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Rosso A, Zhu X, Marcum Z, Bohnen N, Sprague B, Rosano C. Anticholinergic Medication Use, Dopaminergic Genotype, and Recurrent Falls. Innov Aging 2020. [PMCID: PMC7741680 DOI: 10.1093/geroni/igaa057.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Anticholinergic medications (A-chol) increase risk for falls; higher dopaminergic signaling may provide resilience to these effects. In 2489 older adults (mean age=74; 52% women) with 10 years of data on medication use, falls, and dopaminergic genotype (catechol-O-methyltransferase (COMT)), we assessed the association of A-chol use with recurrent falls (≥2) over the subsequent 12 months using generalized estimating equations. Effect modification by COMT (met/met, higher dopamine signaling, n=473 vs val carriers, lower dopamine signaling, n=2016) was tested; analyses were then stratified by COMT and adjusted for demographics and A-chol use indicators. During follow-up, 843 people reported recurrent falls. A-chol use doubled the odds of recurrent falls (OR [95%CI]=2.13[1.74, 2.60]), with a suggested effect modification by COMT (p=0.1). The association was present in val carriers (adjusted OR [95%CI]=1.93[1.36, 2.73]) but not in met/met (adjusted OR [95%CI]=1.30[0.53, 3.22]). Higher dopaminergic signaling may provide protection against the effects of A-chol use on fall risk.
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Affiliation(s)
- Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Xiaonan Zhu
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Zachary Marcum
- University of Washington, Seattle, Washington, United States
| | - Nico Bohnen
- University of Michigan, Ann Arbor, Michigan, United States
| | - Briana Sprague
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Caterina Rosano
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Mance S, Rosso A, Bis J, Studenski S, Bohnen N, Rosano C. Catechol-O-Methyltransferase Genotype, Frailty, and Gait Speed: The Cardiovascular Health Study. Innov Aging 2020. [PMCID: PMC7742836 DOI: 10.1093/geroni/igaa057.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The association of COMT with gait speed varies across studies; frailty, a condition increasing vulnerability to stressors, may influence this association. Cross-sectional data was obtained in 3,744 participants (71 years, 82% white, 39% male) for gait speed, frailty (Fried definition), and COMT. Multivariable regression models of COMT predicting gait were adjusted for demographics, chronic conditions, and locomotor factors. Interactions of COMT by frailty and by race predicting gait speed were p=0.03 and p=0.02, respectively. Compared to Met/Met, the Val/Val group walked marginally more slowly in the full cohort (0.87 vs 0.89 m/sec, p=0.2); differences were significant for those with frailty (n=220, 0.55 vs 0.63m/sec, p=0.03), but not for those with moderate (n=1691, 0.81 vs 0.81m/sec, p=0.9), or no frailty (n=1833, 0.98 vs 0.97 m/sec, p=0.7). Associations were similar by race, but significant for whites only. Studies should assess the influence of dopaminergic signaling on gait slowing due to frailty.
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Affiliation(s)
- Shannon Mance
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Joshua Bis
- University of Washington, Seattle, Washington, United States
| | | | - Nico Bohnen
- University of Michigan, Ann Arbor, Michigan, United States
| | - Caterina Rosano
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Mance S, Rosso A, Bis J, Studenski S, Bohnen N, Rosano C. Catechol-O-Methyltransferase Genotype, Frailty, and Gait Speed in a Biracial Cohort of Older Adults. J Am Geriatr Soc 2020; 69:357-364. [PMID: 33043988 DOI: 10.1111/jgs.16842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether the association between dopamine-related genotype and gait speed differs according to frailty status or race. DESIGN Cross-sectional population-based study (Cardiovascular Health Study). SETTING Multicenter study, four U.S. sites. PARTICIPANTS Volunteer community-dwelling adults aged 65 years and older, without evidence of Parkinson's disease (N = 3,744; 71 years; 82% White; 39% male). MEASUREMENTS Gait speed (usual pace; m/s), physical frailty (Fried definition), and genetic polymorphism of catechol-O-methyltransferase (COMT; rs4680), an enzyme regulating tonic brain dopamine levels, were assessed. Interaction of COMT by frailty and by race predicting gait speed were tested, and, if significant, analyses were stratified. Multivariable regression models of COMT predicting gait speed were adjusted for demographics and locomotor risk factors. Sensitivity analyses were repeated, stratified by clinical cutoffs of gait speed (0.6 and 1.0 m/s) instead of frailty status. RESULTS The interaction of COMT by frailty and COMT by race were P = .02 and P = .01, respectively. Compared with Met/Met (higher dopaminergic signaling), the Val/Val group (lower dopaminergic signaling) walked marginally more slowly in the full cohort (0.87 vs 0.89 m/s; P = .2). Gait speed differences were significant for frail (n = 220; 0.55 vs 0.63 m/s; P = .03), but not for prefrail (n = 1,691; 0.81 vs 0.81 m/s; P = .9) or nonfrail (n = 1,833; 0.98 vs 0.97 m/s; P = .7); results were similar in fully adjusted models. Among frail, associations were similar for Whites and Blacks, with statistical significance for Whites only. Associations stratified by clinical cutoffs of gait speed were not significant. CONCLUSION The association of dopamine-related genotype with gait speed is stronger among adults with frailty compared with those without frailty. The potential effects of dopaminergic signaling on preserving physical function in biracial cohorts of frail adults should be further examined.
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Affiliation(s)
- Shannon Mance
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Andrea Rosso
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Joshua Bis
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
| | | | - Nico Bohnen
- Departments of Radiology & Neurology, University of Michigan School of Medicine & Ann Arbor VA, Ann Arbor, Michigan, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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van der Zee S, Muller M, van Laar T, Bohnen N. Cholinergic degeneration within a large scale neural network is a major driver of cognitive impairment in Parkinson's disease. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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van Eimeren T, Antonini A, Berg D, Bohnen N, Ceravolo R, Drzezga A, Höglinger GU, Higuchi M, Lehericy S, Lewis S, Monchi O, Nestor P, Ondrus M, Pavese N, Peralta MC, Piccini P, Pineda-Pardo JÁ, Rektorová I, Rodríguez-Oroz M, Rominger A, Seppi K, Stoessl AJ, Tessitore A, Thobois S, Kaasinen V, Wenning G, Siebner HR, Strafella AP, Rowe JB. Neuroimaging biomarkers for clinical trials in atypical parkinsonian disorders: Proposal for a Neuroimaging Biomarker Utility System. Alzheimers Dement (Amst) 2019; 11:301-309. [PMID: 30984816 PMCID: PMC6446052 DOI: 10.1016/j.dadm.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Therapeutic strategies targeting protein aggregations are ready for clinical trials in atypical parkinsonian disorders. Therefore, there is an urgent need for neuroimaging biomarkers to help with the early detection of neurodegenerative processes, the early differentiation of the underlying pathology, and the objective assessment of disease progression. However, there currently is not yet a consensus in the field on how to describe utility of biomarkers for clinical trials in atypical parkinsonian disorders. METHODS To promote standardized use of neuroimaging biomarkers for clinical trials, we aimed to develop a conceptual framework to characterize in more detail the kind of neuroimaging biomarkers needed in atypical parkinsonian disorders, identify the current challenges in ascribing utility of these biomarkers, and propose criteria for a system that may guide future studies. RESULTS As a consensus outcome, we describe the main challenges in ascribing utility of neuroimaging biomarkers in atypical parkinsonian disorders, and we propose a conceptual framework that includes a graded system for the description of utility of a specific neuroimaging measure. We included separate categories for the ability to accurately identify an intention-to-treat patient population early in the disease (Early), to accurately detect a specific underlying pathology (Specific), and the ability to monitor disease progression (Progression). DISCUSSION We suggest that the advancement of standardized neuroimaging in the field of atypical parkinsonian disorders will be furthered by a well-defined reference frame for the utility of biomarkers. The proposed utility system allows a detailed and graded description of the respective strengths of neuroimaging biomarkers in the currently most relevant areas of application in clinical trials.
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Affiliation(s)
- Thilo van Eimeren
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Nico Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, and VAMC, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- VAMC, Ann Arbor, MI, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander Drzezga
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Forschungszentrum Jülich, INM-2, Jülich, Germany
| | - Günter U. Höglinger
- German Centre for Neurodegenerative Diseases (DZNE), and Technical University Munich, Department of Neurology, Munich, Germany
| | - Makoto Higuchi
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stephane Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, ICM Team “Movement Investigations and Therapeutics”, Sorbonne Universités, Inserm U1127, CNRS UMR, Paris, France
| | - Simon Lewis
- Brain & Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
- Mater Hospital, South Brisbane, QLD, Australia
| | - Matej Ondrus
- AXON Neuroscience CRM Services SE, Bratislava, Slovak Republic
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - María Cecilia Peralta
- Center for Medical Education and Clinical Research, Section of Neurology, Buenos Aires, Argentina
| | - Paola Piccini
- Department of Medicine, Imperial College London, London, United Kingdom
| | - José Ángel Pineda-Pardo
- hmCINAC, University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Irena Rektorová
- First Department of Neurology – Faculty of Medicine and CEITEC MU, Masaryk University, Brno, Czech Republic
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Alessandro Tessitore
- Department of Medical, Surgery, Neurological, Metabolic and Aging Sciences, University of Campania, “L. Vanvitelli”, Caserta CE, Italy
| | - Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Medecine Lyon Sud Charles Merieux, Lyon, France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C, Lyon, France
- CNRS, Institut des Sciences Cognitives, Bron, France
| | - Valtteri Kaasinen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Gregor Wenning
- Division of Clinical Neurology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN, Toronto, Ontario, Canada
- Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Rosano C, Studenski SA, Rosso AL, Metti A, Bohnen N. HIGHER NIGROSTRIATAL DOPAMINE ATTENUATES GAIT SLOWING DUE TO AGE AND CEREBRAL SMALL VESSEL DISEASE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Rosano
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - S A Studenski
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - A L Rosso
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - A Metti
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - N Bohnen
- Department of Radiology, University of Michigan, Ann Arbor,MI
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Bly B, Muller M, Albin R, Frey K, Bohnen N. The Prevalence of Impaired Olfaction in Parkinson's Disease Is Higher Than Previously Estimated (P07.129). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kotagal V, Albin R, Muller M, Koeppe R, Frey K, Bohnen N. Bradykinesia, Rigidity, and Postural Instability and Gait Difficulty Occur More Commonly in Men with Parkinson Disease Compared to Women Independent of Nigrostriatal Dopaminergic Denervation (P06.044). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kotagal V, Albin R, Muller M, Koeppe R, Frey K, Bohnen N. Diabetes Is Associated with Bradykinesia and Postural Instability and Gait Difficulty in Parkinson Disease Independent of Nigrostriatal Dopaminergic Denervation: A Case-Control Study (P07.125). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bohnen N, Albin R, Kotagal V, Frey K, Muller M. Decreased Vestibular Efficacy Contributes To Balance Impairment in Parkinson Disease (PD4.009). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd4.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lenhart A, Bohnen N, Koeppe R, Chou K. Dopaminergic and Cholinergic Brain Activity and Performance on MMSE and MoCA in Parkinson's Disease (P03.127). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Muller M, Bogan C, Ashton-Miller J, Bohnen N. 050 ASSOCIATION BETWEEN BRAIN WHITE MATTER TRACT INTEGRITY AND CLINICAL MEASURES OF FALL RISK IN OLDER ADULTS. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bohnen N. 021 USING NEUROCHEMICAL IMAGING TO UNDERSTAND GAIT AND MENTAL FUNCTION IN PARKINSON DISEASE. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chou K, Bohnen N. P1.118 Relationship between olfactory dysfunction and Body Mass Index in patients with Parkinson disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bohnen N. Selective Anterior Cerebral Amyloid Angiopathy and Frontal Lobe Dementia: A Clinicopathologic Correlation. Int J Neurosci 2009. [DOI: 10.3109/00207459808986444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bohnen N, Jolles J, Twijnstra A. Modification of the stroop color word test improves differentiation between patients with mild head injury and matched controls. Clin Neuropsychol 2007; 6:178-184. [PMID: 29022450 DOI: 10.1080/13854049208401854] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- N. Bohnen
- a Department of Neuropsychology & Psychobiology , University of Limburg , Maastricht , The Netherlands
| | - J. Jolles
- a Department of Neuropsychology & Psychobiology , University of Limburg , Maastricht , The Netherlands
| | - A. Twijnstra
- a Department of Neuropsychology & Psychobiology , University of Limburg , Maastricht , The Netherlands
- b Department of Neurology , University Hospital Maastricht , The Netherlands
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Abstract
There is insufficient information about the long-term sequelae of mild head injury (postconcussional symptoms, PCS). Therefore, a questionnaire-based investigation was carried out in patients 1-5 years after mild head injury (MHI) and in non-concussed subjects in order to study the nature of long-term complaints after MHI. A three-factor model of residual subjective and psychological complaints that contained a dysthymic factor, a vegetative/bodily complaints factor, and a cognitive performance factor were identified in the patient population. Three rating scales were constructed from the relevant items or factors, and were used to compare the MHI patients with non-concussed controls. It was found that the profile of distresses and discomforts mentioned by a population of MHI patients 1-5 years after the trauma was similar to that of a non-concussed control population. These symptoms were indistinguishable from those encountered in ordinary everyday life. These symptoms were significantly more severe in the MHI patients. Stepwise regression analysis in the patient population indicated that a number of parameters were statistically of predictive importance: comorbidity, sex, and neurological complication at the time of the trauma. The results support the hypothesis that MHI may not ever be completely reversible.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Bohnen N, Jolles J, Degenaar CP. Levels of trace elements in blood in healthy aging subjects. Z Gerontol 1994; 27:324-7. [PMID: 7810199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The effects of age and sex on the serum levels of trace elements were determined after an overnight fast in 80 ambulatory, disease-free adults who had undergone rigorous health screening. Significant age and sex differences were found for Mn. Blood levels of Cu and Zn showed both age and sex differences. No age or sex differences were found for Pb, Cd, Cr, Ni, Se, and Al.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Abstract
Patients with Alzheimer's disease (AD) who have a late onset of dementia may represent a subgroup of AD that has a unique multifactorial/genetic profile. It was hypothesized in the present study that if external factors interact with a biological or genetic susceptibility in at least some subsets of patients with AD, these factors may accelerate the manifestation of the disease. The cumulative exposure to different types of general and major regional anesthetics prior to the onset of dementia was calculated in a population-based study of incident cases of AD residing in Rochester, MN, for more than 40 years preceding the onset of dementia (N = 252). Correlational analysis revealed that age of onset was inversely related to cumulative exposure to general and spinal anesthesia before the age of 50, whereas there was no, or an expected positive, correlation for anesthetic exposure after 50 years. These findings may suggest that the manifestation of dementia in AD patients may be related to exposure to external factors at an earlier age.
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Affiliation(s)
- N Bohnen
- Department of Neurology, Mayo Clinic 55905
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Abstract
Posttraumatic diabetes insipidus has been reported as a sequela to head injury. It is unknown whether subclinical types of diabetes insipidus, or other types of water metabolism disorders, occur after mild head injury (MHI) and, if so, whether they are related to the persistence of postconcussional symptoms. MHI patients (n = 38) were screened for disturbances of water metabolism by comparing plasma and urine osmolalities at about 5 weeks after the trauma. Eight patients had evidence of an increased plasma osmolality together with a relatively decreased urine osmolality after an overnight fast. The presence of this disturbance was significantly related to the persistence of postconcussional symptoms. The results suggest that subclinical disturbances of water metabolism may, among other factors, be related to the persistence of symptoms after MHI.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Bohnen N, Terwel D, Markerink M, Ten Haaf JA, Jolles J. Pitfalls in the Measurement of Plasma Osmolality Pertinent to Research in Vasopressin and Water Metabolism. Clin Chem 1992. [DOI: 10.1093/clinchem/38.11.2278] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The reliability of measurements of plasma osmolality is known to be biased by technical artifacts, such as the anticoagulant and the osmometric technique used; the resulting measurement errors therefore may cause errors in interpretation of data. In assessing the potential biasing influence of procedural variables, we found that the temperature at which fresh plasma samples were stored, the duration of storage, and the freezing and thawing of samples appeared to significantly (P < 0.01) affect osmolality values around the narrow physiological range. These factors should be considered in the interpretation of studies on the osmoregulation of vasopressin secretion. In particular, the results suggest that data obtained for any but fresh samples, whether frozen-thawed samples or samples stored at room temperature, are unreliable.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
| | - D Terwel
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
| | - M Markerink
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
| | - J A Ten Haaf
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
| | - J Jolles
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
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Abstract
Post-concussional symptoms, such as headache, dizziness and irritability, are thought to result from the emotional stress associated with decreased cognitive performance after a head injury. A questionnaire-based investigation was carried out in 71 patients with mild head injury (MHI), using a heterogeneous item pool in order to study the interrelationships between traditional post-concussive complaints, cognitive problems, and more emotional and functional complaints. Factor analysis indicated that post-concussive symptoms loaded together with items on problems associated with decreased work performance and fatigability on a first factor, whereas psychovegetative and emotional complaints loaded together on a second factor. Two rating scales were constructed from the relevant items and were used to compare between subgroups of MHI patients and non-concussed controls. Patients with uncomplicated MHI had significantly higher scores than non-concussed subjects on the post-concussive-cognitive scale, but not on the emotional-vegetative scale. Patients with multiple head injuries or pre-existing emotional problems had higher scores on both the post-concussive-cognitive scale and the emotional-vegetative scale than MHI patients without a history of emotional problems. Reliable rating scales may be useful in multidiagnostic studies of MHI patients.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Bohnen N, Terwel D, Markerink M, Ten Haaf JA, Jolles J. Pitfalls in the measurement of plasma osmolality pertinent to research in vasopressin and water metabolism. Clin Chem 1992; 38:2278-80. [PMID: 1424124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The reliability of measurements of plasma osmolality is known to be biased by technical artifacts, such as the anticoagulant and the osmometric technique used; the resulting measurement errors therefore may cause errors in interpretation of data. In assessing the potential biasing influence of procedural variables, we found that the temperature at which fresh plasma samples were stored, the duration of storage, and the freezing and thawing of samples appeared to significantly (P < 0.01) affect osmolality values around the narrow physiological range. These factors should be considered in the interpretation of studies on the osmoregulation of vasopressin secretion. In particular, the results suggest that data obtained for any but fresh samples, whether frozen-thawed samples or samples stored at room temperature, are unreliable.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
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24
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Abstract
The sequelae of severe closed head injury have received much attention in the literature, but the effects of mild closed head injury (MHI) are less well established. There is a subgroup of patients who complain of persisting postconcussive symptoms (PCS) beyond the first weeks of recovery. Although the symptoms generally develop in the absence of clear neurological abnormalities, the condition of PCS can be chronic and disabling. It has been assumed that PCS result from an interaction between organic and psychological factors. Differentiating between the effect of primary neurological injury and secondary psychosocial problems is often difficult for clinicians and engenders controversy. Neuropsychological, neurophysiological, and neuroimaging measures can be helpful in selecting patients at risk of developing PCS. Assessment of the level of cognitive functioning, individual susceptibility to stress, and environmental demands may be beneficial in treating symptomatic patients. It is true that the vague and aspecific nature of the postconcussion syndrome may have given rise to the controversy over this entity, but the many methodological inconsistencies in the experimental approaches to the syndrome have certainly enhanced the confusion about this issue. The ensuing controversy surrounding research on the outcome of MHI and the postconcussion syndrome reflects ambiguities in definition, inconsistencies in criteria for patient selection, variation in procedures for neurobehavioral assessment, and difficulty in obtaining follow-up data.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Bohnen N, Degenaar CP, Jolles J. Influence of age and sex on 19 blood variables in healthy subjects. Z Gerontol 1992; 25:339-45. [PMID: 1441715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Normal values exist for all clinical chemical tests, but it is not very clear what is normal for healthy elderly subjects. Therefore, routine blood variables were determined in 80 ambulatory, disease-free persons who had undergone rigorous health screening. The subjects were divided into the following age groups: 20 (+/- 3), 40 (+/- 3), 60 (+/- 3), and 80 (+/- 5) years, with 10 males and 10 females per age group. Blood variables were determined after an overnight fast. It was found that even with conservative statistical measures more than half of the variables were significantly affected by age or sex. Significant age differences were found for total cholesterol, triglycerides, sodium, and ASAT. Urea, creatinine, gamma-GT, phosphate, alkaline phosphatase, and albumin were characterized by both age and sex differences. No age or sex differences were found for glucose, potassium, chloride, calcium, calcium ion, iron, magnesium, total protein, and ALAT. The findings suggest that the age or sex-related changes of a number of blood variables such as cholesterol, triglycerides, and liver enzymes are not only of statistical significance, but are also of clinical relevance.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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26
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Bohnen N, Jolles J, Twijnstra A. Neuropsychological deficits in patients with persistent symptoms six months after mild head injury. Neurosurgery 1992; 30:692-5; discussion 695-6. [PMID: 1584379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There is much debate on the nature and duration of cognitive deficits and postconcussive symptoms (PCS) after mild head injury. Most studies performed so far have compared head-injured patients with subjects who had not suffered a concussion, instead of directly comparing patients with and without persistent PCS. The present study examined whether patients with PCS (n = 9) about 6 months after an uncomplicated mild head injury performed less well on selected neuropsychological tests than patients with mild head injuries who did not have PCS (n = 9) and healthy controls (n = 9). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, and education. We found that patients with PCS performed less well on tests of divided and selective attention than both patients without PCS and healthy controls. It is concluded that cognitive deficits may be present up to 6 months after mild head injury when symptoms persist. The findings indicate that patients with mild head injury and subjective symptoms may manifest demonstrable cognitive deficits.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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27
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Bohnen N, Jolles J, Twijnstra A, Mellink R, Sulon J. Coping styles, cortisol reactivity, and performance in a vigilance task of patients with persistent postconcussive symptoms after a mild head injury. Int J Neurosci 1992; 64:97-105. [PMID: 1342053 DOI: 10.3109/00207459209000536] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [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: 12/26/2022]
Abstract
Some patients experience persistent postconcussive symptoms (PCS) after a mild head injury (MHI). According to the coping hypothesis, PCS result from the increased stress that head-injured patients experience when they are not able to cope with environmental demands. This study examined the coping ability and cortisol reactivity of MHI patients with and without PCS and in uninjured controls. Patients with PCS 12-34 months after injury were individually matched with MHI patients without PCS (N = 11) and healthy controls (N = 11) for the time elapsed since the injury, age, sex, education, and IQ. First, we found that patients with PCS reported being less able to cope with problems. These patients appeared to be inferior in active problem solving and had a more depressive attitude toward problems than subjects of the two control groups. Second, we found no differences between the three groups in the mean cortisol response during a vigilance task. These results only partly support the coping hypothesis. With respect to cognitive performance, we found that decrements in a vigilance task were related to an increased cortisol response during this task, especially in apparently "recovered" (asymptomatic) MHI patients. The latter finding may point to an increased cognitive vulnerability of apparently recovered MHI patients when exposed to a CNS stressor.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
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29
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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30
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Bohnen N, Twijnstra A, Wijnen G, Jolles J. Recovery from visual and acoustic hyperaesthesia after mild head injury in relation to patterns of behavioural dysfunction. J Neurol Neurosurg Psychiatry 1992; 55:222-4. [PMID: 1564487 PMCID: PMC1014733 DOI: 10.1136/jnnp.55.3.222] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with head injuries frequently complain of a decreased ability to endure intense light and sound stimuli. The few psychophysical studies that have objectively studied this type of hyperaesthesia have not assessed to what extent patients recover from this hyperaesthesia after mild head injury (MHI). A computerised rating technique was used to assess tolerance to intense sound (95 dB) and light (1500 lux) stimuli in patients with an uncomplicated MHI. Patients were tested 10 days and five weeks after the injury. Although most patients substantially recovered from both visual and acoustic hyperaesthesia, 25% of the patients were still not able to endure intense stimuli by five weeks. Analysis of data obtained with two behavioural rating scales (one with post-concussive/cognitive complaints and a second with emotional/vegetative complaints) indicated that visual hyperaesthesia was specifically related to the post-concussive/cognitive complaints scale.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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31
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Abstract
There is much controversy about whether the persistence of postconcussive symptoms (PCS) in mild head injured patients (MHI) is related to the presence of cognitive deficits. Most studies performed so far have relied on normal non-concussed control subjects rather than directly comparing patients with and without PCS following MHI. In addition, subtle cognitive deficits may be present in MHI patients that are demonstrable only with more demanding cognitive tasks. In the present study the Stroop Color Word Interference Test together with a more demanding modified interference subtask was administered to two groups of patients with uncomplicated MHI 10 days, 5 weeks and 3 months after the injury. Ten patients with persistent symptoms at 3 months were selected and individually matched with MHI patients who had initially reported symptoms but who had recovered by 3 months. The scores of the two retrospectively defined groups were compared at the different time points. Between-subjects analysis revealed overall differences for both the original and modified color word interference subtask. Within-subject analysis indicated that only the recovery rate in the modified interference subtask was significantly different between the two groups. The observation that there was a parallel trend between recovery and persistence of PCS and performance on the cognitive interference measures supports the notion that there is a functional relationship between these two phenomena.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology, University of Limburg, Maastricht, The Netherlands
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Abstract
Although it is well known that patients with mild head injury (MHI) are less able to endure intense light and sound stimuli than normal people, there are few psychophysical studies that have objectively measured this type of hyperaesthesia. In the present study, using a computerised rating scale technique, both the maximal and submaximal levels of reduced tolerance to light and sound were assessed for a wide range of stimuli. Three to six days after the trauma, 40 MHI patients were significantly less tolerant to stimuli of intensities over 71 dB and 500 lux levels than controls. These intensities are common, and MHI patients may suffer as a consequence.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology & Psychobiology, University of Limburg, Maastricht, The Netherlands
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Bohnen N, Twijnstra A, Wijnen G, Jolles J. Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury. J Neurol 1991; 238:443-6. [PMID: 1779251 DOI: 10.1007/bf00314651] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [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: 12/28/2022]
Abstract
Patients with post-concussional symptoms (PCS) about 6 months after a mild head injury (MHI) were examined for tolerance of light and sound in comparison with concussed patients without PCS and non-concussed healthy controls. MHI patients with PCS were individually matched with subjects from the two control groups for the time elapsed from the injury, and for age and sex. Using a computerized rating technique, we assessed both the maximal and submaximal levels of lowered tolerance for light and sound over a wide range of stimuli. We found that the MHI patients with PCS 6 months after the trauma (n = 11) tolerated significantly less well stimuli of intensities of 71 dB and 500 lx than MHI patients without PCS (n = 11) and non-concussed controls (n = 11). There were no significant differences in tolerance for light and sound between MHI patients without PCS and the non-injured controls. Decreased tolerance for light and sound may contribute to the persistence of symptoms up to 6 months after a mild head injury. The psychophysical method provides an objective measure for the evaluation of the late persistent post-concussional syndrome.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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34
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Abstract
The present study examined whether salivary cortisol secretion as an index of stress reactivity to continuous mental task performance reflected individual differences in coping styles. During 4 hr of continuous mental tasks significantly higher cortisol levels were found in comparison with a control session. However, individual variability in the cortisol response was high. Correlational data indicate a significant negative relationship between the coping style 'comforting cognitions' and the individual cortisol response during mental stress. During this particular type of cognitive stress, where the subject has no control over the experimental situation, comforting and emotion-focused coping may be effective because of the subject's efforts of trying to reframe the inevitable situation in a positive and self-encouraging way. In contrast, there was no significant relationship between trait anxiety and individual glucocorticoid susceptibility to mental stress.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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Abstract
The after-effects of fatigue or stress on the performance of cognitive tests have been particularly difficult to demonstrate. In this study we examined whether salivary cortisol, used as an index of stress evoked by the continuous performance of mental tasks, reflected individual differences in cognitive performance. In a within-subject experiment in which 24 subjects were exposed to 4 hours of continuous mental activity and to a control session, significantly higher cortisol levels were found during the continuous task session. Cognitive performance was assessed before and after each session. The relevant test parameters involved aspects of verbal memory, concept shifting and divided attention. When subjects were divided into two groups based on the magnitude of individual cortisol responses to the continuous tasks, it was found that the subgroup with higher cortisol responses decreased in attention compared with their attention after the control session. In contrast, the performance of the subgroup with no or lower cortisol responses did not differ between the two sessions. There was no evidence of similar effects on verbal memory or concept shifting.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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36
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands
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37
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Abstract
The results of the present study show that subjects who received an overnight infusion of isotonic fluid did significantly less well at particular neuropsychological tests than controls who did not receive such an infusion. The relevant test parameters involved aspects of word list learning, and concept shifting on a complex speed task. Potentially biasing factors such as anxiety, disturbed sleep, education and age could be discarded. With respect to the physiological mechanism involved, the results suggest that a relatively expanded extracellular volume without dilutional hyponatremia might underlie the diminished performance. The experimental group did not lose weight overnight, and the hemoglobin and haematocrit level of the experimental group were significantly different from those of the control group; the blood pressure, plasma electrolytes and osmolality were not different. The present results provide evidence that disturbances in fluid homeostasis may affect cognitive performance.
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Affiliation(s)
- N Bohnen
- Department of Neuropsychology and Psychobiology, State University of Limburg, Maastricht, The Netherlands
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