A correlational study between signature, writing abilities and decision-making capacity among people with initial cognitive impairment.

BACKGROUND: Some clinical conditions, including dementia, compromise cognitive functions involved in decision-making processes, with repercussions on the ability to subscribe a will. Because of the increasing number of aged people with cognitive impairment there is an acute and growing need for decision-making capacity evidence-based assessment. AIMS: Our study investigates the relationship between writing abilities and cognitive integrity to see if it is possible to make inferences on decision-making capacity through handwriting analysis. We also investigated the relationship between signature ability and cognitive integrity. METHODS: Thirty-six participants with diagnosis of MCI and 38 participants with diagnosis of initial dementia were recruited. For each subject we collected two samples of signature-an actual and a previous one-and an extract of spontaneous writing. Furthermore, we administered a neuropsychological battery to investigate cognitive functions involved in decision-making. RESULTS: We found significant correlations between spontaneous writing indexes and neuropsychological test results. Nonetheless, the index of signature deterioration does not correlate with the level of cognitive decline. DISCUSSION: Our results suggest that a careful analysis of spontaneous writing can be useful to make inferences on decision-making capacity, whereas great caution should be taken in attributing validity to handwritten signature of subjects with MCI or dementia. CONCLUSIONS: The analysis of spontaneous writing can be a reliable aid in cases of retrospective evaluation of cognitive integrity. On the other side, the ability to sign is not an index of cognitive integrity.

The value of ultrasound screening for proximal vein thrombosis after total hip arthroplasty--a prospective cohort study.

The role of ultrasound screening for proximal deep-vein thrombosis (DVT) following major hip surgery is controversial. 202 consecutive patients, who had received warfarin prophylaxis after total hip arthroplasty underwent a bilateral ultrasound assessment of the proximal vein system (using the criterion of vein compressibility) before hospital discharge. In the 9 patients (4.5%; 95% CI, 2.1-8.3%) with positive test anticoagulant treatment was successfully continued for three months. In all the remaining 193 patients the warfarin treatment was withdrawn. A second ultrasound test was performed 15 days later, and showed a new (asymptomatic) abnormality compatible with proximal DVT in 2 patients (1.0%; 95% CI, 0.1-3.7%). All other 191 patients remained asymptomatic until the completion of a 3-month follow-up period (rate of symptomatic thromboembolism, 0/191, 0%; 95% CI, 0-1.9%). Because of the relatively high incidence of proximal DVT in patients undergoing major orthopaedic surgery under warfarin prophylaxis, screening for proximal DVT at hospital discharge in these patients is indicated. The negativity of this test has the potential of safely preventing the extension of anticoagulation beyond hospital stay. A larger controlled study in which the value of this strategy is tested against the prolongation of oral anticoagulation in patients with a negative ultrasound screening at discharge is indicated.

Clinical outcome of patients with internal carotid artery occlusion: a prospective follow-up study.

PURPOSE: We prospectively evaluated whether, and to what extent, different clinical presentations (symptomatic or asymptomatic) or the presence of atherosclerotic narrowing of the contralateral carotid system modifies the mortality rate and the incidence of nonfatal cerebrovascular events in patients with internal carotid artery (ICA) occlusion. METHODS: A prospective cohort study was conducted in the Unit Care of Angiology at the University Hospital of Padua in Italy. Consecutive patients with ICA occlusion were eligible for the study. Between 1990 and 1991, 41 such patients were identified at our center. All patients were observed prospectively for a mean of 44.5 months, except for one patient who was lost to follow-up after 12 months. Patients with severe (ie, more than 75%) stenosis of the contralateral internal carotid artery were scheduled for thromboendarterectomy. ICA occlusion was objectively documented in all patients by using a combination of echo-color Doppler scanning and continuous-wave Doppler scanning (periorbital flow). RESULTS: The overall mortality rate was 22.0% (95% CI, 10.6-37.6), and the stroke-related mortality rate was 7.3% (95% CI, 1.5-19.9). No differences in overall and stroke-related mortality rates were observed between asymptomatic and symptomatic patients. None of the patients experienced nonfatal cerebrovascular events. CONCLUSION: ICA occlusion seems to represent a relatively benign condition, in both its symptomatic and asymptomatic presentation. The presence of an atherosclerotic stenosis less than 75% of the contralateral ICA does not seem to worsen the prognosis of this condition.