Age related changes in inhibitory control as measured by stop signal task performance.

A modified version of the stop signal task (suitable for use with very young children) was administered to a pre primary school group of children (<5 years, 6 months); a young primary group (5 years, 7 months to 7 years, 6 months); a mid primary group (7 years, 7 months to 9 years, 6 months) and a group of adults. Significant age differences in the ability to inhibit responding were found. These results highlight the need for measures of response inhibition which are appropriate for use with very young children, when the first signs of inhibitory skills are emerging. It is also imperative that such measures allow the assessment of skills across a broad range of age groups in order to comprehensively monitor their development.

Palliative care in neurology.

This article defines the evolving role of the neurologist as a provider of palliative care. As neurologists care for chronically and critically ill, dying patients, and individuals whose diseases are incurable at the time of diagnosis, clinical competence requires expertise in the principles and practice of palliative medicine. Multiple studies suggest that despite available guidelines many patients with neurological disease suffer from pain, dyspnea, and other symptoms at or near the end of life. Recommendations from the American Academy of Neurology and Institute of Medicine are provided and the many ongoing educational efforts aimed at closing the existing gap in knowledge and improving patient care are reviewed.

Symptom assessment and management.

This article reviews how to assess and manage several symptoms commonly encountered by neurologists who care for patients with advanced illness. Scientifically validated guidelines are reviewed and practical advice is offered on how to manage pain, nausea and vomiting, dyspnea, and respiratory secretions at the end of life. The role of the neurologist as a provider of end of life care is discussed including suggestions for communicating with patients and families. This article concludes with a review of when sedation may be offered within the purview of good palliative care to patients who are imminently dying.

Terminal care and bereavement.

Care of patients at the end of life requires a high level of clinical vigilance, compassion and skill. The involvement of the patient's primary neurologist in end-of-life care and into bereavement can be an invaluable comfort to the patient and family. An understanding of the techniques for assessing and anticipating patient and family needs and knowledge of the resources available is essential if the neurologist is to provide guidance in their care.

Further manipulation of the stop-signal task: developmental changes in the ability to inhibit responding with longer stop-signal delays.

The stop-signal task, a measure of inhibitory control, was further modified in order to examine its suitability as a task for very young children. A previous study (Carver et al., 2001) showed that it can be successfully adapted for use with primary school-aged children. The present study manipulated the presentation of the signal to inhibit responding and found that this improved the likelihood of responding. A pre-primary school group of children (< 5 years, 6 months), a young primary school group (5 years, 7 months to 7 years, 6 months), and a mid-primary school group (7 years, 7 months to 9 years, 6 months) participated in the study. The results emphasize the pre- and early school years as a sensitive time for the development of inhibitory skills. Measures of inhibitory control must therefore be age-appropriate and sensitive to these early developmental changes.

End-of-life care: a survey of US neurologists' attitudes, behavior, and knowledge.

OBJECTIVE: The American Academy of Neurology (AAN) surveyed the attitudes, behavior, and knowledge of its members regarding care at the end of life. Three groups of AAN members were surveyed: neuro-oncologists, ALS specialists, and a representative sample of US neurologists. METHODS: The survey presented two clinical scenarios involving end-of-life care. Neurologists were asked a series of questions to assess their knowledge of existing medical, ethical, and legal guidelines; their willingness to participate in physician-assisted suicide (PAS) or carry out voluntary euthanasia (VE); and their general attitudes regarding end-of-life care. RESULTS: Neurologists support a patient's right to refuse life-sustaining treatment, but many believe that they are killing their patients in supporting such refusals. Thirty-seven percent think it is illegal to administer analgesics in doses that risk respiratory depression to the point of death. Forty percent believe they should obtain legal counsel when considering stopping life-sustaining treatment. One half believe that PAS should be made explicitly legal by statute for terminally ill patients. Under current law, 13% would participate in PAS and 4% would carry out VE; if those procedures were legalized, 44% would participate in PAS and 28% in VE. Approximately one third believe that physicians have the same ethical duty to honor a terminally ill patient's request for PAS as they do to honor a such a patient's refusal of life-sustaining therapy. CONCLUSIONS: There is a gap between established medical, legal, and ethical guidelines for the care of dying patients and the beliefs and practices of many neurologists, suggesting a need for graduate and postgraduate education programs in the principles and practices of palliative care medicine. Many neurologists would participate in PAS and carry out VE if legalized.