Profiles of cognitive decline in Alzheimer disease.

Most recent studies have used only two observations to estimate the rate of cognitive decline in patients with Alzheimer disease (AD); few have data taken from more than a 2-year period; and none report on autopsy-verified cases. Repeated observations over the complete course of the disease are necessary to quantitatively evaluate hypotheses such as the triphasic linear model of Brooks et al. (1993). The goal of this study is to compare the triphasic linear and quadratic models of decline in a group of 12 AD patients confirmed at autopsy with a group of age- and sex-matched normal control subjects. Both groups were taken from the University of Western Ontario Dementia Study, and the Extended Scale for Dementia was used as the outcome measure. The squared multiple correlation as a measure of goodness of fit suggested the superiority of the more parsimonious quadratic model over the triphasic linear model. Quantitative models more accurately reflect the profiles of change in AD and may prove more sensitive in measuring the effects of drugs on these patterns.

Seasonal affective disorder in an Arctic community.

OBJECTIVE: To determine the rate of seasonal-pattern depression in an Inuit community above 70 degrees N. METHOD: One-hundred and eleven people from randomly selected households were surveyed for depression and anxiety and the effect of the seasons on their mood. Eighty-eight people provided replies on the influence of the seasons. RESULTS: One in five (22.6%) of the community sample was found to be depressed. Of these, seven (6.3%) had seasonal affective disorder (SAD), with fall onset occurring in six of these (5.4%). Subsyndromal SAD (SSAD) occurred in 11.7%, while any effect of the seasons (seasonality) occurred in 39.6%. Persons with SSAD and seasonality were significantly older than those unaffected by the seasonal effect. No other significant correlation of SAD, SSAD, or seasonality occurred with gender, age, and language preference. CONCLUSION: Seasonal mood changes in this Inuit group living in the Canadian Arctic are elevated above the rates found in other studies using similar survey methods.

Psychosocial aspects of fibromyalgia.

The view that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven. The construct of posttraumatic FMS has not been adequately validated. Similarly, there is no evidence that communicating the diagnosis to patients causes iatrogenic consequences. Research suggesting a higher rate of posttraumatic stress disorder among those with FMS is weak. More research examining specific psychological processes in FMS is desirable. Because of the potential for harm to patients, clinicians should be cognizant of possible undue influences on medical opinion by agencies providing health care and research funding.

Clinical and pathologic features of two groups of patients with dementia with Lewy bodies: effect of coexisting Alzheimer-type lesion load.

The objectives of this study were to examine the clinical and pathologic features of two subgroups of patients with dementia with Lewy bodies (DLB) differing in Alzheimer disease (AD)-type pathology load and to identify clinical variables useful in the differential diagnosis from AD. The records of 64 consecutive demented patients were reviewed. Pathologic diagnoses were independently established [35 AD cases, 11 cases of pure dementia with Lewy bodies (pDLB), and 18 cases of combined AD plus Lewy bodies (AD+LB)], and several neurodegenerative lesions were quantified. Clinical and pathologic data were compared between groups with univariate and multivariate analyses. Compared with the other groups, pDLB cases had more frequent acute-subacute onset of dementia [45% vs. AD (3%) and AD+LB (16%)], early parkinsonism [45% vs. AD (0%) and AD+LB (0%)], early [27% vs. AD (0%) and AD+LB (0%)] and late [73% vs. AD (11%) and AD+LB (16%)] hallucinations, fluctuating course [46% vs. AD (9%) and AD+LB (22%)], delusions [45% vs. AD (11%) and AD+LB (6%)], spontaneous parkinsonism [63% vs. AD (8%) and AD+LB (16%)], less frequent ideomotor apraxia and loss of insight, earlier urinary incontinence [3.2 +/- 1.4 years after onset vs. AD (6.3 years) and AD+LB (5.8 years)], shorter duration of dementia [7.7 +/- 2.4 years vs. AD (9.6 years) and AD+LB (11 years)], milder atrophy in computed tomography scans, greater brain weight, more transcortical spongiosis, wider cortex and subcortex, and less amyloid angiopathy. All pDLB cases but no AD cases had abnormal CA2 neurites. The clinical features of AD+LB patients were similar to those of AD patients other than more frequent acute-subacute onset and fluctuating evolution. Discriminant analyses selected four clinical variables differentiating pDLB from the other two groups as a whole: acute-subacute onset, early parkinsonism, early hallucinations, and early onset of urinary incontinence. Two or more of these features identified pDLB with a sensitivity of 81.8% and a specificity of 95.9%. Differentiation between the three groups (pDLB, AD+LB, and AD) or between both groups with LB (DLB) from AD could be only attained in 70% of cases. We conclude that early symptomatology is the main clue for the diagnosis of pDLB. We identified by discriminant analysis a set of clinical diagnostic criteria similar to those proposed by the Consortium on Dementia With Lewy Bodies. Accuracy was excellent for the diagnosis of pDLB but only mediocre for separating AD+LB as well as the entire DLB group from AD.

Psychiatric disorders in an Arctic community.

OBJECTIVE: To determine the rates of depression, anxiety, and alcohol abuse, using modern nosology, in a random sample of residents aged 14 to 85 years living in an Arctic community. METHOD: A cross-sectional 2-step survey of randomly selected households was undertaken, using a self-report questionnaire to screen for anxiety, depression, and alcohol abuse. The survey included the Hospital Anxiety and Depression Scale (HADS) and Ewing and Roose's 4-question alcohol screening instrument (the CAGE questionnaire). Cut-off scores for the HADS and CAGE were found by comparing HADS and CAGE scores with scores on the Structured Clinical Interview for the DSM-III-R (SCID) in a stratified subsample. RESULTS: Estimated rates of depression and anxiety were 26.5% and 19.0% respectively within the past week, and estimated rates of lifetime alcohol abuse were 30.5%. CONCLUSIONS: The estimated prevalence of psychiatric disorders in this Arctic community is higher than that indicated in previous findings on Native mental health.

A note on suicidal deterioration with recovered memory treatment.

BACKGROUND: Many patients who have been told they have Multiple Personality/Dissociative Identity Disorder (MPD/DID) seem to have deteriorated clinically after being so diagnosed. We report here the results of a survey of suicide attempts in patients diagnosed as having MPD and a comparison group hospitalized with a mood disorder. METHODS: Twenty individuals who had been diagnosed as having MPD, had developed false memories, and had relinquished them, were surveyed with respect to suicide attempts before and after the diagnosis. Twelve of those approached agreed to provide data and were compared with 12 patients from an in-patient mood disorders unit, matched for age and sex. RESULTS: In the MPD group more patients attempted suicide after being diagnosed than before and they made more separate attempts at suicide than before. The reverse was true in the comparison group with patients and suicide attempts before and after hospitalization. Comparing the numbers of attempts in the groups before diagnosis/hospitalization and afterward Chi(2)=20.177, DF=1, P<0.001. LIMITATIONS AND CONCLUSIONS: Both samples were highly selected, and the comparison group does not provide an exact control. Nevertheless, the results support a trend in the literature that finds the diagnosis of multiple personality disorder and the use of recovered memory treatment are harmful.

An autopsy-verified study of the effect of education on degenerative dementia.

A longitudinal study of the relationship between education and age of onset, rate of progression and cerebral lesion burden in a series of autopsy-confirmed demented patients with clinical and 6-monthly psychometric follow-up and autopsy was carried out. The study was conducted at the London Health Sciences Centre University Campus of the University of Western Ontario on 87 patients with pathologically confirmed Alzheimer's disease (60), dementia with Lewy bodies (11) or dementia with Lewy bodies plus Alzheimer's disease (16). Their educational attainment was classified as below high school, high school or above high school, and was similar to that of the age-adjusted general Ontario population. The age of onset of dementia, age at death, progression of cognitive decline, amount of neurodegenerative changes (senile plaques, neurofibrillary tangles and Lewy bodies) and cerebrovascular lesions (infarcts, lacunar state and white matter rarefaction) were assessed. Less educated patients became demented later and died later, but cognitive function declined at the same rate in all educational groups and there was no difference in the burden of neurodegenerative lesions between them. However, the less educated patients had more cerebrovascular lesions. It can be concluded that higher education does not modify the course of Alzheimer's disease, but lower education relates to the occurrence of cerebral infarcts. Our results suggest that a 'brain battering' model related to the higher prevalence of small vascular lesions in less educated individuals may explain their increased risk of dementia described by epidemiological studies better than the prevalent 'brain reserve' hypothesis.

Antidepressants in rehabilitation.

Antidepressant medications have a variety of uses in addition to the treatment of depression. This article focuses on the two most widely used categories of antidepressants, tricyclic antidepressants (TCAs) and the newer selective serotonin reuptake inhibitors (SSRIs), and highlights their use in post-stroke depression and chronic pain.

Does gender affect appraisal of pain and pain coping strategies?

OBJECTIVE: To investigate the impact of gender and a set of pain characteristics on the threat or challenge appraisal of pain and the impact of these appraisals on the coping strategies used to manage the pain. DESIGN: This study used a community telephone survey to examine these relationships for a troublesome pain experienced by respondents in the 2 weeks preceding the interview. STUDY RESPONDENTS: The sampling frame consisted of 1,430 households randomly selected from the Halifax-Dartmouth-Bedford community. Of the 390 respondents with a troublesome pain in the 2 weeks preceding the interview, 309 respondents agreed to participate (79% response rate). RESULTS: Women tended to report more pain located in the head and more somatic problems. They reported significantly more intense pain. For women and men, the most important impact on threat appraisal of pain was overall interference of pain and emotional upset due to pain. These two variables accounted for 48% of the variance in threat appraisal for women and 37% of the variance for men. There was no gender difference in emotional upset due to pain or in the impact of emotional upset on threat appraisal. There was no gender difference in challenge appraisal. Threat appraisal was associated with increased catastrophizing whereas challenge appraisal was associated with positive self-statements. Women reported significantly more problem solving, social support, positive self-statements, and palliative behaviors than did men. CONCLUSIONS: Interference of pain has a greater impact on threat appraisal of pain for women. Increasing threat appraisal is associated with health care utilization for women, but women's more frequent use of several coping strategies is unrelated to their appraisal of pain. Appraisal of pain may have important implications on coping and overall well-being of women and men.

The relationship of catatonia symptoms to symptoms of schizophrenia.

OBJECTIVE: To evaluate the relationships of symptoms of catatonic schizophrenia to 77 symptoms relevant for diagnosing schizophrenia and to socioanamnestic variables. METHOD: Data from a sample of 112 Canadian patients diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) were evaluated via phi correlation coefficients. RESULTS: Forty-five (40.2%) of our 112 patients had catatonic symptoms, either at the time of this study or in the past. However, only weak correlations (phi < 0.31) to other symptoms relevant for diagnosing schizophrenia were found, and no significant correlations to socioanamnestic variables were found. CONCLUSION: Symptoms of catatonia appear to be independent of the key symptoms of schizophrenia.