Comparison of the Halstead-Reitan and Infrared Light Beam Finger Tappers

Computer mediated motor tests can provide highly reliable means for evaluating gross and subtle aspects of psychomotor speed and rhythmicity. A computer mediated test of finger and foot tapping, making use of infrared light beam technology, was recently developed, but little is known regarding its psychometric properties. The purpose of this study was to compare performance of healthy right-handed respondents on the new Light Beam Finger & Foot Tapping Device to a traditional finger tapping test used in the Halstead-Reitan Neuropsychological Battery. Performance on the Halstead-Reitan Finger Tapping Test and on the Light Beam Finger Tapping Test was compared in 16 men and 17 women. The light beam test showed similar psychometric properties to those of the Halstead-Reitan Finger Tapping Test, and scores were moderately correlated between the two tests. Respondents had faster scores on the light beam test; on both tests men were faster than women, and all respondents tapped faster with their dominant hand. Tapping was faster on the Light Beam Finger Tapping Test, possibly because it does not require application of pressure to a mechanical key and a smaller movement registers a tap. In addition to measures of right- and left-hand tapping speed, the light beam test assesses synchronous and alternating tapping and foot tapping. Scores between these subtests showed moderate to high correlations.

[99mTc]TRODAT-1 SPECT imaging correlates with odor identification in early Parkinson disease

BACKGROUND

In vivo imaging of the dopamine transporter with [99mTc]TRODAT-1 (TRODAT) and olfactory testing have both been proposed as potential biomarkers in Parkinson disease (PD).

OBJECTIVE

To evaluate the relationship between TRODAT SPECT imaging, odor identification skills, and motor function in patients with early PD.

METHODS

Twenty-four patients with a clinical diagnosis of early-stage PD (mean Hoehn & Yahr stage = 1.4) underwent TRODAT imaging, Unified PD Rating Scale (UPDRS) ratings of motor function, and administration of the University of Pennsylvania Smell Identification Test (UPSIT). Brain images were obtained using a standardized processing protocol and specific uptake ratios for striatal regions of interest were calculated. Partial correlations between the imaging indices, disease duration, UPSIT scores, and UPDRS motor scores were then calculated.

RESULTS

UPSIT scores were correlated with TRODAT uptake in the striatum as a whole (r = 0.66, p = 0.001). The putamen showed the strongest correlation with the UPSIT (r = 0.74; p < 0.001). The correlation between dopamine transporter density in the caudate and UPSIT was moderate (r = 0.36, p = 0.11), but was not significant.

CONCLUSIONS

Olfactory function is highly correlated with dopamine transporter imaging abnormalities in early Parkinson disease (PD). Further studies are warranted to determine whether changes over time in these two measures are also correlated in early PD.

Effectiveness of an attention- and memory-training program on neuropsychological deficits in schizophrenia

The effect of two cognitive remediation procedures developed for closed head injury, Attention Process Training (APT) and Prospective Memory Training (PROMT), on neuropsychological deficits in schizophrenia was investigated. Six patients with schizophrenia, varying in baseline intellectual function and symptoms, were studied; three in a remediation condition and three in a nonremediated control condition. Results were evaluated individually for each of the three treated patients. Two of three remediation-treated subjects showed marked improvement on tests of sustained and divided attention. Untreated patients showed little evidence of change in neuropsychological test performance across a similar time interval, when tested on a subset of the measures administered to remediation-treated patients. The results of this study are discussed with a view toward future studies using larger sample sizes with homogeneous subject populations.

Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis

A review and critique of the literature pertaining to the use of cognitive remediation techniques in patients with schizophrenia is presented. The review is organized into three sections, according to the neuropsychological deficit targeted for remediation: 1) executive-function, 2) attention, and 3) memory. With regards to executive-function, despite an initial report suggesting that Wisconsin Card Sorting Test performance cannot be remediated, subsequent studies suggest that performance can be improved on a variety of dependent measures including perseverative errors, categories achieved, and conceptual level responses. These observations were confirmed by a meta-analytic investigation that revealed large mean effects sizes (d+ = 0.96) for these studies. Effect sizes were homogenous across discrepant remediation strategies and dependent measures. With regards to attention, serial scanning can be improved with instruction and reinforcement, whereas there is mixed evidence suggesting that practice-based attention drills can improve performance on measures of sustained attention in schizophrenia. With regards to memory, relatively simple semantic and affective elaborate encoding strategies elevates verbal list-learning memory in patients with schizophrenia to levels consistent with controls. A similar encoding procedure, combined with vigilance training, produces substantial improvement in social cue recognition. Avenues for future research are discussed.

Computerized neurocognitive scanning: II. The profile of schizophrenia

Cognitive dysfunction in schizophrenia is well established with neuropsychological batteries, which have assessed multiple domains indicating diffuse deficits especially in processing related to frontotemporal systems. Two studies are reported examining the feasibility of the computerized neurocognitive scan to assess differential deficits in schizophrenia. In Study 1, we tested 53 patients and 71 controls with the traditional and computerized assessments counterbalanced in order. Both showed comparable generalized impairment in schizophrenia with differential deficits in executive functions and memory. The profile was replicated in Study 2 in a new sample of 68 patients and 37 controls, receiving only the computerized scan. The combined sample showed robust correlations between performance on both speed and accuracy measures of the neurocognitive scan and clinical variables, including premorbid adjustment, onset age, illness duration, quality of life, and severity of negative symptoms. These correlations were higher and more prevalent in women than men, who showed correlations predominantly for speed rather than accuracy. Neuroleptic exposure was associated with poorer performance only for speed of memory processing, and in men, this association was seen only for typical neuroleptics. We conclude that the computerized neurocognitive scan can be applied reliably in people with schizophrenia, yielding data that support its construct and criterion validity.

Computerized neurocognitive scanning: I. Methodology and validation in healthy people

Neuropsychological testing batteries are applied in neurobehavioral evaluations of brain disorders, including neuropsychiatric populations. They are lengthy, require expert administrators and professional scorers, and are prone to data handling errors. We describe a brief computerized neurocognitive "scan" that assesses similar domains with adequate reliability. The scan and a traditional battery were administered to a sample of 92 healthy individuals (44 men, 48 women) in a counterbalanced order. Both approaches showed a significant "sex-typical" gradient, with women outperforming men in verbal memory relative to spatial tasks. Both methods also yielded similar profiles of sex differences, with the additional computerized measure of face memory showing better performance in women. Age effects were evident for both methods, but the computerized scan isolated the effects to speed rather than accuracy. Therefore, the computerized scan has favorable reliability and construct validity and can be applied efficiently to study healthy variability related to age and gender.

Controlled and automatic processing during animal word list generation in schizophrenia

Controlled and automatic aspects of semantic-associative functioning in schizophrenia were investigated by evaluating performance on animal word list generation (WLG). Responses from control (n = 47) and patient (n = 38) participants were subjected to multidimensional scaling (MDS), cluster analysis (CA), and indices on the basis of number of shared attributes (SA) between consecutive responses. Patient MDS results accounted for less variance and contained more error than control data. CA results yielded fewer and less clear animal-response subgroups among patients yet demonstrated intact associations among strongly related exemplars. The SA indices revealed better clustering and more effective switching among response clusters in controls than patients. Results suggest that animal WLG in schizophrenia is compromised both by aberrant automatic semantic-associative network activation and by controlled processes such as search, access, and selection. This pattern is consistent with prominent frontotemporal pathology evident in the disorder.

Dysregulation of olfactory receptor neuron lineage in schizophrenia

BACKGROUND

Growing evidence implicates abnormal neurodevelopment in schizophrenia. While neuron birth and differentiation is largely completed by the end of gestation, the olfactory epithelium (OE) is a unique part of the central nervous system that undergoes regeneration throughout life, thus offering an opportunity to investigate cellular and molecular events of neurogenesis and development postmortem. We hypothesized that OE neurons exhibit deviant progress through neurodevelopment in schizophrenia characterized by an increase in immature neurons.

METHODS

Olfactory epithelium was removed at autopsy from 13 prospectively assessed elderly subjects who had schizophrenia and 10 nonpsychiatric control subjects. Sections were immunolabeled with antibodies that distinguish OE neurons in different stages of development, including basal cells (low-affinity nerve growth factor receptor, p75NGFR), postmitotic immature neurons (growth-associated protein 43 [GAP43]), and mature olfactory receptor neurons (olfactory marker protein). Absolute and relative densities of each cell type were determined.

RESULTS

We observed a significantly lower density of p75NGFR basal cells (37%) in schizophrenia and increases in GAP43 + postmitotic immature neurons (316%) and ratios of GAP43 + postmitotic immature neurons to p75NGFR + cells (665%) and olfactory marker protein + mature neurons to p75NGFR + basal cells (328%). Neuroleptic-free schizophrenia subjects exhibited the highest GAP43 + postmitotic immature neuron values.

CONCLUSIONS

Abnormal densities and ratios of OE neurons at different stages of development indicate dysregulation of OE neuronal lineage in schizophrenia. This could be because of intrinsic factors controlling differentiation or an inability to gain trophic support from axonal targets in the olfactory bulb. While caution is necessary in extrapolating developmental findings in mature OE to early brain development, similarities in molecular events suggest that such studies may be instructive.

Cognitive impairment and functional status in elderly institutionalized patients with schizophrenia

OBJECTIVE

The relationship of cognitive impairment to functional status in older adults with schizophrenia was investigated.

PATIENTS

Ninety-three psychiatric inpatients with schizophrenia between the ages of 65 and 88 years. Two subsets of this sample, consisting of 48 and 24 patients, were studied with a greater number of assessment instruments.

MEASURES

The Mini-Mental State Examination (MMSE) was used for brief assessment of overall cognitive functioning, and the Psychogeriatric Dependency Rating Scale (PGDRS) was administered to assess functional status. The cognitive test battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and/or an expanded neuropsychological battery, was given to a subset of the patients.

RESULTS

In the overall sample, patients with greater global cognitive impairment had higher levels of rated impairment on the individual items that comprised the Orientation and Physical, but not Behavior, subscales of the PGDRS. Furthermore, in the two subsamples, specific neuropsychological measures of problem-solving, word list learning, naming and constructional praxis were related to overall measures of outcome.

CONCLUSIONS

Neuropsychological deficit and psychosocial outcome are multi-dimensional entities that relate to one another in complex ways.

Comparison of the standard and structured interview guide for the Hamilton Depression Rating Scale in depressed geriatric inpatients

The interrater reliability of the standard Hamilton Depression Rating Scale (Ham-D) and a structured interview guide for the Ham-D (the SIGH-D) were compared in a sample of 20 elderly inpatients with major depression. Each patient was independently interviewed by four raters; two used the standard 24-item Ham-D, and the other two used a 24-item modified version of the Structured Interview Guide for the Ham-D. Systematic counterbalancing of raters and scales and a stringent evaluation schedule were used to counter position effects, spontaneous symptom change, or diurnal variation. The modified SIGH-D produced uniformly higher item- and summary-scale reliabilities than the unstructured Ham-D.

Olfactory dysfunction in schizophrenia and temporal lobe epilepsy

BACKGROUND

Schizophrenia and mesial temporal lobe epilepsy (TLE) represent two common brain disorders that share dysfunction of temporo-limbic neural substrates.

OBJECTIVE

We evaluated whether patients with schizophrenia exhibited olfactory performance more similar to right or left temporal lobe epilepsy patients.

METHODS

Odor identification ability and detection threshold sensitivity were measured in 40 patients with schizophrenia, 14 patients with right- and 18 patients with left-temporal lobe epilepsy (TLE) patients, and 25 healthy controls. Odor identification was assessed with the University of Pennsylvania Smell Identification Test (UPSIT) and odor detection threshold sensitivity with a single-staircase procedure using the stimulant phenyl ethyl alcohol (PEA).

RESULTS

Relative to controls, only patients with schizophrenia and right TLE exhibited significant impairment in UPSIT performance. Left TLE patients and controls performed comparably on the UPSIT. Detection threshold sensitivity to PEA did not differ significantly among the four groups.

CONCLUSIONS

These data suggest a greater reliance of olfactory processing on right hemisphere structures and are also consistent with recent neuroimaging studies that have implicated aberrant processing of olfactory information in right hemispheric brain regions in schizophrenia.

Olfactory-evoked regional cerebral blood flow in Alzheimer's disease

Olfaction is impaired in Alzheimer's disease (AD). It was hypothesized that AD would reduce olfactory-evoked perfusion in mesial temporal olfactory (piriform) cortex, where neuropathology begins. Seven AD patients and 8 elderly controls (ECs) underwent olfactory threshold and identification tests and olfactory stimulation during positron emission tomography. Odor identification was impaired in AD, but threshold was not. Olfactory stimulation in ECs activated right and left piriform areas and right anterior ventral temporal cortex. AD patients had less activation in right piriform and anterior ventral temporal cortex but not in the left piriform area. Although orbital cortex did not activate in ECs, there was a significant between-groups difference in this area. Right piriform activation correlated with odor identification. Impaired odor identification likely reflects sensory cortex dysfunction rather than cognitive impairment. Given olfactory bulb projections to the mesial temporal lobe, olfactory stimulation during functional imaging might detect early dysfunction in this region.

Ten-year follow-up survey of clinical neuropsychologists: part II. Private practice and economics

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.

Reduced olfactory bulb volume in patients with schizophrenia

OBJECTIVE

The authors' goal in this study was to compare the size of olfactory bulbs of patients with schizophrenia and those of healthy subjects.

METHOD

Magnetic resonance imaging scans of olfactory bulbs were obtained from 26 patients with schizophrenia and 22 healthy comparison subjects. A reliable region of interest procedure was used to measure olfactory bulb volume.

RESULTS

Patients exhibited 23% smaller bilateral bulb volume than comparison subjects, independent of acute clinical, demographic, or treatment measures. Bulb volume correlated with odor detection sensitivity in healthy subjects but not in patients with schizophrenia.

CONCLUSIONS

Patients with schizophrenia exhibit structural olfactory deficits as well as functional olfactory deficits. The olfactory system may be a model system in which to study the neurobiology of the disorder.

Ten-year follow-up survey of clinical neuropsychologists: part I. Practices and beliefs

A 21-item questionnaire previously used to survey practices and beliefs of clinical neuropsychologists (Sweet & Moberg, 1990; Sweet, Moberg, & Westergaard, 1996) was mailed in February 1999 to all ABPP Diplomates in clinical neuropsychology and a larger sample of randomly selected non-ABPP members of Division 40 (Clinical Neuropsychology) of the American Psychological Association. Results were compared with data previously collected in 1989 and 1994. Across 10 years there have been some persistent differences between neuropsychologists based on board certification status. These differences include degree of involvement in neuropsychological practice and forensic practice, involvement in research and teaching, frequency of subscribing to or regularly reading a variety of relevant journals, employment settings, use of assistants, and use of projective assessment. There are also a number of areas of shared belief and common practice. These important areas of agreement are unrelated to board certification status and are interpreted as signs of cohesiveness and maturity in the continuing evolution of the subspecialty. Shared beliefs and common practices include: appropriate field of training, type of degree, assessment philosophy, most types of information to be gathered in evaluations, and time spent per assessment. In general, the use of assistants is correlated significantly with the number of evaluations performed per month. Although sometimes viewed as exclusively providing assessment, the majority of neuropsychologists are also involved in treating patients with brain dysfunction. Survey data appear useful in characterizing and monitoring professional status and trends of clinical neuropsychology.

Olfactory dysfunction in schizophrenia: a qualitative and quantitative review

Olfactory dysfunction in patients with schizophrenia has been a topic of increasing interest, with deficits in odor identification, detection threshold sensitivity, discrimination, and memory being reported. Despite increasing knowledge, controversy has existed about possible differential deficits among olfactory tests as well as the influences of gender, smoking, and medication status on olfactory measures. To help elucidate some of this controversy, we conducted a qualitative and quantitative (meta-analytic) review of the English language literature on olfaction in schizophrenia. Moderator variables such as gender, medication status, and smoking history were also examined. Results indicated that substantial olfactory deficits, across all domains, are observed in patients with schizophrenia. No differential deficits were observed across domains of odor identification, detection threshold sensitivity, discrimination, and memory. The influences of gender, medication status, and smoking on effect sizes were not significant across studies. This supports the hypothesis of primary dysfunction in the olfactory system that is regulated by brain regions where structural and functional abnormalities have also been reported in neuroimaging studies.

MMPI-2 characteristics of adults diagnosed with attention deficit disorder

Attention Deficit Disorder (ADD) has been increasingly recognized as extending into adulthood, affecting occupational, interpersonal, and psychological functioning. The Minnesota Multiphasic Personality Inventory (MMPI) and its revision (MMPI-2) have been widely used in the assessment of patients with psychiatric disorders, but few studies have attempted to characterize the personality profiles of individuals with ADD and none have used the MMPI-2. Thirty-three patients with ADD and 33 schizophrenia patients were compared to 46 healthy control subjects on the MMPI-2 validity, clinical and Harris-Lingoes scales. With the exception of significantly lower scores for general affective distress (F), thought disorder (Sc), and paranoia (Pa), ADD subjects demonstrated remarkably similar profiles to those seen in the schizophrenia group. Significant differences between the three groups were found on a majority of the clinical scales, with ADD subjects showing similar profile elevations as schizophrenic subjects on both clinical- and sub-scales. These results were consistent with previous research using the original MMPI in adults with ADD, and confirm that examination of MMPI-2 profiles may be a useful diagnostic aid for this disorder.

Cellular and molecular neuropathology of the olfactory epithelium and central olfactory pathways in Alzheimer's disease and schizophrenia

Specific deficits in odor detection threshold, identification, and memory have been recognized in a variety of disorders including the neurodegenerative disorder, Alzheimer's disease (AD), and the psychiatric illness, schizophrenia, which is likely due to abnormalities in neurodevelopment. Neuropathological abnormalities in peripheral and central olfactory systems have been described in both disorder. In the olfactory, epithelium, dystrophic neurites that are immunoreactive for tau, neurofilaments and other polypeptides, as well as deposits of beta-amyloid have been observed, and these findings have been thought to contribute to the olfactory dysfunction of these disorders. However, similar findings also occur in the olfactory epithelium of many normal individuals and those with various other neurodegenerative diseases. In contrast, neuropathological studies have reported selective vulnerability of central olfactory pathways for the accumulation of neurofibrillary pathology in AD, and for cytoarchitectural, neuronal morphometric, and cytoskeletal protein abnormalities suggestive of abnormal neurodevelopment in schizophrenia. Thus, it is likely that the olfactory impairments associated with these diseases are due to damage within central olfactory pathways, and that they are further amplified by the less specific impairments associated with age-related sensory neuroepithelial abnormalities. Finally, both the olfactory epithelium and central olfactory pathways represent model systems in which to study the neurobiology of these disorders, which ultimately may yield clues with diagnostic and therapeutic utility.

Parallel loss of presynaptic and postsynaptic dopamine markers in normal aging

Aging of the human brain is associated with a decline in dopamine (DA) function, generally interpreted as reflecting DA cell loss. Positron emission tomography studies revealed that in healthy individuals, the age-related losses in DA transporters (presynaptic marker) were associated with losses in D2 receptors (postsynaptic marker) rather than with increases as is known to occur with DA cell loss. This association was specific for DA synaptic markers, because they were not correlated with striatal metabolism. Furthermore, the association was independent of age, suggesting that a common mechanism regulates the expression of receptors and transporters irrespective of age.

Association between decline in brain dopamine activity with age and cognitive and motor impairment in healthy individuals

OBJECTIVE

Although it is documented that brain dopamine activity declines with age, the functional significance of this is not known. This study assessed the relation between measures of brain dopamine activity and indexes of motor and cognitive function in healthy individuals.

METHOD

Thirty healthy volunteers aged 24-86 years were studied with positron emission tomography and [11C]raclopride to assess dopamine D2 receptors. All subjects underwent a neuropsychological test battery that included tasks found to be sensitive to dopamine alterations in patients with neurodegenerative disease and control tasks.

RESULTS

Transfer of [11C]raclopride from plasma to brain in the striatum and cerebellum was not affected by age. In contrast, D2 receptor availability in the caudate and putamen declined with age. Correlations between D2 receptors and neuropsychological test performance were strongest for the motor task (Finger Tapping Test) and were also significant for most tasks involving frontal brain regions, including measures of abstraction and mental flexibility (Wisconsin Card Sorting Test) and attention and response inhibition (Stroop Color-Word Test, interference score). These relationships remained significant after control for age effects.

CONCLUSIONS

Age-related decreases in brain dopamine activity are associated with a decline in motor function and may also contribute to impaired performance on tasks that involve frontal brain regions. Interventions that enhance dopamine activity may improve performance and quality of life for the elderly. The fact that correlations remained significant after age effects were partialed out suggests that dopamine activity may influence motor and cognitive performance irrespective of age.

Odor identification in Huntington's disease patients and asymptomatic gene carriers

Odor identification was assessed in 20 Huntington's disease (HD) patients, 20 normal adults with the genetic mutation that causes HD, and 20 mutation-negative adults. The University of Pennsylvania Smell Identification Test (UPSIT) revealed substantial odor identification deficits only in HD patients.

Olfaction in neurodegenerative disease: a meta-analysis of olfactory functioning in Alzheimer's and Parkinson's diseases

BACKGROUND

Olfactory deficits in Alzheimer's disease (AD) and idiopathic Parkinson's disease (PD) have been well established.

OBJECTIVE

To clarify and review the literature by evaluating the evidence for olfactory deficits in 3 olfactory domains, including odor identification, recognition, and detection threshold.

DATA SOURCES

A literature search of English-language studies of olfaction in AD, PD, and healthy controls was conducted via online databases (PsycInfo and MEDLINE) and reference lists from review articles.

STUDY SELECTION

To meet selection criteria for meta-analysis, each study required a control group and complete and usable data. This review yielded 26 publications of olfactory identification, recognition, and/or detection threshold. Because of the inclusion of more than 1 relevant study of olfaction in several of these publications (eg, both identification and threshold assessed), 43 studies were ultimately appropriate for meta-analysis.

DATA EXTRACTION

Effect sizes were calculated for each study by expressing differences between patient and control group means in SD units (Cohen's d).

DATA SYNTHESIS

Extremely large effect sizes were shown across all tasks in both AD and PD groups. Both between-group analyses using the Mann-Whitney U test and within-group analyses using Friedman 2-way analysis of variance did not reveal any significant differences (all P > .30).

CONCLUSIONS

As expected, severe deficits were found for both patients with AD and PD in each of the 3 olfactory domains relative to controls. However, no discriminating olfactory deficits were seen between patient groups or among the 3 measured olfactory domains, suggesting a similar disturbance in olfactory function between patients with AD and PD.

Category-specific naming deficit for medical terms after dominant thalamic/capsular hemorrhage

Postmortem, retrograde degeneration, and electrical stimulation studies have implicated the anterior pulvinar in language processing. We examined a patient who, after a hemorrhage affecting the dominant pulvinar and internal capsule, exhibited a circumscribed anomia for medical items and conditions. No other language disturbance was noted. Five category-specific word lists, matched for word frequency, were administered in a naming-to-definition format. Results indicated that the patient exhibited a significant category-specific naming deficit for medical items and conditions compared to matched control subjects. Although medical item lists were found to differ from nonmedical item lists in imageability and abstractness, B.C.'s category-specific deficit did not seem to be caused by word frequency, concept familiarity, imageability, or abstractness. Nor could the patient's performance be explained on the basis of deficits in broader semantic classifications (i.e., animate vs inanimate or man-made vs natural). The patient was unable to retrieve medical items even when given phonemic cues for those he could not name. Findings indicate that subtotal damage in the dominant pulvinar may create category-specific deficits.

Goal setting as a predictor of return to work in a population of chronic musculoskeletal pain patients

To assess prospectively the association between personal attributes, vocational factors, and the return to work outcome for patients with chronic, nonmalignant, musculoskeletal pain, we assessed return to work (RTW) motivation though an open-format listing of treatment goals in 59 chronic pain patients admitted to a university pain management program. Patients were then followed (average of 17.9 months) in the posttreatment period to determine whether they had in fact returned to employment. Results indicated that a number of pretreatment factors predicted future employment status in this patient population. Age, marital status, education and decreased length of unemployment were predictive of RTW outcome. Overall, RTW goal was the single best predictor of return to work outcome. In contrast, increased number of premorbid jobs, compensation status, patient's race and sex were not predictive. The present study suggests that the assessment of an individual's motivation as defined by goal-setting may be a key factor in predicting a favorable outcome in this typically refractory population of patients.

Aging and olfactory recognition memory: effect of encoding strategies and cognitive abilities

The effects of two encoding manipulations on recognition memory for odors were examined in 20 young and 20 elderly males. Subjects were instructed to use two different encoding strategies: (1) labeling-plus-definition (i.e., naming the odor and giving a short description) and, (2) life-episode association (i.e., associating a memory of a life-episode with each odor). Results revealed that elderly subjects performed significantly worse than young subjects in the labeling-plus-definition condition, but not in the life-episode task in which they achieved a level of performance not significantly different from the young. Encoding specificity or precision did not significantly impact recognition memory for the odors in either group. Analysis of response bias revealed that, in the label-plus-definition condition, young subjects were more conservative in responding style, while more liberal in their responding in the life-episode condition. In contrast, elderly subjects exhibited nearly identical response bias across both encoding conditions. The results suggest that age-related deficits in olfactory memory may be strategy dependent.

Olfactory identification deficits in schizophrenia: correlation with duration of illness

OBJECTIVE

The authors examined the relationship between deficits in olfactory identification and duration of illness in young and elderly patients with schizophrenia.

METHOD

Olfactory identification performance of 38 patients with schizophrenia and 40 normal subjects was compared by using the University of Pennsylvania Smell Identification Test.

RESULTS

The schizophrenic patients demonstrated olfactory deficits relative to the comparison group, and the elderly schizophrenic patients displayed a greater magnitude of olfactory deficit than the younger patients. Independent of normal aging effects and cognitive deficit, patients with schizophrenia showed a strong relationship between olfactory identification scores and duration of illness, which suggests that olfactory abilities decline progressively over the course of the disorder.

CONCLUSIONS

In contrast to other neuropsychological measures that have been reported to be stable over the course of illness, olfactory identification abilities deteriorate steadily in patients with schizophrenia, even for those with relatively recent onset.

Olfactory identification in elderly schizophrenia and Alzheimer's disease

In the present study we assessed olfactory identification ability using the University of Pennsylvania Smell Identification Test (UPSIT) in 16 elderly patients with schizophrenia (ES), 20 patients with a diagnosis of probable Alzheimer's disease (AD), and 20 healthy elderly controls (EC). Both patient groups exhibited marked deficits in UPSIT performance relative to controls. ES and AD patients with similar levels of general cognitive impairment did not differ on the UPSIT, suggesting that the two disorders may share a common dysfunction in olfactory brain regions. While there have been recent reports of greater olfactory impairment in males, neither patient group exhibited significant gender differences on the UPSIT.

Olfactory function in Huntington's disease patients and at-risk offspring

Odor identification ability and detection threshold sensitivity were measured in 25 probands with Huntington's disease, 12 at-risk offspring, and 37 unrelated controls. Relative to controls and at-risk offspring, HD patients exhibited significant impairment on both measures of olfactory function. By contrast, at-risk offspring did not evidence any olfactory impairment relative to controls. Thus, impaired olfactory function does not aggregate in the family members of HD patients, and does not serve as an indicator of genetic vulnerability to the disorder.

Proactive inhibition and semantic organization: relationship with verbal memory in patients with schizophrenia

Compared to other cognitive functions in schizophrenia, evidence suggests that verbal memory is particularly impaired. This study used the California Verbal Learning Test (CVLT) to examine proactive inhibition (PI) and semantic processing in verbal memory in 29 patients with schizophrenia and 29 healthy controls. Patients showed significantly less PI, but also did not organize (cluster) their recall according to semantic category. Controls and patients demonstrated small retroactive inhibition (RI) effects regardless of semantic content. Although both groups made similar types and numbers of free recall intrusion errors patients committed more phonemic and nonshared recognition errors. Results suggest that reduced semantic processing prevented build of PI, and contributes to defective memory in schizophrenia. The anatomic-physiologic abnormalities that underlie these findings may be particularly pronounced in prefrontal and temporal-parietal cortical areas.

Neuropsychiatry of 18q- syndrome

Our understanding of neuropsychiatric abnormalities in patients with deletions of the long arm of chromosome 18 (18q- syndrome) is based mainly on sporadic case reports. We characterized the neuropsychiatric phenotype in 27 patients across a wide age range (2-47 years) with breakpoints ranging from 18q22.3-18q21.2. Adaptive behavior scores (Vineland Composite) were significantly higher in females than in males (62 +/- 5 vs. 43 +/- 3). Intelligence ranged from borderline to severely deficient (IQ, 73- < 40), with academic achievement similarly impaired. Performance in specific neuropsychological functions, including attention, novel problem solving, memory, language, visuomotor integration, and fine motor dexterity, was consistently in the moderately-to-severely impaired range. Behavioral problems were common in both sexes, including aggressivity, hyperactivity, and temper tantrums. Contrary to the few previous reports, we found no evidence of psychosis in any patients. In a subset of patients selected on the basis of no prior knowledge of behavioral problems, 1 of 16 patients (6%) had autism, as defined by the Autistic Diagnostic Interview--Revised (ADI-R) [Lord et al., 1994: J Autism Dev Disord 24:659-685]. Thus, the prevalence of autism in 18q- syndrome is probably no greater than that in other developmental disabilities with a similar level of cognitive impairment. In contrast to what has been believed since 18q- was first described 30 years ago, we found no relationship between chromosome deletion size and any measure of cognition or behavior; nor were there any correlations between any of these measures with the presence or absence of abnormalities on MRI or somatosensory-evoked potentials.

Delay in diagnosis of epithelial ovarian cancer

OBJECTIVES

To investigate and analyze the process from first recognition of symptom(s) to final diagnosis at operation in patients with ovarian epithelial cancer.

METHOD

The medical records of 160 women with ovarian cancer were studied and traced back to the doctor first consulted, in order to obtain information on patient- and doctor-related delay.

RESULTS

Symptom duration was 12 weeks in patients with serous tumors and 7 weeks in patients with other histopathological classes; 56% were diagnosed within 4 weeks. Women in stages I and II were diagnosed faster than those in stages III and IV; 4% were diagnosed within 3 days because of an emergency operation; 30% were not diagnosed within 8 weeks.

CONCLUSION

Diagnosis of ovarian cancer is difficult due to the vagueness of the symptoms which mislead both patients and doctors. Methods to enable earlier diagnosis must be sought.

Glial fibrillary acidic protein-immunoreactive astrocytosis in elderly patients with schizophrenia and dementia

Clinical and neuropsychological studies of chronically institutionalized patients with schizophrenia indicate that severe cognitive impairment and functional disability in late life are very prevalent. The biological substrates for this dementia remain unknown. While subtle cytoarchitectural and morphometric abnormalities have been described in patients with schizophrenia and interpreted as reflecting aberrant neurodevelopment, postmaturational injury or neurodegeneration associated with gliosis remain as plausible explanations of at least some of the clinical manifestations of schizophrenia. We monitored astrocytosis and neurofibrillary tangle (NFT) formation in 21 elderly patients with schizophrenia (14 with concurrent dementia, 7 without), and in 12 normal and 5 Alzheimer's disease (AD) control cases. Astrocytes in ventromedial temporal, frontal, and calcarine cortices were immunohistochemically identified with monoclonal antibodies directed at glial fibrillary acidic protein (GFAP) and vimentin, and NFTs were labeled with an anti-tau antibody specific for paired helical filaments. There were no increases in GFAP- or vimentin-immunoreactive astrocyte counts, GFAP optical density, or NFT counts for the schizophrenic group as a whole compared to the non-neuropsychiatric group, while both groups differed from AD. When patients with schizophrenia were divided into demented and non-demented subtypes, those with dementia demonstrated significantly greater numbers of GFAP-positive astrocytes than those without dementia. These data may reflect an up-regulation of GFAP in normal astrocytes or the presence of reactive astrocytosis in a subgroup of schizophrenics. In the absence of any diagnostic neuropathological findings in this subgroup, the implications of these observations for the pathogenesis of schizophrenia remain to be determined.

Prospective clinicopathologic studies of schizophrenia: accrual and assessment of patients

OBJECTIVE

The purpose of this study was to characterize the neuropsychiatric profile of elderly patients with schizophrenia and establish a patient registry for prospective ante-mortem and post-mortem studies.

METHOD

Medical records of all chronically institutionalized patients in eight state hospitals who were over the age of 65 and had a chart diagnosis of schizophrenia (N = 528) were reviewed. Of the potential subjects, 192 were excluded because of clinical histories inconsistent with a diagnosis of schizophrenia, 56 because of insufficient information to establish a psychiatric diagnosis, and 122 because of family members' refusal to give consent for autopsy in the event of death. To date, 81 of the remaining 158 patients have undergone neuropsychiatric evaluation with standard assessment instruments.

RESULTS

Mini-Mental State scores of the 81 patients indicated severe dementia, and Functional Assessment Scale scores showed that patients required assistance with activities of daily living. All patients were rated as severely ill on the Brief Psychiatric Rating Scale. Ratings on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms indicated a predominance of negative symptoms over positive. Of 30 patients who have died to date, research autopsies have been conducted on 26.

CONCLUSIONS

Establishing a well characterized, prospective patient registry for clinicopathologic studies of schizophrenia is feasible but labor intensive. Diagnosis of schizophrenia with a high degree of confidence can be achieved by means of detailed chart review and assessment of current neuropsychiatric functioning with standard rating instruments. These data provide a basis for correlations of clinicopathologic factors.

Smaller neuron size in schizophrenia in hippocampal subfields that mediate cortical-hippocampal interactions

OBJECTIVE

The goal of this study was to characterize the hippocampal formation in patients with schizophrenia by measuring neuron density, neuron size, and variability of neuronal axis orientation.

METHOD

Brain tissue was obtained at autopsy from 14 prospectively accrued elderly patients with chronic schizophrenia and 10 age-compatible individuals without psychiatric disorder. Eight hippocampal regions of interest and two internal control regions (primary motor and visual cortices) were identified on Nissl-stained sections. Morphometric measurements were made without knowledge of diagnosis by means of a computer-based image analysis system.

RESULTS

The patients exhibited smaller neuron size in the hippocampal regions relative to the control regions, which was significant only for the subiculum, CA1, and layer II of the entorhinal cortex. Neuron size in the control regions was nearly identical in the two groups. No significant differences in neuron density or in variability of neuronal axis orientation were identified for any region. There was no correlation between neuron size in any area and several potentially confounding variables (age, post-mortem interval, neuroleptic exposure, sex, brain hemisphere studied, duration of illness), with the exception of a negative correlation with age in layer II of the entorhinal cortex. Regression analyses indicated that the findings could not be attributed to these age effects.

CONCLUSIONS

The subiculum, entorhinal cortex, and CA1 are the major subfields of the hippocampal region that maintain the afferent and efferent connections of the hippocampus with widespread cortical and subcortical targets. The smaller size of neurons in these subfields may reflect the presence of structural or functional impairments that disrupt these connections, which in turn could have important behavioral sequelae.

MMPI characteristics in adults diagnosed with ADD: a preliminary report

Characterization of Attention Deficit Disorder (ADD) in adults has been hampered by an absence of well-defined clinical profiles on objective personality measures. A sample of 22 ADD adults completed personality testing (MMPI) in conjunction with cognitive assessment. A sample of 30 normal controls and 20 patients diagnosed with schizophrenia, who had completed the MMPI as part of a larger research protocol, were utilized as comparison groups. Validity and clinical scales revealed multiple elevations in the ADD group which were similar in nature but not to the same degree as elevations observed in the schizophrenia group. Harris-Lingoes subscales identified the sources of clinical scale elevations indicating a pattern of specific and nonspecific symptomatology which differentiated the three groups. The results may aid in identifying ADD in adults.

Methylphenidate and nortriptyline in the treatment of poststroke depression: a retrospective comparison

The hospital charts of elderly stroke patients with major depression, as determined by DSM-III-R criteria, who were treated with either methylphenidate (n = 28) or nortriptyline (n = 30) were retrospectively reviewed. Fifty-three percent of the methylphenidate patients experienced complete remission of depressive symptoms. Similarly, 43% of the patients in the nortriptyline group showed remission of depressive symptomatology. Whereas the response rates between the two treatment groups were not significantly different in the patients who did respond to treatment (chi 2 = .608, df = 1, p = NS), the speed of response was significantly better in the methylphenidate group (t[13] = 15.9, p < .001). The average peak response time for the methylphenidate patients was 2.4 days compared to 27 days for the nortriptyline group. This finding is consistent with previous reports suggesting a rapid response to methylphenidate and other psychostimulants, typically between 24 and 72 hours. Adverse side effects, such as cardiac changes, did not differ between groups, generally falling in the mild range of severity. These data suggest that the rapid effects of methylphenidate may be especially useful to speed recovery from depression so that patients can participate more fully in rehabilitation programs.

Symptoms and diagnostic difficulties in ovarian epithelial cancer

OBJECTIVE

To investigate and analyze symptoms in patients with different types of ovarian cancer.

METHOD

Records of 160 women with ovarian cancer were studied in detail following the patients from first consultation to operation and diagnosis at Sodersjukhuset, Stockholm.

RESULT

No specific group of symptoms could be linked to type or stage of ovarian cancer. Gastrointestinal symptoms were more common in patients with class 1C tumors. Only 21% complained of gynecological symptoms. Women with class 1C cancer had significantly more advanced disease than those with 2C-5C cancer as 77% had a stage III-IV tumor compared with 40% of class 2C-5C patients.

CONCLUSION

Diagnosis of ovarian cancer is difficult due to the multitude of symptoms often appearing late in the disease. The majority of women did not experience symptoms in the genital organs. Methods to encourage early consultation should be investigated.

Mechanism of age-related differences in frequency discrimination with backward masking: Speed of processing or stimulus persistence?

In Experiment 1, frequency-discrimination thresholds were estimated in a 2-interval, forced-choice, backward masking procedure with a masker acoustically dissimilar to the targets. Young subjects were more efficient in escaping the effects of masking than were their elderly counterparts. In Experiment 2, young and elderly subjects performed the same task, with a masker acoustically similar to the targets and with a target-dissimilar masker. Under target-similar masking and at short target-masker intervals, the elderly demonstrated significant improvement, reaching the level of performance of the young, whereas under the target-dissimilar masker, the age-related differences were restored. Both age-related slowing of information processing and increase in stimulus persistence can account for the results of Experiment 1, but only increased stimulus persistence explains the results of Experiment 2.

Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia ('pseudodementia')

Twenty-six elderly (greater than 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation. CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to 'breed true'. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.

Ventricle-brain ratio, computed tomographic density, and brain area in 50 schizophrenics

A sample of 50 DSM-III-diagnosed schizophrenics (mean age, 34 years) intentionally biased to contain a relatively high proportion of persistently unemployed persons was compared with a sample of 87 normal volunteers on three computed tomographic measures. These were lateral ventricle-brain ratio, regional brain computed tomographic density values, and brain slice area. Images were made with the same computed tomographic scanner and identical scan parameters. Computed tomographic data were assessed blindly using a computer-linked image array processor and electronic planimeter. Ventricle-brain ratios were significantly higher in schizophrenics, with 28% of the patient sample exceeding 2 SDs of the control mean. Brain area measures were not associated with an enlarged ventricle-brain ratio. Contrary to our prediction, ventricular enlargement was unassociated with most negative symptom ratings, but was correlated with the absence of positive symptoms. A history of abnormal delivery and the presence of left-handedness were significant predictors of an enlarged ventricle-brain ratio on multiple regression analysis. Schizophrenics had a significantly smaller brain slice area compared with normal controls, a finding not attributable to height differences between groups. Brain slice area was inversely correlated with computed tomographic brain density across all subjects. After correction of computed tomographic density values for area using a linear regression model, no significant regional density differences were detectable between normal controls and schizophrenics. Within normal controls there was a significant relationship between social class and brain slice area, but not ventricle-brain ratio.

Auditory memory and age-related differences in two-tone frequency discrimination: trace decay and interference

We investigated age-related differences in the time course of two-tone frequency discrimination. Healthy young and elderly adults with normal hearing acuity in the 500-2000 Hz range performed a two-alternative forced choice frequency discrimination task. The stimuli were short tones separated by either a 250-ms (short), 850-ms (medium), or 3000-ms (long) silent inter-interstimulus interval (ISI). Frequency discrimination thresholds were estimated using an adaptive staircase procedure. Although young listeners performed better than the elderly at all ISIs, the latter showed a dramatic elevation of discrimination thresholds at 250 ms, while the thresholds of the young subjects increased significantly at 3000 ms. These results suggest that the elderly may be especially vulnerable to the effects of masking produced by the second tone at the short interval, whereas the young listeners tend to be differentially affected by the trace decay at long ISI. The results are discussed in the framework of stimulus persistence hypothesis.

Use of cefuroxime in preventing postcesarean infection in high-risk patients

Prophylactic antibiotic therapy is accepted for prevention of postceasarean infection in certain risk groups. Of the antibiotic regimens presented none appears superior. Patients having a cesarean section (CS) more than 6 h after membrane rupture were given three doses of cefuroxime (1.5 g every 8th hour) in a prospective study. This prophylaxis was as efficacious as a 7-day treatment with cefuroxime and cefadroxil. The infection rate was 21% which should be compared to approximately 50% when no prophylaxis was given. Patients with membrane rupture of less than 6 h and having a most urgent CS received the same 24-hour prophylaxis. No postoperative infection was recorded. Women having a CS with an ongoing uterine infection were treated with cefuroxime alone or combined with metronidazole. All but one (91%) had an uneventful recovery.

Olfactory recognition: differential impairments in early and late Huntington's and Alzheimer's diseases

Forty-two patients with senile dementia of the Alzheimer type (SDAT), 38 patients with Huntington's disease (HD) and matched normal controls were administered tests of olfactory, verbal, and visual recognition after being screened for normal olfactory discrimination. Early-affected Huntington's patients (EHD) with minimal chorea or cognitive deficit displayed marked deficits in olfactory recognition despite normal verbal and visual performance, even after correction for task difficulty, suggesting involvement of olfactory brain regions early in the disease process. In the early Alzheimer's group (EAD), marked deficits were seen on all recognition modalities indicating more global impairment. Both overall (early plus late) patient groups were impaired relative to controls on all recognition tasks, with the olfactory paradigm being most affected.

Prevention of postoperative infection in cesarean section after rupture of the membranes

Patients having a cesarean section more than 6 h after rupture of the membranes constitute a high risk group for postoperative infections. Two such groups were studied. Patients were given either cefuroxime 1.5 g every 8th hour for 24 h followed by cefadroxil 0.5 g twice daily for 6 days or received no medication. The infection rate was significantly reduced in the treatment group as compared to the control group (15% vs. 48%). Non-infected patients had a significantly shorter stay in hospital (8 days vs. 12 days). Combined use of these drugs for prevention of post-cesarean infection has not previously been reported. No side effects of the antibiotic prophylaxis were reported.

Adenocarcinoma of the uterine cervix

Between 1958 and 1969, 251 patients were treated at Radiumhemmet in Stockholm for adenocarcinoma of the uterine cervix. The histologic specimens were reevaluated. In the 211 cases of pure adenocarcinoma, the 5-year survival rate was compared with that in the total of cervical epithelial malignancies. The rate was lower in the adenocarcinoma cases, with respective crude 5-year survival rates of 84%, 50%, and 9% in Stages I, II, and III. Two modes of treatment, irradiation alone or irradiation plus radical surgery, were used in Stages IB and IIA. The combined treatment gave significantly improved 5-year survival rates.

Anaerobic bacteria in urine before and after prostatic massage of infertile men

In the present study 25 infertile men delivered urine before and after prostatic massage. Expressed prostatic secretion (EPS) was obtained from 11 men. Aerobic and anaerobic bacterial analyses showed that a total of 33 isolates was found in samples of urine voided before massage as compared to 59 isolates after massage of the prostate. There was an increase in the number of anaerobes whereas there was no change in the number of aerobes. The occurrence of EPS did not influence the number of aerobic and anaerobic isolates in urine voided after massage of the prostate. The most often isolated anaerobes in urine voided after prostatic massage were Eubacterium lentum, Peptococcus asaccharolyticus and Bacteroides species and the most common anaerobe in EPS was Peptostreptococcus micros.

Symptomatic, familial, perinatal, and social correlates of computerized axial tomography (CAT) changes in schizophrenics and bipolars

Computerized axial tomography (CAT) scans were blindly examined, and lateral ventricular-to-brain ratios calculated in 19 schizophrenic and 27 bipolar patients, and in an equal number of individually matched normal controls. Family history, early development, past psychiatric history, and current functioning and symptomatology were analyzed for all patients. Lateral ventricular enlargement on CAT was found in a significant proportion of both patient groups. Patients with such enlargement tended to have greater numbers of negative symptoms and poorer premorbid adjustment, but did not differ regarding family history of psychiatric illness. A subgroup of schizophrenics with presumed early brain damage was identified. This group had more marked ventricular enlargement, a greater number of negative symptoms, and an earlier onset of illness.

Analysis of prostatic acid phosphatase in urine voided before and after massage of the prostate in infertile men

Prostatic acid phosphatase (PAP) - a specific marker of prostatic secretion - has been analyzed by radioimmunoassay in samples of urine voided before and after massage of the prostate. In all patients there was an increase in urine PAP concentration after massage irrespective of the occurrence of expressed prostatic secretion. The mean PAP values increased from 4.9 to 45.8 micrograms/l. No significant change in urine creatinine concentration was observed. No lactoferrin was detected in the urine which should indicate that no secretion from the seminal vesicles was expressed into the urethra during massage of the prostate. Analysis of PAP in urine after massage of the prostate could increase the value of a urine sediment and microbial analysis in the investigation of male infertility.