Donepezil in Alzheimer's disease: eighteen month results from Southampton Memory Clinic.

The objective of this study was to assess the efficacy of donepezil in patients with mild to moderate Alzheimer's disease (AD) in clinical practice. This was an open-label study in which patients were referred to an elderly mental health clinic in Southampton, UK. Eighty patients with mild to moderate AD received 5 mg/day donepezil for the first 4 weeks, after which, if tolerated, the dose was increased to 10 mg/day. Efficacy and safety assessments were carried out every 3 months. Efficacy was assessed by the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Neuropsychiatric Inventory-carer Distress Scale (NPI-D). Mean improvements from baseline were observed at the 3-month assessment on all four efficacy measures. At 3 months, 39% of patients showed an improvement of at least 4 points on the ADAS-cog, and 37% of patients had improved by 4 points or more on the NPI. In those patients who showed improvement and were maintained on donepezil, improvements were sustained for 18 months on the MMSE and NPI, 15 months on the NPI-D, and for 6 months on the ADAS-cog. Six per cent of patients discontinued medication due to adverse events. In a typical clinical practice setting, patients with mild to moderate AD tolerated donepezil well. Clinically meaningful improvements in cognitive function and a reduction in neuropsychiatric symptoms were demonstrated in nearly 40% of patients with associated reduction in carer distress. Continued benefit was seen for up to 18 months in the selected group of patients who initially responded in treatment.

Use of significance image to determine patterns of cortical blood flow abnormality in pathological and at-risk groups.

UNLABELLED: The purpose of this work was to determine whether certain pathological groups and other groups at risk for neurological damage exhibited distinctive patterns of regional cerebral blood flow (rCBF) abnormality. METHODS: HMPAO SPECT images obtained from six groups of subjects were compared with a normal cortical rCBF atlas, based on multivariate, voxel-by-voxel methods. In each case, a significance image was outputted, highlighting voxels with deficits of > or =3 s.d. of normal. Abnormal patterns were examined for the six groups, which comprised a further 40 normal volunteers, 18 diver controls, 50 divers with decompression illness (DCI), 34 boxers, 23 schizophrenics and 21 subjects with Alzheimer's disease. RESULTS: The percentages of abnormal cortical voxels for each group were 0.41%, 0.53%, 1.38%, 1.05%, 0.56% and 2.24%, respectively. The percentages of images in each group with at least one lesion of 10 or more connected abnormal voxels and at least 10 lesions of two or more connected voxels, respectively, were 8% and 8% (normal volunteers), 17% and 11% (diver controls), 38% and 38% (divers with DCI), 41% and 29% (boxers), 26% and 13% (schizophrenics) and 90% and 48% (subjects with Alzheimer's disease). This suggests that multiple small lesions are as common as single large lesions for divers with DCI but not for patients with Alzheimer's disease or schizophrenia. Large lesions are located predominantly in the parietal and inferior temporal regions for Alzheimer's disease, in the parietal and occipital regions for divers with DCI and boxers and in the inferior frontal region for schizophrenia. CONCLUSION: It appears that the groups considered here do have different rCBF patterns and that the significance image is a useful way of demonstrating this fact.

Obsessive-compulsive disorder occurring as a complication in benzodiazepine withdrawal.

A case history of obsessive-compulsive disorder occurring in a 32-year-old woman after benzodiazepine withdrawal is presented. The possible biochemical and neuropsychological mechanisms involved in the etiology and maintenance of this condition are reviewed.

A comparison of intelligence and social maturity in children with unilateral complete clefts and those with isolated cleft palates.

Intelligence and social development were evaluated in 226 subjects with palatal clefts. The subjects were divided into four groups composed of 111 with unilateral complete clefts of the lip and palate (Unilateral Group); 16 with unilateral complete clefts with associated congenital malformations (Unilateral-C Group); 76 with clefts of the palate only (Palatal Group; and 39 with clefts of the palate only with other congenital malformations (Palatal-C Group). Comparisons among groups suggested that subjects in the Unilateral Group were most competent both mentally and socially followed by those in the Palatal, Unilateral-C, and Palatal-C Groups. The presence of congenital abnormalities other than cleft increased the risk of developmental disabilities, particularly in subjects with isolated palatal clefts.

A review of the results of two different surgical procedures for the repair of clefts of the soft palate only.

This study evaluated results of the two surgical procedures for repair of cleft palate. Simple closure using the Von Langenbeck technique was compared with the V-Y retroposition technique as modified by Wardill and Kilner. The population consisted of two groups of children who were similar in chronological age and intelligence and for whom surgery was performed at an average age of 1 year, 11 months, in the simple closure group and 1 year, 8 months, in the V-Y repair group. In the early pre-school years, the children were evaluated in the areas of intelligence, language, hypernasality hearing, articulation, and voice quality. The two groups were found to be roughly similar in intelligence, language, and articulation at that time. The simple closure group was at first found to be slightly more hoarse than the V-Y repair group while the latter was found to have slightly more hypernasality. Hearing acuity was somewhat poorer in the simple closure group. The final evaluation was carried out when the mean chronological ages were 10 years, 1 month, for the simple closure group and 10 years, 2 months, for the V-Y repair group. Included in the second assessment were measurements of intelligence, language, articulation, nasal resonance, hoarseness, nasal emission, hearing, and velopharyngeal closure, The groups were judged to roughly comparable in intelligence, language, articulation, hypernasality, nasal emission, and velopharyngeal closure. A difference between groups occurred in regard to hearing acuity where the simple closure group showed slightly more hearing loss. This group was also judged to have more hoarseness. In regard to velopharyngeal closure, it was noted that all subjects in both groups had mechanisms of adequate or borderline efficiency. However, the children in the simple closure group compared as well as they did with the V-Y retroposition group only after 27 per cent had had secondary procedures as compared to 11 per cent in the V-Y repair group...