BE FAST Versus FAST: A Randomized Pilot Trial Comparing Retention of Stroke Symptoms Between 2 Mnemonics.

BACKGROUND: Balance, Eye, Face, Arm, Speech, Time (BE FAST) was proposed to increase the public's ability to recognize more signs of stroke by adding balance (B) and eyesight changes (E) to the stroke acronym FAST (Face, Arm, Speech, Time). Previous prospective studies suggested these additions did not result in increased stroke detection. METHODS AND RESULTS: A randomized, assessor blinded prospective pilot study assessed retention of BE FAST and FAST. The 174 participants were randomized to 1 of 2 education arms, educated similarly visually and auditorily, and retention was tested at 3 time points. Mnemonic recall was similar at 30 days (79.5% versus 69.8%, P=0.104). Significantly lower retention was seen in the BE FAST group's ability to recall all symptoms at 3 to 5 minutes (75% versus 30.2%, P<0.001), 60 minutes (70.5% versus 41.9%, P<0.001), and 30 days (51.1% versus 24.4%, P<0.001). Significantly higher retention was observed in the FAST group for partial recall at 3 to 5 minutes (94.3% versus 84.9%, P=0.041), 60 minutes (86.4% versus 77.9%, P=0.045), and 30 days (76.1% versus 59.3%, P=0.012). For BE FAST, retention of more common symptoms at 30 days was lower for face (78.4% versus 60.5%, P=0.010), speech (65.9% versus 47.7%, P=0.015), and arm (63.6% versus 52.3%, P=0.131). CONCLUSION: Significantly higher retention and ability to recall stroke symptoms, fully or partially, was found with FAST. Adding B and E to FAST resulted in lower retention of more common symptoms. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06152016.

Epidural cortical stimulation of the left dorsolateral prefrontal cortex for refractory major depressive disorder.

BACKGROUND: A significant number of patients with major depressive disorder are unresponsive to conventional therapies. For these patients, neuromodulation approaches are being investigated. OBJECTIVE: To determine whether epidural cortical stimulation at the left dorsolateral prefrontal cortex is safe and efficacious for major depressive disorder through a safety and feasibility study. METHODS: Twelve patients were recruited in this randomized, single-blind, sham-controlled study with a 104-week follow-up period. The main outcome measures were Hamilton Depression Rating Scale-28 (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Global Assessment of Function (GAF), and Quality of Life Enjoyment and Satisfaction (QLES) questionnaire. An electrode was implanted over Brodmann area 9/46 in the left hemisphere. The electrode provided long-term stimulation to this target via its connections to an implanted neurostimulator in the chest. RESULTS: During the sham-controlled phase, there was no statistical difference between sham and active stimulation, although a trend toward efficacy was seen with the active stimulation group. In the open-label phase, we observed a significant improvement in outcome scores for the HDRS, MADRS, and GAF but not the QLES (HDRS: df = 7, F = 7.72, P < .001; MADRS: df = 7, F = 8.2, P < .001; GAF: df = 5, F = 16.87, P < .001; QLES: df = 5, F = 1.32, P > .2; repeated measures ANOVA). With regard to the HDRS, 6 patients had ≥ 40% improvement, 5 patients had ≥ 50% improvement, and 4 subjects achieved remission (HDRS < 10) at some point during the study. CONCLUSION: Epidural cortical stimulation of the left dorsolateral prefrontal cortex appears to be a safe and potentially efficacious neuromodulation approach for treatment-refractory major depressive disorder.

Multiple sclerosis.

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that commonly leads to inflammatory and atrophic brain pathology, often causing cognitive impairment. MS-associated cognitive impairment was first described over a century ago. However, with the advent of standardized neuropsychological testing and quantitative brain imaging, the frequency, quality, and correlates of cognitive impairment are better understood. Dementia is rare in MS, although it is known to occur in 10 to 25% of patients. Our data suggest a frequency of 22% among clinic attendees. In addition to the cognitive impairments evident in MS dementia, changes in personality and social behavior also occur. For example, some patients develop euphoria sclerotica and marked deficiency in social empathy, conditions that in combination with executive dysfunction cause considerable hardship for patients and caregivers. These neuropsychiatric manifestations of MS dementia are correlated with magnetic resonance imaging indicators of brain atrophy, including ventricle enlargement, neocortical volume, and normalized whole brain volume. Recent developments in pharmacological treatment for disease progression and management of cognitive symptoms hold promise for patients suffering from the degenerative aspects of MS.

Cognitive dysfunction in multiple sclerosis: a review of recent developments.

PURPOSE OF REVIEW: Nearly half of all patients diagnosed with multiple sclerosis will develop cognitive dysfunction, a symptom associated with significant decline in activities of daily living. The purpose of this review is to discuss recent literature investigating issues related to cognitive dysfunction in multiple sclerosis. RECENT FINDINGS: Recent studies, examined in this review, have provided increased understanding regarding specific cognitive processes affected in multiple sclerosis, as well as a characterization of its natural history. Studies have also continued to emphasize the extent to which cognitive deficits in the condition are associated with decline in daily living skills. Recent concerns regarding driving performance have been documented among cognitively impaired individuals. Studies have also examined correlates of cognitive dysfunction, with particular emphasis on neuroimaging techniques reflecting disease activity or lesion burden. With increased understanding of neurobiological correlates of cognitive deficits, investigators have begun to examine potential treatments for managing cognitive dysfunction. SUMMARY: This area of research has suggested that disease modifying medications can have an impact on magnetic resonance imaging disease activity by altering the cerebral demyelinating process resulting in a slower decline in cognitive functions over time and improved activities of daily living for patients with multiple sclerosis.

Neural basis of the Stroop interference task: response competition or selective attention?

Previous neuroimaging studies of the Stroop task have postulated that the anterior cingulate cortex (ACC) plays a critical role in resolution of the Stroop interference condition. However, activation of the ACC is not invariably seen and appears to depend on a variety of methodological factors, including the degree of response conflict and response expectancies. The present functional MRI study was designed to identify those brain areas critically involved in the interference condition. Healthy subjects underwent a blocked-trial design fMRI experiment while responding to 1 of 3 stimulus conditions: (1) incongruent color words, (2) congruent color words, and (3) color-neutral words. Subjects responded to the printed color of the word via a manual response. Compared to the congruent and neutral conditions, the incongruent condition produced significant activation within the left inferior precentral sulcus (IpreCS) located on the border between the inferior frontal gyrus, pars opercularis (BA 44) and the ventral premotor region (BA 6). Significant deactivations in the rostral component of the ACC and the posterior cingulate gyrus were also observed. Selective activation of the left IpreCS is compatible with findings from previous neuroimaging, lesion, electrophysiological, and behavioral studies and is presumably related to the mediation of competing articulatory demands during the interference condition.

Minimal neuropsychological assessment of MS patients: a consensus approach.

Cognitive impairment is common in multiple sclerosis (MS), yet patients seen in MS clinics and neurologic practices are not routinely assessed neuropsychologically. In part, poor utilization of NP services may be attributed to a lack of consensus among neuropsychologists regarding the optimal approach for evaluating MS patients. An expert panel composed of neuropsychologists and psychologists from the United States, Canada, United Kingdom, and Australia was convened by the Consortium of MS Centers (CMSC) in April, 2001. Our objectives were to: (a) propose a minimal neuropsychological (NP) examination for clinical monitoring of MS patients and research, and (b) identify strategies for improving NP assessment of MS patients in the future. The panel reviewed pertinent literature on MS-related cognitive dysfunction, considered psychometric factors relevant to NP assessment, defined the purpose and optimal characteristics of a minimal NP examination in MS, and rated the psychometric and practical properties of 36 candidate NP measures based on available literature. A 90-minute NP battery, the Minimal Assessment of Cognitive Function in MS (MACFIMS), emerged from this discussion. The MACFIMS is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval). It is supplemented by a measure of estimated premorbid cognitive ability. Recommendations for assessing other factors that may potentially confound interpretation of NP data (e.g., visual/sensory/motor impairment, fatigue, and depression) are offered, as well as strategies for improving NP assessment of MS patients in the future.