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Among participants with Alzheimer's disease (AD) we estimated the minimal clinically important difference (MCID) in apathy symptom severity on three scales.
Design:
Retrospective anchor- and distribution-based analyses of change in apathy symptom scores.
Setting:
Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2 randomized controlled trials conducted at three and ten clinics specialized in dementia care in United States and Canada, respectively.
Participants:
Two hundred and sixty participants (60 ADMET, 200 ADMET 2) with clinically significant apathy in Alzheimer’s disease.
Measurements:
The Clinical Global Impression of Change in Apathy scale was used as the anchor measure and the MCID on the Neuropsychiatric Inventory – Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) were estimated with linear mixed models across all study visits. The estimated thresholds were evaluated with performance metrics.
Results:
Among the MCID was a decrease of four points (95% CI: −4.0 to −4.8) on the NPI-A, 0.56 points (95% CI: −0.47 to −0.65) on the DAIR, and three points on the AES-I (95% CI: −0.9 to −5.4). Distribution-based analyses were largely consistent with the anchor-based analyses. The MCID across the three measures showed ∼60% accuracy. Sensitivity analyses found that MMSE scores and apathy severity at baseline influenced the estimated MCID.
Conclusions:
MCIDs for apathy on three scales will help evaluate treatment efficacy at the individual level. However, the modest correspondence between MCID and clinical impression of change suggests the need to consider other scales.
A summary of the Third International Obsessive Compulsive Disorder Conference proceedings on neuroimaging research and neurocircuitry models of obsessive-compulsive disorder (OCD) is presented. This survey of recent and ongoing research indicates that a wide range of modern techniques and experimental strategies are being employed in a complementary fashion to enhance our understanding of OCD. Imaging studies in animal models of OCD are helping to elaborate relevant normal anatomy and neuro-chemistry. Functional imaging methods are being employed in conjunction with behavioral, pharmacologic, and cognitive challenge paradigms. Magnetic resonance spectroscopy as well as radiotracer methods are being utilized to measure neurochemical and neuropharmacologic indices in OCD. Transcranial magnetic stimulation has emerged as a tool for probing neurocircuitry that may also have therapeutic potential. Experimental designs and data-analytic methods are evolving to help elucidate the pathophysiology of OCD and related disorders, delineate neurobiologically meaningful subtypes of OCD, and identify potential predictors of treatment response. Collectively, these efforts promise important advances as we approach the new millennium.
By
Christian W. Kreipke, Wayne State University School of Medicine, Detroit, USA,
David R. Rosenberg, Wayne State University School of Medicine, Detroit, USA,
Matcheri S. Keshavan, University of Pittsburgh School of Medicine, Pittsburgh, USA
This chapter focuses on the neurodevelopmental basis of diagnostic overlap and symptom commonality by addressing similarities and differences in the neuroanatomical and functional neurochemical basis of three common childhood/adolescent-onset neuropsychiatric disorders: attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and mood disorder, including major depressive disorder (MDD) and bipolar disorder (BPD). These disorders are selected because of the clinical commonalities with schizophrenia and because of the known or presumed developmental origins of these disorders. Schizophrenia, BPD, and OCD have their onset in adolescence or early adulthood, and they may be preceded by symptoms similar to those in developmental disorders such as ADHD. The disorders are discussed in comparison with schizophrenia. The chapter describes the relevant findings in schizophrenia. It limits the pathophysiological discussion to the neuroimaging findings, and considers common genetic and environmental etiologic factors that may cut across these disorders.
Surface passivation of unpassivated Al nanoparticles has been realized using self assembled monolayers (SAMs). Nanoscale Al particles were prepared in solution by catalytic decomposition of H3Al•NMe3 or H3Al•N(Me)Pyr by Ti(OiPr)4 and coated in situ using a perfluoroalkyl carboxylic acid SAM. Because the Al particles are prepared using wet chemistry techniques and coated in solution, they are free of oxygen passivation. This SAM coating passivates the aluminum and seems to prevent the oxidation of the particles in air and renders the composite material, to some extent, soluble in polar organic solvents such as diethyl ether. Characterization data including SEM, TEM, TGA, and ATR-FTIR of prepared materials is presented.
This chapter discusses the use of magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging (fMRI) techniques in childhood-onset anxiety disorders. It reviews brain imaging studies in various childhood-onset anxiety disorders, including obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), panic disorder, social phobia, and post-traumatic stress disorder (PTSD), as well as suggest directions for future investigation. Functional neuroimaging has most consistently identified the caudate nucleus, ventral prefrontal cortex, and anterior cingulate as neural substrates of OCD. These regions have shown abnormal serotonergic and/or glutamatergic function. The brain regions implicated in panic disorder are consistent with the brain networks subserving fear and anxiety. The structural imaging findings suggest that functional dysfunction in the hippocampus is associated with PTSD. The studies highlight that some of the common findings in OCD and PTSD may reflect similarities in symptoms, with both disorders involving repetitive, ritualistic behaviors and intrusive thoughts.
Data are presented on 17 children who received extracorporeal membrane oxygenation (ECMO) in the neonatal period for persistent pulmonary hypertension (PPHN). These children are being followed as part of a larger program of follow-up research on children who have been treated for PPHN with several treatment methods. On intelligence testing at ages 5 to 8 years, these 17 children had unusual patterns of results. A higher-than-predicted percentage of the ECMO survivors had discrepancies between their Verbal and Performance IQ and a much-higher-than-predicted percentage had areas of unusual strength or weakness on their IQ subtest scores. Also, there was a significant correlation between the amount of time a child received ECMO and the child's Performance IQ: the longer the child received ECMO, the higher the Performance IQ. While findings of unusual weaknesses or deficits on intelligence testing at school age in children who have been severely ill in the neonatal period are not unusual, findings of high scores and areas of strength are not easily explained, particularly when these findings seem to relate to an invasive treatment like ECMO. Similar findings have been reported in two other small studies, which suggest that the impact of ECMO on the developing infant brain may not be purely detrimental.
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