Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics.

OBJECTIVE: To characterize the neuropsychiatric symptoms (NPS) of subjects classified as not cognitively impaired (NCI), cognitively impaired-not demented (CIND), and dementia. METHODS: A Canadian Cohort Study of Cognitive Impairment and Related Dementias (ACCORD) is a longitudinal investigation of individuals referred to eight Canadian dementia centers for evaluation of cognitive impairment and neurobehavioral symptoms. Of the inception cohort of 804 subjects for whom the informant-based Neuropsychiatric Inventory (NPI) was completed at study entry, 35 were classified as NCI, 193 as CIND, and 576 as dementia. The three diagnostic groups were compared on each of the 12 NPI items. Within each diagnostic group, comparisons were also made between symptomatic (NPS+; total score > 1) and asymptomatic (NPS-; total score = 0) subjects on measures of general cognitive status and functional disability. A subset of the NCI and CIND individuals were also compared on a comprehensive neuropsychological test battery. RESULTS: There was at least one NPI item reported in 60% of subjects with NCI, 74% with CIND, and 89% with dementia. The item scores for delusions, hallucinations, agitation, apathy, disinhibition, aberrant motor behavior, and problems with appetite were greater in dementia subjects than in NCI or CIND. There were no significant differences between subjects with NCI and CIND on any NPI item. For each diagnostic group, NPS+ subjects were more impaired on functional but not neuropsychological measures. CONCLUSIONS: Across all levels of cognition, neuropsychiatric symptoms (NPS) are an important feature in individuals referred to dementia clinics. The current data suggest that NPS may precede cognitive deficits in individuals classified as not cognitively impaired and cognitively impaired-not demented.

Predictors of seizure outcome following cortical resection in pediatric and adolescent patients with medically refractory epilepsy.

Several preoperative clinical variables have been reported to have value as predictors of seizure outcome following the surgical resection of epileptogenic focus in adults who have had medically refractory epilepsy. The present paper reports the results of a retrospective review of the ability of these variables to predict seizure outcome in a group of pediatric patients who had medically refractory epilepsy and underwent surgical resection of an epileptogenic focus at the Children's Hospital of Eastern Ontario. Variables in this review included age at first seizure, age at time of surgery, duration of seizures, seizure type, sex, family history, etiology, level of intelligence, EEG data, results of imaging studies, findings on examination of the central nervous system, and location and site of surgical resection. We found 64 patients who met the entry criteria for this review. Normal intelligence and tumor as etiology were associated with a good postoperative seizure outcome in patients who had a temporal resection; no variables had positive correlation with outcome in the extratemporal group. Caution must be used in the extrapolation of data and inclusion of studies of predictors of seizure outcome for adults to pediatric age groups.

Long-term socioeconomic outcome following surgical intervention in the treatment of refractory epilepsy in childhood and adolescence.

Surgical treatment of refractory epilepsy in childhood and adolescence has been shown to be effective in reducing the seizure frequency. This paper examines the question: "Does this result in a better socioeconomic outcome in later years?" Patients who underwent a surgical procedure for the treatment of their medically refractory epilepsy at our hospital, had more than 2-years' follow-up, and were less than 18 years old at time of survey were included. From a retrospective chart review, age at onset and at surgery, duration of seizures prior to surgery, years of follow-up, type of surgery, and neurological status were obtained. From a telephone survey, seizure frequency after surgery, marital, financial and driving status, level of education, and employment status were ascertained. Sixty-four patients in our epileptic surgical series meet entry criteria. Significantly higher levels of education, employment status and independence were found in patients with a class I Engel outcome compared to other Engel outcomes.

Patient satisfaction with surgical treatment of refractory epilepsy done in childhood and early adolescence.

The results of a retrospective self-controlled telephone satisfaction survey of 63 patients who had undergone an earlier resection for the treatment of medically refractory epilepsy before the age of 18 years was reported. The survey items consisted of a global rating scale and a series of open-ended questions about positive and negative outcomes as a result of the surgery. Most (80%) of the patients felt the surgery had had a positive effect on their lives. The mean global score was 6.24+2.4 (scale 0-9). Strong positive correlations were found between seizure control and degree of satisfaction and between perceived postsurgical neurological deficits and dissatisfaction.