Importance of psychiatric examination in predictive genetic testing for Huntington disease.

BACKGROUND AND PURPOSE: Huntington disease (HD) is an au-tosomal dominant hereditary neurodegenerative disease with multiplication of CAG triplet in the short arm of chromoso-me 4, manifested by motor symptoms, cognitive dysfunction progressing to dementia, and various types of neuropsychiat-ric disorders. The diagnosis of HD is confirmed by a gene-tic test, which may also be carried out presymptomatically. MATERIAL AND METHODS: We studied differences in psychiatric examination and psychometric measures among the 52 people at risk of HD, who were recommended to postpone or to continue in the predictive protocol. In addition to the psychiatric examination, we administered the Eysenck Personality Questionnaire (EPQ-A), the Symptom Checklist 90 (SCL-90), and quality of life questionnaire (MANSA). RESULTS: People at risk of HD with the recommended test postponement showed lower rate of neuroticism and EPQ-A lie score, higher values on the phobia and the so-called 'positive symptom distress index' in SCL-90 and lower quality of life than people at risk of HD with the recommendation to continue. CONCLUSIONS: Our results indicate that the formalized testing does not bring significant information whereas the clinical psychiatric examination remains the main decisive factor in the recommendation to perform a predictive genetic test. The motivation of applicants is considered as the most important factor in the decision-making process.

Verbal memory capacity after treatment for ruptured intracranial aneurysm--the outcomes of three psychological tests: within a month, 1 year after and 5-7 years after treatment.

BACKGROUND: Verbal memory is an essential cognitive ability with scope for adequate treatment of information and for orientation in everyday life. Our study is centered on memory performance in the wake of treatment for ruptured intracranial aneurysm. METHODS: Three psychological tests were performed: (1) within a month of the neurosurgical intervention, (2) 1 year and (3) 5-7 years after the ruptured aneurysm treatment. Under comparison are the overall results of tests for verbal memory capacity in a cohort of patients (N = 59) and in the control group. RESULTS: Three post-treatment measurements revealed a persistent deficit of verbal memory. The cohort's average performance improved from -1.3 SD (standard deviation) below the average of the norm to -0.5 SD below the norm at the second test 1 year after treatment, while at the third test the deficit had worsened to -0.68 SD. Similarly, testing for long-term recovery at 5-7 years postoperatively showed the patients' performances to be 2/3 SD below the average of the general population. CONCLUSIONS: The results of the study imply the need for long-term rehabilitation of memory in this particular group of patients.

Cognitive functions before and 1 year after surgical and endovascular treatment in patients with unruptured intracranial aneurysms.

BACKGROUND AND PURPOSE: This prospective study investigated whether surgery or endovascular treatment for unruptured intracranial aneurysms (UIAs) affects cognitive functions. METHODS: Four neuropsychological variables from an Auditory Verbal Learning Test (overall capacity of verbal memory and delayed recall) and a Trail Making Test (psychomotor speed and cognitive flexibility) were investigated before and 1 year after treatment for UIAs in 65 patients < 61 years of age. This cohort consists of 15 men and 50 women aged 15-60 (mean age 44.9) years. RESULTS: Group-rate analysis showed a non-significant increase in post-treatment scores in the four neuropsychological variables. In addition, no significant differences were found between the surgical clipping (SC) and endovascular coiling (EC) group. Event-rate analysis demonstrated that two patients from the EC and one from the SC group developed cognitive impairment after treatment. CONCLUSIONS: Surgical and endovascular repair for UIAs do not impair cognition in patients without postoperative restrictions in lifestyle.

Smokers with intracranial aneurysms who underwent neurosurgical or endovascular treatment have not stopped smoking one year after surgery.

Smoking increases the risk of forming, growing, and rupture of intracranial aneurysms. We retrospectively reviewed patients with intracranial aneurysms treated by neurosurgical or endovascular treatment--154 patients (45 men, 109 women, 15 to 62 years, average 46.3 years, CI +/- 1.72). We found 74% (114/154) of smokers--80% (36/45) men and 71.6% (78/109) women, with the mean value of the Fagerström Test of Nicotine Dependence 4.4 (CI +/- 0.40). The average age of smoking initiation was 18.2 years (CI +/- 0.66), the average period of smoking 26.8 years (CI +/- 2.13). The average number of cigarettes consumed daily was 18.2 (CI +/- 1.58). With statistical significance p < 0.05, the athero-index was lower in nonsmokers than smokers: 3.4 (CI +/- 0.56) vs. 4.5 (CI +/- 0.51). HDL cholesterol was higher in non-smokers than smokers: 1.6 mmol/L (CI +/- 0.25) vs. 1.4 (CI +/- 0.10), and triglycerides were higher in smokers than non-smokers: 1.3 mmol/l (CI +/- 0.16) vs. 1.9 (CI +/- 0.35). Forty-two per cent of smokers (48/114) were controlled one year after the treatment; 18.8% of them stopped smoking, 41.7% reduced smoking, and 39.6% continued to smoke as extensively as before. The prevalence of smoking in our sample was higher than in the Czech population (28.2%). Only 18.8% of controlled smokers were able to quit one year after the intervention.

Quality of life 1 year after aneurysmal subarachnoid hemorrhage in good outcome patients treated by clipping or coiling.

BACKGROUND AND PURPOSE: A study was conducted to compare the quality of life (QOL) of surgically versus endovascularly treated patients with ruptured cerebral aneurysms. METHODS: We treated 45 patients surgically (surgical clipping [SC] group) and 44 by endovascular therapy (coil embolization [CE] group). A standardized test of QOL and a structured interview were employed to assess changes 1 year after subarachnoid hemorrhage (SAH). One neurosurgical team using the same treatment protocols treated all patients. The SC and CE groups did not differ significantly in age, sex, education, aneurysm size, Hunt and Hess grade, Glasgow outcome scale (GOS) score, and intelligence quotient (IQ). RESULTS: Generally, the patients reported psychological changes (impairment in memory, 47%; concentration, 20%; and ability to learn new things, 12%), which they subjectively related to SAH. On the one hand, 31% of the patients believed that close relatives noticed changes in their psychological condition as a result of the intervention. On the other hand, 61% reported an unaltered economic situation, 51% were well adjusted in work, and 70% claimed their family relationships remained unchanged. In comparison with the controls, patients claimed to have lower QOL in the areas of sexuality, love, psychic well-being, physical autonomy, and health. No differences in QOL were found between the SE and CE groups. CONCLUSIONS: The differences in QOL in the patients treated by either coiling or clipping were small and nonsignificant. Participants in both groups mentioned lower QOL in the areas of intimate relationships and health.