Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia.

Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A's husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.

Use of beta-blockers and risk of aseptic loosening in total hip and knee arthroplasty: a nested case - control study.

OBJECTIVES: To analyze the effect of beta-blockers on the risk of aseptic loosening (AL) in Total Hip (THA) or Knee (TKA) Arthroplasty. METHODS: A nested case-control study was conducted. Cases were patients who underwent revision surgery for THA or TKA due to AL. Controls were patients who sustained primary THA or TKA and were matched to cases in respect to age, sex, type of prostheses and follow-up in a 4:1 ratio. The use of beta-blockers was achieved. A logistic regression analysis adjusted to potential confounders was performed to determine the risk of AL. Analysis was also adjusted to cardioselectivity of the beta-blocker and the adherence to treatment, measured as Proportion of Days Covered (PDC). RESULTS: 24 cases and 96 controls were selected. Compared to non-users, any use of beta-blockers was associated with a reduced risk of AL [adjusted OR 0.141 (Confidence Interval (CI) 95% 0.04-0.86)]. Use of selective beta-blockers showed significant lower risk of AL [adjusted OR 0.112 (CI95% 0.01-0.91)]. PDC ≥50% was associated with reduced risk of AL compared to non-users [adjusted OR 0.083 (CI95% 0.01-0.66)]. CONCLUSION: The first clinical evidence showing an association between the use of beta-blockers and lower risk of aseptic loosening in THA and TKA is provided.

Bilateral brain reorganization with memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia: An ERP study.

Changes in ERP (P100 and N400) and root mean square (RMS) were obtained during a silent reading task in 28 patients with chronic post-stroke aphasia in a randomized, double-blind, placebo-controlled trial of both memantine and constraint-induced aphasia therapy (CIAT). Participants received memantine/placebo alone (weeks 0-16), followed by drug treatment combined with CIAT (weeks 16-18), and then memantine/placebo alone (weeks 18-20). ERP/RMS values (week 16) decreased more in the memantine group than in the placebo group. During CIAT application (weeks 16-18), improvements in aphasia severity and ERP/RMS values were amplified by memantine and changes remained stable thereafter (weeks 18-20). Changes in ERP/RMS occurred in left and right hemispheres and correlated with gains in language performance. No changes in ERP/RMS were found in a healthy group in two separated evaluations. Our results show that aphasia recovery induced by both memantine alone and in combination with CIAT is indexed by bilateral cortical potentials.

Discriminating power of CPPQ-Mohedo: a new questionnaire for chronic pelvic pain.

OBJECTIVES: In the absence of a gold-standard tool to measure chronic pelvic pain (CPP), most studies on the prevalence of CPP use the NIH-chronic prostatitis symptom index (CPSI) questionnaire. However, its suitability and relevance for use in both sexes have not yet been evaluated, and generalized interpretation of the results is therefore questionable. Accordingly, we designed a questionnaire that discriminates between patients with and without symptoms of CPP. METHODS: We undertook a study to test the discriminating capacity for chronic pelvic pain questionnaire (CPPQ)-Mohedo test for CPP among healthy and unhealthy individuals, and if this discrimination was similar for men and women. We did a matched study - 40 unhealthy men were matched by age with 40 unhealthy women - and each of those was matched with six healthy controls by age and sex (480 in total). To elaborate the questionnaire (CPPQ-Mohedo), we started with the NIH-CPSI, adapting the items referring to anatomic areas for women, changing the type of response and including various items on pelvic pain not previously recorded. RESULTS: The NIH-CPSI questionnaire [area under the receiver operating characteristic (ROC curve), 0.946] was very similar to that of the CPPQ-Mohedo questionnaire (area under the ROC curve, 0.968), but the first required more items. CPPQ-Mohedo showed similar discriminant capacity between men and women. The dimensions involved (pain and quality of life) showed internal consistency (Cronbach's alpha: 0.75). CONCLUSIONS: The CPPQ-Mohedo questionnaire presented discriminating power in men and women with symptoms of CPP. This questionnaire may be used as a screening tool to identify patients and include them in treatment programmes, as an outcome assessment tool for treatment and clinical trials, or as a tool to assess the prevalence of CPP in epidemiologic studies.