Do baseline WAIS-III subtests predict treatment outcomes for depressed inpatients receiving fluoxetine?

This study aimed to determine whether baseline WAIS-III subtests could be associated with treatment outcomes for patients with major depressive disorder (MDD) receiving a 6-week fluoxetine treatment. A total of 131 acutely ill MDD inpatients were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Eight WAIS-III subtests were administered at baseline. Symptom severity and functional impairment were assessed at baseline, and again at weeks 1, 2, 3, 4, and 6 using the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Modified Work and Social Adjustment Scale (MWSAS), respectively. The generalized estimating equations method was used to analyze the influence of potential predictors over time on the HAMD-17 and MWSAS, after adjusting for covariates. Of the 131 participants, 104 (79.4%) who completed 8 WAIS-III subtests at baseline and had at least one post-baseline assessment were included in the analysis. Patients with lower forward digit span scores were more likely to have poor treatment outcomes, both measured by HAMD-17, and by MWSAS. Forward digit span may be clinically useful in identifying MDD patients with greater treatment difficulty in symptoms and functioning. Other neurocognitive tests to predict treatment outcome require further exploration.

Higher levels of thyroxine may predict a favorable response to donepezil treatment in patients with Alzheimer disease: a prospective, case-control study.

BACKGROUND: Cholinergic hypothesis has been advanced as an etiology of Alzheimer disease (AD) on the basis of the presynaptic deficit found in the diseased brains, and cholinesterase inhibitors (ChEIs) are the treatment of choice for these patients. However, only about half of treatment efficacy was found. Because increasing evidence supports an extensive interrelationship between thyroid hormones (THs), cortisol level and the cholinergic system, the aim of the present study was to evaluate thyroid function and cortisol level in patients with mild to moderate AD before and after ChEIs treatment, and to identify possible variations in response. This was a prospective, case-control, follow-up study. Levels of cortisol and THs were evaluated in 21 outpatients with mild to moderate AD and 20 normal controls. All patients were treated with 5 mg/day of donepezil (DPZ) and were reevaluated after 24-26 weeks of treatment. RESULTS: The patients had worse cognitive function, higher cortisol level, and lower levels of triiodothyronine (T3) and its free fraction than the controls. There were no significant differences in global cognitive function or cortisol level after treatment, however, significant reductions in T3 and thyroxin (T4) levels were observed. Responders had higher levels of T4 than non-responders, followed by a significant reduction after treatment. CONCLUSIONS: These results suggest that relatively higher levels of T4 may predict a favorable response to DPZ treatment. Further studies are warranted to confirm the relationship between THs and ChEIs therapy in AD and to explore new therapeutic strategies. On the other hand, cortisol levels are more likely to respond to interventions for stress-related neuropsychiatric symptoms in patients with AD rather than ChEIs treatment. Further studies are warranted to investigate the association between cortisol level and the severity of stress-related neuropsychiatric symptoms in patients with AD.

Parallel improvement of cognitive functions and P300 latency following donepezil treatment in patients with Alzheimer's disease: a case-control study.

PURPOSE: To evaluate the effect of donepezil, one of the cholinesterase inhibitors, on P300 measurements in patients with Alzheimer's disease (AD) and investigate the relationship between the subfactors of cognitive performance and P300 components. METHODS: One hundred outpatients with AD were evaluated for cognitive function (cognitive ability screening instrument) and event-related potentials before and after 22 to 23 weeks of treatment with donepezil (5 mg/day). Twenty age-matched normal control subjects were recruited. RESULTS: The patients with AD showed prolonged P300 and N200 latency, no significant differences in N100 and P200 components, and poor performance in neuropsychological assessments compared with control subjects at baseline. After donepezil treatment, the patients with AD had reduction in P300 latency at Pz lead, which was associated with a parallel improvement in cognitive function in terms of remote memory, recent memory, visual instruction, and orientation. The pre-post treatment difference of P300 latency significantly correlated with the cognitive ability screening instrument score difference and recent memory score difference, respectively. CONCLUSIONS: The patients with AD still had intact early sensory processing but impaired higher-level cognitive processes that could influence behavior deviation. The donepezil treatment, which enhances higher-level cognitive processing time, revealed that P300 latency decreases as cognitive capability increases, especially improved in recent memory.

Impairment of perceptual and motor abilities at the end of a night shift is greater in nurses working fast rotating shifts.

OBJECTIVE: A three-shift work schedule with fast rotation is common among healthcare workers in Taiwan. This study compared cognitive performance at the time of maximum fatigue (3-4am on the last night shift of the rotation) between nurses working two, three, and four consecutive night shifts. METHODS: Sixty-two nurses [mean age 26.4 (standard deviation 2.0) years] were recruited from the acute psychiatric ward and assigned at random to three groups: two, three, and four consecutive night shifts. The exclusion criteria were: current use of hypnotic drugs, regular consumption of coffee, psychiatric illness, major systemic disease, and sleep disorders. Cognitive performance was assessed using the State-Trait Anxiety Inventory, Stanford Sleepiness Scale, Wisconsin Card Sorting Test, Taiwan University Attention Test, Digit Symbol Substitution Test, and Symbol Searching Test. RESULTS: Greater impairment of perceptual and motor ability was seen among subjects who worked two consecutive night shifts compared with those who worked four consecutive night shifts. No differences in demographic data, executive function or attention were found between the three groups. CONCLUSION: The main duties of nurses working night shifts at the study hospital include checking medical orders and prescriptions, which require perceptual and motor abilities. The results of this study suggested that a fast shift rotation may increase the risk of medical errors.

Correlation of attention deficit, rapid eye movement latency and slow wave sleep in schizophrenia patients.

AIM: Schizophrenia patients present both reduced slow wave sleep (SWS) and shortened rapid eye movement latency (REML) in polysomnographic (PSG) profiles, which have been linked to dopaminergic and muscarinic impairment, respectively. Two main selective attentional systems involve different anatomical structures. The first system is the parietal cortical areas and thalamic areas, which are linked to cholinergic neurotransmission. This is responsible for automatic attention response. The second system is the frontal regions, which are linked to dopaminergic neurotransmission. This is responsible for voluntary control of attentional resources. It was hypothesized that low attentional performance in schizophrenia patients is associated with shortened REML and reduced SWS. METHODS: The PSG profile was correlated with the continuous performance test (CPT) in 15 schizophrenia inpatients under treatment with risperidone. Schizophrenia was diagnosed according to DSM-IV criteria, and clinical symptoms were evaluated on the Brief Psychiatric Rating Scale. RESULTS: REML was negatively correlated with errors of omission (P < 0.05), reaction time (RT; P < 0.05) and positively correlated with hit rate (HR; P < 0.05). No association was found between SWS and CPT performance. CONCLUSIONS: The significant indicators of CPT represent different attention processes. Errors of omission, which are linked to the problems with automatic attention processing, RT, which represent the speed of automatic processing, and HR, are involved in the integration of autonomic and voluntary attention control. The present results suggest that REML is associated with thalamus-related automatic attention response. Due to study limitations, however, confirmation of these findings in a large-scale controlled study of drug-naïve patients is needed.