Memory versus intelligence in dementia screening--MMSE.

The Mini-Mental State exam is a widely used screening instrument for dementia. Recent research has suggested that errors in classification reported for this instrument may be due to premorbid levels of intelligence and education, Thirty-one ambulatory patients diagnosed with Alzheimer's disease were administered a standard neuropsychological testing battery. MMSE scores and intelligence are significantly correlated. However when memory ability is partialed out, the covariance of MMSE and intellectual abilities does not add any further information to that already provided by the memory scores.

Neuropsychological impairment from acute low-level exposure to carbon monoxide.

OBJECTIVE: To investigate the effects of acute low-level exposure to carbon monoxide on higher cognitive functions in healthy humans. DESIGN: An empirical study of the effects of low-level exposure to carbon monoxide on higher cognitive functions in young healthy volunteers and a matched nonexposed control group. SETTING: A dormitory at the Hebrew University campus in Jerusalem, Israel. PARTICIPANTS: Forty-five student volunteers who were exposed to carbon monoxide from residential kerosene stoves for 1.5 to 2.5 hours (air carbon monoxide concentrations of 17-100 ppm; mean +/- SD, 61 +/- 24 ppm) served as the experimental group and 47 nonexposed students served as the control group. MAIN OUTCOME MEASURES: A battery of neuropsychological tests was administered to each participant including digit span, the revised Wechsler Memory Scale for verbal and figural memory, Trail-Making Test parts A and B, digit symbol, block design, and the Rey Auditory Verbal Learning Test. RESULTS: Venous blood carboxyhemoglobin (Hbco) levels in participants of the study group ranged from 0.01 to 0.11 (mean +/- SD, 0.04 +/- 0.03) and correlated with air carbon monoxide concentrations (r = 0.39; P = .01). The experimental group scored significantly lower than controls on the following tests: digit span forward (P = .02), short-term (P = .008) and long-term semantic memory (P = .008), digit symbol (P = .004), block design (P = .009), recall of figural memory (P = .02), and Trail-Making part A (P = .04). No significant differences were found between the experimental and control groups in other tests. CONCLUSIONS: The lower scores on neuropsychological tests indicate dysfunctions in memory, new learning ability, attention and concentration, tracking skills, visuomotor skills, abstract thinking, and visuospatial planing and processing. These dysfunctions correspond with previous reports of carbon monoxide neurotoxic effects in patients with moderate carbon monoxide poisoning. Low-level exposure to carbon monoxide results in impairment of higher cognitive functions. Neuropsychological testing appears to be sensitive in the detection of subtle neurologic dysfunctions resulting from carbon monoxide poisoning.

Parental attitudes toward obstetric ultrasound examination.

OBJECTIVE: The aim of the study was to assess the effect of ultrasound examination on parental attitudes and anxieties. MATERIAL AND METHOD: Ultrasound examinations were carried out on 1,089 pregnant women with uncomplicated pregnancies at a mean gestational age of 20.9 weeks (minimum 10 weeks). Before and after the ultrasound examination, patients completed a questionnaire comprising 26 five-point numerical scales relating to anxiety levels, and difference scores for pre- and post-scan levels of fears and anxieties were computed. RESULTS: We showed that the reduction of anxiety following ultrasound examination was inversely related to gestational age, but was unrelated to demographic or medical variables, such as the risk level at the time of the scan. Similarly, anxiety was not reduced because of the presence of the spouse, although the spouse's presence did significantly increase inter-partner bonding. CONCLUSION: This study showed that "routine" ultrasound scan may have significant psychological effects on parental attitudes toward each other and the fetus.

The effect of the amount of feedback on anxiety levels during ultrasound scanning.

This study examined the influence of different levels of feedback and of other situational and buffering variables on the psychological effects of ultrasound examinations of 211 pregnant women. The patients were randomly assigned to two different experimental conditions: high feedback and low feedback. The subjects' levels of anxiety (both trait- and state-anxiety) were measured immediately before and after the ultrasound examination. Overall, there was a significant decrease in the level of state-anxiety, which could not be explained by the different levels of feedback provided. Situational and buffering variables were not found to be related to the degree of psychological benefit produced by the scan.

Anxiety levels of pregnant women during ultrasound examination: coping styles, amount of feedback and learned resourcefulness.

Anxiety levels were measured before and after ultrasound examination in 183 women who underwent the procedure as part of their routine prenatal care. Women were classified according to their preferred mode of information gathering, their amount of available cognitive resources and predetermined feedback conditions. The results indicated significant reductions in state or situational anxiety levels for all subjects while trait anxiety was unaffected. In addition, the results suggested a correspondence between learned resourcefulness and informational coping styles. Women who had higher levels of cognitive resources and actively sought out information showed significantly greater decreases in state anxiety levels. This finding was also true for women who had lower levels of cognitive resources and tended to block out information. The impact of the scan was more profoundly affected by personality repertoires and informational coping styles than by either of the feedback conditions.

The effect of feedback on anxiety levels during ultrasound scanning for ovarian cancer.

Women undergoing ultrasound scanning for the detection of ovarian cancer benefit psychologically from the examination, which has been shown to reduce levels of anxiety, depression, hostility and complaints about somatic symptoms. However, it is not completely clear what aspects of the ultrasound examination are responsible for these effects, and how these beneficial psychological effects vary under different circumstances. This study examined, in particular, the effect of various levels of feedback on patients' anxiety levels before and after ultrasound examination. Two hundred and seven women were randomly assigned to two different experimental conditions: high feedback and low feedback. The subjects' levels of anxiety (both trait and state anxiety) were measured immediately before and after the ultrasound examination. The women's individual risk factors for ovarian cancer were also recorded. This study showed a significant decrease in the level of trait anxiety following ultrasound scanning. The decrease in anxiety did not relate to the level of feedback provided to the patients, nor to the woman's degree of risk for ovarian cancer. The results are discussed in terms of possible implications for clinical care and the allocation of resources in the medical system.

Self-critical and dependent aspects of loneliness.

In this study, the concept of loneliness is examined in relation to different types of depression. The Depressive Experience Questionnaire and the short form of the Revised UCLA Loneliness scale were administered to 70 normal subjects. Both anaclitic and introjective factors of depression were found to be significantly related to loneliness. Contrary to expectations self-critical (introjective) depression accounted for twice the variance of the loneliness measure than dependent (anaclitic) depression. Introjective depression as an integral component of the inner dynamic of loneliness is discussed.

L'homme qui rit: inappropriate laughter and release phenomena of the frontal subdominant lobe.

Witzelsucht and moria are time-honored neurobehavioral terms. Witzelsucht is a tendency to tell inappropriate jokes, and moria is euphoric behavior. Focal right-orbitofrontal parenchymal lesion is often the anatomical substrate for these behavioral attitudes. This case report presents a patient with a longstanding witzelsucht-moria behavior. Single photon emission computerized tomography (SPECT) showed hypoperfused right-frontoparietal area in the absence of structural damage.

A reversible case of Klüver-Bucy syndrome in association with shigellosis.

The Klüver-Bucy syndrome is characterized by psychic blindness or visual agnosia, blunted affect, hypermetamorphosis, hyperorality, bulimia, and sexual behavioral alterations. To date, there have been fewer than 10 reported cases of Klüver-Bucy syndrome in children, most of them irreversible. We describe here a reversible case of the complete Klüver-Bucy syndrome in a child suffering from Shigella encephalopathy.

Central nervous system involvement in Leber congenital amaurosis.

Sixteen patients with ocular criteria of Leber congenital amaurosis (LCA) were studied. Neurological examination was normal in 11 of 16 patients. The electroencephalogram was normal in six of eight patients, while two had nonspecific theta slowing. Computerized tomography of the brain was normal in two of five; hypoplasia of the cerebellar vermis was seen in one, and mild to moderate ventriculomegaly was seen in two of five. Six patients underwent the verbal subtests of the Wechsler Intelligence Scale and a detailed battery of neuropsychological tests. Subtests dependent on early environmental influences were most severely affected, while culture-free subtests showed average or well above average performance. These results strongly support the hypothesis that children with LCA may be capable of normal cognitive functioning, although they perform poorly on standard IQ tests. This is related to their early environmental and sensory deprivation, rather than to a primary central nervous system dysfunction.

Age related decline in aluminum-activated human platelet adenylate cyclase: post-receptor changes in cyclic AMP second messenger signal amplification in normal aging and dementia of the Alzheimer type.

Low, micromolar concentrations of aluminum (in the presence of NaF) were shown to strongly activate human platelet adenylate cyclase and provided a useful probe for evaluating cyclic AMP second messenger function distal to the receptor: The effect of normal aging and disease state on second messenger activity in man was studied by measurements of the aluminum-activated enzyme. A significant decline in aluminum-stimulated platelet adenylate cyclase activity in older, healthy subjects was observed. An age-associated decline in NaF-stimulated cyclic AMP synthesis was also demonstrated for normal, non-demented subjects. These findings suggest an age-associated lesion at the level of the guanine nucleotide regulatory protein/catalytic subunit of the adenylate cyclase complex. However, for patients with Alzheimer's disease no such decline in platelet adenylate cyclase activity was detected, and increased sensitivity to both aluminum and NaF was demonstrated.