Effects of age of onset and medication on cognitive performance and quality of life in patients with epilepsy.

Previous research shows that earlier age of onset of epilepsy and larger antiepileptic drug (AED) load are related to cognitive impairment and lower quality of life in patients with epilepsy. However, there has been a discrepancy in the specific cognitive domains that are affected and whether AED load is a significant contributor to the cognitive impairment. This study aimed to examine (a) the specific cognitive domains that are affected by age of epilepsy onset and (b) the effects of AED treatment and age of onset on cognition and quality of life. Participant data included scores on (1) the Wisconsin Card Sorting Test (WCST), (2) Digit Span subtest of the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV), (3) Test of Everyday Attention (TEA), (4) Brief Visuospatial Memory Test (BVMT), (5) Quality of Life in Epilepsy (QOLIE-31), (6) Beck Depression Inventory (BDI-2), and (7) a medical record review for drug treatment information. Earlier age of epilepsy onset predicted lower auditory attention span and working memory as assessed by digit span forward (DSF) and digit span backward (DSB). Additionally, larger AED load predicted lower visuospatial memory as assessed by BVMT-Delayed Recall (BVMT-DR). No relationship between either age of onset or AED load and quality of life in epilepsy was found. However, depression was highly correlated with quality of life. These results highlight the need to balance epilepsy control and AED effects, especially in early-onset epilepsy, and to gain awareness of the specific cognitive domains affected by epilepsy variables to effectively monitor and treat it.

Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation.

Studies have come to conflicting conclusions about whether posttraumatic stress disorder (PTSD) is associated with poorer memory for emotionally neutral information. The authors report a meta-analysis of 27 studies that investigated verbal and/or visual memory in samples with PTSD and healthy controls. The results indicated that the association between PTSD and memory impairment appears to be robust, small to moderate in size, and stronger for verbal than for visual memory. Effect sizes did not vary according to whether recall was immediate or delayed. The association is found in both civilian and military samples and cannot be readily explained as being due to the use of nontraumatized healthy control groups or concurrent head injury. The findings are placed in the context of recent neurobiological and experimental cognitive research.

Effectiveness of intravenous fluid resuscitation in the emergency room for treatment of hypotension in dogs: 35 cases (2000-2010).

OBJECTIVE: To assess the effectiveness of fluid resuscitation for the treatment of hypotensive dogs presented to the emergency room. DESIGN: Retrospective study (2000-2010). SETTING: University teaching hospital. ANIMALS: Thirty-five dogs with confirmed hypotension. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records from 2000 to 2010 were searched for dogs that had documented arterial hypotension (Doppler blood pressure <90 mm Hg) upon presentation to the emergency room. The following data were collected for retrospective analysis: signalment, body weight, systolic blood pressure (BP) and heart rate (HR) before and after fluid resuscitation, type and volume of fluid administered within the first hour of hospitalization, presence or absence of confirmed sepsis, and outcome. There was a significant increase in BP following fluid resuscitation and 23 dogs showed normalization of blood pressure (Doppler blood pressure >90 mm Hg) following bolus IV fluid therapy within 1 hour of presentation. Fluid responsive animals were significantly less likely to be euthanized compared to those animals that did not respond to a fluid bolus (P = 0.013). The HR did not change significantly in either group postbolus therapy. Twenty-three dogs (65.7%) in the study received only isotonic crystalloid therapy, 11 dogs were administered both isotonic crystalloids and synthetic colloids, and 1 dog received only synthetic colloid resuscitation. A significant difference was not detected between groups with respect to type or volume of fluid administered. CONCLUSIONS: Bolus fluid therapy for the treatment of hypotensive dogs resulted in increased in systolic arterial BP in all dogs, although the HR did not reliably decrease as might be expected. Dogs that showed normalization of BP within the first hour of fluid resuscitation were more likely to be discharged alive than those who remained hypotensive. A majority of dogs received and responded to isotonic crystalloids fluid resuscitation.

Test of memory malingering (TOMM) trial 1 as a screening measure for insufficient effort.

The identification of insufficient effort is critical to neuropsychological evaluation, and several existing instruments assess effort on neuropsychological tasks. Yet instruments designed to detect insufficient effort are underutilized in standard neuropsychological assessments, perhaps in part because they typically require significant administration time and are, therefore, not ideally suited to screening contexts. The Test of Memory Malingering (TOMM) is a commonly administered, well-validated symptom validity test. This study evaluates the utility of TOMM Trial 1 as a relatively brief screening measure of insufficient effort. Results suggest that TOMM Trial 1 demonstrates high diagnostic accuracy and is a viable option for screening insufficient effort. Diagnostic accuracy estimates are presented for a range of base rates. The need for more comprehensive SVT assessment in most clinical and forensic situation is discussed.