ABSTRACT
The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized neuropsychological assessment battery that has demonstrated utility in a variety of clinical populations including multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, acquired brain injury, migraine headaches, and Alzheimer's disease. This study utilized selected tests from the ANAM General Neuropsychological Screening Battery (ANAM GNS), a newly defined subset of tests from the broader ANAM library designed for general clinical assessment of cognition. ANAM GNS is an expansion of the ANAM Core battery which has been utilized in a military setting. The efficacy of the ANAM GNS was explored in a mixed clinical sample relative to well-established, traditional neuropsychological measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). It was hypothesized that scores from the ANAM GNS would accurately predict participants as either impaired (n = 30) or normal (n = 113). Participants were grouped a priori based on RBANS Total Index scores with impairment defined as scores ≤ 15th percentile. Logistic regression analysis was conducted to evaluate the classification accuracy of the ANAM GNS. The predictor variables were the Throughput scores from seven selected ANAM GNS subtests. The full model significantly predicted impairment status, sensitivity was 81% and specificity was 89.1%. Overall classification rate was 87.9% and the Odds Ratio for the overall model was 34.65. Positive predictive value was 56.7% and negative predictive value was 96.4%. This study represents the first clinical data on the ANAM GNS, and documents that it has good concurrent and predictive validity with a well-established neuropsychological measure.
Subject(s)
Cognition Disorders/diagnosis , Neuropsychological Tests , Adolescent , Adult , Aged , Aged, 80 and over , Cognition Disorders/etiology , Cognition Disorders/psychology , Female , Humans , Male , Mental Disorders/complications , Middle Aged , Nervous System Diseases , Odds Ratio , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
CONTEXT: Polycystic ovary syndrome (PCOS) presents in adolescence, and obesity is a common finding. The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear. OBJECTIVE: We investigated the effects of metformin, oral contraceptives (OCs), and/or lifestyle modification in obese adolescent women with PCOS. DESIGN: Two small, randomized, placebo-controlled clinical trials were performed. PATIENTS AND PARTICIPANTS: A total of 79 obese adolescent women with PCOS participated. INTERVENTIONS: In the single treatment trial, subjects were randomized to metformin, placebo, a lifestyle modification program, or OC. In the combined treatment trial, all subjects received lifestyle modification and OC and were randomized to metformin or placebo. MAIN OUTCOME MEASURES: Serum concentrations of androgens and lipids were measured. RESULTS: Lifestyle modification alone resulted in a 59% reduction in free androgen index with a 122% increase in SHBG. OC resulted in a significant decrease in total testosterone (44%) and free androgen index (86%) but also resulted in an increase in C-reactive protein (39.7%) and cholesterol (14%). The combination of lifestyle modification, OC, and metformin resulted in a 55% decrease in total testosterone, as compared to 33% with combined treatment and placebo, a 4% reduction in waist circumference, and a significant increase in HDL (46%). CONCLUSIONS: In these preliminary trials, both lifestyle modification and OCs significantly reduce androgens and increase SHBG in obese adolescents with PCOS. Metformin, in combination with lifestyle modification and OC, reduces central adiposity, reduces total testosterone, and increases HDL, but does not enhance overall weight reduction.
