Cognitive Component Structure of a Neuropsychological Battery Administered to Cognitively-Normal Adults in the SIU Longitudinal Cognitive Aging Study.

We used principal component analysis (PCA) to examine the component structure of a neuropsychological test battery administered to 943 cognitively-normal adults enrolled in the Southern Illinois University (SIU) Longitudinal Cognitive Aging Study (LCAS). Four components explaining the most variance (63.9%) in the dataset were identified: speed/cognitive flexibility, visuospatial skills, word-list learning/memory, and story memory. Regression analyses confirmed that increased age was associated with decreased component scores after controlling for gender and education. Our identified components differ slightly from previous studies using PCA on similar test batteries. Factors such as the demographic characteristics of the study sample, the inclusion of mixed patient and control samples, the inclusion of different test measures in previous studies, and the fact that many neuropsychological test measures assess multiple cognitive processes simultaneously, may help to explain these inconsistencies.

Systemic White Blood Cell Count as a Biomarker for Malignant Cerebral Edema in Large Vessel Ischemic MCA Stroke.

OBJECTIVES: Large middle cerebral artery (MCA) strokes remain a major cause for mortality and morbidity all over the world, and therefore early identification of patients with the highest risk for malignant cerebral edema is crucial for early intervention. Neutrophils to lymphocytes ratio (NLR) and peripheral total white blood cell (WBC) count are inflammatory markers done routinely for all patients, and this study evaluated the use of NLR and elevated white blood cell count within the first 24 h of MCA ischemic stroke onset, with the absence of significant hemorrhagic transformation, to predict malignant cerebral edema. MATERIALS AND METHODS: A total of 156 patients with large MCA strokes were included. We collected demographic, clinical, radiological data, and NLR and WBCs within the first 24 h from admission.We excluded patients who had any underlying infections diagnosed 7 days before or within 72 h after admission. We used a body temp of 38 C or more, abnormal CXR or abnormal urine analysis within the first 72 h to exclude patients with possible infections.We excluded immune-compromised patients and patients on steroid therapy. We compared the NLR and WBC count in patients who developed malignant cerebral edema versus the patients who did not. NLR > 3.5 and < 3.5 was used for comparison. We then conducted multivariate logistic regression models to explore the relationship between cerebral edema, WBCs and NLR count simultaneously. RESULTS: NLR, WBC, radiological involvement of more than 50% of MCA territory infarction on presentation, hyperdense MCA sign, and NIH stroke scale were all significantly higher in patients with malignant cerebral edema within the first 24 h. Using univariate logistic regression, NLR performs better than WBC when predicting the occurrence of malignant cerebral edema (AUC = 0.74 vs. 0.62). However, NIH stroke scale scores, and radiological involvement of more than 50% of MCA territory infarction on the first 24 h of presentation on CT scan both showed better discriminative performance for malignant cerebral edema than NLR (AUC = 0.84 and 0.76, respectively). When combined, NLR > 3.5 paired with the NIH stroke scale score had the best predictive performance (AUC = 0.87). CONCLUSION: NLR > 3.5 can be used for early prognostication in patients with large vessel MCA ischemic strokes with no significant hemorrhagic transformation within the first 24 h regardless if they had reperfusion therapy or not. Combining NLR of > 3.5 in addition to high NIHSS provided the best predictive model in our study. Further studies are needed to further develop the best predictive model in diverse populations.

Absent hyperdense middle cerebral artery sign is associated with poor functional outcome after mechanical thrombectomy.

BACKGROUND: The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. AIMS: Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. METHODS: We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. RESULTS: Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30-8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. CONCLUSION: The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.

Many caregivers of persons with memory loss or Alzheimer's disease are unaware of the abilities of their persons with AD to recall their drugs and medical histories.

BACKGROUND: Caregiver awareness of the abilities of those they care for has much practical importance, especially from the safety standpoint. OBJECTIVES: To determine whether the caregivers of persons with memory impairment or Alzheimer's disease know if their persons are able to recall their own drugs and medical histories. METHOD: Persons with prodromal or probable AD (persons with AD) and their caregivers who were visiting our medical school's neurology and internal medicine clinics for routine follow-up care were recruited on the days of their appointments. Sixty-four caregiver-person with AD dyads were recruited. We first asked the caregivers to predict the ability of their persons with AD to answer questions about their drugs and medical histories. We then asked the persons with AD the questions to determine the accuracy of their caregivers' predictions. RESULTS: Considering the caregivers of those with Mini-Mental State Exam scores ≥24, 41% incorrectly predicted whether their persons with AD could recall the number of drugs they were taking, 24% incorrectly predicted whether they could recall the names of the drugs, and 34% incorrectly predicted whether they could recall why they were taking the drugs. Most of the caregivers' errors were overestimations. As expected, the persons with AD themselves had much difficulty in answering the questions; only 30% could recall the number of drugs they were taking, only 14% could recall the names of the drugs, and only 16% could recall why they were taking the drugs. CONCLUSIONS: Many caregivers of persons with memory impairment or AD are unaware of their persons' inability to recall their drugs and medical histories. Particularly concerning is the relatively high frequency of caregiver overestimations of the abilities of their persons with AD, which highlights a safety concern and presents an opportunity for caregiver education.

Spatial analysis of disparities in asthma treatment among adult asthmatics.

BACKGROUND: Spatial analytic techniques can uncover important differences in asthma treatment and identify geographic areas with poor asthma management. OBJECTIVE: To review geographical differences in asthma treatment in an adult asthmatic population. METHODS: This was a retrospective, cross-sectional chart review study (n = 519) using Geographic Information System approaches to determine the impact of spatial access to pharmacies and other factors on inappropriate rescue and inadequate controller medication use. Statistical analyses included chi-square test for categorical variables and Kruskall-Wallis test for continuous variables. Logistic regression was used to determine unadjusted and adjusted odds of inappropriate and inadequate pharmaceutical management of asthma based upon distance to pharmacy and other factors. Choropleth maps were constructed to display zip code level variation of asthma management. RESULTS: Inappropriate medication users lived further from their preferred pharmacy compared to appropriate users (median distances of 3.02 and 1.96 miles respectively; p = 0.01). Inappropriate and inadequate management of asthma varied by zip code, ranging from 5.5 to 17.3% and 25.0-59.6%, respectively. A statistically significant difference in appropriate use by age was found, with nearly 17% of adults age 65 and older overusing their rescue inhaler. Conversely, patients age 18-34 years, 35-49 years, and 50-64 years, used their controller medications inadequately (64.2%, 57.3%, and 48.2%, respectively) compared to 42.5% of patients aged 65 and older. Unadjusted and adjusted analyses showed that former smokers had higher odds of inadequate management of asthma. CONCLUSION: The unadjusted findings suggest that distance to pharmacies may play a role in the pharmaceutical management of asthma, though these findings are explained by confounding factors. Future research should continue to explore the effect of spatial access to pharmacies on chronic disease management and the role that maps can play in guiding medication management interventions in a larger sample to allow for more rigorous analysis.