Validation of the questionnaire for impulsive-compulsive disorders in Parkinson's disease.

As no comprehensive assessment instrument for impulse control disorders (ICDs) in Parkinson's disease (PD) exists, the aim of this study was to design and assess the psychometric properties of a self-administered screening questionnaire for ICDs and other compulsive behaviors in PD. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) has 3 sections: Section 1 assesses four ICDs (involving gambling, sexual, buying, and eating behaviors), Section 2 other compulsive behaviors (punding, hobbyism, and walkabout), and Section 3 compulsive medication use. For validation, a convenience sample of 157 PD patients at 4 movement disorders centers first completed the QUIP, and then was administered a diagnostic interview by a trained rater blinded to the QUIP results. A shortened instrument (QUIP-S) was then explored. The discriminant validity of the QUIP was high for each disorder or behavior (receiver operating characteristic area under the curve [ROC AUC]: gambling = 0.95, sexual behavior = 0.97, buying = 0.87, eating = 0.88, punding = 0.78, hobbyism = 0.93, walkabout = 0.79). On post hoc analysis, the QUIP-S ICD section had similar properties (ROC AUC: gambling = 0.95, sexual behavior = 0.96, buying = 0.87, eating = 0.88). When disorders/behaviors were combined, the sensitivity of the QUIP and QUIP-S to detect an individual with any disorder was 96 and 94%, respectively. Scores on the QUIP appear to be valid as a self-assessment screening instrument for a range of ICDs and other compulsive behaviors that occur in PD, and a shortened version may perform as well as the full version. A positive screen should be followed by a comprehensive, clinical interview to determine the range and severity of symptoms, as well as need for clinical management.

The election of Sarah McNutt as the first woman member of the American Neurological Association.

The authors investigated the early women physicians of the New York Infirmary for Women and Children and their role in shaping the career and accomplishments of their student and later colleague, Dr. Sarah J. McNutt. These influences eventually led McNutt to be inducted into the American Neurologic Association (ANA). McNutt was educated at the New York Infirmary for Women and Children by early women physicians including Drs. Elizabeth and Emily Blackwell and Mary Putnam Jacobi. McNutt worked to improve the educational opportunities for practicing physicians and nurses by developing postgraduate lectures and organizations. With her early colleagues she developed the New York Infirmary for Women and Children into a reputable hospital and woman's medical college. One of the consultants to the New York Infirmary for Women and Children was Royal W. Amidon, secretary of the ANA in 1883. McNutt's close association with the Clinical Society of the New York Post Graduate Medical School and Hospital brought her into direct contact with other prominent ANA members including C.L. Dana and W.A. Hammond. In 1884, McNutt was nominated by Amidon and Hammond as the first woman member to the ANA and was elected. Her ANA thesis was Double Infantile Spastic Hemiplegia. McNutt was elected into the ANA at a time when women physicians were first being recognized and included into mainstream medicine. Her historic election acknowledged her accomplishments and highlighted the proactive role of the early ANA in forging new medical policies in the United States.

Montreal cognitive assessment performance in patients with Parkinson's disease with "normal" global cognition according to mini-mental state examination score.

OBJECTIVES: To examine Montreal Cognitive Assessment (MoCA) performance in patients with Parkinson's disease (PD) with "normal" global cognition according to Mini-Mental State Examination (MMSE) score. DESIGN: A cross-sectional comparison of the MoCA and the MMSE. SETTING: Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center. PARTICIPANTS: A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications. MEASUREMENTS: Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age- and education-adjusted MMSE score were included in the analyses (N=100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI). RESULTS: Mean MMSE and MoCA scores+/-standard deviation were 28.8+/-1.1 and 24.9+/-3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower educational level, and greater disease severity; older age was the only predictor in a multivariate model. CONCLUSION: Approximately half of patients with PD with a normal MMSE score have cognitive impairment based on the recommended MoCA cutoff score. These results suggest that MCI is common in PD and that the MoCA is a more sensitive instrument than the MMSE for its detection.