Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study.

OBJECTIVE: To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy. DESIGN: A prospective longitudinal cohort study. PARTICIPANTS: Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination. SETTING: Obstetric outpatient clinic at Stavanger University Hospital, Norway. METHODS: Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain. RESULTS: 503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests. CONCLUSION: If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

Executive Functions Do Not Mediate Prospective Relations between Indices of Physical Activity and Academic Performance: The Active Smarter Kids (ASK) Study.

Changes in cognitive function induced by physical activity have been proposed as a mechanism for the link between physical activity and academic performance. The aim of this study was to investigate if executive function mediated the prospective relations between indices of physical activity and academic performance in a sample of 10-year-old Norwegian children. The study included 1,129 children participating in the Active Smarter Kids (ASK) trial, followed over 7 months. Structural equation modeling (SEM) with a latent variable of executive function (measuring inhibition, working memory, and cognitive flexibility) was used in the analyses. Predictors were objectively measured physical activity, time spent sedentary, aerobic fitness, and motor skills. Outcomes were performance on national tests of numeracy, reading, and English (as a second language). Generally, indices of physical activity did not predict executive function and academic performance. A modest mediation effect of executive function was observed for the relation between motor skills and academic performance. Trial registration: Clinicaltrials.gov registry, trial registration number: NCT02132494.

Preventing Poor Vocational Functioning in Psychosis Through Early Intervention.

OBJECTIVE: This study tested the hypothesis that early detection of psychosis improves long-term vocational functioning through the prevention of negative symptom development. METHODS: Generalized estimating equations and mediation analysis were conducted to examine the association between employment and negative symptoms over ten years among patients in geographic areas characterized by usual detection (N=140) or early detection (N=141) of psychosis. RESULTS: Improved vocational outcome after ten years among patients in the early-detection area was mediated by lower levels of negative symptoms during the first five years. Regardless of symptoms, rates of full-time employment or study were lower among patients in the usual-detection versus the early-detection area. CONCLUSIONS: Patients from an early-detection area attained lower negative symptom levels earlier compared with patients from a usual-detection area, which seemed to have facilitated vocational careers.

The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement.

INTRODUCTION: Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis. METHOD: Participants (n = 84), including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP). The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks). Symptomatic change was measured by PANSS. RESULTS: The proportion of subjects with cognitive impairment (t < 35) was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016). There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change. CONCLUSION: The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.

Loss of Dopamine Transporter Binding and Clinical Symptoms in Dementia With Lewy Bodies.

BACKGROUND: Little is known about the underlying mechanisms of clinical symptoms in dementia with Lewy bodies. The aim of this study was to explore the association between loss of striatal dopamine transporter binding and symptoms in dementia with Lewy bodies. METHODS: Thirty-five patients with dementia with Lewy bodies underwent single-photon emission computerized tomography brain imaging with N-ω-fluoropropyl-2ß-carbomethoxy-3ß-(4-iodophenyl)nortropane ([(123) I]FP-CIT). Associations between striatal binding ratios and motor (UPDRS), psychiatric (Neuropsychiatric Inventory; [NPI]), and cognitive (Mini-Mental State Examination [MMSE] and neuropsychological tests) symptoms were assessed by linear regression analysis. RESULTS: The explorative analysis showed that the motor UPDRS was negatively associated with putamen dopamine transporter binding, whereas no association with striatal dopamine transporter binding was found for total NPI, hallucinations, apathy, depression, anxiety, and MMSE scores. However, in post-hoc analysis, executive impairment was positively associated with dopamine transporter loss after adjustment of age and gender. CONCLUSIONS: Dopamine deficiency in patients with dementia with Lewy bodies was associated with severity of motor symptoms, but did not correlate significantly with ratings of neurobehavioral disturbances or overall cognition.

Cognitive executive impairment and dopaminergic deficits in de novo Parkinson's disease.

Cognitive impairment in Parkinson's disease (PD) is common and does directly impact patients' everyday functioning. However, the underlying mechanisms of early cognitive decline are not known. This study explored the association between striatal dopaminergic deficits and cognitive impairment within a large cohort of early, drug-naïve PD patients and tested the hypothesis that executive dysfunction in PD is associated with striatal dopaminergic depletion. A cross-sectional multicenter cohort of 339 PD patients and 158 healthy controls from the Parkinson's Progression Markers Initiative study was analyzed. Each individual underwent cerebral single-photon emission CT (SPECT) and a standardized neuropsychological assessment with tests of memory as well as visuospatial and executive function. SPECT imaging was performed with [(123) I]FP-CIT, and specific binding ratios in left and right putamen and caudate nucleus were calculated. The association between specific binding ratios, cognitive domain scores, and age was analyzed using Pearson's correlations, partial correlation, and conditional process analysis. A small, but significant, positive association between total striatal dopamine transporter binding and the attention/executive domain was found (r = 0.141; P = 0.009) in PD, but this was not significant after adjusting for age. However, in a moderated mediation model, we found that cognitive executive differences between controls and patients with PD were mediated by an age-moderated striatal dopaminergic deficit. Our findings support the hypothesis that nigrostriatal dopaminergic deficit is associated with executive impairment, but not to memory or visuospatial impairment, in early PD.

Cerebrospinal fluid Aß levels correlate with structural brain changes in Parkinson's disease.

ParkWest is a large Norwegian multicenter study of newly diagnosed drug-naïve subjects with Parkinson's disease (PD). Cognitively normal PD subjects (PDCN) and PD subjects with mild cognitive impairment (PDMCI) from this cohort have significant hippocampal atrophy and ventricular enlargement, compared to normal controls. Here, we aimed to investigate whether the same structural changes are associated with cerebrospinal fluid (CSF) levels of amyloid beta (Aß)38 , Aß40 , Aß42 , total tau (t-tau), and phosphorylated tau (p-tau). We performed three-dimensional radial distance analyses of the hippocampi and lateral ventricles using the MRI data from ParkWest subjects who provided CSF at baseline. Our sample consisted of 73 PDCN and 18 PDMCI subjects. We found significant associations between levels of all three CSF Aß analytes and t-tau and lateral ventricular enlargement in the pooled sample. In the PDCN sample, all three amyloid analytes showed significant associations with the radial distance of the occipital and frontal horns of the lateral ventricles. CSF Aß38 and Aß42 showed negative associations, with enlargement in occipital and frontal horns of the lateral ventricles in the pooled sample, and a negative association with the occipital horns in PDMCI. CSF Aß levels in early PD correlate with ventricular enlargement, previously associated with PD dementia. Therefore, CSF and MRI markers may help identify PD patients at high risk for developing cognitive decline and dementia in the course of their illness. Contrary to Alzheimer's disease, we found no associations between CSF t-tau and p-tau and hippocampal atrophy.

Verbal memory is associated with structural hippocampal changes in newly diagnosed Parkinson's disease.

BACKGROUND AND OBJECTIVE: Cognitive impairment, including impairment of episodic memory, is frequently found in newly diagnosed Parkinson's disease (PD). In this longitudinal observational study we investigated whether performance in memory encoding, retention, recognition and free recall is associated with reduced hippocampal radial distance. METHODS: We analysed baseline T1-weighted brain MRI data from 114 PD subjects without cognitive impairment, 29 PD subjects with mild cognitive impairment and 99 normal controls from the ParkWest study. Age- and education-predicted scores for the California Verbal Learning Test 2 (CVLT-2) and tests of executive function were regressed against hippocampal radial distance while adjusting for imaging centre. RESULTS: There was no association between encoding or performance on executive tests and hippocampal atrophy in the PD group. In the full PD sample we found bilaterally significant associations between lower delayed free recall scores and hippocampal atrophy in the CA1, CA3 and subiculum area (left, p=0.0013; right, p=0.0082). CVLT-2 short delay free recall scores were associated with bilateral hippocampal CA1 and subicular atrophy in the full PD sample (left, p=0.013; right, p=0.047). CVLT-2 recognition scores showed a significant association with right-sided subicular and CA1 atrophy in the full PD sample (p=0.043). CONCLUSIONS: At the time of PD diagnosis, subjects' verbal memory performance in recall and recognition are associated with atrophy of the hippocampus, while encoding is not associated with hippocampal radial distance. We postulate that impaired recall and recognition might reflect deficient memory consolidation at least partly due to structural hippocampal changes.

Hippocampal and ventricular changes in Parkinson's disease mild cognitive impairment.

We analyzed T1-weighted brain magnetic resonance imaging data of 100 cognitively normal elderly controls (NC), 127 cognitively normal Parkinson's disease (PD; PDCN) and 31 PD-associated mild cognitive impairment (PDMCI) subjects from the Norwegian ParkWest study. Using automated segmentation methods, followed by the radial distance technique and multiple linear regression we studied the effect of clinical diagnosis on hippocampal and ventricular radial distance while adjusting for age, education, and scanning site. PDCN subjects had significantly smaller bilateral hippocampal radial distance relative to NC. Nonamnestic PDMCI subjects showed smaller right hippocampal radial distance relative to NC. PDMCI subjects showed significant enlargement of all portions of the lateral ventricles relative to NC and significantly larger bilateral temporal and occipital and left frontal lateral ventricular expansion relative to PDCN subjects. Nonamnestic PDMCI subjects showed significant ventricular enlargement spanning all parts of the lateral ventricle while those with amnestic PDMCI showed changes localized to the left occipital horn. Hippocampal atrophy and lateral ventricular enlargement show promise as structural biomarkers for PD.

Ventricular enlargement and mild cognitive impairment in early Parkinson's disease.

Mild cognitive impairment (MCI) may predict future development of dementia in Parkinson's disease (PD). We aimed to examine the extent of subcortical brain atrophy in patients with early PD with and without MCI compared to normal controls (NC). Participating in a population-based study were 43 early, drug-naïve PD patients and 41 NC. Eleven patients were classified with MCI (MCI PD) and 32 patients without (non-MCI PD). Volumetric segmentation of 3D-T1 weighted brain MRI was performed using FreeSurfer. Groups were compared applying MANCOVA corrected for total intracranial volume, age, and sex. Results showed that left inferior lateral ventricle and third ventricle volumes were significantly larger in MCI PD than in non-MCI PD and NC. Fourth ventricular size in MCI PD was significantly different from NC and highly correlated with memory performance in MCI PD patients. This suggests that cognitive dysfunction in early PD may be associated with ventricular enlargement.

Evaluating rivastigmine in mild-to-moderate Parkinson's disease dementia using ADAS-cog items.

Rivastigmine has been shown to improve cognition in patients with Parkinson's disease dementia (PDD). To further explore the impact of anticholinesterase therapy on PDD, Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) items were assessed in a retrospective analysis of a 24-week, double-blind, placebo-controlled trial of rivastigmine. Mean changes from baseline at week 24 were calculated for ADAS-cog item scores and for 3 cognitive domain scores. A total of 362 patients were randomized to 3 to 12 mg/d rivastigmine capsules and 179 to placebo. Patients with PDD receiving rivastigmine improved versus placebo on items: word recall, following commands, ideational praxis, remembering test instructions, and comprehension of spoken language (P < .05), with standardized mean differences ranging from 0.04 to 0.30. Rivastigmine also showed significant effects versus placebo on all domains: memory, language, and praxis. The ADAS-cog is sensitive to broad cognitive changes in PDD. Overall, rivastigmine was associated with improvements on individual cognitive items and general cognitive domains.

Disturbance of automatic auditory change detection in dementia associated with Parkinson's disease: A mismatch negativity study.

OBJECTIVE: To investigate whether automatic auditory change detection, as measured by the mismatch negativity (MMN) event-related potential waveform, differs in dementia associated with Parkinson's disease (PDD) and dementia with Lewy-bodies (DLB) as compared to Alzheimer's disease (AD), Parkinson's disease without dementia (PD) and healthy control subjects (HC). METHOD: Seventeen DLB, 15 PDD, 16 PD, 16 AD patients and 18 HC subjects participated. A passive MMN event-related potential paradigm and an oddball-distractor reaction time paradigm were presented. RESULTS: The PDD patients had reduced MMN area and amplitude compared to the DLB, PD, and the HC groups. The MMN area correlated significantly with number of missed target stimuli in the oddball-distractor task, and the PDD group missed targets significantly more often than the DLB group. CONCLUSION: The results indicate that PDD patients to a larger degree than patients with DLB have a deficit of automatic auditory change detection that contributes to impairment in their ability to selectively attend and respond to deviant auditory stimuli.

Climate for work group creativity and innovation: Norwegian validation of the team climate inventory (TCI).

The present study assessed the psychometric properties and the validity of the Norwegian translation of the Team Climate Inventory (TCI). The TCI is a measure of climate for innovation within groups at work and is based on the four-factor theory of climate for innovation (West, 1990). Cronbach's alpha revealed satisfactory reliabilities and exploratory factor analysis successfully extracted the four original factors as well as a fifth factor that has also been reported in other studies (N = 195 teams from a wide range of professions). Results from confirmatory factor analysis, using a different sample (N = 106 teams from the Norwegian public postal service), suggested that the five-factor solution had the most parsimonious fit. Criterion validity was explored by correlating TCI scores from 92 post offices and 395 postal distribution teams with customer satisfaction scores. Significant positive relationships were found between three of four TCI scales and customer satisfaction.