ABSTRACT
Circadian cycles of sleep:wake and gene expression change with age in all organisms examined. Metabolism is also under robust circadian regulation, but little is known about how metabolic cycles change with age and whether these contribute to the regulation of behavioral cycles. To address this gap, we compared cycling of metabolites in young and old Drosophila and found major age-related variations. A significant model separated the young metabolic profiles by circadian timepoint, but could not be defined for the old metabolic profiles due to the greater variation in this dataset. Of the 159 metabolites measured in fly heads, we found 17 that cycle by JTK analysis in young flies and 17 in aged. Only four metabolites overlapped in the two groups, suggesting that cycling metabolites are distinct in young and old animals. Among our top cyclers exclusive to young flies were components of the pentose phosphate pathway (PPP). As the PPP is important for buffering reactive oxygen species, and overexpression of glucose-6-phosphate dehydrogenase (G6PD), a key component of the PPP, was previously shown to extend lifespan in Drosophila, we asked if this manipulation also affects sleep:wake cycles. We found that overexpression in circadian clock neurons decreases sleep in association with an increase in cellular calcium and mitochondrial oxidation, suggesting that altering PPP activity affects neuronal activity. Our findings elucidate the importance of metabolic regulation in maintaining patterns of neural activity, and thereby sleep:wake cycles.
Subject(s)
Circadian Clocks , Drosophila , Animals , Drosophila/metabolism , Sleep , Reactive Oxygen Species/metabolism , Pentose Phosphate Pathway , Circadian RhythmABSTRACT
Aging is associated with a number of physiologic changes including perturbed circadian rhythms; however, mechanisms by which rhythms are altered remain unknown. To test the idea that circulating factors mediate age-dependent changes in peripheral rhythms, we compared the ability of human serum from young and old individuals to synchronize circadian rhythms in culture. We collected blood from apparently healthy young (age 25-30) and old (age 70-76) individuals and used the serum to synchronize cultured fibroblasts. We found that young and old sera are equally competent at driving robust ~24h oscillations of a luciferase reporter driven by clock gene promoter. However, cyclic gene expression is affected, such that young and old sera drive cycling of different genes. While genes involved in the cell cycle and transcription/translation remain rhythmic in both conditions, genes identified by STRING and IPA analyses as associated with oxidative phosphorylation and Alzheimer's Disease lose rhythmicity in the aged condition. Also, the expression of cycling genes associated with cholesterol biosynthesis increases in the cells entrained with old serum. We did not observe a global difference in the distribution of phase between groups, but find that peak expression of several clock controlled genes (PER3, NR1D1, NR1D2, CRY1, CRY2, and TEF) lags in the cells synchronized with old serum. Taken together, these findings demonstrate that age-dependent blood-borne factors affect peripheral circadian rhythms in cells and have the potential to impact health and disease via maintaining or disrupting rhythms respectively.
ABSTRACT
Sleep loss has been associated with increased seizure risk since antiquity. Despite this observation standing the test of time, how poor sleep drives susceptibility to seizures remains unclear. To identify underlying mechanisms, we restricted sleep in Drosophila epilepsy models and developed a method to identify spontaneous seizures using quantitative video tracking. Here we find that sleep loss exacerbates seizures but only when flies experience increased sleep need, or sleepiness , and not necessarily with reduced sleep quantity. This is supported by the paradoxical finding that acute activation of sleep-promoting circuits worsens seizures, because it increases sleep need without changing sleep amount. Sleep-promoting circuits become hyperactive after sleep loss and are associated with increased whole-brain activity. During sleep restriction, optogenetic inhibition of sleep-promoting circuits to reduce sleepiness protects against seizures. Downregulation of the 5HT1A serotonin receptor in sleep-promoting cells mediates the effect of sleep need on seizures, and we identify an FDA-approved 5HT1A agonist to mitigate seizures. Our findings demonstrate that while homeostatic sleep is needed to recoup lost sleep, it comes at the cost of increasing seizure susceptibility. We provide an unexpected perspective on interactions between sleep and seizures, and surprisingly implicate sleep- promoting circuits as a therapeutic target for seizure control.
ABSTRACT
Chronic sleep loss profoundly impacts metabolic health and shortens lifespan, but studies of the mechanisms involved have focused largely on acute sleep deprivation.1,2 To identify metabolic consequences of chronically reduced sleep, we conducted unbiased metabolomics on heads of three adult Drosophila short-sleeping mutants with very different mechanisms of sleep loss: fumin (fmn), redeye (rye), and sleepless (sss).3,4,5,6,7 Common features included elevated ornithine and polyamines, with lipid, acyl-carnitine, and TCA cycle changes suggesting mitochondrial dysfunction. Studies of excretion demonstrate inefficient nitrogen elimination in adult sleep mutants, likely contributing to their polyamine accumulation. Increasing levels of polyamines, particularly putrescine, promote sleep in control flies but poison sleep mutants. This parallels the broadly enhanced toxicity of high dietary nitrogen load from protein in chronically sleep-restricted Drosophila, including both sleep mutants and flies with hyper-activated wake-promoting neurons. Together, our results implicate nitrogen stress as a novel mechanism linking chronic sleep loss to adverse health outcomes-and perhaps for linking food and sleep homeostasis at the cellular level in healthy organisms.
Subject(s)
Drosophila Proteins , Drosophila melanogaster , Animals , Drosophila melanogaster/physiology , Drosophila Proteins/genetics , Drosophila Proteins/metabolism , Sleep/physiology , Drosophila/metabolism , PolyaminesABSTRACT
Sleep is controlled by homeostatic mechanisms, which drive sleep after wakefulness, and a circadian clock, which confers the 24-h rhythm of sleep. These processes interact with each other to control the timing of sleep in a daily cycle as well as following sleep deprivation. However, the mechanisms by which they interact are poorly understood. We show here that hugin+ neurons, previously identified as neurons that function downstream of the clock to regulate rhythms of locomotor activity, are also targets of the sleep homeostat. Sleep deprivation decreases activity of hugin+ neurons, likely to suppress circadian-driven activity during recovery sleep, and ablation of hugin+ neurons promotes sleep increases generated by activation of the homeostatic sleep locus, the dorsal fan-shaped body (dFB). Also, mutations in peptides produced by the hugin+ locus increase recovery sleep following deprivation. Transsynaptic mapping reveals that hugin+ neurons feed back onto central clock neurons, which also show decreased activity upon sleep loss, in a Hugin peptide-dependent fashion. We propose that hugin+ neurons integrate circadian and sleep signals to modulate circadian circuitry and regulate the timing of sleep.
Subject(s)
Circadian Clocks/physiology , Drosophila Proteins/metabolism , Neurons/physiology , Neuropeptides/genetics , Neuropeptides/metabolism , Sleep/physiology , Animals , Drosophila Proteins/genetics , Drosophila melanogaster/genetics , Drosophila melanogaster/physiology , Female , Homeostasis , Locomotion , Mutation , Sleep Deprivation , Wakefulness/physiologyABSTRACT
STUDY OBJECTIVES: While wake duration is a major sleep driver, an important question is if wake quality also contributes to controlling sleep. In particular, we sought to determine whether changes in sensory stimulation affect sleep in Drosophila. As Drosophila rely heavily on their sense of smell, we focused on manipulating olfactory input and the olfactory sensory pathway. METHODS: Sensory deprivation was first performed by removing antennae or applying glue to antennae. We then measured sleep in response to neural activation, via expression of the thermally gated cation channel TRPA1, or inhibition, via expression of the inward rectifying potassium channel KIR2.1, of subpopulations of neurons in the olfactory pathway. Genetically restricting manipulations to adult animals prevented developmental effects. RESULTS: We find that olfactory deprivation reduces sleep, largely independently of mushroom bodies that integrate olfactory signals for memory consolidation and have previously been implicated in sleep. However, specific neurons in the lateral horn, the other third-order target of olfactory input, affect sleep. Also, activation of inhibitory second-order projection neurons increases sleep. No single neuronal population in the olfactory processing pathway was found to bidirectionally regulate sleep, and reduced sleep in response to olfactory deprivation may be masked by temperature changes. CONCLUSIONS: These findings demonstrate that Drosophila sleep is sensitive to sensory stimulation, and identify novel sleep-regulating neurons in the olfactory circuit. Scaling of signals across the circuit may explain the lack of bidirectional effects when neuronal activity is manipulated. We propose that olfactory inputs act through specific circuit components to modulate sleep in flies.
Subject(s)
Olfactory Pathways , Smell , Animals , Drosophila , Mushroom Bodies , SleepABSTRACT
Prolonged wakefulness stimulates the homeostatic need to sleep, but transition to sleep also depends on the circadian time of day. However, links between circadian and homeostatic influences are not well understood. Guo et al. (2018) identify a Drosophila circuit connecting circadian clock neurons to sleep-promoting ring neurons in the ellipsoid body.
Subject(s)
Circadian Clocks , Drosophila , Animals , Arousal , Circadian Rhythm , Sleep , WakefulnessABSTRACT
A number of studies have demonstrated that the Sirtuin family member, Sirt1, is a key integrator of growth, metabolism, and lifespan. Sirt1 directly interacts with and deacetylates key regulators of the circadian clock, positioning it to be an important link between feeding and circadian rhythms. In fact, one study suggests that Sirt1 is necessary for behavioral anticipation of limited daily food availability, a circadian process termed food anticipatory activity (FAA). In their study, mice overexpressing Sirt1 had enhanced FAA, while mice lacking Sirt1 had little to no FAA. Based on the supposition that Sirt1 was indeed required for FAA, we sought to use Sirt1 deletion to map the neural circuitry responsible for FAA. We began by inactivating Sirt1 using the cell-type specific Cre-driver lines proopiomelanocortin, but after observing no effect on body weight loss or FAA we then moved on to more broadly neuronal Cre drivers Ca2+/calmodulin-dependent protein kinase II and nestin. As neither of these neuronal deletions of Sirt1 had impaired FAA, we then tested 1) a broad postnatal tamoxifen-inducible deletion, 2) a complete, developmental knockout of Sirt1, and 3) a gene replacement, catalytically inactive, form of Sirt1; but all of these mice had FAA similar to controls. Therefore, our findings suggest that FAA is completely independent of Sirt1.
Subject(s)
Anticipation, Psychological/physiology , Caloric Restriction , Feeding Behavior/physiology , Feeding Behavior/psychology , Sirtuin 1/metabolism , Animals , Body Weight/physiology , Brain/cytology , Brain/metabolism , Female , Homeostasis/physiology , Male , Mice, Inbred C57BL , Mice, Transgenic , Neurons/cytology , Neurons/metabolism , Sirtuin 1/geneticsABSTRACT
Loss of the Neurofibromatosis 1 (Nf1) protein, neurofibromin, in Drosophila disrupts circadian rhythms of locomotor activity without impairing central clock function, suggesting effects downstream of the clock. However, the relevant cellular mechanisms are not known. Leveraging the discovery of output circuits for locomotor rhythms, we dissected cellular actions of neurofibromin in recently identified substrates. Herein, we show that neurofibromin affects the levels and cycling of calcium in multiple circadian peptidergic neurons. A prominent site of action is the pars intercerebralis (PI), the fly equivalent of the hypothalamus, with cell-autonomous effects of Nf1 in PI cells that secrete DH44. Nf1 interacts genetically with peptide signaling to affect circadian behavior. We extended these studies to mammals to demonstrate that mouse astrocytes exhibit a 24-hr rhythm of calcium levels, which is also attenuated by lack of neurofibromin. These findings establish a conserved role for neurofibromin in intracellular signaling rhythms within the nervous system.
Subject(s)
Circadian Rhythm/genetics , Drosophila Proteins/genetics , Genes, Neurofibromatosis 1 , Nerve Tissue Proteins/genetics , ras GTPase-Activating Proteins/genetics , Animals , Animals, Genetically Modified , Cell Line , Drosophila , Male , Neurofibromatosis 1/geneticsABSTRACT
Neural processing in the brain controls behavior through descending neurons (DNs) - neurons which carry signals from the brain to the spinal cord (or thoracic ganglia in insects). Because DNs arise from multiple circuits in the brain, the numerical simplicity and availability of genetic tools make Drosophila a tractable model for understanding descending motor control. As a first step towards a comprehensive study of descending motor control, here we estimate the number and distribution of DNs in the Drosophila brain. We labeled DNs by backfilling them with dextran dye applied to the neck connective and estimated that there are ~1100 DNs distributed in 6 clusters in Drosophila. To assess the distribution of DNs by neurotransmitters, we labeled DNs in flies in which neurons expressing the major neurotransmitters were also labeled. We found DNs belonging to every neurotransmitter class we tested: acetylcholine, GABA, glutamate, serotonin, dopamine and octopamine. Both the major excitatory neurotransmitter (acetylcholine) and the major inhibitory neurotransmitter (GABA) are employed equally; this stands in contrast to vertebrate DNs which are predominantly excitatory. By comparing the distribution of DNs in Drosophila to those reported previously in other insects, we conclude that the organization of DNs in insects is highly conserved.
Subject(s)
Drosophila melanogaster/anatomy & histology , Neurons/classification , Neurotransmitter Agents/metabolism , Animals , Drosophila Proteins/metabolism , Drosophila melanogaster/metabolism , Microscopy, Confocal , Neurons/metabolism , Neurons/ultrastructure , Staining and Labeling , Tissue DistributionABSTRACT
In rodents, daily feeding schedules induce food anticipatory activity (FAA) rhythms with formal properties suggesting mediation by food-entrained circadian oscillators (FEOs). The search for the neuronal substrate of FEOs responsible for FAA is an active area of research, but studies spanning several decades have yet to identify unequivocally a brain region required for FAA. Variability of results across studies leads to questions about underlying biology versus methodology. Here we describe in C57BL/6 male mice the effects of varying the 'dose' of caloric restriction (0%, 60%, 80%, 110%) on the expression of FAA as measured by a video-based analysis system, and on the induction of c-Fos in brain regions that have been implicated in FAA. We determined that more severe caloric restriction (60%) leads to a faster onset of FAA with increased magnitude. Using the 60% caloric restriction, we found little evidence for unique signatures of neuronal activation in the brains of mice anticipating a daily mealtime compared to mice that were fasted acutely or fed ad-libitum-even in regions such as the dorsomedial and ventrolateral hypothalamus, nucleus accumbens, and cerebellum that have previously been implicated in FAA. These results underscore the importance of feeding schedule parameters in determining quantitative features of FAA in mice, and demonstrate dissociations between behavioral FAA and neural activity in brain areas thought to harbor FEOs or participate in their entrainment or output.
Subject(s)
Brain/physiology , Feeding Behavior/physiology , Hunger/physiology , Animals , Caloric Restriction , Cerebellum/physiology , Hypothalamus/physiology , Male , Mice , Mice, Inbred C57BL , Nucleus Accumbens/physiologyABSTRACT
When rodents are fed in a limited amount during the daytime, they rapidly redistribute some of their nocturnal activity to the time preceding the delivery of food. In rats, anticipation of a daily meal has been interpreted as a circadian rhythm controlled by a food-entrained oscillator (FEO) with circadian limits to entrainment. Lesion experiments place this FEO outside of the light-entrainable circadian pacemaker in the suprachiasmatic nucleus. Mice also anticipate a fixed daily meal, but circadian limits to entrainment and anticipation of more than 2 daily meals, have not been assessed. We used a video-based behavior recognition system to quantify food anticipatory activity in mice receiving 2, 3, or 6 daily meals at intervals of 12, 8, or 4-hours (h). Individual mice were able to anticipate as many as 4 of 6 daily meals, and anticipation persisted during meal omission tests. On the 6 meal schedule, pre-prandial activity and body temperature were poorly correlated, suggesting independent regulation. Mice showed a limited ability to anticipate an 18 h feeding schedule. Finally, mice showed concurrent circadian and sub-hourly anticipation when provided with 6 small meals, at 30 minute intervals, at a fixed time of day. These results indicate that mice can anticipate feeding opportunities at a fixed time of day across a wide range of intervals not previously associated with anticipatory behavior in studies of rats. The methods described here can be exploited to determine the extent to which timing of different intervals in mice relies on common or distinct neural and molecular mechanisms.
Subject(s)
Circadian Rhythm/physiology , Feeding Behavior , Animals , Food Deprivation , Male , Mice , Mice, Inbred C57BL , Suprachiasmatic Nucleus/physiologyABSTRACT
Timing activity to match resource availability is a widely conserved ability in nature. Scheduled feeding of a limited amount of food induces increased activity prior to feeding time in animals as diverse as fish and rodents. Typically, food anticipatory activity (FAA) involves temporally restricting unlimited food access (RF) to several hours in the middle of the light cycle, which is a time of day when rodents are not normally active. We compared this model to calorie restriction (CR), giving the mice 60% of their normal daily calorie intake at the same time each day. Measurement of body temperature and home cage behaviors suggests that the RF and CR models are very similar but CR has the advantage of a clearly defined food intake and more stable mean body temperature. Using the CR model, we then attempted to verify the published result that orexin deletion diminishes food anticipatory activity (FAA) but observed little to no diminution in the response to CR and, surprisingly, that orexin KO mice are refractory to body weight loss on a CR diet. Next we tested the orexigenic neuropeptide Y (NPY) and ghrelin and the anorexigenic hormone, leptin, using mouse mutants. NPY deletion did not alter the behavior or physiological response to CR. Leptin deletion impaired FAA in terms of some activity measures, such as walking and rearing, but did not substantially diminish hanging behavior preceding feeding time, suggesting that leptin knockout mice do anticipate daily meal time but do not manifest the full spectrum of activities that typify FAA. Ghrelin knockout mice do not have impaired FAA on a CR diet. Collectively, these results suggest that the individual hormones and neuropepetides tested do not regulate FAA by acting individually but this does not rule out the possibility of their concerted action in mediating FAA.
Subject(s)
Feeding Behavior/physiology , Gene Deletion , Ghrelin/genetics , Intracellular Signaling Peptides and Proteins/genetics , Leptin/genetics , Neuropeptide Y/genetics , Neuropeptides/genetics , Animals , Behavior, Animal/physiology , Body Temperature/genetics , Caloric Restriction , Ghrelin/deficiency , Intracellular Signaling Peptides and Proteins/deficiency , Leptin/deficiency , Mice , Mice, Knockout , Neuropeptide Y/deficiency , Neuropeptides/deficiency , OrexinsABSTRACT
Anticipation of resource availability is a vital skill yet it is poorly understood in terms of neuronal circuitry. Rodents display robust anticipatory activity in the several hours preceding timed daily access to food when access is limited to a short temporal duration. We tested whether this anticipatory behavior could be generalized to timed daily social interaction by examining if singly housed male mice could anticipate either a daily novel female or a familiar female. We observed that anticipatory activity was moderate under both conditions, although both a novel female partner and sexual experience are moderate contributing factors to increasing anticipatory activity. In contrast, restricted access to running wheels did not produce any anticipatory activity, suggesting that an increase in activity during the scheduled access time was not sufficient to induce anticipation. To tease apart social versus sexual interaction, we tested the effect of exposing singly housed female mice to a familiar companion female mouse daily. The female mice did not show anticipatory activity for restricted female access, despite a large amount of social interaction, suggesting that daily timed social interaction between mice of the same gender is insufficient to induce anticipatory activity. Our study demonstrates that male mice will show anticipatory activity, albeit inconsistently, for a daily timed sexual encounter.
Subject(s)
Anticipation, Psychological/physiology , Conditioning, Operant/physiology , Sexual Behavior, Animal/physiology , Animals , Feeding Behavior/physiology , Female , Mice , Mice, Inbred C57BL , Motor Activity/physiology , Sex Factors , Social Behavior , Time FactorsABSTRACT
The ability to sense time and anticipate events is a critical skill in nature. Most efforts to understand the neural and molecular mechanisms of anticipatory behavior in rodents rely on daily restricted food access, which induces a robust increase of locomotor activity in anticipation of daily meal time. Interestingly, rats also show increased activity in anticipation of a daily palatable meal even when they have an ample food supply, suggesting a role for brain reward systems in anticipatory behavior, and providing an alternate model by which to study the neurobiology of anticipation in species, such as mice, that are less well adapted to "stuff and starve" feeding schedules. To extend this model to mice, and exploit molecular genetic resources available for that species, we tested the ability of wild-type mice to anticipate a daily palatable meal. We observed that mice with free access to regular chow and limited access to highly palatable snacks of chocolate or "Fruit Crunchies" avidly consumed the snack but did not show anticipatory locomotor activity as measured by running wheels or video-based behavioral analysis. However, male mice receiving a snack of high fat chow did show increased food bin entry prior to access time and a modest increase in activity in the two hours preceding the scheduled meal. Interestingly, female mice did not show anticipation of a daily high fat meal but did show increased activity at scheduled mealtime when that meal was withdrawn. These results indicate that anticipation of a scheduled food reward in mice is behavior, diet, and gender specific.
Subject(s)
Feeding Behavior , Mice/physiology , Animals , Female , Male , Mice/genetics , Mice, Inbred C57BL , Motor ActivityABSTRACT
Although prion diseases are most commonly modeled using the laboratory mouse, the diversity of prion strains, behavioral testing and neuropathological assessments hamper our collective understanding of mouse models of prion disease. Here we compared several commonly used murine strains of prions in C57BL/6J female mice in a detailed home cage behavior detection system and a systematic study of pathological markers and neurotransmitter systems. We observed that mice inoculated with RML or 139A prions develop a severe hyperactivity phenotype in the home cage. A detailed assessment of pathology markers, such as microglial marker IBA1, astroglial marker GFAP and degeneration staining indicate early striatal pathology in mice inoculated with RML or 139A but not in those inoculated with 22L prions. An assessment of neuromodulatory systems including serotonin, dopamine, noradrenalin and acetylcholine showed surprisingly little decline in neuronal cell bodies or their innervations of regions controlling locomotor behavior, except for a small decrease in dopaminergic innervations of the dorsal striatum. These results implicate the dorsal striatum in mediating the major behavioral phenotype of 139A and RML prions. Further, they suggest that measurements of activity may be a sensitive manner in which to diagnose murine prion disease. With respect to neuropathology, our results indicate that pathological stains as opposed to neurotransmitter markers are much more informative and sensitive as markers of prion disease in mouse models.
Subject(s)
Hyperkinesis/complications , Hyperkinesis/pathology , Neostriatum/pathology , Prion Diseases/complications , Prion Diseases/pathology , Prions/pathogenicity , Animals , Behavior, Animal , Choline/metabolism , Gliosis/complications , Gliosis/pathology , Homeostasis , Hyperkinesis/physiopathology , Locus Coeruleus/metabolism , Locus Coeruleus/pathology , Locus Coeruleus/physiopathology , Longevity , Mesencephalon/pathology , Mesencephalon/physiopathology , Mice , Neostriatum/physiopathology , Nerve Degeneration/complications , Nerve Degeneration/pathology , Neural Inhibition , Neurons/metabolism , Neurons/pathology , Parvalbumins/metabolism , Prion Diseases/physiopathology , Serotonin/metabolism , Substantia Nigra/pathology , Substantia Nigra/physiopathology , Time Factors , gamma-Aminobutyric Acid/metabolismABSTRACT
OBJECTIVE: To test the validity and reliability of latent trait measures estimated from ratings by low-vision patients of the importance and difficulty of selected activity goals. DESIGN: Validation of a telephone-administered functional assessment instrument using Rasch analysis of self-assessment ratings. SETTING: Telephone interviews of respondents in their homes. Participants Consecutive series of 600 outpatients with low vision. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ratings of the importance and difficulty of achieving 41 activity goals. Person and item traits were measured with the Andrich rating scale model. Measurement validity and reliability were tested statistically by comparing response patterns and distributions with measurement model expectations. RESULTS: Patients could distinguish only 3 categories of importance and 4 categories of difficulty. The distributions of person and item measure fit statistics were consistent with 2 unidimensional constructs: value of independence estimated from importance ratings and visual ability estimated from difficulty ratings. However, 8 of 41 activity goals were poor estimators of value of independence and 7 of 41 activity goals were poor estimators of visual ability. Person measure distributions could be divided into 3 statistically distinct strata for estimates from both importance ratings and difficulty ratings. Item measure distributions could be divided into 21 strata for estimates from importance ratings and 7 strata for estimates from difficulty ratings. CONCLUSIONS: The 2 variables that define visual disability-value of independence and visual ability-are valid constructs that can be estimated accurately and reliably from patient ratings of the importance and difficulty of activity goals.
Subject(s)
Activities of Daily Living , Goals , Vision, Low/physiopathology , Adult , Aged , Aged, 80 and over , Disability Evaluation , Female , Humans , Male , Middle Aged , Psychometrics , Surveys and Questionnaires , Telephone , Vision, Low/rehabilitationABSTRACT
OBJECTIVES: To test the validity and reliability of measures of visual ability and to evaluate the relation between measurements made at the task level and measurements made at the goal level of a hierarchical model for visual disability. DESIGN: Validation of a telephone-administered functional assessment instrument using Rasch analysis on self-assessment ratings. SETTING: Telephone interviews of respondents in their homes. PARTICIPANTS: Consecutive series of 600 outpatients with low vision. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ordinal ratings of the difficulty in performing a subset of 337 tasks. Measures of the visual ability of each patient and the required visual ability to perform each task were made using the Andrich rating scale model. Measurement validity and reliability were tested statistically by comparing response patterns and distributions to measurement model expectations. RESULTS: Results were consistent with a single visual ability construct. Patients' visual ability estimated from task difficulty ratings agreed with estimates from goal difficulty ratings ( r =.74); the difficulty of individual goals was equal to the weighted average of the difficulties of subsidiary tasks ( r =.79). However, conclusions from the Rasch analysis were not confirmed by principal components analysis of item residuals, which indicated that visual ability had a 2-dimensional structure, with 1 factor related to mobility and the other related to reading. Factor analysis on person measures estimated from subsets of functionally grouped items confirmed the 2-dimensional structure of visual ability. CONCLUSIONS: Our study results confirm the hierarchical structure of the Activity Breakdown Structure model and show how the individualized Activity Inventory can produce measures of limitations in functional vision.
Subject(s)
Activities of Daily Living , Disability Evaluation , Vision, Low/physiopathology , Adult , Aged , Aged, 80 and over , Female , Humans , Likelihood Functions , Male , Middle Aged , Reproducibility of Results , Surveys and Questionnaires , Telephone , Vision, Low/rehabilitationABSTRACT
PURPOSE: The authors present a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) associated with a systemic necrotizing vasculitis with mixed features of Wegener granulomatosis and polyarteritis nodosa (PAN). METHODS: Case report. RESULTS: A 29-year-old woman developed a severe nosebleed, followed by a low-grade fever, night sweats, and a productive cough. One month later, she began experiencing high fevers, headache, myalgia, neck stiffness, and abdominal pain as well as bilateral blurred vision from APMPPE. Systemic evaluation revealed nasal ulcerations, bilateral pleural effusions, and a bilateral maxillary and ethmoid sinusitis, consistent with Wegener granulomatosis. However, ANCA testing was negative, and a renal and mesenteric angiogram showed aneurysmal dilatations suggestive of PAN. Her ocular and systemic symptoms markedly improved with systemic corticosteroids. CONCLUSIONS: The cause of APMPPE is unknown. This case of APMPPE associated with systemic necrotizing vasculitis provides support for the choroid as being primarily involved by a diffuse vasculitic process that interrupts choroidal perfusion and causes the characteristic fundus findings in APMPPE.
Subject(s)
Pigment Epithelium of Eye/pathology , Retinal Necrosis Syndrome, Acute/complications , Retinal Vasculitis/complications , Adult , Drug Therapy, Combination , Ethmoid Sinusitis/complications , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Granulomatosis with Polyangiitis/diagnosis , Humans , Maxillary Sinusitis/complications , Methylprednisolone Hemisuccinate/therapeutic use , Polyarteritis Nodosa/diagnosis , Prednisolone/therapeutic use , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Retinal Vasculitis/diagnosis , Retinal Vasculitis/drug therapyABSTRACT
A 47-year-old woman with a 2-month history of bilateral progressive visual loss was found to have a bilateral retrobulbar optic neuropathy. Her serum vitamin B(12) concentration and hemoglobin level were normal, but her serum folic acid concentration was decreased. The patient had a minimal alcohol intake and moderate tobacco use that had been unchanged for over 20 years; however, she had markedly altered her diet 4 years earlier in the setting of clinical depression. After treatment with oral folic acid and diet modification without change in her tobacco or alcohol use, the patient's visual function returned to normal. This case supports the role of folic acid deficiency as an important cause of some cases of nutritional optic neuropathy.