Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease

BACKGROUND

Long term effects of subthalamic nucleus (STN) stimulation on cognition, mood, and behaviour are unknown.

OBJECTIVE

This study evaluated the cognitive, mood, and behavioural effects of bilateral subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson's disease (PD) followed up for three years.

METHODS

A consecutive series of 77 PD patients was assessed before, one, and three years after surgery. Mean (SD) age at surgery was 55 (8). Seven patients died or were lost for follow up. Neuropsychological assessment included a global cognitive scale, memory, and frontal tests. Depression was evaluated using the Beck depression inventory. Assessment of thought disorders and apathy was based on the unified Parkinson's disease rating scale. Reports of the behavioural changes are mainly based on interviews done by the same neuropsychologist at each follow up.

RESULTS

Only two cognitive variables worsened (category fluency, total score of fluency). Age was a predictor of decline in executive functions. Depression improved whereas apathy and thought disorders worsened. Major behavioural changes were two transient aggressive impulsive episodes, one suicide, four suicide attempts, one permanent apathy, one transient severe depression, four psychoses (one permanent), and five hypomania (one permanent).

CONCLUSIONS

Comparing baseline, one year, and three year postoperative assessments, STN stimulation did not lead to global cognitive deterioration. Apathy scores mildly increased. Depression scores mildly improved. Behavioural changes were comparatively rare and mostly transient. Single case reports show the major synergistic effects of both medication and stimulation on mood and behaviour, illustrating the importance of a correct postoperative management.

Beryllium Exposure Control Program at the Cardiff Atomic Weapons Establishment in the United Kingdom

The Cardiff Atomic Weapons Establishment (AWE) plant, located in Cardiff, Wales, United Kingdom, used metallic beryllium in their beryllium facility during the years of operation 1961-1997. The beryllium production processes included melting and casting, powder production, pressing, machining, and heat and surface treatments. As part of Cardiff's industrial hygiene program, extensive area measurements and personal lapel measurements of airborne beryllium concentrations were collected for Cardiff workers over the 36-year period of operation. In addition to extensive air monitoring, the beryllium control program also utilized surface contamination controls, building design, engineering controls, worker controls, material controls, and medical surveillance. The electronic database includes 367,757 area sampling records at 101 locations and 217,681 personal lapel sampling records collected from 194 employees over the period 1981-1997. Similar workplace samples were collected from 1961 to 1980, but they were not analyzed because they were not available electronically. Annual personal mean sampling concentrations for all workers ranged from 0.11 to 0.72 micrograms per cubic meter (microg/m3) with 95th percentiles ranging from 0.22 to 1.89 microg/m3; foundry workers worked in the highest concentration areas with a mean of 0.87 microg/m3 and a 95th percentile of 2.9 microg/m3. Area sampling concentrations, as expected, were lower than personal sampling concentrations. Mean annual area sample concentrations for all locations ranged from 0.02 to 0.32 microg/m3. The area sample 95th percentile concentrations for all years were below 0.5 microg/m3. For the overwhelming majority of samples, airborne beryllium concentrations were below the 2.0 microg/m3 standard. Although blood lymphocyte testing for beryllium sensitization has not been routinely conducted among these workers, this metal beryllium processing facility is the only large scale beryllium facility of its kind to have experienced only one unique a case of clinical chronic beryllium disease (CBD) ascertained by traditional medical monitoring procedures. The treating physician determined that this lung disease was likely caused by a systems reaction resulting from a mound contaminated with beryllium. However, he could not rule out the potential for inhalation exposure. Over the 17 years of measurement data analyzed, on occasion, airborne beryllium concentrations have exceeded 2.0 microg/m3; however, the Cardiff experience demonstrates that strict and consistent adherence to exposure control measures that emphasized airborne and surface levels and appropriate engineering controls, work practices, and use of personal protective equipment appears to have successfully prevented the incidence of clinical CBD with the exception of one unique case.

Universal maternal screening for neonatal group B streptococcal disease

Group B streptococcal infection is a leading cause of neonatal morbidity and mortality in the developed world. Data obtained in our region suggest that the incidence in the UK may be higher than previously reported, and together with the results of a pilot study indicate that preventive strategies based on maternal risk factors alone would prevent less than half the cases of neonatal disease.

Developing a generic health status measure for use in a computer-based outcomes infrastructure

This descriptive, correlational study was designed to determine the sensitivity of a generic health status instrument to patient population and to time. The study sample included adult patients undergoing total joint replacement (TJR), adult patients in acute congestive heart failure (CHF), and pediatric patients receiving chemotherapy (PediOnc). A 2 x 3 (population x time) ANOVA for TJR and CHF demonstrated a significant main effect of time (F = 8.0, p = .0006) and a significant interaction effect between time and population (F = 14.4, p < .0001) for functional status. In the PediOnc subsample (HSOD child version), the highest scores for all HSOD factors with the exception of functional status were at Time 3. There was also a significant main effect of time on health care involvement, on the caregiver factor, and the family factor. These results support the sensitivity of the HSOD to patient population and to time.

Health of the foreign-born population: United States, 1989-90

The health status of immigrants is of vital interest to health policy planners as the number of immigrants in the United States increases. This report has shown that, overall, foreign-born persons had better health than the U.S.-born population, although this health advantage varied by length of residence in the United States. In virtually every measure of health status, and with regard to almost every sociodemographic characteristic, the most recent immigrants were healthier than foreign-born persons who have lived in the United States 10 years or more as well as healthier than the U.S.-born population. Immigrants who had lived in the United States 10 years or longer were generally healthier than U.S.-born adults, although the differences were not as striking as between recent immigrants and the native-born population. These findings may be explained in several ways. First, recent cohorts of immigrants may have been healthier than earlier cohorts of immigrants at the time of immigration. If so, as their duration of residence in the United States increases, they will continue to be significantly healthier than native-born persons. Second, earlier cohorts of immigrants may have been as healthy as recent cohorts at the time of immigration, but their health has deteriorated with increased duration of residence in the United States. This suggests that immigrants had or acquired physical conditions or behaviors that put them at risk in their new environment or that access to health care has been limited. It also suggests that more recent cohorts of immigrants could experience a similar deterioration of health as their duration of residence in the United States increases. Finally, these findings may reflect a combination of these influences or other factors not considered. To understand these patterns will require additional research, including comparative studies of the health of immigrants in the United States with the health of nonmigrants (stayers) in the countries of immigrant origin.

Effect of birthplace on infants with low birth weight

From December 1983 to June 1985, 162 infants of less than 32 weeks' gestation or weighing less than 1,500 g, or both, were cared for at the regional neonatal intensive care unit in Leeds. Of the 162, 64 (40%) were born in the unit because their mothers had received antenatal care there, 58 (36%) were born in another hospital and subsequently transferred, and 40 (25%) were transferred in utero because of potential complications. The overall mortalities for each group were 14%, 38%, and 18% respectively. These differences were significant, but when they were corrected for gestation, birth weight, and mode of delivery there was no difference in either the mortality or the incidence of intraventricular haemorrhage in the three study populations. Although there seem to be no distinct advantages of in utero transfer in terms of mortality and morbidity, there are other psychological and emotional advantages.