Response to Algarabel et al., 2012 "Recognition memory deficits in mild cognitive impairment". Reconsidering claims of familiarity disruptions in mild cognitive impairment.

There is some debate over the relative impairment of recollection and familiarity in mild cognitive impairment (MCI). A recent publication by Algarabel et al. (2012, Recognition memory deficits in mild cognitive impairment, Aging, Neuropsychology, and Cognition, 19, 608-619) claims to undermine previous studies reporting preserved familiarity in patients with MCI. Here, we respond to their main criticisms, concluding that they are not sufficiently supported by the data presented. The role of recollection and familiarity in MCI remains unresolved and further work will be required to disentangle the mixed literature.

The prevalence of migraine in women aged 40-74 years: a population-based study.

The objective of this study was to investigate the age-dependence of the prevalence and characteristics of migraine headache and migraine visual aura. A neurologist interviewed 728 women attending a mammography screening programme. International Headache Society (IHS) criteria were used. The lifetime prevalence of migraine headache was 31.5% and the 1-year prevalence 18.0%. The magnitude of the decline of the prevalence of active (one or more attacks in the previous year) migraine headache was estimated to 50% per decade. The prevalence of active migraine visual aura was 3.8%. This did not vary by age. Except for the pain intensity and the presence of nausea, other characteristics and concomitant symptoms did not change with age. Active migraine headache and migraine visual aura in middle-aged and older women are common and modified differently by age. We suggest that the decline of prevalence of active migraine headache with age is caused by a decrease in pain intensity.

The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain-generating mechanisms.

Forty-two patients with subacromial impingement syndrome entered a randomized prospective study comparing open anterior acromioplasty with a physiotherapy regime. The criterion for a successful outcome of treatment was a reduction of the initial pain score of more than 50% using the visual analogue scale (VAS) technique. The evaluation was performed by an independent observer. At the 6-month follow-up, treatment in the surgical group had been successful in 12/21 (57%) patients versus 6/18 (33%) in the physiotherapy group. A one-year evaluation revealed 16/21 (76%) "successes" in the surgical group. A direct and unbiased comparison with the physiotherapy group was not possible at one year, since 13 patients chose surgery after initial physiotherapy. However, in "an intention to treat" analysis outcome at one year was significantly better in those randomized to surgery. We found two standardized, composite, active movements--the "Pour out of a Pot" manoeuvre requiring the emptying of a pot of water, and the "Hand in Neck" manoeuvre--to be of predictive value for the outcome of surgery. When combining three pain-related variables into a criterion for prediction of success, a sensitivity of 78% (p < 0.02) and a specificity of 90% (p < 0.03) were attained. We advance the hypothesis that pain in the impingement syndrome is mainly elicited by comparison of the subacromial bursa. In some patients a traction-responsive pain generator in the supraspinatus tendon may be present as well.

The reliability of three active motor tests used in painful shoulder disorders. Presentation of a method of general applicability for the analysis of reliability in the presence of pain.

This article deals with reliability aspects of standardized, active motor tests ("functional tests") when applied to patients with painful shoulder disorders. Motor performance was rated independently by the same two examiners in a standardized way in three different manoeuvres: the Hand in Neck, Hand in Back, and Pour out of a Pot tests. Pain experienced during these tests was rated by the patients on a verbal scale. A method of general applicability is presented for the analysis of reliability of standardized, active motor tests when applied to painful shoulder joint disorders. The importance of differential motivation is stressed, as is the importance of using reliability measures that are adapted to the specific purpose of a particular clinical investigation.

Pain is a major determinant of impaired performance in standardized active motor tests. A study in patients with fracture of the proximal humerus.

We have followed the recovery of motor performance and the subsidence of pain for one year in 12 patients after fracture of the proximal humerus. Performance scores during standardized active motor tests were recorded 3, 8, 16, 24, and 52 weeks after injury, and the pain ratings during each of three manoeuvres were assessed on a modified Borg verbal scale. The manoeuvres were: Hand in Neck, Hand in Back, and Pour out of a Pot. In a cross-sectional analysis of data obtained 3 weeks after injury, significant correlations were found between movement-induced pain and impairment of performance in all three tests. A multivariate analysis indicated a strong association between decreasing pain and increasing performance and this was significant after elimination of the influence of healing as measured by time. In contrast, the association between time and increasing performance, after eliminating of the influence of decreasing pain, was weak and non-significant. It is concluded that pain is a major determinant of impaired performance after fracture of the proximal humerus, and that performance scores in standardized active motor tests are inversely correlated with the amount of movement-induced pain.

Positron emission tomography with [11C]deuterium-deprenyl in temporal lobe epilepsy.

We performed positron emission tomography (PET) with [11C]deuterium-deprenyl in 9 patients with temporal lobe epilepsy (TLE) undergoing evaluation for possible epilepsy surgery. Seven patients had unilateral and 2 had bilateral mesiotemporal epileptic foci based on the preoperative investigation including ictal EEG discharges and PET with 2-[18F]fluoro-2-deoxyglucose (FDG). Deprenyl is an irreversible inhibitor of monoamine oxidase type B (MAO-B) with a very high affinity for the enzyme. In the brain, MAO-B is preferentially located in astrocytes, and a previous in vitro study showed increased binding of the ligand in sclerotic hippocampi. Dynamically acquired N-[methyl-11C]-a,a-di-deutero-L-deprenyl distribution in PET images were analyzed graphically, and the focus regions were assessed visually on the PET images. In addition, the accumulation rate and distribution volume of the tracer relative to the cerebellar cortex were measured in standardized homologous temporal regions by semiquantitative methods. Uptake of [11C]deuterium-deprenyl was significantly increased in the epileptogenic temporal lobes, both apparently and semiquantitatively. By calculating mean interlobar ratios, we identified the temporal lobe containing the epileptic focus in six unilateral cases. One case was ambiguous but was not falsely localized. The two bilateral cases were correctly identified as such. Our results suggest that PET with [11C]deuterium-deprenyl might be a useful method for identification of epileptogenic temporal lobes.

The hand in neck manoeuvre as a tool to analyze pain-generating mechanisms in the subacromial impingement syndrome.

A scoring system for a standardized composite movement of the shoulder--the Hand in Neck (HIN) manoeuvre--is presented. The EMG activity of the supraspinatus muscle was studied in 5 healthy subjects at different performance levels of this test. It is shown that the supraspinatus muscle is about four times more active during normal performance than at the subnormal levels, which among themselves do not differ. EMG activity was also studied during normal performance of another standardized manoeuvre--the Pour out of a Pot (POP) test. Based on a comparison of the EMG data with clinical data from patients with the subacromial impingement syndrome it is suggested that an abnormal HIN test indicates the presence of a traction responsive pain generator in the supraspinatus tendon. In the same patient group, the combination of a normal HIN test and an abnormal POP test indicates pain generated by compression of subacromial structures.

The influence of scapular retraction and protraction on the width of the subacromial space. An MRI study.

The width and configuration of the subacromial space was studied in retraction and protraction of the shoulder girdle in four healthy subjects by magnetic resonance imaging. The anterior opening of the subacromial space narrowed as the shoulder moved from a retracted to a protracted position.

The subacromial bursa and the impingement syndrome. A clinical and histological study of 30 cases.

Biopsies from the subacromial bursa were obtained from 30 patients with an impingement syndrome and from an autopsy series of 13 "normal" shoulders. Bursal fibrosis seemed to be a characteristic of the patient group; inflammatory cells, found in 7/30 specimens from the patients, were not found in the autopsy series. The microscopic findings could not be predicted from peroperative observations. There was an association between a poor outcome of surgery and absence of bursal fibrosis.

Syncope induced by glossopharyngeal neuralgia: sympathetic outflow to muscle.

We studied a patient who regularly developed asystole and fainted during attacks of glossopharyngeal neuralgia. A cardiac pacemaker did not prevent syncope. Spontaneous sympathetic activity in muscle nerves disappeared during the attacks, and blood pressure fell despite a functioning pacemaker. Fainting probably resulted from abnormal spread of afferent impulses from the neuralgic trigger zone in the pharynx to brainstem vasomotor centers. Presumably, the pacemaker failed to prevent syncope because of the profound sympathetic inhibition that coincided with cardiac vagal excitation.

Acute pandysautonomia and severe sensory deficit with poor recovery. A clinical, neurophysiological and pathological case study.

A patient with acute loss of autonomic functions and virtually all afferent functions of peripheral nerves is described. The course was chronic and the outcome fatal. The clinical course was followed with measurements of sensory thresholds and conduction velocities, autonomic tests and microneurographic recordings. Neuropathological changes were severe and localised in the peripheral nervous system. Previously reported similar cases were reviewed. It was concluded that acute pandysautonomia is a disorder similar to the Guillain-Barré syndrome; the course is often protracted and residual neurological deficit common.

Pseudoclaudication syndrome caused by a tumour of the cauda equina.

A typical case of pseudoclaudication syndrome (neurogenic intermittent claudication), where the cause of the lumbar spinal canal narrowing was an intraspinal neoplasm, is reported. A neoplasm as the cause of this syndrome seems to be very rare, possibly because of the progressive nature of the space-occupying lesion and hence the rapid development of other predominant symptoms.

Intermittent bladder paresis in the pseudoclaudication syndrome.

The pseudoclaudication syndrome, now a well known neurological entity, can simulate intermittent claudication of arterial origin in its clinical appearance. Walking and sometimes simply standing upright for a while can cause transitory pain, numbness or weakness in the legs. The symptoms are caused by entrapment of the cauda equina fibers. Intermittent bladder paresis with total inability of micturition despite urgency to void may sometimes be a prominent feature of the syndrome, a fact that seems to be less well known as seen from a review of the literature.

Recurrent and reversible cerebellar ataxia with concomitant episodes of hyperthyroidism: a new autoimmune syndrome.

A new disorder with possible autoimmune background is described in a 67-year-old man. He had experienced episodes of cerebellar ataxia induced by infections over the last 40 years. In 1963 he had thyrotoxicosis. The patient underwent bilateral subtotal thyroidectomy. Recently it has been possible to detect involvement also of his remaining thyroid gland, with findings compatible with hyperthyroidism concomitant with his cerebellar atixia.