White matter hyperintensities and medication adherence.

White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = -.25) and with higher systolic blood pressure (rs = .46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = -.53, p < .05). Adherence was associated with immediate memory (rs = .54, p < .05) and inversely associated with failure to maintain set on the Wisconsin Card Sorting Test (WCST; rs = -.61, p < .05). These findings provide preliminary evidence for the association between WMH, assessments of prefrontal function, and medication adherence.

The negative association of independent personality and medication adherence.

OBJECTIVE: This investigation examines the association of personality factors and medication adherence among older adults. METHOD: The Six-Factor Personality Questionnaire was mailed to participants involved in a medication adherence investigation. Medication adherence was monitored with an electronic monitoring cap for 8 weeks for one prescribed daily medication. RESULTS: Sixty older adults, mean age 77 years (range 67 to 93 years), returned the questionnaire (69% response rate). Stepwise regression analysis demonstrates that when age and level of education are controlled, independence predicts medication adherence. This factor demonstrates a negative relationship with adherence suggesting that higher levels of independence may be related to lower adherence to prescribed medication. The facet component self-reliance is predictive of poor medication adherence. DISCUSSION: The finding that higher self-reliance is associated with lower adherence in an older population deserves further investigation and clinical consideration.

A case of psychogenic fugue: I understand, aber ich verstehe nichts.

Psychogenic fugue is a disorder of memory that occurs following emotional or psychological trauma and results in a loss of one's personal past including personal identity. This paper reports a case of psychogenic fugue in which the individual lost access not only to his autobiographical memories but also to his native German language. A series of experiments compared his performance on a variety of memory and language tests to several groups of control participants including German-English bilinguals who performed the tasks normally or simulated amnesia for the German language. Neuropsychological, behavioral, electrophysiological and functional neuroimaging tests converged on the conclusion that this individual suffered an episode of psychogenic fugue, during which he lost explicit knowledge of his personal past and his native language. At the same time, he appeared to retain implicit knowledge of autobiographical facts and of the semantic or associative structure of the German language. The patient's poor performance on tests of executive control and reduced activation of frontal compared to parietal brain regions during lexical decision were suggestive of reduced frontal function, consistent with models of psychogenic fugue proposed by Kopelman and Markovitsch.

Factors associated with fatigue, sleep, and cognitive function among patients with head and neck cancer.

BACKGROUND: Fatigue, sleep disturbances, and cognitive impairment are prevalent and clinically important problems among head and neck cancer patients. Our study aim was to determine the most important correlates of these problems among patients with head and neck cancer. METHODS: A cross-sectional, self-administered survey was completed by 58 (response rate 79%) patients with head and neck cancer in an academic oncology clinic. RESULTS: Multiple linear-regression analyses demonstrated that fatigue was associated with younger age (beta=-0.22), previous radiation therapy (beta=0.23), fewer months since cancer diagnosis (beta=-0.25), and depression (beta=0.40). Sleep dysfunction was associated with younger age (beta=-0.31) and higher symptom index (beta=0.39). Cognitive dysfunction was associated with higher symptom index only (beta=-0.49). CONCLUSIONS: Younger age, previous radiation, more recent cancer diagnosis, depression, and more severe symptoms may be associated with fatigue, sleep, and/or cognitive dysfunction. These results suggest at-risk subgroups warranting more aggressive screening and potentially supportive care interventions.

Bilateral hippocampal volume predicts verbal memory function in temporal lobe epilepsy.

The present study used quantitative volume estimates of the hippocampus based on structural magnetic resonance imaging (MRI) to predict memory performance of individuals with epilepsy of temporal lobe origin (TLE). Twenty individuals with TLE completed standardized neuropsychological tests and a quality of life inventory, and participated in a brain MRI protocol designed to obtain high-resolution images of the hippocampus. The combined volume of the left and right hippocampi was found to be the best predictor of objective verbal memory performance. This finding is consistent with the functional adequacy model of hippocampal function. In contrast, the asymmetry between right and left hippocampal volume was the best predictor of subjective ratings of cognitive functioning, which is consistent with the functional reserve model. The collective and complementary functions of the left and right hippocampi merit further exploration in prospective studies of memory function and TLE.