Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux.

The treatment of gastroesophageal reflux disease may be clinical or surgical. The clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. The objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease - 16 submitted to sham technique and 22 submitted osteopathic technique - were randomly selected. The average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann-Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. The MEP had no statistical difference (P= 0.146). The values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.

Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screening Examination for Cognitive Impairment (SEFCI).

Cognitive impairment affects 40 to 70% of patients with multiple sclerosis (MS), but its occurrence cannot be predicted from knowledge of the individual patient's age, level of physical disability, duration of disease, disease type, or performance on standard mental status examinations. To evaluate the usefulness of a brief screening battery, the Screening Examination for Cognitive Impairment (SEFCI), 103 community-dwelling MS patients and 32 healthy normal controls received the SEFCI and a 2-hour battery of other neuropsychological tests chosen for their sensitivity to the cognitive impairments most often observed in MS. Performance on the SEFCI correctly identified 86% of the patients with impairment on any of the 11 measures from the longer battery, 100% of the patients with impairments in at least three cognitive domains, and 90% of the patients without cognitive impairment. Because the SEFCI is sensitive, specific, and easily administered and scored, it should aid the physician in deciding whether to refer an MS patient for a complete evaluation.

Cortical and subcortical influences on clustering and switching in the performance of verbal fluency tasks.

Impairments on lexical and semantic fluency tasks occur in both cortical and subcortical dementia. Recent reports that the average size of phonemic and semantic clusters is reduced in Alzheimer's disease (AD), but not in Parkinson's disease (PD) could support the hypothesis that in AD verbal fluency deficits arise from degraded memory storage while in PD the same impairments result from defective retrieval. In the present study, patients with AD, PD with dementia, or Huntington's disease produced fewer words, fewer switching responses and smaller semantic cluster sizes. Patients with multiple sclerosis, regardless of whether or not they were demented, produced fewer words and switching responses, but normal size clusters, and patients with PD without dementia performed normally on all fluency measures. These results indicate that reductions in cluster size on verbal fluency tests are best interpreted as changes in the efficiency of access to lexical and semantic memory stores. The findings are also consistent with the idea that patterns of cognitive impairment may differ among diseases that result in subcortical dementia.

Spatial cognition in alcoholics: influence of concurrent abuse of other drugs.

Several tests of visuospatial cognition are known to be sensitive to chronic alcohol abuse, but the consequences of combined abuse of alcohol and other drugs on these measures in not known. To address this issue, groups that had abused only alcohol, alcohol and marijuana, or alcohol and multiple other drugs (Alc/Poly) were compared to community controls. Testing occurred after at least 3 weeks of treatment for the drug abusers. On all measures of visuospatial perception and construction and on all measures of visuospatial learning and memory, all groups of alcoholics were impaired relative to controls, but there were no significant differences among the groups that abused alcohol. By contrast, on all measures of geographical knowledge that required place localization, subjects in the Alc/Poly group were impaired while subjects who abused only alcohol or alcohol and marijuana performed as well as controls. Measures of alcohol consumption, mood or childhood or adult attention deficit were not consistently correlated with test performance.

Visuospatial perception, construction and memory in alcoholism.

OBJECTIVE: To analyze visuospatial cognition in recently detoxified alcoholics from the perspectives of three ways of conceptualizing spatial information processing: egocentric versus allocentric orientation, featural versus configural analysis, and categorical versus coordinate spatial judgements. METHOD: Twenty-eight chronic alcoholics (19 men, 9 women) were compared to 20 (10 men, 10 women) controls of comparable age and education on a battery of tests of visuospatial scanning, construction, mental imagery, and anterograde and remote spatial memory. Tests were administered 21-40 days after alcoholics entered treatment. RESULTS: Alcoholics displayed impairment in visuospatial scanning, construction, utilizing and manipulating information from visual images and on three tests of anterograde spatial memory, but remote spatial memory was not significantly affected. Their deficits were evident on some measures of allocentric orientation, featural and configural analysis, but consistent deficits on egocentric orientation or categorical or coordinate spatial judgments were not seen. CONCLUSIONS: Deficits in spatial cognition exhibited by alcoholics do not seem to arise from dysfunction in any localized brain region. Small but potentially important impairments in fundamental aspects of spatial information processing such as scanning and use of visual imagery were found. The empirical basis and clinical significance of these deficits requires further study.

Autobiographical memory in multiple sclerosis.

Studies have consistently found that patients with multiple sclerosis (MS) are impaired on tests of anterograde memory, but the status of remote memory in MS remains unclear. To better understand remote memory in MS we administered the Autobiographical Memory Interview (AMI) to 44 MS patients and 19 normal controls matched for age, education, and gender. Additionally, a shortened version of the Famous Faces Test, a test of recall of past U.S. presidents, and a 14-word learning list were administered. Patients performed significantly lower than controls on the learning list and Famous Faces Test, but not on recall of past presidents. On the AMI, patients were significantly impaired on recall of semantic but not of episodic memories. These results indicate that MS patients exhibit retrograde amnesia that cannot be attributed to anterograde memory deficits or lack of exposure to task-relevant information.

Cognitive and physical fatigue in multiple sclerosis: relations between self-report and objective performance.

Fatigue is one of the most disabling symptoms of multiple sclerosis (MS), but little is known about patients' perceptions of fatigue and changes in their performance on cognitive tasks. To study these relations, 39 patients with clinically definite MS and 19 matched healthy control participants completed baseline self-reports of physical and cognitive fatigue and measurements of grip strength, word list learning, and vigilance. Following 30 min of testing on a cognitive work battery (verbal fluency, Wechsler Adult Intelligence Scale-Revised [WAIS-R] Comprehension, WAIS-R Vocabulary), the baseline measures were readministered. At baseline, MS patients reported more physical and cognitive fatigue than did controls and the MS patients performed more poorly on the grip strength, word list learning, and vigilance tasks. Following cognitive work, the patients reported increased physical and cognitive fatigue, but their objective performance on grip strength, learning, and vigilance was unchangecl from baseline. Controls showed no change in fatigue ratings or performance.

Further validation of constructs from the selective reminding test.

The Selective Reminding Test (SRT) partitions recall into three classes. Short-Term Recall (STR), Random Long-Term Recall (RLTR), and Consistent Long-Term Recall (CLTR). Examination of conditional probabilities of delayed recall or recognition of individual words as a function of their memory status at the end of a standard 12-word, 12-trial test showed that Buschke's (1973) operational definitions of STR, RLTR, and CLTR have excellent predictive validity.

Memory disturbance in multiple sclerosis: reconsideration of patterns of performance on the selective reminding test.

Comparison of the average performance by 99 patients with multiple sclerosis (MS) and 32 healthy controls on the Selective Reminding Test (SRT) suggested that the patients' memory deficits arose primarily from difficulties in retrieving information from long-term storage. However, six different cluster analysis methods indicated three distinct patterns of SRT performance by patients, emphasizing the heterogeneity of memory function in MS. Approximately 25% of the patients performed normally while about 22% exhibited a severe amnesia-like disturbance. The remaining patients (53%) showed mild to moderate memory impairments, but only two patients met strict operational criteria for "pure retrieval failure".

Attention in multiple sclerosis: correlates of impairment on the WAIS-R Digit Span Test.

To re-examine the status of attention in multiple sclerosis (MS) 109 patients with clinically definite MS were administered the WAIS-R Digit Span (DS) and a battery of other neuropsychological (NP) tests of problem solving, abstraction, short-term memory (STM), long-term memory and verbal fluency. Compared to a group of controls of equivalent age and education, the MS patients were impaired on DS and all of the other NP tests. Although the magnitude of the patients' overall DS deficits was comparable for forward and backward spans, the patterns of correlations of NP tests with performance on the forward and backward DS tests were distinctly different. These results can be accounted for by postulating that MS patients suffer from a mild generalized difficulty in maintaining concentration and a more specific impairment in regulatory systems that allocate limited attentional resources among multiple stimulus inputs or tasks.

Correlates of coping style in patients with multiple sclerosis.

To examine certain correlates of patterns of coping with stress, 43 patients with multiple sclerosis (MS) read a vignette describing a stressful social situation and completed the Ways of Coping Checklist, describing how they would cope with the stressful situation. Performance on a test of solving problems in everyday living was positively correlated with the total number of coping responses and with the number of problem-focused strategies, but neither vocabulary nor verbal abstract reasoning were related to coping patterns. In agreement with earlier work, increases in psychological distress were positively correlated with endorsement of emotion-focused coping strategies but unrelated to the use of other coping responses.