Utilization of sunglasses: A pilot study to examine a simple test for cognitive dysfunction.

OBJECTIVE: Utilization is an executive function disorder and implies an inappropriate response to external stimuli. The sunglasses test is a simple test to examine utilization by offering a pair of sunglasses to a patient without any instruction. PATIENTS AND METHODS: We performed a pilot study to examine the sunglasses test in 100 patients, of which 50 had cognitive symptoms and 50 did not have cognitive symptoms. When the patient put on the sunglasses, the test was considered positive. Cognitive dysfunction was based on the results of the MMSE, results of the clock test and neuropsychological examination (blinded). The final diagnosis was based on all results of the work-up (including MRI). RESULTS: Of the 50 patients with cognitive symptoms 30 had a positive test and 28 of them had cognitive dysfunction. Final diagnosis in most patients was Dementia due to probable Alzheimers disease, followed by Frontotemporal dementia. Seven of the 20 patients with a negative test also had cognitive dysfunction. None of the 50 patients without cognitive symptoms put on the sunglasses. Sensitivity of the sunglasses test to detect cognitive dysfunction was 80% and specificity was 97%, with a positive predictive value of 93%. CONCLUSION: Offering sunglasses is a simple test to screen for utilization. Putting on sunglasses without instruction to do so can be indicative for cognitive dysfunction and further cognitive evaluation should be considered. Future studies are needed in a larger group of patients and to determine the role of this test in different diseases with cognitive decline.

[An artist with neurosyphilis and AIDS]. / Een kunstenaar met neurolues en aids.

Neurosyphilis is a neuropsychiatric disorder which can be severely incapacitating and even fatal, but which has been associated historically with genius and artistic inspiration. We describe an artist with neurologic and psychiatric complaints who owed not only his disease symptoms, but possibly also his artistic talent to neurosyphilis. Gradually, our patient developed all the clinical symptoms of neurosyphilis. In addition, he turned out to suffer from AIDS. At a late stage, the clinical picture was complicated by opportunistic infections and epilepsy. Although the patient received the best possible treatment, he ultimately died from opportunistic infections.