Validity and reliability of State-Trait Anxiety Inventory in Danish women aged 45 years and older with abnormal cervical screening results.

BACKGROUND: State Trait Anxiety Inventory (STAI) scale was developed in the 1980's and has been widely used both in clinical settings and in research. However the Danish version of STAI has not been validated. The aim of this study was to assess the validity and reliability of STAI - state anxiety scale in Danish women aged 45 years and older with abnormal cervical cancer screening results. METHODS: Women ≥45 years referred with an abnormal cervical cytology and healthy volunteers (n = 12) underwent cognitive interview after completing STAI. Further, STAI was sent out in an electronic questionnaire to women (n = 109) seen at the gynecological department with abnormal cervical cancer screening test during 2018. Validity and reliability of STAI was evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist by examining internal consistency, test-retest reliability, measurement error, floor and ceiling, construct validity and content validity. RESULTS: In the cognitive interviews the content validity was evaluated to be very good. The internal consistency of the scale was excellent with Cronbach's α = 0.93. Test-retest reliability was good with an intra-class correlation coefficient of 0.80 and the systematic difference between test-retest results was negligible. The construct validity was good. CONCLUSION: To our best knowledge, this is the first validation study of the Danish translation of STAI-state anxiety scale. This version of STAI demonstrates an acceptable reliability and validity when used in a gynecological setting.

A systematic surveillance programme for infectious salmon anaemia virus supports its absence in the Pacific Northwest of the United States.

In response to reported findings of infectious salmon anaemia virus (ISAV) in British Columbia (BC), Canada, in 2011, U.S. national, state and tribal fisheries managers and fish health specialists developed and implemented a collaborative ISAV surveillance plan for the Pacific Northwest region of the United States. Accordingly, over a 3-1/2-year period, 4,962 salmonids were sampled and successfully tested by real-time reverse-transcription PCR. The sample set included multiple tissues from free-ranging Pacific salmonids from coastal regions of Alaska and Washington and farmed Atlantic salmon (Salmo salar L.) from Washington, all representing fish exposed to marine environments. The survey design targeted physiologically compromised or moribund animals more vulnerable to infection as well as species considered susceptible to ISAV. Samples were handled with a documented chain of custody and testing protocols, and criteria for interpretation of test results were defined in advance. All 4,962 completed tests were negative for ISAV RNA. Results of this surveillance effort provide sound evidence to support the absence of ISAV in represented populations of free-ranging and marine-farmed salmonids on the northwest coast of the United States.

Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.

BACKGROUND: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. METHODS: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (> or = 65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. RESULTS: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had > 4 prescribed drugs at admission and scored less well in the SPMSQ test. CONCLUSION: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.

The works of living social insects as pseudofossils and the age of the oldest known metazoa.

Living organisms are known to create structures in ancient rocks that are indigenous but not primary and that have been mistaken for fossils. Examination of burrows recently reported as fossils from 10(9)-year-old sedimentary rocks indicates that they are not the same age as the rocks but were probably made by termites working down after water. The burrows are partially filled with material from a modern lateritic surface from which they descend into steeply dipping, decomposed silt-stones of the Zambian Copperbelt. In fact, no authentic record of Metazoa that are demonstrably coeval with rocks older than 680 million years is known.

Response during Sleep with Intervening Waking Amnesia.

During stage 1 sleep, subjects responded to suggestions on two or more nights, up to 5 months apart. While they were awake they did not recall the material to which they successfully responded while asleep on a subsequent night.

ADHD in adult psychiatry. Minimum rates and clinical presentation in general psychiatry outpatients.

The objective of the study was to determine the prevalence and comorbidity of persisting attention-deficit hyperactivity disorder (ADHD) in adult psychiatric outpatients. Consecutive patients, first visits excluded, at a general psychiatric outpatient clinic were offered a screening for childhood ADHD with the Wender Utah Rating Scale (WURS). One hundred and forty-one patients out of 398 (35%) completed and returned the scale. Patients above or near cut-off for ADHD (n=57) were offered an extensive clinical evaluation with psychiatric as well as neuropsychological examination. The attrition was analysed regarding age, sex and clinical diagnoses. Out of the screened sample, 40% had scores indicating possible childhood ADHD. These 57 patients were invited to the clinical part of the study, but 10 declined assessment, leaving 47 (37 women and 10 men) who were actually examined. Thirty of these (21 women and nine men) met diagnostic criteria for ADHD at the time of examination. Among the patients with ADHD, affective disorders were the most common psychiatric diagnoses. The rate of alcohol and/or substance abuse, as noted in the medical records, was also high in the ADHD group. In the WURS-screened group, 22% (30 patients assessed as part of this study and one person with ADHD previously clinically diagnosed) were shown to have persisting ADHD. Therefore, it is clearly relevant for psychiatrists working in general adult psychiatry to have ADHD in mind as a diagnostic option, either as the patient's main problem or as a functional impairment predisposing for other psychiatric disorders.

Connectivity-based risk ranking of infectious salmon anaemia virus (ISAv) outbreaks for targeted surveillance planning in Canada and the USA.

Infectious salmon anaemia (ISA) can be a serious viral disease of farmed Atlantic salmon (Salmo salar). A tool to rank susceptible farms based on the risk of ISA virus (ISAv) infection spread from infectious farms after initial incursion or re-occurrence in an endemic area, can help guide monitoring and surveillance activities. Such a tool could also support the response strategy to contain virus spread, given available resources. We developed a tool to rank ISAv infection risks using seaway distance and hydrodynamic information separately and combined. The models were validated using 2002-2004 ISAv outbreak data for 30 farms (24 in New Brunswick, Canada and 6 in Maine, United States). Time sequence of infection spread was determined from the outbreak data that included monthly infection status of the cages on these farms. The first infected farm was considered as the index site for potential spread of ISAv to all other farms. To assess the risk of ISAv spreading to susceptible farms, the second and subsequent infected farms were identified using the farm status in the given time period and all infected farms from the previous time periods. Using the three models (hydrodynamic only, seaway-distance, and combined hydrodynamic-seaway-distance based models), we ranked susceptible farms within each time interval by adding the transmission risks from surrounding infected farms and sorting them from highest to lowest. To explore the potential efficiency of targeted sampling, we converted rankings to percentiles and assessed the model's predictive performance by comparing farms identified as high risk based on the rank with those that were infected during the next time interval as observed in the outbreak data. The overall predictive ability of the models was compared using area under the ROC curve (AUC). Farms that become infected in the next period were always within the top 65% of the rank predicted by our models. The overall predictive ability of the combined (hydrodynamic-seaway-distance based model) model (AUC = 0.833) was similar to the model that only used seaway distance (AUC = 0.827). Such models can aid in effective surveillance planning by balancing coverage (number of farms included in surveillance) against the desired level of confidence of including all farms that become infected in the next time period. Our results suggest that 100% of the farms that become infected in the next time period could be targeted in a surveillance program, although at a significant cost of including many false positives.

Expert Elicitation Provides a Rapid Alternative to Formal Case-Control Study of an H7N9 Avian Influenza Outbreak in the United States.

An expert elicitation was staged to rapidly decipher plausible routes and risks of pathogen transmission in the 2017 H7N9 avian influenza (AI) outbreak in the four-state region of Tennessee, Alabama, Georgia, and Kentucky. The process included the identification of risk factors found in a preponderance of commercial broiler breeder case farms over matched controls and an opinion-based weighting of risks and mitigations perceived influential to this outbreak. Although the two highly pathogenic AI case farms had general location and company ownership in common, obvious connections were lacking for the remainder of H7N9-infected (all low pathogenicity) commercial farms. Expert elicitation of differences between known cases and controls suggested a key role for environmental rather than lateral (business network) pathways in the distribution of low pathogenicity AI across commercial broiler breeder operations. Factors with greatest strength as predictors of disease, whether or not they were causal, included mesopredator or rodent incursions, enclosure defects, and habitat disturbance that might attract wildlife to the farm (e.g., feed spills and vacating of neighboring properties). Business affiliations that may have facilitated farm-to-farm transfer, in contrast, were limited. Biosecurity standards varied across this study group but were no more or less stringent among cases over controls. However, results from a parallel hypothetical scenario staged to address field data gaps suggest that uniformity and consistency in the implementation of biosecurity practices may impact risk of disease introduction. Importantly, this study was conducted within a few weeks and with little disruption to emergency response activities. As such, the approach offers an alternative model for interim field investigation of new or emerging high-consequence diseases with immediate decision support needs.

Hydrographics and the timing of infectious salmon anemia outbreaks among Atlantic salmon (Salmo salar L.) farms in the Quoddy region of Maine, USA and New Brunswick, Canada.

Infectious salmon anemia (ISA) has caused severe morbidity and mortality in farmed Atlantic salmon in North America, Norway, Scotland and the Faroe Islands. The Quoddy region of Maine, United States of America (USA), and New Brunswick (NB), Canada is characterized by extensive tidal mixing and close proximity between farms. This region is also prone to recurrent appearances of ISA, though control measures limit disease spread and severity on infected farms. We conducted a retrospective longitudinal analysis of the apparent impact of hydrographics on the incidence and timing of ISA outbreaks on Atlantic salmon (Salmo salar L.) farms in the Quoddy region from May 2002 to August 2004. A time-series cross-sectional regression of 32 farms over 28 months demonstrated a limited, but statistically significant, spatio-temporal clustering of ISA outbreaks linked hydrographically. New outbreaks correlated temporally with those occurring on-site 1 and 3 months prior, and those occurring within one tidal-excursion upstream the same month. Other risk factors included holdover of previous year-class fish, wharf sharing, and possibly harvests of cages infected in previous months. Conclusions suggest that tidal dispersion does play a role in ISAV transmission in the Quoddy region. Dispersal of free virus and/or tidal distribution of lice or other hydrographically influenced vectors or fomites could all contribute to the spatio-temporal patterns described.

The effects of different bill-trimming methods on the well-being of Pekin ducks.

Pekin ducks are often bill-trimmed to prevent feather pecking and cannibalism, but this practice has been criticized because of the resulting potential for acute and chronic pain. The goal of this experiment was to compare 2 different bill-trimming methods, hot blade trimming with cautery (TRIM) and cautery only (tip-searing; SEAR), on the behavior, bill morphology, and weight gain of Pekin ducks. Ducklings (n = 192, 96 per sex) were trimmed at the hatchery and assigned to 12 floor pens (3.66 x0.91 m) by treatment. Behavior was evaluated by scan sampling, and plumage condition was scored using a 0 to 3 scoring system. Thirty-six ducks were randomly euthanized at 3 and 6 wk of age, and their bills were collected for examination. Following fixation and decalcification, the bills were embedded in paraffin wax and sectioned longitudinally. Alternate sections were stained with hematoxylin and eosin and Masson's trichrome for the connective tissues, and with Bielschowsky's silver impregnation, Bodian's staining, and Holmes' staining for the nerve fibers. Trimmed ducks engaged in fewer bill-related behaviors and rested more than untrimmed ducks (NOTRIM) during the first 2 wk posttrim. Ducks in the SEAR and NOTRIM groups showed similar patterns of weight gain, but those in the TRIM group had a lower rate of gain than ducks in the SEAR group during the first week posttrim and had a lower rate of gain than those in the NOTRIM group for 2 wk posttrim. Feather scores of ducks in the NOTRIM group were significantly worse than those in the TRIM or SEAR group by 18 d, and scores continued to deteriorate at a greater rate than those of trimmed ducks throughout the study. Both trimming methods caused connective tissue proliferation in the bill stumps, but the TRIM method caused thicker scar tissue than the SEAR method. No neuromas were found with either trimming method, but there were more nerve fibers in bill stumps of the SEAR ducks than the TRIM ducks. These results suggest that acute pain is associated with both trimming methods, but that SEAR may be a preferable method, causing less check in weight gain and fewer bill morphological changes while still being effective in minimizing feather pecking damage.

Area contact networks and the spatio-temporal spread of infectious salmon anemia virus (ISAV) in Chile.

Area management, the coordination of production and biosecurity practices across neighboring farms, is an important disease control strategy in aquaculture. Area management in aquaculture escalated in prominence in response to outbreaks of infectious salmon anemia (ISA) internationally. Successes in disease control have been attributed to the separation achieved through area-level synchronized stocking, fallowing, movement restrictions, and fomite or pest control. Area management, however, is costly; often demanding extra biosecurity, lengthy or inconveniently timed fallows, and localization of equipment, personnel, and services. Yet, this higher-order organizational structure has received limited epidemiologic attention. Chile's National Fisheries and Aquaculture Service instigated area management practices in response to the 2007 emergence of ISA virus (ISAV). Longitudinal data simultaneously collected allowed retrospective evaluation of the impact of component tenets on virus control. Spatiotemporal analyses identified hydrographic linkages, shared ports, and fish transfers from areas with recent occurrence of ISAV as the strongest predictors of virus spread between areas, though specifics varied by ISAV type (here categorized as HPR0 for the non-virulent genotypes, and HPRv otherwise). Hydrographic linkages were most predictive in the period before implementation of enhanced biosecurity and fallowing regulations, suggesting that viral load can impact spread dynamics. HPR0 arose late in the study period, so few HPRv events were available by which to explore the hypothesis of HPR0 as progenitor of outbreaks. However, spatiotemporal patterns in HPRv occurrence were predictive of subsequent patterns in HPR0 detection, suggesting a parallel, or dependent, means of spread. Better data precision, breadth and consistency, common challenges for retrospective studies, could improve model fit; and, for HPR0, specification of diagnostic test accuracy would improve interpretation.

Cell swelling and glycogen metabolism in hepatocytes from fasted rats.

Cell swelling is known to increase net glycogen production from glucose in hepatocytes from fasted rats by activating glycogen synthase. Since both active glycogen synthase and phosphorylase are present in hepatocytes, suppression of flux through phosphorylase may also contribute to the net increase in glycogen synthesis by cell swelling. We have developed an isotopic procedure to estimate the fluxes through glycogen synthase and phosphorylase in intact hepatocytes and we have examined the effect of cell swelling on both enzyme fluxes. The following observations were made. (1) Hypotonic or glutamine-induced cell swelling increased net glycogen production by activating flux through glycogen synthase with little effect on phosphorylase flux. Proline, previously shown to increase glycogen synthesis more than could be accounted for by its ability to cause cell swelling, increased flux through glycogen synthase and inhibited phosphorylase flux. (2) Incorporation of [14C]glucose into glycogen preceded complete mixing of [14C]glucose with the intracellular pool of UDPglucose. It is concluded that cell swelling affects glycogen synthase only and that UDPglucose is compartmentalized.

Using expert opinion to identify risk factors important to infectious salmon-anemia (ISA) outbreaks on salmon farms in Maine, USA and New Brunswick, Canada.

Thirty industry or regulatory professionals, with extensive experience in the local infectious salmon-anemia (ISA) epidemic, were queried on their opinions regarding the spread and impact of ISA in Maine, USA and New Brunswick, Canada. Subjective probability-estimation techniques were used to elicit likelihood ratios (LR) for risk factors of potential relevance to the epidemic. Experts were asked to answer questions based on their direct and local experience with ISA, rather than through knowledge gained from scientific references or experience in other regions. The results found the strongest independent predictors of ISA infection to include (1) a site's proximity to other farms with clinically infected fish, (2) a previous history of ISA on the site, (3) whether a site fallows for a month or more between year classes and (4) whether the site employs harvest vessels practicing full containment of blood and stun water. The strongest predictors of ISA severity included (1) stocking density, (2) the length of time between infection and removal of infected fish, (3) whether fish are moved between pens (after infection) and (4) a farm's sea-lice (Lepeophtheirus salmonis) status. Experts believed that transmission of ISA virus during the local epidemic was influenced by proximity (spatial and temporal) to activities resulting in large-scale shedding of virus into a shared water column, and that severity of infection corresponded more to infected-fish removal practices and certain husbandry decisions. Personnel and equipment biosecurity measures were not seen as strong predictors of either infection or severity in this analysis, though their perceived level of importance was greater among government than industry experts.

Increased hypoxic stress decreases AMP hydrolysis in rabbit heart.

OBJECTIVE: AMP conversion to adenosine by cytosolic 5'nucleotidase (5NT) or to IMP by AMP deaminase determines the degree of nucleotide degradation, and thus ATP resynthesis, during reoxygenation. To elucidate the regulation of AMP hydrolysis during ischemia, data from 31P NMR spectroscopy and biochemical analyses were integrated via a mathematical model. Since 5NT is downregulated during severe underperfusion (5% flow), we tested 5NT regulation during less severe underperfusion (10% flow) and then made the perfusate hypoxic to see if the greater stress reactivated 5NT. METHODS: 31P NMR spectra and coronary venous effluents were obtained from Langendorff-perfused rabbit hearts subjected to two 30-min periods of underperfusion (10% flow); the second period with or without additional hypoxia (30% O2). Data were analyzed with a mathematical model describing the kinetics of myocardial energetics and metabolism. RESULTS: A single 30-min period of 10% flow causes downregulation of AMP hydrolysis and the data from the second period of underperfusion are best described by lower 5NT activity, even in the presence of extra hypoxia. Thirty percent less purines appear in the venous effluent than predicted by the phosphoenergetics (PCr and ATP) when IMP is not allowed to accumulate by the model, however the model indicates that a constant accumulation of IMP via AMP deaminase could explain the discrepancy between expected and measured purines in the venous effluent. CONCLUSIONS: While AMP hydrolysis to adenosine is prominent in early ischemia and acts to preserve cellular energy potential, during a second ischemic period, nucleotides are conserved by the stable inhibition of AMP hydrolysis. Furthermore, during 10% flow conditions, nucleotides are conserved, possibly via an IMP-accumulatory pathway.

Enteric outbreak surveillance in British Columbia, 2009-2013.

BACKGROUND: Understanding enteric disease outbreak sources, burden of illness, mode of transmission and use of interventions informs planning, policy development and prevention programs. OBJECTIVE: To describe trends in enteric disease outbreaks investigated in British Columbia (BC) between 2009 and 2013. METHODS: An analysis was conducted of enteric disease outbreaks that had been entered into a national, secure web-enabled outbreak reporting system using the Canadian Network for Public Health Intelligence (CNPHI) and investigated in BC between January 1, 2009 and December 31, 2013. The data included information on pathogen, number of cases, hospitalizations, deaths, setting, mode of transmission, source, factors that contributed to the outbreak and interventions. Residential facility-based viral outbreaks and outbreaks associated with international travel were excluded. RESULTS: There were 104 outbreaks investigated in BC between 2009 and 2013. Ninety-three were reported by BC organizations and 11 were national outbreak investigations reported by the Public Health Agency of Canada (PHAC). There was an average of 21 outbreaks per year. Overall, the annual rate of foodborne outbreaks in BC was 2.8 per one million population. Seventy-nine (76%) outbreaks had a pathogen identified, most commonly norovirus, Salmonella and E. coli. There was a total of 108 hospitalizations (3.8% of all cases) and two deaths (0.1% of all cases); one caused by botulism, the other by E. coli O157. Food service establishments were the most common setting (33.7%), followed by the community (24.0%) and private functions (12.5%). The food types most often reported were fruits and vegetables, meat and seafood. The data showed a pathogen-food source combination between Salmonella and eggs. CONCLUSION: This is the first publication summarizing trends in enteric disease outbreaks in BC including assessing sources, burden and interventions. Ongoing reporting and analysis of outbreak data in BC will allow for improved assessment of trends in sources and pathogens over time and further understanding of the effectiveness of interventions associated with outbreaks.

Physostigmine and tetrahydroaminoacridine treatment of Alzheimer's disease.

The cholinergic hypothesis of Alzheimer's disease (AD) was tested in two doubleblind crossover studies. Physostigmine given intravenously to 10 AD patients for two hours caused improvement of reaction time and EEG and increased regional cerebral blood flow (rCBF) in the temporoparietal cortex. 17 AD patients (mean age 62.6 +/- 6.8 years) obtained three types of treatment: tetrahydroaminoacridine (THA), THA + lecithin and placebo in randomized order. Each treatment period was 6 weeks. The mean THA dose was 104 +/- 20 mg/day. There were differences in outcome between groups of patients over the total 26 weeks treatment period. The subclassification in responders, unchanged and deteriorated was supported by rCBF, EEG and psychometric testing.

What is dementia?

Dementia is a descriptive term derived from the Latin root de mens, indicating an observable decline in mental abilities. It is an acquired clinical syndrome characterised by deterioration of mental functioning in its cognitive, emotional and conative aspects. The concept is comprehensive with several different clinical profiles and courses. The diagnosis of dementia implies that several mental faculties are involved and exclude isolated neuropsychiatric disturbances such as amnesia and aphasia which occur with focal brain lesions. Description and classification of dementia conditions have however to deal with the problem that the word "dementia" might have different meanings in different contexts. It might denote a clinical syndrome irrespective of etiology, but also imply that the etiology of this syndrome is brain dysfunction. Moreover, the term dementia is sometimes used in a wider sense to describe the underlying brain disease from its early subtle manifestations to advanced stages of severe deterioration. By definition this deterioration previously was progressive and irreversible with little hope for the patient. Clinical experience however has changed our views, and it is now accepted that the course of dementia can be progressive, static or remittent.

Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria.

OBJECTIVE: To improve clinical recognition and provide research diagnostic criteria for three clinical syndromes associated with frontotemporal lobar degeneration. METHODS: Consensus criteria for the three prototypic syndromes-frontotemporal dementia, progressive nonfluent aphasia, and semantic dementia-were developed by members of an international workshop on frontotemporal lobar degeneration. These criteria build on earlier published clinical diagnostic guidelines for frontotemporal dementia produced by some of the workshop members. RESULTS: The consensus criteria specify core and supportive features for each of the three prototypic clinical syndromes and provide broad inclusion and exclusion criteria for the generic entity of frontotemporal lobar degeneration. The criteria are presented in lists, and operational definitions for features are provided in the text. CONCLUSIONS: The criteria ought to provide the foundation for research work into the neuropsychology, neuropathology, genetics, molecular biology, and epidemiology of these important clinical disorders that account for a substantial proportion of cases of primary degenerative dementia occurring before the age of 65 years.

Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias.

Our objectives were to investigate the utility of the Hachinski Ischemic Score (HIS) in differentiating patients with pathologically verified Alzheimer's disease (AD), multi-infarct dementia (MID), and "mixed" (AD plus cerebrovascular disease) dementia, and to identify the specific items of the HIS that best discriminate those dementia subtypes. Investigators from six sites participated in a meta-analysis by contributing original clinical data, HIS, and pathologic diagnoses on 312 patients with dementia (AD, 191; MID, 80; and mixed, 41). Sensitivity and specificity of the HIS were calculated based on varied cutoffs using receiver-operator characteristic curves. Logistic regression analyses were performed to compare each pair of diagnostic groups to obtain the odds ratio (OR) for each HIS item. The mean HIS (+/- SD) was 5.4 +/- 4.5 and differed significantly among the groups (AD, 3.1 +/- 2.5; MID, 10.5 +/- 4.1; mixed, 7.7 +/- 4.3). Receiver-operator characteristic curves showed that the best cutoff was < or = 4 for AD and > or = 7 for MID, as originally proposed, with a sensitivity of 89.0% and a specificity of 89.3%. For the comparison of MID versus mixed the sensitivity was 93.1% and the specificity was 17.2%, whereas for AD versus mixed the sensitivity was 83.8% and the specificity was 29.4%. HIS items distinguishing MID from AD were stepwise deterioration (OR, 6.06), fluctuating course (OR, 7.60), hypertension (OR, 4.30), history of stroke (OR, 4.30), and focal neurologic symptoms (OR, 4.40). Only stepwise deterioration (OR, 3.97) and emotional incontinence (OR, 3.39) distinguished MID from mixed, and only fluctuating course (OR, 0.20) and history of stroke (OR, 0.08) distinguished AD from mixed. Our findings suggest that the HIS performed well in the differentiation between AD and MID, the purpose for which it was originally designed, but that the clinical diagnosis of mixed dementia remains difficult. Further prospective studies of the HIS should include additional clinical and neuroimaging variables to permit objective refinement of the scale and improve its ability to identify patients with mixed dementia.

The effects of bromvincamine and vincamine on regional cerebral blood flow and mental functions in patients with multi-infarct dementia.

The effects of vincamine and bromvincamine (BV 26-723) on mental functions and regional cerebral blood flow (rCBF) measured by the 133Xe inhalation method, were investigated in ten patients with mild to severe symptoms of multi-infarct dementia. The double blind cross over design included three treatment periods, each of 2 weeks' duration. The patients were drug free at the time of the first investigation in each treatment period. Then placebo, vincamine or bromvincamine was given orally (4 X 20 mg/day). Psychiatric evaluation, psychometric assessment and measurement of rCBF were done at start of medication and after 1 and 2 weeks during medication. There were 2 drug-free weeks between the first and second, and second and third treatment periods. Results from treatment with vincamine showed a significant increase in the global CBF level and reduction of initial right-left asymmetry of hemispheric means. No effects were seen in regional flow patterns. Performance score on a verbal memory test increased significantly. No significant effect on the global rCBF level was indicated for bromvincamine. However, the number of ischemic regions decreased significantly during treatment. Performance on two memory tests improved significantly. No significant changes in overall psychiatric ratings were observed for any of the treatment periods.