Heart failure in Parkinson's disease: analysis of the United States medicare current beneficiary survey.

OBJECTIVE: We sought to examine the prevalence of heart failure in elderly PD versus non-PD patients using a national sample of Medicare beneficiaries in the United States. SCOPE: The prevalence of heart failure in elderly PD patients was 2.27 times that of non-PD patients (19.4% versus 8.7%, 95% CI = 1.43-3.60, p 0.0005), and remained twice as high after excluding patients with stroke and possible vascular parkinsonism. CONCLUSIONS: In this cross-sectional study of a national Medicare database, heart failure occurred twice as frequently in elderly PD patients as in non-PD patients. Prospective studies are warranted to verify these findings.

Driving safety in Parkinson's disease.

In this study, 39 patients with PD and 25 control subjects without neurologic disease completed testing in a driving simulator. PD patients had more total collisions on the driving simulator than control subjects (t = -3.7, p < 0.01). In PD patients, collisions were associated with Hoehn and Yahr stage (chi(2) = 12.4, p = 0.006) and correlated with Unified Parkinson's Disease Rating Scale score (r = 0.5, p < 0.01).

Bilateral human fetal striatal transplantation in Huntington's disease.

BACKGROUND: Transplanted striatal cells have been demonstrated to survive, grow, establish afferent and efferent connections, and improve behavioral signs in animal models of Huntington's disease (HD). OBJECTIVE: To evaluate feasibility and safety and to provide preliminary information regarding the efficacy of bilateral human fetal striatal transplantation in HD. METHODS: Seven symptomatic patients with genetically confirmed HD underwent bilateral stereotactic transplantation of two to eight fetal striata per side in two staged procedures. Tissue was dissected from the lateral half of the lateral ventricular eminence of donors 8 to 9 weeks postconception. Subjects received cyclosporine for 6 months. RESULTS: Three subjects developed subdural hemorrhages (SDHs) and two required surgical drainage. One subject died 18 months after surgery from probable cardiac arrhythmia secondary to severe atherosclerotic cardiac disease. Autopsy demonstrated clearly demarcated grafts of typical developing striatal morphology, with host-derived dopaminergic fibers extending into the grafts and no evidence of immune rejection. Other adverse events were generally mild and transient. Mean Unified HD Rating Scale (UHDRS) motor scores were 32.9 plus minus 6.2 at baseline and 29.7 plus minus 7.5 12 months after surgery (p = 0.24). Post-hoc analysis, excluding one subject who experienced cognitive and motor deterioration after the development of symptomatic bilateral SDHs, found that UHDRS motor scores were 33.8 plus minus 6.2 at baseline and 27.5 plus minus 5.2 at 12 months (p = 0.03). CONCLUSIONS: Transplantation of human fetal striatal cells is feasible and survival of transplanted cells was demonstrated. Patients with moderately advanced HD are at risk for SDH after transplantation surgery.

MMPI-2 fake-bad scales: an attempted cross-validation of proposed cutting scores for outpatients.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) results were compared in 118 psychiatric outpatients given standard instructions, instructions to exaggerate their problems, instructions to feign a disorder they did not have, or instructions to feign global psychological disturbance. The groups were comparable on demographic, occupational and diagnostic characteristics as well as intake MMPI-2 results. Experimental MMPI-2 results showed that clinical scales were generally elevated in the feigning groups, with only modest differences across dissimulating instruction sets. The feigning groups had reliably higher scores than controls on all overreporting indexes examined, although no significant differences between feigning groups were present for overreporting indexes. Classification rates using previously proposed cutting scores for outpatients on individual feigning indexes showed near perfect specificity, but low to at best moderate sensitivity. Multiple regression analyses indicated that Gough's (1954) Dissimulation Scale (Ds2) was most strongly related to feigning status, and no other feigning scale contributed a significant increment in predictive power once Ds2 was entered.

Hemispheric lateralization of perception and memory for emotional verbal stimuli in normal individuals.

The purposes of this study were to extend the literature on lateralization of perception of emotional verbal stimuli in normal individuals, including a test of both the right hemisphere and valence models, and to investigate predictions from these models regarding lateralization of memory for emotional verbal stimuli in normal individuals, an area that, to our knowledge, has not been investigated. Seventy-nine undergraduates were presented lateralized positive, negative, and neutral English words and nonwords. Participants were then asked to freely recall the presented words and, after a 20-min delay, to recognize the words. Recognition memory data provided strong support for the valence model. In addition, free-recall and perception data provided partial support for this model. The literature on the lateralization of processing emotional verbal and nonverbal material is discussed.

Autobiographical memory: influence of right hemisphere damage on emotionality and specificity.

This study investigated the ability of right hemisphere damaged (RHD) patients to recall autobiographical material in response to emotional versus nonemotional cues. A modified Crovitz paradigm was used in which patients were asked to recall a specific episode from their own life that related to a cue word. These episodes were rated for emotionality and specificity by independent raters. Patients also rated the emotionality of their own episodes. Independent raters judged the reports of the RHD patients as less specific and less emotional than those of matched nonneurologic control subjects. This was true for episodes in response to emotional as well as nonemotional cue words. RHD patients' own ratings of these episodes, however, did not differ from those of controls. These findings are discussed in terms of RHD patients' overall difficulties in processing emotional material and in terms of the nature of autobiographical memory.

Altitudinal neglect.

Previous clinical observations on patients with hemispatial neglect from unilateral hemispheric lesions suggest the brain's attentional mechanisms are organized along the horizontal dimensions of extrapersonal space. We now report a patient with Balint's syndrome caused by bilateral parieto-occipital infarctions, who demonstrated altitudinal neglect. On visual and tactile bisection of vertical rods, the patient consistently placed her mark well above the true midpoint, and this performance remained unchanged when the stimuli were simultaneously explored visually and tactually. She also showed altitudinal inattention in the visual modality by extinguishing the stimulus presented in the lower quadrants during double simultaneous stimulation across the horizontal meridian. These findings suggest that bilateral damage to the parietal lobes can lead to multimodal attentional and exploratory deficits along the vertical dimensions of extrapersonal space.