Composite Indices of the Color-Picture Version of Boston Naming Test Have Better Discriminatory Power: Reliability and Validity in a Chinese Sample with Diverse Neurodegenerative Diseases.

BACKGROUND: The Boston Naming Test (BNT) is the most widely used measure to assess anomia. However, it has been criticized for failing to differentiate the underlying cognitive process of anomia. OBJECTIVE: We validated the color-picture version of BNT (CP-BNT) in a sample with diverse neurodegenerative dementia diseases (NDDs). We also verified the differential ability of the composite indices of CP-BNT across NDDs groups. METHODS: The present study included Alzheimer's disease (n = 132), semantic variant primary progressive aphasia (svPPA, n = 53), non-svPPA (n = 33), posterior cortical atrophy (PCA, n = 35), and normal controls (n = 110). We evaluated psychometric properties of CP-BNT for the spontaneous naming (SN), the percentage of correct responses on semantic cuing and word recognition cuing (% SC, % WR). Receiver operating characteristic analysis was used to examine the discriminatory power of SN alone and the composite indices (SN, % SC, and % WR). RESULTS: The CP-BNT had sufficient internal consistency, good convergent, divergent validity, and criterion validity. Different indices of CP-BNT demonstrated distinct cognitive underpinnings. Category fluency was the strongest predictor of SN (ß= 0.46, p < 0.001). Auditory comprehension tests highly associated with % WR (Sentence comprehension: ß= 0.22, p = 0.001; Word comprehension: ß= 0.20, p = 0.001), whereas a lower visuospatial score predicted % SC (ß= -0.2, p = 0.001). Composite indices had better predictability than the SN alone when differentiating between NDDs, especially for PCA versus non-svPPA (area under the curve increased from 63.9% to 81.2%). CONCLUSION: The CP-BNT is a highly linguistically relevant test with sufficient reliability and validity. Composite indices could provide more differential information beyond SN and should be used in clinical practice.

A Color-Picture Version of Boston Naming Test Outperformed the Black-and-White Version in Discriminating Amnestic Mild Cognitive Impairment and Mild Alzheimer's Disease.

Despite the ubiquity of the Boston naming test (BNT) in clinical practice and research, concerns have been expressed about its poor quality pictures, insufficient psychometric properties, and cultural bias in non-English language backgrounds. We modified the black-and-white BNT with a set of color pictures since color effects have been suggested to improve naming accuracy in the visual naming test. This study aimed to examine and compare the reliability and validity of the color-picture version of BNT (CP-BNT) and the black-and-white version of BNT (BW-BNT) to differentiate amnestic mild cognitive impairment (aMCI) or mild Alzheimer's disease (AD) from the cognitive normals. This study included two subgroups, and each subgroup had 101 normal controls, 51 aMCI, and 52 mild AD. One subgroup undertook BW-BNT and the other conducted CP-BNT. The reliability, convergent and discriminant validity, and the diagnostic accuracy of two versions of BNT were evaluated. The CP-BNT showed a greater area under the curve (AUC) than the BW-BNT for aMCI (80.3 vs.s 69.4%) and mild AD (93.5 vs. 77.6%). The CP-BNT also demonstrated better convergent validity with CDR global scores and better reliability (Cronbach's coefficient 0.66 for the CP-BNT vs. 0.55 for the BW-BNT). At the optimal cutoff value of spontaneous naming, the CP-BNT demonstrated improved sensitivity and specificity for differentiating mild AD from NC with a higher positive predictive value, negative predictive value, and lower false-positive rate. Compared with BW-BNT, CP-BNT is a more reliable and valid test to assess cognitive and naming impairment.

[Relationship between computed tomography perfusion imaging and prognosis in hyperacute cerebral infarction].

OBJECTIVE: To explore the diagnostic valves of computed tomography perfusion imaging (CTP) in hyperacute cerebral infarction patients and examine the correlation of time period from symptom onset to examination and CTP parameters. METHODS: Non-enhancement CT and CTP were performed on 75 patients with acute cerebral infarction of internal carotid system within 8 hours of symptom onset at our department from January 2006 to May 2008. National Institute of Health Stroke Scale score (NIHSS), Barthel index (BI) and modified Rankin scale (mRS) were assessed at the same day, days 14 and 90 after stroke onset respectively for neurological function impairment, activity of daily living and extent of disability in prognosis. RESULTS: (1) All CTP parameters in ischemic region had no correlation with time period from symptom onset to examination (P > 0.05). No significant differences were found between the patients with > 3 hours and < 3 hours after stroke onset in terms of the above parameters; (2) the areas of CBF (cerebral blood flow) on ischemic region significantly correlated with NIHSS at the day of symptom onset (r = 0.391, P < 0.001), Day 14 (r = 0.564, P < 0.001) and Day 90 (r = 0.549, P < 0.001) after symptom onset. CBV (cerebral blood volume) and TTP (time-to-peak) on ischemic region significantly correlated with the evaluation indices of predicting clinical outcomes at the day of symptom onset, Days 14 and 90 (P < 0.01). CBF, CBV, rCBF (regional CBF) and rCBV (regional CBV) correlated only with some of the clinical outcome scores. CONCLUSION: Time period after symptom onset can not reflect the ischemic extent and volume of cerebral infarction. But CTP may evaluate the severity and prognosis of acute cerebral infarction patients. The area of abnormal perfusion is the most sensitive parameter.

[Transrectal high-intensity focused ultrasound for treatment of benign prostatic hyperplasia: report of 262 cases].

OBJECTIVE: To explore the application of transrectal high-intensity focused ultrasound (HIFU) for treatment of benign prostatic hyperplasia (BPH). METHODS: From Dec. 2002 to Dec. 2006, 262 BPH patients underwent transrectal HIFU ablative therapy. After the treatment, IPSS, QOL score, peak uroflow rate and prostatic volume measured by TRUS were used for evaluation. RESULTS: After 1 to 3 years' follow-up, IPSS, QOL score, and prostatic volume all decreased, while the peak uroflow rate increased obviously (P<0.01). Mild hematuria was noted in all the cases after the treatment, and epididymitis was found in 7 cases (2.7%), short-term hematospermia in 66 cases (25.2%), retrograde ejaculation in 35 cases (13.4%), and urethro-rectal fistula in 1 case (0.3%). No urinary incontinence was found in these cases. TURP was performed in 18 cases (6.8%) in 3 years after the treatment due to an excessively large volume of the prostates or bladder neck contracture. CONCLUSION: HIFU is effective and safe in the treatment of BPH which causes minimal invasion, absence of intraoperative bleeding, good tolerance and few complications, and is especially suitable in elderly patients.

Autologous peripheral blood stem cell transplantation for severe multiple sclerosis.

We describe the results of a clinical trial to evaluate the feasibility and toxicity of autologous hematopoietic stem cell transplantation (auto-HSCT) for patients with progressive multiple sclerosis (MS). Fifteen patients (all patients with secondary progressive MS) were enrolled. The median expanded disability status scale (EDSS) score at baseline was 6.0 (range, 4.5-7.5). Peripheral blood stem cells were obtained by leukapheresis after mobilization with granulocyte colony-stimulating factor. In 9 patients, CD34+ cell selection was performed with a CliniMACS cell selection system, and 6 patients accepted infusion of unmodified peripheral blood stem cells. The modified BEAM (carmustine, teniposide, cytarabine, and melphalan) was the sole conditioning regimen used. The adverse effects included infections, mucositis, transient hepatotoxicity, and diarrhea. Three patients had flares of neurologic deterioration during mobilization, 8 patients had the same manifestation during transplantation, and 2 patients had similar flares within 3 months of transplantation. Six patients experienced continuous neurologic improvement after transplantation, 5 patients experienced neurologic progression, and 4 patients had stabilization of their disease. The confirmed progression-free rate was 63.8% at 49 months. The results of lymphocyte purging were no better than for no purging. Auto-HSCT proved to be safe and beneficial for some MS patients. Further studies are needed to establish the merit of this procedure for MS patients.