Eryngium foetidum L. (Apiaceae): A Literature Review of Traditional Uses, Chemical Composition, and Pharmacological Activities.

Eryngiumfoetidum L. is popularly known as chicória-do-Pará, is native to the Amazon region, and is widely distributed in Northern Brazil. It is considered a versatile species due to its diversified uses in ethnomedicine, gastronomy, and pharmaceutical industry. The objective of this study was to review the literature on the traditional uses, chemical composition, and pharmacological activities of E. foetidum based on information published in national and international scientific articles between the years 2011 and 2021. Literature searches were performed with the combination of the expressions "Eryngium foetidum L.," "chicória-do-Pará," "traditional uses," "ethnobotany," "volatile compounds," and "essential oil." The species is widely used as a flavoring condiment in beans, meat, duck, and fish, and in the preparation of tucupi (cassava sap), showing to have great importance for the Amazonian food culture. In traditional medicine, it has analgesic, antibacterial, antiflu, and antipyretic applications. The chemical profile is characterized by the presence of aromatic and aliphatic aldehydes, mainly (2E)-2-dodecenal in leaves and 2,3,4-trimethylbenzaldehyde in roots, in addition to fixed compounds such as carotenoids, flavonoids, and phenols. These compounds have shown diverse biological activities and potential antibacterial, anthelmintic, and antioxidant applications, confirming their potential for use in folk medicine. Therefore, it is inferred that this aromatic plant has vast potential uses and is an important alternative as a natural resource for the food and pharmaceutical industries in view of its antioxidant capacity and bioactive compounds.

[Epidemiological, clinical, evolutionary and risk factors of erysipelas in three hospitals in Nouakchott-Mauritania]. / Aspects epidemiologiques, cliniques, evolutifs et facteurs de risque de l'erysipele dans trois hopitaux de Nouakchott-Mauritanie.

INTRODUCTION: Erysipelas is an acute non-necrotizing dermohypoderma of bacterial origin, mainly due to streptococcus. Its elective topography is the leg, it is a frequent reason for consultation and hospitalization in medicine. This is a potentially serious medical emergency that can be life threatening. Our study aims to determine the epidemiological and clinical characteristics, as well as the risk and prognosis factors of erysipelas in Mauritania. PATIENTS AND METHODS: This was a cross-sectional descriptive observational study from January 01, 2016 to July 30, 2017. The study population was represented by patients seen for an acute inflammatory placard, hot, painful and feverish. RESULTS: In the 61 patients, the mean age was 40 years with extremes of 1 and 73 years. A female predominance was observed. The locations were one-sided. In 93.4% of cases, erysipelas was found in the lower limbs. Satellite lymphadenopathy was present in 40 patients, ie 66% of cases. A fever greater than or equal to 38 ° C was observed in 87% of cases, it was associated with chills 10% of cases. Local risk factors are represented by a traumatic wound, acute eczema and intertrigo inter toe. General factors are obesity, taking nonsteroidal anti-inflammatory drugs and artificial depigmentation. The outcome of our patients is favorable in 95% of cases on antibiotics. 9 patients presented with abscess during the course, ie 15%. CONCLUSION: In our study, erysipelas was observed mainly in a young housewife in her forties. Clinically, the preferred location was that of the leg found in 93.4%. Several risk factors are associated with erysipelas in our study.

INTRODUCTION: L'érysipèle est une dermohypodermite aiguë non nécrosante d'origine bactérienne, essentiellement due au streptocoque.Sa topographie élective est la jambe, il constitue un motif fréquent de consultation et d'hospitalisation en médecine. Il s'agit d'une urgence médicale, potentiellement grave pouvant engager le pronostic fonctionnel et vital. Notre étude a pour objectif de déterminer les caractéristiques épidémiologiques, cliniques, ainsi que les facteurs de risque et pronostic de l'érysipèle en Mauritanie. PATIENTS ET MÉTHODES: Il s'agissait d'une étude observationnelle descriptive transversale du 01 Janvier 2016 jusqu'au 30 Juillet 2017. La population d'étude était représentée par les patients consultant pour un placard inflammatoire aigu, chaud, douloureux et fébrile. RÉSULTATS: Chez les 61 patients recrutés, l'âge moyen était de40 ans avec des extrêmes de 1 et 73 ans. Une prédominance féminine était observée. Les localisations étaient unilatérales. Dans 93,4% des cas, l'érysipèle siégeait aux membres inférieurs. Une adénopathie satellite était présente chez 40 patients soit 66% des cas. Une fièvre supérieure ou égale à 38°c était observée dans 87% des cas, elle était associée à des frissons 10% des cas. Les facteurs de risque locaux sont représentés par une plaie traumatique, un eczéma aigu et un intertrigo inter orteil. Les facteurs généraux sont l'obésité, la prise d'anti-inflammatoires non stéroïdiens et la dépigmentation artificielle. L'évolution de nos patients est favorable dans 95% des cas sous antibiotiques. 9 patients présentaient une abcédation au cours de l'évolution soit 15%. CONCLUSION: Dans notre étude, l'érysipèle est observé surtout chez une jeune femme au foyer de la quarantaine. Sur le plan clinque, la localisation préférentielle était celle de la jambe retrouvée dans 93,4%. Plusieurs facteurs de risque sont associés à l'érysipèle dans notre étude.

[Skin Leishmaniosis : Epidemiological And Clinical-Biological Study In Two Public Hospitals In Nouakchott]. / Leishmaniose Cutanee : Etude Epidemiologique Et Clinico-Biologique Dans Deux Hopitaux Publics De Nouakchott.

Many cases of cutaneous leishmaniasis are observed during hospital consultations in Nouakchott. The objective of our study is to collect all cases of cutaneous leishmaniasis in Nouakchott and to study its epidemiological and clinico-biological characteristics. METHOD: This is a prospective multicenter descriptive study conducted in two specialized hospital departments in Nouakchott from September 1st, 2016 to the end of October 2017. All patients with suspicious lesions of cutaneous leishmaniasis during this period were selected. Parasitological skin sampling, PCR and histology have been performed to patients. RESULTS: Twenty one out of 9000 patients were diagnosed during the study period, with an average age of 23 years (ranging from 3 to 70 years). A male predominance was noted with a sex ratio of 2/1. The most frequent locations are the discovered parts of the body (the 4 members). The ulcero-crusty form is encountered in 2/3 of the cases. L. major is more frequently identified (61.9%) followed by L infantum in 23.8% of cases. Meglume Antimoniate was administered intralesionally in 57.1% of patients. In Nouakchott, cutaneous leishmaniasis is not uncommon. The cases observed are related to an origin or a stay in the southern regions.

De nombreux cas de leishmaniose cutanée sont observés lors des consultations hospitalières à Nouakchott. L'objectif de notre étude est de recueillir tous les cas de leishmanioses cutanées à Nouakchott et d'en étudier les caractéristiques épidémiologiques et clinico-biologiques. MÉTHODE: Il s'agit d'une étude multicentrique descriptive prospective réalisée dans 2 services hospitaliers spécialisés de Nouakchott du 1er septembre 2016 à la fin du mois d'octobre 2017. Tous les patients présentant des lésions suspectes de leishmaniose cutanée durant cette période ont été retenus. Un prélèvement cutané à visée parasitologique, une PCR et une histologie ont été effectués aux patients. RÉSULTATS: Vingt et un patients sur 9000 consultants ont été diagnostiqués durant la période d'étude, avec un âge moyen de 23 ans (variant de 3 à 70 ans). Une prédominance masculine a été notée avec un sexe ratio de 2/1. Les localisations les plus fréquentes sont les parties découvertes du corps (les 4 membres). La forme ulcéro-crouteuse est rencontrée dans 2/3 des cas. L. major est plus fréquemment identifiée (61,9 %) suivi de L infantum dans 23,8% des cas. L'Antimoniate de Meglume a été administré par voie intralésionnelle chez 57,1% des patients. A Nouakchott, la Leishmaniose cutanée n'est pas rare. Les cas observés sont liés à une origine ou un séjour dans les régions du Sud.

Leishmaniose cutanée : étude épidémiologique et clinico-biologique dans deux hôpitaux publics de Nouakchott

De nombreux cas de leishmaniose cutanée sont observés lors des consultations hospitalières à Nouakchott. L'objectif de notre étude est de recueillir tous les cas de leishmanioses cutanées à Nouakchott et d'en étudier les caractéristiques épidémiologiques et clinico-biologiques. Méthode : Il s'agit d'une étude multicentrique descriptive prospective réalisée dans 2 services hospitaliers spécialisés de Nouakchott du 1er septembre 2016 à la fin du mois d'octobre 2017. Tous les patients présentant des lésions suspectes de leishmaniose cutanée durant cette période ont été retenus. Un prélèvement cutané à visée parasitologique, une PCR et une histologie ont été effectués aux patients. Résultats : Vingt et un patients sur 9000 consultants ont été diagnostiqués durant la période d'étude, avec un âge moyen de 23 ans (variant de 3 à 70 ans). Une prédominance masculine a été notée avec un sexe ratio de 2/1. Les localisations les plus fréquentes sont les parties découvertes du corps (les 4 membres). La forme ulcéro-crouteuse est rencontrée dans 2/3 des cas. L. major est plus fréquemment identifiée (61,9 %) suivi de L infantum dans 23,8% des cas. L'Antimoniate de Meglume a été administré par voie intralésionnelle chez 57,1% des patients. A Nouakchott, la Leishmaniose cutanée n'est pas rare. Les cas observés sont liés à une origine ou un séjour dans les régions du Sud

Fasting plasma glucose in young adults free of diabetes is associated with cognitive function in midlife.

Background: Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults free of diabetes is scarce and based on middle-aged and older adults. We examined the association of FPG, measured at age 30, and of change in FPG from age 30 to 43, with cognitive function at age 50. Methods: 505 nondiabetic participants of the population-based Jerusalem Lipid Research Clinic (LRC) cohort study had baseline FPG, 2-h post-oral challenge plasma glucose (OGTT) and insulin determined at ages 28-32, and FPG and OGTT again at ages 41-46. Subsequently at ages 48-52, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery, using multiple linear regression and multivariable logistic models. Results: Hyperglycemia (FPG ≥ 5.6 mmol/l vs. <5.6 mmol/l) at baseline was associated with poorer global cognitive function in midlife (predominantly in the visual spatial and attention domains), independent of socio-demographic characteristics, life style variables, body mass index (BMI), and inflammatory and biochemical variables (standardized Beta = -0.121, P = 0.002, plinear trend(FPG continuous) =0.016). Similarly, increased odds for low-ranked (lowest fifth) global cognition was evident (ORper mmol/l FPG=2.31, 95% CI = 1.30-4.13, P = 0.005). Baseline OGTT, insulin resistance (HOMA-IR) and change in FPG and OGTT over 13 years were not associated with cognition. Conclusion: A higher FPG in young adults was associated with lower cognitive performance in midlife. Although we cannot dismiss the possibility of reverse causation, hyperglycemia at a young age may be a modifiable risk factor for low-ranked cognitive function in midlife.

Body Mass Index, Height and Socioeconomic Position in Adolescence, Their Trajectories into Adulthood, and Cognitive Function in Midlife.

BACKGROUND: Whether life course anthropometric indices relate to cognitive function in midlife remains insufficiently explored. Rarely was socioeconomic position (SEP) adequately accounted for. OBJECTIVE: To examine the association of the cumulative life course burden of high-ranked body mass index (BMI), its trajectory, and stature with cognitive function in midlife. METHODS: Weight and height were measured from age 17 across a 33-year follow-up. 507 individuals completed a NeuroTrax computerized cognitive assessment at ages 48-52. Life course SEP was assessed by multiple methods. Using mixed models we calculated the area under the curve (AUC), representing both the life-course burden of BMI (total AUC) and trends in BMI (incremental AUC) from age 17 to midlife. The associations of BMI and height with global cognition and its five component domains were assessed by multiple regression. RESULTS: Higher BMI in late adolescence and total AUC over the life course were associated with poorer global cognition (Standardized beta (Beta) = -0.111, p = 0.005 and Beta = -0.105, p = 0.018, respectively), adjusted for childhood and adulthood SEP, and demographic characteristics. The associations with higher adolescent and midlife BMI were both restricted to those with low childhood SEP (p < 0.05 for interaction). Short adolescent stature was related to poorer cognition (Beta = 0.115, p = 0.040), whereas late final growth in women was associated with better cognition (Beta = 0.213, p = 0.007). CONCLUSION: An adverse association of higher BMI with cognitive function began in adolescence and was restricted to low childhood SEP. Taller stature in both sexes and late growth in women were associated with better midlife cognitive performance.

Measurement of the Reactor Antineutrino Flux and Spectrum at Daya Bay.

This Letter reports a measurement of the flux and energy spectrum of electron antineutrinos from six 2.9 GWth nuclear reactors with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls in the Daya Bay experiment. Using 217 days of data, 296 721 and 41 589 inverse ß decay (IBD) candidates were detected in the near and far halls, respectively. The measured IBD yield is (1.55±0.04) ×10(-18) cm(2) GW(-1) day(-1) or (5.92±0.14) ×10(-43) cm(2) fission(-1). This flux measurement is consistent with previous short-baseline reactor antineutrino experiments and is 0.946±0.022 (0.991±0.023) relative to the flux predicted with the Huber-Mueller (ILL-Vogel) fissile antineutrino model. The measured IBD positron energy spectrum deviates from both spectral predictions by more than 2σ over the full energy range with a local significance of up to ∼4σ between 4-6 MeV. A reactor antineutrino spectrum of IBD reactions is extracted from the measured positron energy spectrum for model-independent predictions.

New measurement of antineutrino oscillation with the full detector configuration at Daya Bay.

We report a new measurement of electron antineutrino disappearance using the fully constructed Daya Bay Reactor Neutrino Experiment. The final two of eight antineutrino detectors were installed in the summer of 2012. Including the 404 days of data collected from October 2012 to November 2013 resulted in a total exposure of 6.9×10^{5} GW_{th} ton days, a 3.6 times increase over our previous results. Improvements in energy calibration limited variations between detectors to 0.2%. Removal of six ^{241}Am-^{13}C radioactive calibration sources reduced the background by a factor of 2 for the detectors in the experimental hall furthest from the reactors. Direct prediction of the antineutrino signal in the far detectors based on the measurements in the near detectors explicitly minimized the dependence of the measurement on models of reactor antineutrino emission. The uncertainties in our estimates of sin^{2}2θ_{13} and |Δm_{ee}^{2}| were halved as a result of these improvements. An analysis of the relative antineutrino rates and energy spectra between detectors gave sin^{2}2θ_{13}=0.084±0.005 and |Δm_{ee}^{2}|=(2.42±0.11)×10^{-3} eV^{2} in the three-neutrino framework.

Increase in the Inflammatory Marker GlycA over 13 Years in Young Adults Is Associated with Poorer Cognitive Function in Midlife.

BACKGROUND: Inflammatory markers are elevated in patients with dementia. Evidence for an association between inflammation and cognitive function in dementia-free individuals is sparse, inconsistent, and predominantly restricted to the elderly. Assessment of inflammatory markers in young adults as predictors of cognitive function in midlife, well before the onset of overt dementia, is lacking. Furthermore, rarely has the relation with longitudinal change in inflammatory markers been examined. OBJECTIVE: To examine the association of the inflammatory markers C-reactive protein (CRP), fibrinogen, white blood cell count (WBC) and GlycA, a novel NMR-determined biomarker of systemic inflammation, measured in young adulthood and of GlycA change over 13 years follow-up with cognitive function in midlife. METHODS: 507 participants of the Jerusalem Lipid Research Clinic (LRC) study were assessed at 3 time points over 18-22 years. First, the inflammatory variables GlycA, CRP, fibrinogen, and WBC were measured in blood samples drawn at ages 28-32. Then, in blood samples drawn a mean 13 years later (range, 12-16 years) at ages 41-46, GlycA was again measured (in 484 individuals). Subsequently at ages 48-52, on average 7 years later, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery. Multiple regression and multivariable logistic models were applied. RESULTS: Inverse unadjusted associations were shown for baseline levels and longitudinal change in inflammatory markers and measures of cognition. Multiple regression models were adjusted for age at cognitive assessment, sex, socio-demographic characteristics, baseline measures of leisure-time vigorous activity, smoking status and body mass index (BMI) at ages 28-32, change in smoking status and BMI between ages 28-32 and 41-46, and depression assessed at the time of cognitive testing. The highest quintile of GlycA change, but not the baseline inflammation measures, was inversely related to global cognition (standardized ß = -.109, p = .011) as well as to the information processing speed and memory domains (standardized ß = -.124, p = .008 and-.117, p = .014, respectively). The multivariable-adjusted odds ratio for low ranked global cognitive function (lowest fifth) comparing the extreme quintiles of GlycA change was 4.8 (95%CI, 1.7-13.5, p = .003; p for trend = .031). CONCLUSIONS: In this longitudinal study of a novel systemic inflammatory marker in a population-based cohort of young adults, GlycA increase over 13 years, but not baseline measures of inflammation, was associated with poorer cognitive function in midlife.

Search for a light sterile neutrino at Daya Bay.

A search for light sterile neutrino mixing was performed with the first 217 days of data from the Daya Bay Reactor Antineutrino Experiment. The experiment's unique configuration of multiple baselines from six 2.9 GW(th) nuclear reactors to six antineutrino detectors deployed in two near (effective baselines 512 m and 561 m) and one far (1579 m) underground experimental halls makes it possible to test for oscillations to a fourth (sterile) neutrino in the 10(-3) eV(2)<|Δm(41)(2) |< 0.3 eV(2) range. The relative spectral distortion due to the disappearance of electron antineutrinos was found to be consistent with that of the three-flavor oscillation model. The derived limits on sin(2) 2θ(14) cover the 10(-3) eV(2) ≲ |Δm(41)(2)| ≲ 0.1 eV(2) region, which was largely unexplored.

Adverse medical complications: an under-reported contributory cause of death in New York City.

OBJECTIVES: The current death certification system in the USA fails to accurately track deaths due to adverse medical events. The aim of this study was to demonstrate the under-reporting of deaths due to adverse medical events due to limitations in the current death certification/reporting system, and the benefits of using the term 'therapeutic complication' as the manner of death. STUDY DESIGN: Retrospective review and comparison of death certificates and vital statistical coding. METHODS: The manner of death is certified as a therapeutic complication when death is caused by predictable complications of appropriate therapy, and would not have occurred but for the medical intervention. Based on medical examiner records, complications that caused or contributed to deaths over a five-year period were examined retrospectively. These fatalities were compared with deaths coded as medical and surgical complications by the New York City Bureau of Vital Statistics. RESULTS: The Medical Examiner's Office certified 2471 deaths as therapeutic complications and 312 deaths as accidents occurring in healthcare facilities. In contrast, the New York City Bureau of Vital Statistics reported 188 deaths due to complications of medical and surgical care. CONCLUSIONS: Use of the term 'therapeutic complication' as the manner of death identified nearly 14 times more deaths than were reported by the New York City Bureau of Vital Statistics. If these therapeutic complications and medical accidents were considered as a 'disease', they would rank as the 10th leading cause of death in New York City, surpassing homicides and suicides in some years. Nationwide policy shifts that use the term 'therapeutic complication' would improve the capture and reporting of these deaths, thus allowing better identification of fatal adverse medical events in order to focus on and assess preventative strategies.

Spectral measurement of electron antineutrino oscillation amplitude and frequency at Daya Bay.

A measurement of the energy dependence of antineutrino disappearance at the Daya Bay reactor neutrino experiment is reported. Electron antineutrinos (ν¯(e)) from six 2.9 GW(th) reactors were detected with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls. Using 217 days of data, 41 589 (203 809 and 92 912) antineutrino candidates were detected in the far hall (near halls). An improved measurement of the oscillation amplitude sin(2)2θ(13)=0.090(-0.009)(+0.008) and the first direct measurement of the ν¯(e) mass-squared difference |Δm(ee)2|=(2.59(-0.20)(+0.19))×10(-3) eV2 is obtained using the observed ν¯(e) rates and energy spectra in a three-neutrino framework. This value of |Δm(ee)2| is consistent with |Δm(µµ)2| measured by muon neutrino disappearance, supporting the three-flavor oscillation model.

Observation of electron-antineutrino disappearance at Daya Bay.

The Daya Bay Reactor Neutrino Experiment has measured a nonzero value for the neutrino mixing angle θ(13) with a significance of 5.2 standard deviations. Antineutrinos from six 2.9 GWth reactors were detected in six antineutrino detectors deployed in two near (flux-weighted baseline 470 m and 576 m) and one far (1648 m) underground experimental halls. With a 43,000 ton-GWth-day live-time exposure in 55 days, 10,416 (80,376) electron-antineutrino candidates were detected at the far hall (near halls). The ratio of the observed to expected number of antineutrinos at the far hall is R=0.940±0.011(stat.)±0.004(syst.). A rate-only analysis finds sin(2)2θ(13)=0.092±0.016(stat.)±0.005(syst.) in a three-neutrino framework.

Learning from radiation incidents: the new OTHEA website.

OTHEA is the name of a new website (www.othea.net), created by the Health Protection Agency (UK) and the Centre d'étude sur l'évaluation de la protection dans le domaine nucléaire (CEPN, France), and supported by several other stakeholders including national societies and associations. The website is bi-lingual (French and English) and the purpose is to share the lessons learnt from radiological incidents that have occurred in the industrial, medical, research and teaching, and other non-nuclear sectors. OTHEA contains a collection of incident reports, categorised according to the sector and the type of application, and a search facility. The reports can be freely downloaded and printed, for example for use in radiation protection training activities. To encourage dissemination, the incident reports have been made anonymous, i.e. any information that could identify a particular individual, organisation or site has been removed. Each report contains a brief summary of the incident, the radiological consequences, and the lessons learnt. The aim is not to capture every single incident, but to provide a range of reports selected according to the value of the lessons learnt. For OTHEA to be a long-term success, it needs to be sustained with new reports. Therefore users are encouraged to submit incident reports that can be considered for inclusion in OTHEA. This note summarises the background to OTHEA, and provides a description of the operating features and content at its launch in summer 2010.

Validity of a short computerized assessment battery for moderate cognitive impairment and dementia.

BACKGROUND: Computerized cognitive assessment tools have been developed to make precise neuropsychological assessment readily available to clinicians. Mindstreams batteries for mild impairment have been validated previously. We examined the validity of a Mindstreams battery designed specifically for evaluating those with moderate cognitive impairment. METHODS: 170 participants over the age of 60 years performed the computerized battery in addition to standard clinical evaluation. The battery consists of six technician-administered tests and one patient-administered interactive test sampling the cognitive domains of orientation (to time and place), memory, executive function, visual spatial processing, and verbal function. Staging was according to the Clinical Dementia Rating Scale (CDR) on the basis of clinical data but independent of computerized cognitive testing results, thus serving as the gold standard for evaluating the discriminant validity of the computerized measures. RESULTS: Seven participants received a global CDR score of 0 (not impaired), 76 were staged as CDR 0.5 (very mildly impaired), 58 as CDR 1 (mildly impaired), 26 as CDR 2 (moderately impaired), and 3 as CDR 3 (severely impaired). Mindstreams Global Score performance was significantly different across CDR groups (p < 0.001), reflecting poorer overall battery performance for those with greater impairment. This was also true for the domain summary scores, with Executive Function (d = 0.67) and Memory (d = 0.65) distinguishing best between CDR 0.5 and 1, and Orientation best differentiating among CDR 1 and 2 (d = 1.20). CONCLUSIONS: The Mindstreams battery for moderate impairment differentiates among varying degrees of cognitive impairment in older adults, providing detailed and distinct cognitive profiles.

Computerized cognitive assessment of mild cognitive impairment in urban African Americans.

Few objective cognitive assessment tools have been validated for mild cognitive impairment (MCI) in African Americans despite higher prevalence of disease. This preliminary study evaluated discriminant validity of a computerized cognitive assessment battery for MCI in an urban African American cohort. Twenty-seven participants with MCI and 22 cognitively healthy individuals completed a multidomain battery (Mindstreams, NeuroTrax Corp, New Jersey). Mild cognitive impairment participants performed more poorly than cognitively healthy participants in all domains, with significant differences in memory (P = .003; d = 0.96), executive function (P = .046; d = 0.64), and overall battery performance (P = .041; d = 0.63). Adjustment for intelligence quotient (IQ) yielded significant differences in memory (P < .001; d = 1.34), executive function (P = .007; d = 0.86), attention (P = .014; d = .80), and overall performance (P = .001; d = 1.09). Such a validated battery may help to address an important clinical need in this population.

Adjustment of cognitive scores with a co-normed estimate of premorbid intelligence: implementation using mindstreams computerized testing.

Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of +/-1 SD and 6 normalized units for scores of +/-2 SD. The present approach shows promise as a practical solution for assessment of high- and low-intelligence individuals.

Practicality of a computerized system for cognitive assessment in the elderly.

BACKGROUND: Early detection and diagnosis are critical to dementia care. However, many early cases remain undiagnosed as a result of the impracticality of neuropsychological testing, particularly in primary care. Mindstreams is an office-based computerized system for measuring cognitive function in multiple domains, with demonstrated validity, test-retest reliability, and sensitivity to treatment effects. This study evaluated its feasibility for assessment of the elderly. METHODS: Usability data were collected after each of 2,888 consecutive initial-visit testing sessions at the first 11 clinical centers to use Mindstreams. The chi(2) goodness-of-fit test was employed to determine whether patients and supervisors more often rated tests easy versus hard to use. Separate analyses were run for non-computer users, patients older than 75 years, and poor performers (< or =1 standard deviation on overall battery performance). RESULTS: For all patients (n = 2,888; age, 64.7 +/- 18.2 years), 83% rated the tests easy to use (P < .001). Seventy-three percent of non-computer users, 70% of patients older than 75, and 69% of poor performers rated them easy to use (Ps < .001). Supervisor ratings and ease of understandability ratings were similar. For all patients, 76% of supervisor ratings indicated no patient frustration (P < .001). Seventy-eight percent of ratings for non-computer users, 76% for patients older than 75, and 74% for poor performers indicated no frustration (Ps < .001). CONCLUSIONS: Mindstreams was easily employed, including in patients with considerable cognitive impairment, supporting its practicality for in-office cognitive assessment of the elderly. The availability of such valid and practical assessment suggests the feasibility of integrating the technology within a clinical algorithm for improved detection of cognitive decline.