Lifelong Reading Disorder and Mild Cognitive Impairment: Implications for Diagnosis.

Although neuropsychological tests are commonly used in the evaluation of possible mild cognitive impairment (MCI), poor test scores may be indicative of factors other than neurological compromise. The current study assessed the role of lifelong reading disorder on MCI classification. Community dwelling older adults with a suspected developmental reading disorder were identified by inference based on reading test performance. Individuals with a suspected reading disorder were significantly more likely to perform at a level consistent with MCI on several commonly used neuropsychological tests. The findings suggest a relationship between a history of reading disorder and MCI classification.

Effects of anti-viral therapy and HCV clearance on cerebral metabolism and cognition.

BACKGROUND & AIMS: Chronic hepatitis C virus (HCV) infection is associated with altered cerebral metabolism and cognitive dysfunction. We aimed to evaluate the effect of pegylated interferon/ribavirin (PIFN/R) and HCV clearance on cerebral metabolism, and neuropsychological performance. METHODS: Fifteen non-cirrhotic HCV positive subjects underwent (1)H MR spectroscopy (MRS) before, during, and after treatment with PIFN/R. The metabolites of interest namely, N-acetylaspartate (NAA), choline (Cho), myo-inositol (MI), and the control metabolite creatine (Cr), were acquired from 3 different brain regions; left basal ganglia, left frontal cortex, and left dorso-lateral pre-frontal cortex. Coinciding with this, subjects also underwent a battery of neuropsychological tests to evaluate the domains of verbal learning, memory, attention, language, executive functioning, and motor skills. Seven HCV positive controls (not receiving anti-viral therapy) underwent MRS and neuropsychological testing at two time points, 12 weeks apart, to examine for variation in cerebral metabolites over time and the practice effect of repeat neuropsychological testing. RESULTS: Significant reductions in basal ganglia Cho/Cr (p=0.03) and basal ganglia MI/Cr (p=0.03) were observed in sustained virological responders (SVRs, n=8), but not non-responders/relapsers (NR/R, n=6), indicative of reduced cerebral infection and/or immune activation in those who cleared virus. SVRs demonstrated significant improvements in verbal learning, memory, and visuo-spatial memory. A small but significant improvement in neurocognitive function secondary to the practice effect was seen in both HCV controls and HCV subjects during treatment. CONCLUSIONS: HCV eradication has a beneficial effect on cerebral metabolism and selective aspects of neurocognitive function and is an important factor when contemplating anti-viral therapy in HCV, especially in those with mild disease.

A protocol for assessment of risk in wheelchair driving within a healthcare facility.

PURPOSE: The purpose of this article is to describe how a skilled nursing facility with significant wheelchair traffic developed a protocol for the multidisciplinary assessment and intervention management of patients whose wheelchair use represents a risk to self and others. This article describes the procedure and two case studies illustrating the utility of the protocol. METHOD: Staff of the facility developed a protocol for responding to sentinel events related to patients hurting themselves and others while using a wheelchair or observed using the wheelchair in an unsafe manner. The goal of the protocol is to determine the cause of the event, identify the necessary multidisciplinary interventions, and the evaluation of the effectiveness of the interventions. RESULTS: Case study analysis of the interventions indicated that a multidisciplinary evaluation and treatment plan leads to treatment interventions that suit the patient's medical condition while affording the patient the greatest amount of independence. CONCLUSION: Many patients who live in a long-term skilled nursing facility must use either a manual or a power wheelchair for mobility. For these patients, the wheelchair may represent one of the last forms of independence they enjoy. The implementation of the protocol helped staff respond to important changes to the patient's condition and prepare a coordinated intervention. The patients found the protocol to be a helpful component of their treatment.