsychological test scores included age, with older participants showing less improvement over time. Other predictors included baseline cognitive domains (language, memory, and attention), previous cocaine use, disease status, intelligence quotient, and quality of life measures. Findings support previous studies in patients with hematological malignancies who showed cognitive impairments at baseline prior to HSCT. However, there was little evidence for further cognitive decline over the course of 18 months.
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Affiliation(s)
- Mary-Ellen Meadows
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Chang G, Meadows ME, Jones JA, Antin JH, Orav EJ. Substance use and survival after treatment for chronic myelogenous leukemia (CML) or myelodysplastic syndrome (MDS). Am J Drug Alcohol Abuse 2010; 36:1-6. [PMID: 20141389 DOI: 10.3109/00952990903490758] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients' substance use problems are a particularly understudied aspect of psychosocial variables in cancer treatment. OBJECTIVES The specific hypothesis tested was that lifetime substance use disorders increased the risk of adverse outcome, in the context of other psychosocial and clinical characteristics demonstrated in other studies to have an impact on treatment outcome. METHOD Prospective cohort study of 106 adults with chronic myelogenous leukemia or primary myelodysplastic syndrome. None satisfied criteria for current substance abuse or dependence, but the lifetime rates of substance use disorders in this sample were 28% for alcohol, 12% for cannabis, and 9% for cocaine. RESULTS Participants received treatment as directed by their physicians, and were followed until death or the end of the study (median 1.5 years). Twenty-eight died. Multivariate survival analysis identified three predictors of outcome: lifetime cocaine use, associated with a six-fold increased risk of death (p = .04), and two protective variables, baseline hemoglobin (p = .002) and estimated intelligence quotient (IQ) (p = .04). CONCLUSION The results of this study highlight the potential significance of substance use disorders, and lifetime cocaine diagnoses in particular, on treatment outcome for people with chronic myelogenous leukemia or myelodysplastic syndrome. Whereas neither lifetime alcohol nor cannabis use were associated with survival on either the univariate or multivariate models of survival, lifetime cocaine diagnoses were associated with significant six-fold increased risk of death (p = .04).
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Affiliation(s)
- Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
BACKGROUND The growing numbers of survivors of innovative cancer treatments, such as hematopoietic stem cell transplantation (HSCT), often report subsequent cognitive difficulties. The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia (CML) or primary myelodysplastic syndrome (MDS) after allogeneic HSCT or other therapies. METHODS In this prospective cohort study, serial evaluations of attention, concentration, memory, mood, and quality of life were used in a consecutive sample of 106 eligible patients who had CML (n = 91) or MDS (n = 15) at enrollment and then 12 months and 18 months after HSCT or other therapy. RESULTS The 3 evaluations at enrollment, 12 months, and 18 months were completed by 98%, 95%, and 89% of surviving participants, respectively. Among all patients, there was significant improvement in memory over 18 months. For example, the 45 patients who underwent HSCT (42 patients with CML and 3 patients with MDS) compared favorably with the patients who received other treatment on most measures of neuropsychological function, except they had improved mental health (P = .034), worse physical function (P = .049), and more difficulty with coordination and fine motor speed bilaterally (dominant hand, P = .005; nondominant hand, P = .0019). Patients with CML overall had improved phonemic fluency (P = .014). CONCLUSIONS The current study indicated that time and diagnosis may be important factors when assessing neurocognitive and other changes. Complaints regarding "chemobrain" after HSCT merit further study, because deficits actually may predate the initiation of treatment and subsequently may improve. The study results could reassure prospective HSCT recipients, because HSCT compared favorably with other treatments when mental status side effects were considered.
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Affiliation(s)
- Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Suarez RO, Whalen S, Nelson AP, Tie Y, Meadows ME, Radmanesh A, Golby AJ. Threshold-independent functional MRI determination of language dominance: a validation study against clinical gold standards. Epilepsy Behav 2009; 16:288-97. [PMID: 19733509 PMCID: PMC2758322 DOI: 10.1016/j.yebeh.2009.07.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 07/23/2009] [Accepted: 07/24/2009] [Indexed: 11/25/2022]
Abstract
Functional MRI (fMRI) is often used for presurgical language lateralization. In the most common approach, a laterality index (LI) is calculated on the basis of suprathreshold voxels. However, strong dependencies between LI and threshold can diminish the effectiveness of this technique; in this study we investigated an original methodology that is independent of threshold. We compared this threshold-independent method against the common threshold-dependent method in 14 patients with epilepsy who underwent Wada testing. In addition, clinical results from electrocortical language mapping and postoperative language findings were used to assess the validity of the fMRI lateralization method. The threshold-dependent methodology yielded ambiguous or incongruent lateralization outcomes in 4 of 14 patients in the inferior frontal gyrus (IFG) and in 6 of 14 patients in the supramarginal gyrus (SMG). Conversely, the threshold-independent method yielded unambiguous lateralization in all the patients tested, and demonstrated lateralization outcomes incongruent with clinical standards in 2 of 14 patients in IFG and in 1 of 14 patients in SMG. This validation study demonstrates that the threshold-dependent LI calculation is prone to significant within-patient variability that could render results unreliable; the threshold-independent method can generate distinct LIs that are more concordant with gold standard clinical findings.
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Affiliation(s)
- Ralph O. Suarez
- Department of Radiology, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A,Department of Neurosurgery, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Stephen Whalen
- Department of Neurosurgery, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Aaron P. Nelson
- Department of Neurology, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A,Department of Psychiatry, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Mary-Ellen Meadows
- Department of Neurology, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A,Department of Psychiatry, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Alireza Radmanesh
- Department of Radiology, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A,Department of Neurosurgery, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
| | - Alexandra J. Golby
- Department of Radiology, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A,Department of Neurosurgery, Brigham and Women's Hospital, MA, U.S.A., Harvard Medical School, Boston, MA, U.S.A
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Greenberg SM, Tennis MK, Brown LB, Gomez-Isla T, Hayden DL, Schoenfeld DA, Walsh KL, Corwin C, Daffner KR, Friedman P, Meadows ME, Sperling RA, Growdon JH. Donepezil therapy in clinical practice: a randomized crossover study. Arch Neurol 2000; 57:94-9. [PMID: 10634454 DOI: 10.1001/archneur.57.1.94] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the efficacy of donepezil hydrochloride for the treatment of Alzheimer disease in patients drawn from clinical practice. DESIGN Two-center, randomized, placebo-controlled, double-masked crossover study. SETTING Memory disorders units at Massachusetts General and Brigham and Women's hospitals, Boston. PATIENTS Sixty individuals (30 men and 30 women; mean +/- SD age, 75.0+/-9.5 years) with probable Alzheimer disease and scores of 20 or less on the information-memory-concentration subscale of the Blessed Dementia Scale. INTERVENTIONS Placebo wash-in, followed in randomized sequence by (1) donepezil hydrochloride therapy, 5 mg/d, for 6 weeks, followed by placebo washout for 6 weeks and (2) placebo treatment for 6 weeks. PRIMARY OUTCOME MEASURE Change in Alzheimer's Disease Assessment Scale cognitive subscale scores from the beginning to the end of the two 6-week treatment periods. RESULTS Among patients completing treatment and testing for both periods (n = 48), subscale scores improved (mean +/- SEM) 2.17+/-0.98 points (95% confidence interval, 0.20-4.10 points) during donepezil therapy relative to placebo therapy (P = .04). Scores returned toward baseline within 3 weeks of drug washout. There was no associated change in caregiver-rated global impression (donepezil vs placebo: proportion improved, 0.24 vs 0.22; proportion worsened, 0.27 vs 0.35; P = .34) or on specific tests of explicit memory or verbal fluency. Contrary to studies with tacrine, the presence of the apolipoprotein E epsilon4 allele did not predict donepezil treatment failure. Most common adverse events related to donepezil therapy were nausea (5 patients), diarrhea (3 patients), and agitation (3 patients). Serious events possibly related to drug use were seizure, pancreatitis, and syncope (1 patient each). CONCLUSION This independent confirmation of data from phase 3 trials suggests that donepezil therapy modestly improves cognition in patients with Alzheimer disease who are encountered in clinical practice.
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Affiliation(s)
- S M Greenberg
- Department of Neurology, Partners HealthCare Inc of Massachusetts General Hospital, Boston 02114, USA.
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Kaplan RF, Jones-Woodward L, Workman K, Steere AC, Logigian EL, Meadows ME. Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology. Appl Neuropsychol 1999; 6:3-11. [PMID: 10382565 DOI: 10.1207/s15324826an0601_1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A small percentage of Lyme patients develop mild to moderate encephalopathic symptoms months to years after diagnosis and treatment. Their symptoms typically include fatigue, memory loss, sleep disturbance, and depression. However, the etiology of this syndrome remains controversial. It is generally thought that Lyme patients with abnormal cerebral spinal fluid (CSF) have a neurological basis to their illness. To further examine this question, we compared Lyme patients with evidence of abnormal CSF, intrathecal antibody to Borrelia burgdorferi, elevated protein, or a positive polymerase chain reaction for B. burgdorferi DNA (n = 14); Lyme patients with normal CSF (n = 18); and healthy controls (n = 15) on a battery of neuropsychological and personality tests. Although both Lyme groups reported memory problems, only the Lyme group with abnormal CSF had measurable memory deficits. Both Lyme groups had higher depression scores than the normal control group, although depression was not correlated with memory scores. It appears that Lyme patients with abnormal CSF may have a neurological basis to their illness, whereas affective symptoms, common to many chronic disorders, may predispose other Lyme patients to the perception of cognitive dysfunction.
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Affiliation(s)
- R F Kaplan
- Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Fisher M, Meadows ME, Do T, Weise J, Trubetskoy V, Charette M, Finklestein SP. Delayed treatment with intravenous basic fibroblast growth factor reduces infarct size following permanent focal cerebral ischemia in rats. J Cereb Blood Flow Metab 1995; 15:953-9. [PMID: 7593356 DOI: 10.1038/jcbfm.1995.121] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Basic fibroblast growth factor (bFGF) is a polypeptide that supports the survival of brain cells (including neurons, glia, and endothelia) and protects neurons against a number of toxins and insults in vitro. This factor is also a potent dilator of cerebral pial arterioles in vivo. In previous studies, we found that intraventricularly administered bFGF reduced infarct volume in a model of focal cerebral ischemia in rats. In the current study, bFGF (45 micrograms/kg/h) in vehicle, or vehicle alone, was infused intravenously for 3 h, beginning at 30 min after permanent middle cerebral artery occlusion by intraluminal suture in mature Sprague-Dawley rats. After 24 h, neurological deficit (as assessed by a 0- to 5-point scale, with 5 = most severe) was 2.6 +/- 1.0 in vehicle-treated and 1.5 +/- 1.3 in bFGF-treated rats (mean +/- SD; N = 12 vs. 11; p = 0.009). Infarct volume was 297 +/- 65 mm3 in vehicle- and 143 +/- 135 mm3 in bFGF-treated animals (p = 0.002). During infusion, there was a modest decrease in mean arterial blood pressure but no changes in arterial blood gases or core or brain temperature in bFGF-treated rats. Autoradiography following intravenous administration of 111In-labeled bFGF showed that labeled bFGF crossed the damaged blood-brain barrier to enter the ischemic (but not the nonischemic) hemisphere. Whether the infarct-reducing effects of bFGF depend on intraparenchymal or intravascular mechanisms requires further study.
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Affiliation(s)
- M Fisher
- Department of Neurology, Medical Center of Central Massachusetts, Worcester 01605, USA
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14
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Cohen RA, O'Donnell BF, Meadows ME, Moonis M, Stone WF, Drachman DA. ERP indices and neuropsychological performance as predictors of functional outcome in dementia. J Geriatr Psychiatry Neurol 1995; 8:217-25. [PMID: 8561835 DOI: 10.1177/089198879500800404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We compared the relative value of neuropsychological and event-related potentials (ERPs) obtained during both passive and active auditory oddball paradigm measures for determining functional outcome in dementia 4 years following initial assessment. Functional outcome was assessed by structured interview of family members of 29 patients with dementia, and patients' functional status was rated in seven areas: mortality, incontinence, institutionalization, ADL dependence, verbal responsiveness, recognition of family members, and capacity for social interaction. A total functional outcome score (ADLTOTAL) was obtained by summing across these individual outcome measures. Many of the neuropsychological measures correlated strongly with overall functional outcome, whereas P3 amplitude and latency on the active ERP condition were the only ERP indices to predict functional outcome. When ERP and neuropsychological measures were considered simultaneously using stepwise multiple regression analyses, the neuropsychological measures were better predictors of most functional outcomes, although P3 latency was the best predictor of mortality. However, neuropsychological performance and ERPs appear to be sensitive to different functional outcomes. Therefore, evaluation of both ERPs and neuropsychological performance may ultimately have prognostic utility in the assessment of patients with dementia.
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Affiliation(s)
- R A Cohen
- Department of Neuropsychology, Miriam Hospital, Brown University Medical School, Providence, Rhode Island 02906, USA
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15
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Cobia DC, Center H, Buckhalt JA, Meadows ME. An interprofessional model for serving youth at risk for substance abuse: the team case study. J Drug Educ 1995; 25:99-109. [PMID: 7658299 DOI: 10.2190/3va1-3r2c-gmcw-l6d7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Three models of interprofessional education appropriate for serving youth at risk for substance abuse are described. One of the models, the team case study, was evaluated by school personnel trained in its use. Results indicated that participants were more sensitive to the multiple needs of youth at risk, experienced increased comfort in seeking consultation from other agents working with such youth, and were more confident of their abilities to select and implement appropriate interventions for youth at risk for substance abuse following their training.
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Affiliation(s)
- M E Meadows
- Tufts University School of Medicine-New England Medical Center, Department of Neurology, Boston, MA
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17
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Abstract
Autonomic and subjective responses to emotional and neutral slides were studied in patients with right hemisphere damage (RHD), left hemisphere damage (LHD) and normal controls (CON). Orienting and habituation to a series of pure tones (1000 Hz) were also examined. All subjects showed appropriate slide recognition and there were no group differences in subjective ratings. The CON group showed higher skin conductance responses (SCRs) to the emotional slides relative to the neutral slides, while the RHD group showed lower SCRs to both sets of slides. The LHD group showed higher SCRs independent of slide type. The results support the hypothesis (Heilman and Watson, Handbook of Neurology, Elsevier Science, 1989) that emotional paucity in RHD patients may be related to reduced autonomic arousal. However, there were no significant differences between groups in the orienting response or habituation to loud tones, suggesting that decreased arousal following RHD is not ubiquitous.
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Affiliation(s)
- M E Meadows
- Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts
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18
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Kaplan RF, Meadows ME, Verfaellie M, Kwan E, Ehrenberg BL, Bromfield EB, Cohen RA. Lateralization of memory for the visual attributes of objects: evidence from the posterior cerebral artery amobarbital test. Neurology 1994; 44:1069-73. [PMID: 8208402 DOI: 10.1212/wnl.44.6.1069] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We used the posterior cerebral artery amobarbital test to examine how each temporal lobe mediates memory for objects. Temporal lobectomy candidates were presented with four objects while one hemisphere was anesthetized. We assessed recall and recognition following recovery from the drug. Verbal recall was significantly better following object presentation to the left hemisphere when the left hemisphere was not the seizure focus. Recognition memory, tested with two identical objects, two objects that shared the same name but had different physical characteristics, and two foils, was superior following object presentation to the right hemisphere. Only the right hemisphere could discriminate identical objects from same-name foils. These data confirm that the left temporal lobe has an advantage in encoding the verbal representation of an object and suggest that the right temporal lobe is critical for memory of specific visual attributes of objects.
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Affiliation(s)
- R F Kaplan
- Tufts University School of Medicine, Boston, MA
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19
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Abstract
Skin conductance response (SCR) was measured in an orienting response (OR) and habituation paradigm in 10 post-cingulotomy and age-matched control subjects. While both groups habituated, the cingulotomy patients exhibited a slower habituation rate, and greater variability across trials compared to controls. Habituation abnormalities were not associated with increased sensitization, as neither extended habituation training or dishabituation differentiated the groups. An increased frequency of spontaneous SCR activations occurred post-cingulotomy. The results suggest that the cingulate cortex influences the temporal stability of habituation. These findings are consistent with the subtle attentional dysfunction noted following cingulate damage.
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Affiliation(s)
- R A Cohen
- Department of Neurology, University of Massachusetts Medical School, Worcester 01655
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Meadows ME, Fisher M, Minematsu K. Delayed Treatment with a Noncompetitive NMDA Antagonist, CNS-1102, Reduces Infarct Size in Rats. Cerebrovasc Dis 1993. [DOI: 10.1159/000108446] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Abstract
Type A behavior scores on the Jenkins Activity Survey, Form T, and ACT Interest Inventory data were collected for 90 male and 90 female university students who equally represented three eye-color groups, black/brown, blue, and other. Chi-squared analyses indicated no statistically significant associations at the .05 level. Observations which may be of interest to researchers are noted.
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Affiliation(s)
- S C Rohmer
- Counseling and Testing Service, University of South Alabama, Mobile 36688
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22
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Kaplan RF, Meadows ME, Vincent LC, Logigian EL, Steere AC. Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients. Neurology 1992; 42:1263-7. [PMID: 1620329 DOI: 10.1212/wnl.42.7.1263] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Lyme encephalopathy, primarily manifested by disturbances in memory, mood, and sleep, is a common late neurologic manifestation of Lyme disease. We compared 20 patients with Lyme encephalopathy with 11 fibromyalgia patients and 11 nonpsychotically depressed patients using the California Verbal Learning Test, Wechsler Memory Scale, Rey-Osterrieth Complex Figure Test, Minnesota Multiphasic Personality Inventory (MMPI), and Beck Depression Inventory. Compared with patients with fibromyalgia or depression, the Lyme encephalopathy group showed mild, but statistically significant, memory deficits on two of the three memory tests. In contrast, the patients with fibromyalgia scored significantly higher than both other groups on the MMPI scale most sensitive to somatic concerns (scale 1), while the depressed patients scored higher than the Lyme patients on the scales most sensitive to depression (scale 2) and anxiety (scale 7). Physical complaints and depression were not major factors in memory performance among Lyme patients. These data support the hypothesis that Lyme encephalopathy is caused by CNS dysfunction and cannot be explained as a psychological response to chronic illness.
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Affiliation(s)
- R F Kaplan
- Department of Neurology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111
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Buckhalt JA, Halpin G, Noel R, Meadows ME. Relationship of drug use to involvement in school, home, and community activities: results of a large survey of adolescents. Psychol Rep 1992; 70:139-46. [PMID: 1565712 DOI: 10.2466/pr0.1992.70.1.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
All 7th, 9th, and 11th grade students in 129 school districts responded to a 466-variable survey that primarily assessed drug use but also contained questions about involvement in various activities. Meaningful relationships were obtained between students' involvement in school, family, and church activities and reported use of tobacco, alcohol, and marijuana. Factors reflecting the extent of parental supervision were also related to the reported use of those substances.
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Affiliation(s)
- J A Buckhalt
- Counseling & Counseling Psychology Department, Auburn University, AL 36849
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Abstract
Seven variations of a letter cancellation test were used to examine how varying attentional demands affect hemispatial neglect in patients with right hemisphere lesions. While the 14 targets always remained in the same location, the number of distractors (zero, nine, 28, or 82) as well as their complexity (one letter or nine different letters) were varied. The percentage of targets canceled in the left hemispace was linearly related to the number of distractors. There were no differences between the complexity conditions. In a second study, the same 14 targets were presented but the distractors (zero, 14, or 41) were all placed on the right. Increasing the number of distractors on the right increased neglect on both sides of the space. Taken together, these results suggest that, while the limited attentional resources of the left hemisphere are biased toward the right hemispace, the absence of contralateral attentional demands allows these resources to be directed ipsilaterally.
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Affiliation(s)
- R F Kaplan
- Department of Neurology, Tufts University School of Medicine, Boston, Mass
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