Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease.

INTRODUCTION: Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD. METHODS: Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity. RESULTS: The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability. DISCUSSION: While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.

Freezing of gait subtypes have different cognitive correlates in Parkinson's disease.

BACKGROUND: Freezing of gait (FOG) is a major concern for Parkinson's disease (PD) patients because it is a leading cause of falls and is associated with poor quality of life. The pathophysiology is unknown but it is hypothesized that it relates to cognitive abnormalities; particularly executive and visuospatial dysfunction. However, prior results have been discrepant. Pharmacologic subtypes of FOG include those that are responsive and unresponsive to levodopa. OBJECTIVE: To determine whether executive and visuospatial dysfunction are associated specifically with the levodopa unresponsive subtype of FOG. METHODS: 135 PD subjects completed a single assessment included FOG questionnaire, UPDRS motor scale, comprehensive cognitive battery and measure of hallucinations. Analyses compared unresponsive (n = 16), responsive (n = 20) and no FOG (n = 99) subtypes. RESULTS: The unresponsive subtype had a significantly older age of onset of PD than the responsive group (p = .03) and had worse motor scores (p = .003) than the no FOG group. Longer disease duration was associated with the responsive group compared to the no FOG group (p = .002). The unresponsive FOG group had significantly poorer visuospatial ability (p = .001) and executive functioning (p = .02) than both the no and responsive FOG subgroups. These latter groups were not significantly different. The responsive FOG group was associated with the presence of hallucinations. CONCLUSION: Aside from pharmacological differences, unresponsive FOG is associated with executive and visuospatial dysfunction implicating frontostriatal pathways while responsive FOG is associated with hallucinations suggesting involvement of posterior cortical regions. Further study and treatment of FOG should include appropriate subtype classification.

Degeneración hepato lenticular: enfermedad de Wilson / Hepatolenticular degeneration: Wilson's disease

Estudio de un caso de Degeneración Hepato Lenticular (Enfermedad de Wilson) en un paciente joven. Se analizan los criterios clínicos y de laboratorio empleados en el diagnóstico, lo mismo que la actualización en el abordaje terapéutico de esta dolencia

Family educational intervention in the treatment of schizophrenia.

In the aftermath of deinstitutionalization, when current public policy dictates greater community management of schizophrenia, patients and their families play an increasing role in the treatment of the illness. Since mental health professionals often neglect to educate them on the causes, symptoms, and treatment of schizophrenia, patients and their families are often misinformed, fearful, and ill-equipped to aid in treatment. The authors describe a brief family educational intervention and the questionnaire that was used to compare the knowledge of patients and their families who received the intervention with the knowledge of those who did not. The findings suggest that patients and their families in family treatment programs can acquire and retain information about schizophrenia more readily than patients and families involved in individual treatment. This knowledge enables them to become more effective participants in aftercare and helps surmount the problems associated with posthospital adjustment.

Effect of aspirin and dexamethasone on intraocular pressure in primary uveitis produced by Herpes simplex virus.

The intracameral injection of New Zealand white male rabbits with type 1 herpes simplex virus produced acute anterior uveitis with biphasic elevation of the intraocular pressure (IOP). The first IOP increase occurred on day 1 and 2 and the second increase on day 8. There was no significant correlation between the IOP changes and multiplication of herpes simplex virus in the uvea and cornea, nor between the IOP changes and histopathologic alteration of the tissue. Aspirin suppressed significantly the first as well as the second IOP elevation, whereas dexamethasone suppressed significantly only the second elevation.

Proteus species isolated from human eyes.

Of 34 species of Proteus isolated from human eyes, 29 (85%) were P. mirabilis and five (15%) were P. morganii. In vitro antibiotic sensitivity studies showed that gentamicin best controlled both P. mirabilis and P. morganii of all the antibiotics tested. In vivo tests on experimental Proteus infections of rabbit coreas, treated with gentamicin and tobramycin, yielded comparable clinical results, but gentamicin was more effective in eliminating the organism from the experimental lesions.

Immune host response to corneal grafts sensitized to herpes simplex virus.

Experiments were performed to study the fate of corneal grafts sensitized to herpes antigens when grafted to HSV-sensitized hosts. Nonsensitized grafts in systemically sensitized hosts remained clear, whereas all locally sensitized grafts in systemically sensitized hosts became opaque within ten days. The stroma showed severe lymphocytic and plasma cell infiltration and neovascularization. One-half of the corneas from systemically sensitized hosts grafted to eyes previously infected opacified in an accelerated manner. Round cells were found in the stroma and endothelium. The histological reaction in both groups was similar to that found in the immune graft reaction even though the clinical picture was not typical (peripheral and progressive edema with a rejection line). The accelerated reaction was probably related to the presence of virus antigens in graft stroma and subepithelial areas of the graft. The significance of HSV-sensitized donor tissue grafted onto HSV-sensitized hosts is discussed because of its possible implication in tissue transplantation.

Corneal chromomycosis: double infection by Phialophora verrucosa (Medlar) and Cladosporium cladosporioides (Frescenius).

Phialophora verrucosa and Cladosporium cladosporioides were isolated from a corneal ulcer. The lesion had been previously treated with antivirals and steroids and did not respond to Pimaricin therapy or conjunctival flap. A penetrating keratoplasty was performed with good functional and optical results. Chromomycosis of the cornea is an unusual infection. This is the second case of Phialophora in Florida and the first case of Cladosporium infection.