Low vitamin D level is associated with higher relapse rate in natalizumab treated MS patients.

BACKGROUND: Previous research suggested a relationship between low vitamin D and relapse rate. We examined whether vitamin D levels were associated with: 1) MS severity and 2) recent MS relapse activity, in patients treated with natalizumab. METHODS: All patients (n=118) were treated with natalizumab and were tested for vitamin D levels during the winter of 2009-10. Number of relapses during treatment with natalizumab was determined by retrospective chart review. MS severity was estimated with the Roxburgh's MS Severity Score (MSSS) at the time of the initial blood draw and 1 year preceding and following initial draws. Vitamin D levels of 50 nmol/L or greater were defined as normal. RESULTS: Patients with deficient vitamin D levels (DVD) totaled 45. Sixteen of the 26 patients with relapse in the year prior to the initial blood draw (4 patients had multiple relapses - all were in DVD) and 12 of 17 patients with relapse in the following year were in the DVD group. There was a significant difference between the normal vitamin D group (NVD) and DVD in MS relapse activity in the year prior (p=0.005) and following blood draw (p=0.006). There was no significant between group differences in MSSS at any time. CONCLUSIONS: Natalizumab treated patients with DVD were more likely to experience relapse and may experience more relapses than patients with NVD.

Alcohol, dementia, and Alzheimer's disease: comparison of neuropsychological profiles.

Thirty-nine detoxified elderly alcoholics (mean age = 65.85) completed a comprehensive assessment designed to identify individuals meeting DSM-IV criteria for alcohol-related dementia. Ten subjects meeting criteria (mean age = 69.8; mean Mini-Mental State Examination [MMSE] = 25.1) were compared to the 29 nondemented alcoholics (mean age = 64.5; mean MMSE = 27.8), 9 patients with Alzheimer's disease (mean age = 73.4; mean MMSE = 22.3), and 15 control subjects (mean age = 70.8; mean MMSE = 28). Comparison of neuropsychological test scores revealed several statistically significant differences. Furthermore, the overall pattern of test performance between the two demented groups was different. Alzheimer's patients were more impaired on confrontation naming, recognition memory, animal fluency, and orientation. Alcohol dementia subjects were more impaired than controls on initial letter fluency, fine motor control, and free recall. However, alcohol dementia subjects did not differ from controls on tests of verbal recognition memory. This study suggests that it is possible to clinically differentiate the cognitive deficits of alcohol-related dementia from typical Alzheimer's disease. However, the results are preliminary and are based on small sample sizes so should be interpreted with caution.

Short-term prognosis in early relapsing-remitting multiple sclerosis.

OBJECTIVE: To characterize a group of patients with early MS using prognostic factors and to determine whether these prognostic factors impact on short-term prognosis. METHODS: Data were collected prospectively on 98 patients newly diagnosed with MS in our MS clinic between 1990 and 1998 (average follow-up, 37 months from the time of onset of clinically definite MS [CDMS]). Six prognostic factors were recorded: age at onset, symptoms at onset, MRI status at onset and at diagnosis of CDMS, interval between the first and second attack, attack frequency in the first 2 years, and completeness of recovery from initial attacks. Completeness of recovery was determined using Expanded Disability Status Scale scores (EDSS). Progression was determined by final EDSS and changes in EDSS between initial presentation and final follow-up. RESULTS: Patients predicted to have low risk of progression of MS based on the prognostic factors represented 17% of our patient population (0 to 1 risk factor for progression). The patients with high risk of progression (4 to 6 risk factors) represented 24% of patients. Patients with a high number of risk factors did significantly worse than those with a small or medium number of risk factors in terms of final EDSS and progression to higher EDSS. At the time of diagnosis of CDMS, MRI findings suggestive of MS were seen in 84% of patients (suspicious in 13%, negative in 3%). CONCLUSION: Short-term prognosis was influenced by the presence or absence of a high number of these six risk factors.

Use of dipyridyl-dithio substrates to measure directly the protein disulfide-thiol interchange activity of the auxin stimulated NADH: protein disulfide reductase (NADH oxidase) of soybean plasma membranes.

Dipyridyl-dithio substrates were cleaved by isolated vesicles of plasma membranes prepared from etiolated hypocotyls of soybean. The cleavage was stimulated by auxins at physiological concentrations. The substrates utilized were principally 2,2'-dithiodipyridine (DTP) and 6,6'-dithiodinicotinic acid (DTNA). The DTP generated 2 moles of 2-pyridinethione whereas the 6,6'-dithiodinicotinic acid generated 2 moles of 6-nicotinylthionine. Both products absorbed at 340 nm. The auxin herbicide, 2,4-dichlorophenoxyacetic acid (2,4-D) stimulated the activity approximately 2-fold to a maximum at about 10 microM. Concentrations of 2,4-D greater than 100 microM inhibited the activity. Indole-3-acetic acid stimulated the activity as well. The growth-inactive auxin, 2,3-dichlorophenoxyacetic acid (2,3-D), was without effect. DTNA cleavage correlated with oxidation of NADH and reduction of protein disulfide bonds reported earlier in terms of location at the external plasma membrane surface, absolute specific activity, pH dependence and auxin specificity. The dipyridyl-dithio substrates provide, for the first time, a direct measure of the disulfide-thiol interchange activity of the protein previously measured only indirectly as an auxin-dependent ability of isolated plasma membrane vesicles to restore activity to scrambled and inactive RNase.

Poststroke depression and anxiety: different assessment methods result in variations in incidence and severity estimates.

Patients with right and left hemisphere stroke (RH, LH) and a control group (CG) were administered a structured clinical interview (SCID-R) and rating scales for anxiety and depression (Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, and Hamilton Depression Rating Scale). The three groups did not differ when compared for the mean level of distress on the rating scales or frequency of mood or anxiety disorder diagnosis using the SCID-R. By contrast, participants in the LH group were more likely to be classified as distressed using rating scales cutoff scores and on measures of severity when compared only to the RH group. The rating scales were sensitive to psychiatric disorders, but lacked specificity in all groups. There were significant correlations between scales suggesting the rating scales measure a common factor in the controls, while in the stroke groups associations were weaker and less likely to be significant. Together, these results suggest the need for caution in using rating scales of depression and anxiety in neurologic patients and support the notion that these scales are sensitive to distress rather than specific for identifying depressive and anxiety disorders.

State-dependent learning in older and younger adults.

In this study state-dependent learning in younger and older adults was compared. State was manipulated by having participants rest or exercise for 5 min, followed by exposure to 3 learning trials of a 20-item word list. After a 20-min delay, participants engaged either in the congruent or in the incongruent activity followed by free-recall trial, cued-recall, and recognition tests. Heart rate, blood pressure, and self-report of distress measures verified that the experimental conditions influenced the participants' physiologic state, but the distracter tasks did not. There was no difference in learning that was due to initial exercise condition, but both age groups showed greater recall when state was congruent before learning and delayed recall. This replicates previous research in which consistent state-dependent learning effects in younger adults were found and supports research suggesting that older adults spontaneously use contextual information to facilitate recall. The demonstration of state-dependent learning in older adults is discussed as an example of implicit memory not affected by aging.

Judgement research and neuropsychological assessment: a narrative review and meta-analyses.

The authors review judgment research in the area of neuropsychological assessment. Topics include the reliability and validity of judgments, the appropriateness of confidence ratings, the value of training and experience, the cognitive processes of neuropsychologists, and the use of decision aids, including automated assessment programs and statistical prediction rules. Most of the research is on reliability and validity. The results indicate that neuropsychologists frequently make reliable and moderately valid judgments. However, for several tasks, experimenters have not studied the reliability and validity of judgments.

The role of psychological factors in the report of building-related symptoms in sick building syndrome.

Sick building syndrome (SBS) is an increasingly common problem, although continued skepticism exists regarding its validity. Because of this, the attribution of complaints to psychogenic causes or mas hysteria persists. In this study (N = 111), self-report measures of psychopathology (Minnesota Multiphasic Personality Inventory [Hathaway & McKinley, 1983] and SCL-90-R [Derogatis, 1983]) and physical symptom reports failed to discriminate symptomatic from nonsymptomatic workers in an affected building but could more generally differentiate workers in the target building from control subjects. These results suggest that SBS cannot be justifiably attributed to psychological factors alone, although working in a contaminated environment appeared to have deleterious psychological consequences for some workers. Smoking history (in pack/years [packs per day x number of years smoked]) was reliably associated with the development of symptoms in exposed workers. Issues related to the assessment of psychological complaints in SBS are discussed.

Sick building syndrome.

"Sick building syndrome" (SBS) is one of the more colorful terms describing an increasingly common pattern of symptoms found among workers in modern office buildings. Core symptoms include lethargy, mucous membrane irritation, headache, eye irritation, and dry skin. To prompt a diagnosis of SBS, these otherwise common symptoms must be "excessively" reported and primarily "work-related." The World Health Organization now estimates that 30% of new or remodeled office buildings show signs of SBS, and that between 10% and 30% of the occupants of these buildings are affected by SBS. Despite such figures, SBS remains poorly researched and even more poorly understood. The following review provides the clinician an overview of SBS that will allow a more accurate differential diagnosis and will help to prevent the widespread suffering that can accrue when SBS is not quickly recognized.