Deep brain stimulation effects on memory.

As the population of many countries ages, disorders of cognition and memory-such as Alzheimer's Disease (AD) and dementia associated with Parkinson's Disease-will become a major societal burden. At present, few effective medical therapies against these conditions are available. Deep brain stimulation (DBS) may be a potential therapeutic option, because it can directly target and modulate the activity of structures implicated in circuits subserving memory function. In this article, we review the scientific literature to address some of the mechanisms by which DBS may impact memory and cognition. We then summarize the results of recent clinical experience with DBS in AD and Parkinsonian dementia.

The relations between social support, life stress, and quality of life following spinal decompression surgery.

STUDY DESIGN: Assessed social support, life stress, and quality of life among degenerative spine disease patients. OBJECTIVE: To examine how social support and life stress relate to quality of life following spinal decompression surgery among patients with degenerative spine disease. SETTING: Neurosurgical clinic at Saint Michael's Hospital in Toronto, Canada. METHODS: A total of 19 patients with degenerative spine disease who had undergone spinal decompression surgery within the past 14 months filled out social support, life stress, and quality of life questionnaires. Correlational techniques were used to assess the relations among the variables. RESULTS: The correlations between social support scores and health-related and nonhealth-related quality of life scores were r=0.72, P=0.001, and r=0.50, P=0.028, respectively. The correlations between life stress scores and health-related and nonhealth-related quality of life scores were r=-0.83, P<0.001, and r=-0.72, P=0.001, respectively. CONCLUSIONS: Degenerative spine disease patients experiencing more social support and less life stress tend to report greater satisfaction in medical outcome and overall quality of life following spinal decompression surgery than those with less social support and more life stress. Assessing social support and life stress in patients with degenerative spine disease and including a consideration of social support and life stress in the management of patients with degenerative spine disease could help to improve patients' satisfaction with their medical outcome and general quality of life following spinal decompression surgery.

The antioxidant enzyme quinone reductase is up-regulated in vivo following cerebral ischemia.

An astrocyte antioxidant enzyme, quinone reductase (QR), was studied in vivo to assess whether its activity was up-regulated following cerebral ischemia. Rats were given a unilateral focal cerebral infarct and regions of interest within the ischemic penumbra compared to the non-ischemic side for QR activity. At 7 days post-ischemia, QR activity was significantly up-regulated within cells of astrocyte morphology in the cortex (p = 0.007) and subcortical (p = 0.005) areas adjacent to the infarct. This enzyme activity peaked at 7 days but was still significantly up-regulated at 14 days. Up-regulation of QR activity occurs within the ischemic penumbra of a stroke in this animal model and may contribute to factors that limit ischemic damage to neurons in this area.

The woman who wanted electroconvulsive therapy and do-not-resuscitate status. Questions of competence on a medical-psychiatry unit.

A case involving an elderly woman suffering concurrently from serious psychiatric and medical illnesses is presented. Ethical considerations concerning her treatment on a medical-psychiatry unit are discussed with special attention to her requests for both electroconvulsive therapy (ECT) and do-not-resuscitate (DNR) status. The compatibility of simultaneous requests for ECT and DNR is examined on three levels. The effect of depression upon competence to request and refuse treatment is analyzed. This case illustrates a conflict between medical and psychiatric treatment goals and ethical traditions which will become more common as psychiatrists treat older and more medically ill patients.