RESUMEN
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare, non-Hodgkin lymphoma which arises within the capsules of breast implants. These particular tumours have expression of CD30 and are negative for Anaplastic Lymphoma Kinase (ALK). Here, we report a case of BIA-ALCL in a 48-year-old woman post breast reconstruction. This case report is aimed at raising awareness and education on the significance of considering the development of BIA-ALCL in cases where cytology is negative and helping better understand this disease process.
RESUMEN
OBJECTIVES: To identify environmental and management factors affecting injury rate in racing greyhounds. METHODS: Surveys of racing injuries at two greyhound tracks in the UK were conducted using injury data collected by track veterinary surgeons. At Track A the relative frequency of common injuries was determined and compared with previously published studies conducted in the UK. At Track B the effects of month of the year, ambient temperature and track condition ("going") on injury rate were determined. RESULTS: Comparison of common injuries at Track A with previous studies suggested a change in the relative frequency of some injury types following a change in track surface from grass to sand. Estimated injury rates suggest improved track safety with the change in track surface. At Track B, injury rate increased significantly with faster track conditions. Time of year and ambient temperature had no significant effect on injury rate. CLINICAL SIGNIFICANCE: Changes in track maintenance resulting in a slower track may reduce injury rate in racing greyhounds, with associated welfare benefits.
Asunto(s)
Perros/lesiones , Carrera/lesiones , Animales , Carpo Animal/lesiones , Esfuerzo Físico , Estaciones del Año , Tarso Animal/lesionesRESUMEN
The psychostimulant methylphenidate has been previously shown to improve cognitive performance in both normal control volunteers and patient populations. In the present case study, the effects of methylphenidate on cognitive and behavioural function were examined in a single patient with idiopathic normal pressure hydrocephalus (NPH) who had undergone ventriculoperitoneal shunting. A double-blind placebo-controlled ABBA drug design was employed, with the administration of two different doses of methylphenidate followed by neuropsychological assessment on a number of psychometric tests and cognitive tasks drawn from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methylphenidate produced a dose-dependent positive improvement in behavioural measures in the patient associated with a reduction in apathy. It also had a dose-independent enhancing effect on performance of a Spatial Recognition task. These findings require replication in a large sample of patients to determine whether methylphenidate may prove to be generally useful in enhancing cognition and reducing apathy in normal pressure hydrocephalus.
Asunto(s)
Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastornos del Conocimiento/tratamiento farmacológico , Hidrocéfalo Normotenso/complicaciones , Metilfenidato/uso terapéutico , Anciano , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Método Doble Ciego , Femenino , Humanos , Hidrocéfalo Normotenso/psicología , Memoria/efectos de los fármacos , Pruebas Neuropsicológicas , PsicometríaRESUMEN
Normal pressure hydrocephalus (NPH) accounts for one of the few known forms of reversible dementia. Varied aetiology and clinical presentation contribute to difficulties with early or differential diagnoses, and delayed surgical treatment may be less efficacious. Clinical neuropsychology provides a means of determining a cognitive profile for NPH, assisting in differential diagnosis, tracking the disorder's progression and assessing the efficacy of treatment. This article will review possible applications of clinical neuropsychology and propose a clinical assessment protocol for NPH.
Asunto(s)
Trastornos del Conocimiento/diagnóstico , Hidrocéfalo Normotenso/diagnóstico , Protocolos Clínicos , Cognición/fisiología , Trastornos del Conocimiento/fisiopatología , Demencia/diagnóstico , Demencia/fisiopatología , Humanos , Hidrocéfalo Normotenso/fisiopatología , Hidrocéfalo Normotenso/psicología , Presión Intracraneal , Pruebas Neuropsicológicas , Desempeño Psicomotor/fisiología , Calidad de Vida , InvestigaciónRESUMEN
OBJECTIVES: To determine the relative impact of hydrocephalus and spinal dysraphism in young adults on intellectual and cognitive functioning. Sub-groups of patients with congenital hydrocephalus and/or spina bifida were assessed between 1995 and 2003. The entry criteria were that individuals should have (i) intact global function, (ii) average verbal intelligence (or above), and (iii) should not have clinical depression. There were three sub-groups: patients with hydrocephalus and spina bifida, patients with hydrocephalus without spina bifida, and patients with spina bifida without hydrocephalus. METHODS: Patients were neuropsychologically assessed as part of their normal clinical assessment during their annual medical review. Each individual completed a screening battery assessing global functioning, verbal intelligence, and mood. In addition they completed additional tests including measures of emotional intelligence, memory, attention, and executive function. Results were analysed to compare the performance of the patient sub-groups and to compare them to a healthy control group. RESULTS: Patients with hydrocephalus (with or without spina bifida) were significantly impaired on the vast majority of all test scores as compared to patients with spina bifida and healthy controls. They were particularly poor on measures assessing executive function. By contrast for patients with spina bifida with no associated hydrocephalus, the significant majority of all test scores fell within the average range or above. CONCLUSIONS: The neuropsychological profile of patients with hydrocephalus is one of relative impairment and this is so whether or not spina bifida is present. In spina bifida alone, in the absence of hydrocephalus, cognitive function is relatively spared.
Asunto(s)
Trastornos del Conocimiento/etiología , Hidrocefalia/etiología , Hidrocefalia/psicología , Inteligencia , Disrafia Espinal/complicaciones , Disrafia Espinal/psicología , Adulto , Atención , Estudios de Casos y Controles , Femenino , Humanos , Pruebas de Inteligencia , Masculino , MemoriaRESUMEN
Overproduction of parathyroid hormone-related protein (PTHRP) occurs in a high proportion of primary breast cancers (PBC) and is strongly implicated in their metastatic spread to bone. Although the PTHRP-receptor (PTHRP-R) is often coexpressed with PTHRP in PBC, its role in regulating breast cancer cell proliferation and metastases to bone remains unclear. The aims of this study were to determine the expression of the PTHRP-R in breast cancer bone metastases (BM) and to investigate the effects of PTHRP-R overexpression on breast cancer cell proliferation. PTHRP-R expression occurred in 85% (11 out of 13) of BM compared with 58% (39 out of 67) of PBC. Median expression was higher (P<0.05) in BM compared with PBC. PTHRP increased cAMP accumulation and DNA synthesis in MCF-7 cells stably overexpressing the PTHRP-R (MCF-7(WTR)) but not in MCF-7(VEC) control cells. The increase in DNA synthesis was mimicked by the cAMP pathway activator forskolin. The receptor antagonist PTHRP(7-34) reduced DNA synthesis in MCF-7(WTR) cells, but not MCF-7(VEC) cells, indicating that receptor overexpression promotes autocrine PTHRP activity. MCF-7(WTR) cells showed increased mitogenic responsiveness to fetal calf serum and reduced doubling times. PTHRP induced weak activation of ERK1 and ERK2 and potentiated their activation by serum growth factors. Collectively these results show that the PTHRP-R is frequently expressed in breast cancer BM and indicate that receptor overexpression drives proliferation via autocrine signals that are mediated via cAMP and ERK pathways.
Asunto(s)
Comunicación Autocrina , Neoplasias Óseas/metabolismo , Neoplasias Óseas/secundario , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Receptores de Hormona Paratiroidea/metabolismo , División Celular , AMP Cíclico/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Proteínas Quinasas Activadas por Mitógenos/metabolismo , Metástasis de la Neoplasia , Receptor de Hormona Paratiroídea Tipo 1 , Receptores de Hormona Paratiroidea/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Células Tumorales CultivadasRESUMEN
Estrogens administered in high doses were commonly used for therapy of advanced breast cancer before the introduction of contemporary endocrine therapy. While the mechanism of the antitumor effect is unknown, in vitro investigations have shown estrogens in high concentrations to be toxic to cell growth. Further, it has been shown that exposure of MCF-7 cells to estrogens in low concentrations may enhance the sensitivity and also lower the toxicity threshold to estrogens. This study was designed to evaluate treatment with diethylstilbestrol (DES) in postmenopausal women with advanced breast cancer becoming resistant to estrogen deprivation. Thirty-two patients with advanced breast cancer previously exposed to multiple endocrine treatment regimens (median 4, range 2-10) were enrolled. Their tumor should have revealed evidence of endocrine sensitivity (previous partial response or at least stable disease for > or = 6 months to therapy). Each patient received DES 5 mg t.i.d. Four patients terminated therapy after < or = 2 weeks on therapy due to side effects; another two patients terminated therapy before progression for similar reasons (one patient after SD for 15 weeks and one with a PR after 39 weeks). Four patients obtained CR and six patients PR. In addition, two patients had SD for > or = 6 months duration. Five patients had an objective response and one patient a SD lasting for > or = 1 year. Our results reveal estrogens administered in high doses may have antitumor effects in breast cancer patients heavily pretreated with endocrine therapy. Such treatment represents a valuable alternative to chemotherapy in selected patients.
Asunto(s)
Antineoplásicos Hormonales/farmacología , Neoplasias de la Mama/tratamiento farmacológico , Dietilestilbestrol/farmacología , Estrógenos no Esteroides/farmacología , Administración Oral , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Relación Dosis-Respuesta a Droga , Resistencia a Antineoplásicos , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Resultado del TratamientoRESUMEN
The development of novel treatments for Alzheimer's disease (AD), aimed at ameliorating symptoms and modifying disease processes, increases the need for early diagnosis. Neuropsychological deficits such as poor episodic memory are a consistent feature of early-in-the-course AD, but they overlap with the cognitive impairments in other disorders such as depression, making differential diagnosis difficult. Computerised and traditional tests of memory, attention and executive function were given to four subject groups: mild AD (n = 26); questionable dementia (QD; n = 43); major depression (n = 37) and healthy controls (n = 39). A visuo-spatial associative learning test accurately distinguished AD from depressed/control subjects and revealed an apparent sub-group of QD patients who performed like AD patients. QD patients' performance correlated with the degree of subsequent global cognitive decline. Elements of contextual and cued recall may account for the task's sensitivity and specificity for AD.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Memoria , Pruebas Neuropsicológicas , Anciano , Enfermedad de Alzheimer/psicología , Análisis de Varianza , Estudios de Casos y Controles , Demencia/diagnóstico , Trastorno Depresivo Mayor/psicología , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Angiogenesis, the development of new blood vessels from pre-existing vasculature, is a prerequisite for tumor growth and metastasis. Surrogate markers for angiogenesis would be useful for studying the effectiveness of antiangiogenesis drugs. We examined the potential of three serum glycoproteins-vascular cell adhesion molecule-1 (VCAM-1), endothelial selectin (E-selectin), and von Willebrand factor (VWF)-to serve as markers for angiogenesis. METHODS: Preoperative serum levels of VCAM-1, E-selectin, and VWF were measured by enzyme-linked immunosorbent assay in 93 women with early breast cancer and were compared with microvessel density in each tumor, histologic features, and recurrence after surgery. Serum samples were taken from 55 women with advanced breast cancer who were commencing hormonal therapy, both immediately before therapy and 3 months later. Changes in serum levels of VCAM-1, E-selectin, and VWF were compared with the response of the disease to hormonal therapy assessed 6 months after the start of hormone therapy or at disease progression. All P: values are two-sided. RESULTS: In women with early breast cancer, serum levels of VCAM-1 (but not of E-selectin or VWF) correlated closely with microvessel density in tumors (r =.65; P:<.001), and women who developed early recurrence had higher preoperative levels of serum VCAM-1 than those who remained disease free (P: =.01). Serum VCAM-1 levels rose in women with advanced breast cancer whose disease progressed (P:<.001) but remained unchanged or fell in women with advanced breast cancer whose disease remained stable or showed a partial response to hormonal therapy. CONCLUSION: Serum VCAM-1 appears to be a surrogate marker of angiogenesis in breast cancer. Its measurement may, therefore, help in the assessment of antiangiogenesis drugs currently in phase II trials.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Neoplasias de la Mama/irrigación sanguínea , Selectina E/sangre , Neovascularización Patológica/sangre , Molécula 1 de Adhesión Celular Vascular/sangre , Factor de von Willebrand/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Groups of subjects whose primary drug of abuse was amphetamine or heroin were compared, together with age- and IQ-matched control subjects. The study consisted of a neuropsychological test battery which included both conventional tests and also computerised tests of recognition memory, spatial working memory, planning, sequence generation, visual discrimination learning, and attentional set-shifting. Many of these tests have previously been shown to be sensitive to cortical damage (including selective lesions of the temporal or frontal lobes) and to cognitive deficits in dementia, basal ganglia disease, and neuropsychiatric disorder. Qualitative differences, as well as some commonalities, were found in the profile of cognitive impairment between the two groups. The chronic amphetamine abusers were significantly impaired in performance on the extra-dimensional shift task (a core component of the Wisconsin Card Sort Test) whereas in contrast, the heroin abusers were impaired in learning the normally easier intra-dimensional shift component. Both groups were impaired in some of tests of spatial working memory. However, the amphetamine group, unlike the heroin group, were not deficient in an index of strategic performance on this test. The heroin group failed to show significant improvement between two blocks of a sequence generation task after training and additionally exhibited more perseverative behavior on this task. The two groups were profoundly, but equivalently impaired on a test of pattern recognition memory sensitive to temporal lobe dysfunction. These results indicate that chronic drug use may lead to distinct patterns of cognitive impairment that may be associated with dysfunction of different components of cortico-striatal circuitry.
Asunto(s)
Trastornos Relacionados con Anfetaminas/fisiopatología , Trastornos del Conocimiento/diagnóstico , Dependencia de Heroína/fisiopatología , Adolescente , Adulto , Trastornos Relacionados con Anfetaminas/complicaciones , Anfetaminas/efectos adversos , Análisis de Varianza , Atención/efectos de los fármacos , Enfermedad Crónica , Trastornos del Conocimiento/etiología , Femenino , Heroína/efectos adversos , Dependencia de Heroína/complicaciones , Humanos , Pruebas del Lenguaje , Masculino , Memoria/efectos de los fármacos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Reconocimiento Visual de Modelos/efectos de los fármacos , Tiempo de Reacción/efectos de los fármacos , Disposición en PsicologíaRESUMEN
Studies of breast cancer suggest that parathyroid hormone-related protein (PTHrP) is important in the development of bone metastases. To determine whether PTHrP expression is important in prostate cancer metastasis, immunohistochemistry and in situ hybridization were used to assess the expression of PTHrP and its receptor in primary prostate cancer and bone metastases from both prostate and non-prostate cancers. PTHrP was expressed in more prostate primary tumours than bone metastases (p=0.003, Fisher's exact test). All bone metastases from non-prostate cancers expressed PTHrP. In contrast, PTHrP receptor was expressed in all bone metastases, but in only 19% of primary prostate tumours (p=0.001). The receptor to PTHrP was found to be highly expressed in bone metastases from prostate and other primaries, whereas PTHrP protein was found to have lower expression in the bone metastases than in the primary tumours. In conclusion, the expression of the receptor to PTHrP is increased in bone metastases from prostate cancer and may play an important role in their formation.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Próstata/patología , Proteínas/metabolismo , Receptores de Hormona Paratiroidea/metabolismo , Neoplasias Óseas/metabolismo , Sondas de ADN , ADN Complementario , Humanos , Inmunohistoquímica , Hibridación in Situ , Antígeno Ki-67/metabolismo , Masculino , Proteína Relacionada con la Hormona Paratiroidea , Neoplasias de la Próstata/metabolismo , ARN Mensajero , Receptor de Hormona Paratiroídea Tipo 1RESUMEN
OBJECTIVES: Eleven patients with idiopathic normal pressure hydrocephalus (NPH) were selected from an initial cohort of 43 patients. The patients with NPH fell into two distinctive subgroups: preshunt, group 1 (n=5) scored less than 24 on the mini mental state examination (MMSE) and were classified as demented and group 2 (n=6) scored 24 or above on the MMSE and were classified as non-demented. METHODS: All patients were neuropsychologically assessed on two occasions: preshunt and then again 6 months postshunt. Group 1 completed the mini mental state examination (MMSE) and the Kendrick object learning test (KOLT). In addition to the MMSE and KOLT, group 2 completed further tasks including verbal fluency and memory and attentional tasks from the CANTAB battery. Nine of the 11 patients also underwent postshunt MRI. RESULTS: Group 1, who, preshunt, performed in the dementing range on both the MMSE and KOLT, showed a significant postoperative recovery, with all patients now scoring within the normal non-demented range. Group 2, although showing no signs of dementia according to the MMSE and KOLT either preshunt or postshunt, did show a specific pattern of impairment on tests sensitive to frontostriatal dysfunction compared with healthy volunteers, and this pattern remained postoperatively. Importantly, this pattern is distinct from that exhibited by patients with mild Alzheimer's disease. Eight of the nine patterns of structural damage corresponded well to cognitive performance. CONCLUSIONS: These findings are useful for three main reasons: (1) they detail the structural and functional profile of impairment seen in NPH, (2) they demonstrate the heterogeneity found in this population and show how severity of initial cognitive impairment can affect outcome postshunt, and (3) they may inform and provide a means of monitoring the cognitive outcome of new procedures in shunt surgery.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/diagnóstico , Hidrocéfalo Normotenso/diagnóstico , Anciano , Enfermedad de Alzheimer/complicaciones , Encéfalo/patología , Derivaciones del Líquido Cefalorraquídeo , Estudios de Cohortes , Femenino , Humanos , Hidrocéfalo Normotenso/complicaciones , Hidrocéfalo Normotenso/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Proyectos Piloto , Cuidados Posoperatorios , Cuidados Preoperatorios , Índice de Severidad de la Enfermedad , Conducta Verbal/fisiologíaAsunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Proteína Relacionada con la Hormona Paratiroidea , Hormona Paratiroidea/fisiología , Fragmentos de Péptidos/fisiología , Neoplasias Óseas/fisiopatología , Femenino , Humanos , Osteólisis/fisiopatología , Receptores de Hormona Paratiroidea/antagonistas & inhibidores , Receptores de Hormona Paratiroidea/fisiologíaRESUMEN
Recovery following different types of inguinal hernia repair has been objectively assessed by measuring reaction times when the subject performs an emergency stop in a driving simulator. A control group of patients who underwent varicose vein surgery to the groin under general anaesthetic without any muscle dissection demonstrated no alteration in response times. Eighty-two percent of those who underwent laparoscopic repair and 64% of those who underwent Lichtenstein repair returned to their preoperative times by 7 days after surgery. There was no difference in recovery of response times after Lichtenstein repair performed under local or general anaesthetic, in comparison with 33% of patients after Bassini repair. These results may influence the advice given by surgeons to patients after inguinal hernia surgery.
Asunto(s)
Conducción de Automóvil , Hernia Inguinal/cirugía , Laparoscopía/métodos , Tiempo de Reacción , Humanos , Periodo Posoperatorio , Factores de TiempoRESUMEN
BACKGROUND: Complications of axillary surgery occur due to severance of the intercostobrachial nerve (ICBN). The feasibility and benefit of preserving the ICBN to prevent sensory loss was studied prospectively. METHODS: Sensory symptoms and deficits were documented, and shoulder movement and arm circumference were measured at discharge and 3 months later in 120 patients randomized to either preservation or division of the ICBN. RESULT: Preserving the ICBN was feasible in 39 (65 per cent) of the 60 patients randomized to the preservation group. Preserving the nerve prolonged the procedure by a median of 5 min. No difference in sensory symptoms between the groups was seen at 3 months. At 3 months 53 per cent of patients randomized to ICBN preservation had a sensory deficit compared with 84 per cent of those randomized to ICBN sacrifice (P < or = 0.05). CONCLUSION: Preserving the ICBN reduces the incidence of sensory deficit (but not symptoms) in patients after axillary clearance.
Asunto(s)
Plexo Braquial/lesiones , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático/métodos , Adulto , Anciano , Anciano de 80 o más Años , Axila/cirugía , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Trastornos de la Sensación/prevención & control , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this study was to investigate mnemonic strategic deficits in schizophrenic patients. METHODS: Analogous tasks were used that required the self-generation of an efficient strategy and its implementation in two domains: visuospatial and verbal. The tasks were given to 20 IQ preserved schizophrenics and 20 matched normal controls. A number of different scores was derived from each task including strategy, short-term memory capacity and perseveration. RESULTS: Overall, the schizophrenic patients were significantly impaired in their ability to generate effective mnemonic strategies on both tasks. In addition, on the visuospatial task there was no difference between the groups on the memory scores, but the schizophrenic patients made significantly more perseverative errors than controls. They were disproportionately worse on the verbal strategy task, showing impairment on memory as well as on strategy scores and were also impaired at semantically classifying the words. Performance was similar to the deficit seen in patients with frontal lobe excisions and Parkinson's disease, in terms of the inability to generate an effective strategy. The deficit on the verbal task was similar to patients with temporal lobe excisions who show impaired verbal memory. However, the pattern differed in the sense that the temporal lobe patients were able to generate effective strategies, unlike the patients with schizophrenia. CONCLUSIONS: High functioning schizophrenic patients are impaired in utilizing visuospatial and verbal mnemonic strategies. By comparing the results with those of neurosurgical excision patients, further evidence is provided for both frontal and temporal lobe involvement in schizophrenia.
Asunto(s)
Trastornos del Conocimiento/diagnóstico , Desempeño Psicomotor/fisiología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adulto , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/psicología , Femenino , Percepción de Forma/fisiología , Lóbulo Frontal/fisiopatología , Humanos , Masculino , Memoria/fisiología , Persona de Mediana Edad , Análisis de Regresión , Esquizofrenia/fisiopatología , Semántica , Percepción Espacial/fisiología , Lóbulo Temporal/fisiopatología , Aprendizaje Verbal/fisiologíaRESUMEN
Whether neuropsychological changes follow carotid artery surgery is unclear, in part because of complications by multiple perioperative variables. Therefore, we carried out a detailed analysis of patients who underwent carotid artery surgery in which we attempted to control for the most important variables by excluding patients with a preoperative stroke and by adopting a standard operative technique without use of intraoperative carotid shunts. Thirty inpatients with symptomatic carotid artery disease admitted for carotid endarterectomy were assessed with a comprehensive battery of neuropsychological tests administered immediately before and after (48-72 h) surgery. No carotid bypass shunt was inserted during the operation. The battery included dementia and depression screening tests, standardised neuropsychological measures including Verbal Fluency and the National Adult Reading Test, and a battery of contemporary computerised tasks designed to measure different aspects of memory and attention from the Cambridge Neuropsychological Test Automated Battery (CANTAB). No significant difference was found in the cognitive scores postoperatively as compared with the patients' preoperative scores or compared with scores of a control group matched by age and intelligence.
Asunto(s)
Trastornos del Conocimiento/etiología , Endarterectomía Carotidea/efectos adversos , Anciano , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Diagnóstico por Computador , Endarterectomía Carotidea/psicología , Humanos , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Groups of patients with Parkinson's disease, either medicated or unmedicated, were compared with a matched group of normal control subjects on a computerized battery of tests designed to assess spatial, verbal and visual working memory. In the spatial working memory task, subjects were required to search systematically through a number of boxes to find 'tokens' whilst avoiding those boxes in which tokens had previously been found. In the visual and verbal conditions, the subjects were required to search in exactly the same manner, but through a number of abstract designs or surnames, respectively, avoiding designs or names in which a token had previously been found. Medicated Parkinson's disease patients with severe clinical symptoms were impaired on all three tests of working memory. In contrast, medicated patients with mild clinical symptoms were impaired on the test of spatial working memory, but not on the verbal or visual working memory tasks. Non-medicated patients with mild clinical symptoms were unimpaired on all three tasks. These data are compared with the results of a previous study comparing groups of neurosurgical patients with frontal, temporal or amygdalo-hippocampectomy excisions on the same three tests of working memory. Taken together, the findings suggest that working memory deficits in Parkinson's disease emerge, and subsequently progress, according to a defined sequence, the evolution of which may be linked to the likely spatiotemporal progression of dopamine depletion within the striatum, in relation to the terminal distribution of its cortical afferents.