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Comparing the distribution of neuropsychiatric symptoms among individuals with depression and mild cognitive impairment
- A. Keng, D. Kapustin, C. Ma, K. Bingham, C. Fischer, L. Mah, D. Gallagher, M. A. Butters, C. R. Bowie, A. Voineskos, A. Graff, A. Flint, N. Herrmann, B. Pollock, B. Mulsant, T. Rajji, S. Kumar, P.-M. Study Group
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S173
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Introduction
Neuropsychiatric symptoms (NPS) are common during the course of neurocognitive disorders. NPS have been previously reported in early and late stages of Alzheimer’s Disease. However, our understanding of NPS in high-risk states for dementia such as mild cognitive impairment (MCI) and major depressive disorder (MDD) is poor.
ObjectivesTo compare the frequency and factor structure of neuropsychiatric symptoms among individuals with Mild Cognitive Impairment (MCI), Major Depressive Disorder (MDD) in remission, and comorbid MCI and MDD (in remission) (MCI-D).
MethodsWe used baseline data from the Prevention of Alzheimer’s Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study, a multicenter trial across five academic sites in Toronto, Canada (clinical trial No. NCT0238667). We used ANOVA or χ2-test to compare frequency of NPS across groups. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items in the three groups.
ResultsWe included 374 participants with a mean age of 72.0 years (SD = 6.3). In the overall sample, at least one NPS was present in 64.2% participants, and 36.1 % had at least moderate severity NPS (36.1%). Depression (54%, χ2 < 0.001) and apathy (28.7%, χ2=0.002) were more prevalent in the MCI-D group as compared to MCI and MDD groups. In factor analysis, NPS grouped differently in MCI, MDD, and MCI-D groups. A “psychotic” subgroup emerged among MCI and MCI-D, but not in MDD. Night-time behaviors and disinhibition grouped differently across all three groups.
ConclusionsPrevalence of NPS seems higher in persons with MCI-D as compared to those with only MCI or MDD. The factor structure of NPS differed between MCI, MDD, and MCI-D groups. Future studies should investigate the association of NPS factors with cognition, function, and illness biomarkers.
Disclosure of InterestNone Declared
LO36: Hyoscine butylbromide (Buscopan) for abdominal pain in children: a randomized controlled trial
- N. Poonai, S. Elsie, K. Kumar, K. Coriolano, S. Brahmbhatt, E. Dzongkowski, H. Stevens, P. Gupta, M. Miller, D. Ashok, G. Joubert, A. Butter, S. Ali
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S20
- Print publication:
- May 2019
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Introduction: Abdominal pain is one of the most frequent reasons for an emergency department (ED) visit. Most cases are functional and no therapy has proven effective. Our objective was to determine if hyoscine butylbromide (HBB) (BuscopanTM) is effective for children who present to the ED with functional abdominal pain. Methods: We conducted a randomized, blinded, superiority trial comparing HBB 10 mg plus acetaminophen placebo to oral acetaminophen 15 mg/kg (max 975 mg) plus HBB placebo using a double-dummy approach. We included children 8-17 years presenting to the ED at London Health Sciences Centre with colicky abdominal pain rated >40 mm on a 100 mm visual analog scale (VAS). The primary outcome was VAS pain score at 80 minutes post-administration. Secondary outcomes included adverse effects; caregiver satisfaction with pain management using a five-item Likert scale; recidivism and missed surgical diagnoses within 24-hours of discharge. Analysis was based on intention to treat. Results: We analyzed 225 participants (112 acetaminophen; 113 HBB). The mean (SD) age was 12.4 (3.0) years and 148/225 (65.8%) were females. Prior to enrollment, the median (IQR) duration of pain prior was 2 (4.5) hours and analgesia was provided to 101/225 (44.9%) of participants. The mean (SD) pre-intervention pain scores in the acetaminophen and HBB groups were 62.7 (15.9) mm and 60.3 (17.3) mm, respectively. At 80 minutes, the mean (SD) pain scores in the acetaminophen and HBB groups were 30.1 (28.8) mm and 29.4 (26.4) mm, respectively and there were no significant differences adjusting for pre-intervention scores (p = 0.96). The median (IQR) caregiver satisfaction was high in the acetaminophen [5 (2)] and HBB [5 (1)] groups (p = 0.79). The median (IQR) length of stay between acetaminophen [235 (101)] and HBB [234 (103)] was not significantly different (p = 0.53). The proportion of participants with a return visit for abdominal pain was 4/112 (3.5%) in the acetaminophen group and 6/113 (5.3%) in the HBB group. The most common adverse effect was nausea (9% in each group) and there were no significant differences in adverse effects between acetaminophen (26/112, 23.2%) and HBB (31/113, 27.4%) (p = 0.52). There were no missed surgical diagnoses. Conclusion: For children with presumed functional abdominal pain who present to the ED, both acetaminophen and HBB produce a clinically important (VAS < 30 mm) reduction in pain and should be routinely considered in this clinical setting.
GD03: Hyoscine butylbromide (Buscopan) versus acetaminophen for non-surgical abdominal pain in children: a randomized controlled superiority trial
- N. Poonai, A. Butter, D. Ashok, M. Rieder, S. Ali
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S63
- Print publication:
- May 2017
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Background: Children with abdominal pain in the emergency department (ED) are at particular risk of suboptimal analgesia due to fears of missing appendicitis and absent guidelines. Many still experience pain at discharge. Acetaminophen is the most commonly used analgesic and efficacy of hyoscine butylbromide (HBB) is supported by adult evidence. However, no evidence exists for either agent in children with abdominal pain. Objective: To determine if HBB is superior to acetaminophen for abdominal pain in children. Methods: We will consecutively recruit children 8-17 years presenting to the ED with presumed non-surgical abdominal pain rated >4/10 on the Faces Pain Scale – Revised (FPS-R) and described as colicky, excluding:-Suspected appendicitis or bowel obstruction-Anticholinergic, analgesic, or antispasmodic <12 hours-Peritoneal inflammation-Unable to swallow pills-Hypersensitivity to either intervention-Medically unstable-Previous bowel obstruction, abdominal surgery, myasthenia gravis, liver disease, glaucoma, or recent abdominal trauma (<48 hours)-Toxin ingestion (<24 hours)-Vomiting-Pregnancy Randomization and allocation concealment will be pharmacy-controlled and performed using a computerized random number generator and sequentially numbered, opaque, sealed envelopes, respectively. The physician, research assistant, nurse, and participant will be blinded. Due to perceptible differences, participants will be randomized in a double-dummy approach to:-HBB 10 mg tablet + acetaminophen placebo OR-Acetaminophen 15 mg/kg liquid (maximum 975 mg) + HBB placebo. The primary outcome will be the difference from baseline on the FPS-R at 120 minutes, reflecting HBB’s time to peak plasma concentration. The FPS-R has been validated in children >five years. Secondary outcomes include:-Pain scores at 15, 30, 45, 60, 80, 100, and 120 minutes post-intervention (FPS-R and 100 mm visual analog scale)-Discharge pain score-Rescue analgesia-Time to achieve a 20% reduction in pain-Adverse effects-Recidivism <48 hours-Missed surgical diagnoses (National Ambulatory Care Reporting System (NACRS) database)-Caregiver satisfaction (five-item Likert scale). Using the intention to treat principle, ordinal, ratio, and categorical data will be analyzed using the Mann-Whitney, paired t-test, and Pearson’s chi-square, respectively and summarized using 95% confidence intervals. Assuming a standard deviation of 2 faces, 83 children per group will be required to detect a 1-face difference at 5% significance with 90% power. Increasing by 20% equals 100 participants per group. P values <0.05 will be considered significant. An institutional audit revealed 380 eligible patients per year during research assistant availability. Given a 30% refusal rate, we expect five participants enrolled per week for 40 weeks. Importance: Our findings will guide evidence-based analgesic choices for children with non-surgical abdominal pain in the ED.
Decline in working memory associated with HIV infection
- J. C. Stout, D. P. Salmon, N. Butters, M. Taylor, G. Peavy, W. C. Heindel, D. C. Delis, L. Ryan, J. H. Atkinson, J. L. Chandler, I. Grant, the HNRC Group
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- Journal:
- Psychological Medicine / Volume 25 / Issue 6 / November 1995
- Published online by Cambridge University Press:
- 09 July 2009, pp. 1221-1232
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HIV infection has been associated with decline in a number of cognitive functions that are components of ‘working memory’. Thus, tests of working memory that require the interaction of these components may be particularly sensitive to cognitive dysfunction that arises from HIV infection. To assess this possibility, working memory was examined in 147 HIV-seropositive (HIV+) and 38 HIV-seronegative (HIV−) males using the Reading Span Test and the Digit Span subtest from the Wechsler Memory Scale-Revised (WMS-R). Speed of information processing, a component of some working memory tasks, was assessed with a version of the Sternberg Memory Scanning task. Results indicated that symptomatic HIV+ subjects were impaired relative to HIV− control subjects on the Reading Span and Digit Span tests. Asymptomatic and mildly symptomatic HIV+ groups exhibited a trend toward impairment on these tests, and on the whole, a greater proportion of HIV+ subjects than HIV− subjects were impaired. The groups did not differ significantly in information processing speed. These results indicate that deficits in working memory are apparent in at least a subset of HIV-infected individuals. These deficits are most apparent in symptomatic HIV+ individuals, but the decline may begin during the asymptomatic phase of infection.
Effect of dietary condensed tannins on gastrointestinal nematodes
- N. L. BUTTER, J. M. DAWSON, D. WAKELIN, P. J. BUTTERY
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- Journal:
- The Journal of Agricultural Science / Volume 137 / Issue 4 / December 2001
- Published online by Cambridge University Press:
- 23 January 2002, pp. 461-469
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It has been previously shown in this laboratory that feeding a model condensed tannin, quebracho tannin, reduces the small intestinal nematode burden in sheep and rats. The aim of the current programme was to determine whether this occurs through direct toxicity against the parasites. Both in vivo and in vitro studies were conducted. The first study compared the effect of dietary quebracho tannin (40 g/kg) on the establishment of the parasitic nematodes Nippostrongylus brasiliensis and Trichinella spiralis in the rat small intestine. The burden of N. brasiliensis, which, although closely associated with the mucosa, actually dwells within the small intestinal lumen, was significantly reduced (P<0·001) by dietary quebracho tannin. In contrast, T. spiralis, which penetrates into the small intestinal mucosa, was unaffected (>0·05) by the dietary inclusion of quebracho tannin. The second study involved monitoring the survival of adult N. brasiliensis and T. spiralis when incubated in vitro in varying concentrations of quebracho tannin in Hanks’ balanced salt solution. The survival of N. brasiliensis was compromised at concentrations as low as 0·01% (w/v) quebracho tannin but improved with the addition of 0·1% (w/v) polyethylene glycol, which binds to, and inactivates, tannin. T. spiralis was similarly affected, but much more rapidly. These results suggest that dietary quebracho tannin may reduce nematode worm burdens through a toxic effect that requires direct contact between parasite and tannin. This raises the possibility that feeding locally available plant material containing condensed tannins may be an alternative method for controlling parasite infections, especially in areas such as the tropics and subtropics.
Effect of dietary tannin and protein concentration on nematode infection (Trichostrongylus colubriformis) in lambs
- N. L. BUTTER, J. M. DAWSON, D. WAKELIN, P. J. BUTTERY
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- The Journal of Agricultural Science / Volume 134 / Issue 1 / January 2000
- Published online by Cambridge University Press:
- 01 January 2000, pp. 89-99
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The aim of this study was to determine whether the inclusion of a condensed tannin (quebracho tannin, QT) and/or the elevation of dietary protein could reduce Trichostrongylus colubriformis establishment and existence in the small intestine of lambs. Thirty-six lambs (mean liveweight 32·6±3·9 kg) were randomly allocated to one of six experimental groups, groups 1–5 were parasitized with a trickle infection of 3000 infective Trichostrongylus colubriformis larvae daily, whilst group 6 remained as uninfected controls. Experimental diets were formulated to contain 222 g CP/kg (high protein) or 97 g CP/kg (low protein) with or without the inclusion of 50 g QT/kg. All six animal groups were fed the low protein diet, group 2 fed low protein diet+QT, for one month prior to infection (groups 1–5). Once nematode eggs were observed in the faeces, diets were abruptly changed in three experimental groups. Group 1 remained on the low protein diet, group 2 remained on the low protein+QT diet, group 3 changed to the high protein diet, group 4 changed to the high protein+QT diet, group 5 changed to the low protein+QT diet and group 6 remained uninfected and fed the low protein diet. Production, haematological and parasitological parameters were monitored at regular intervals. Results show that parasitized animals fed the high protein diet achieved growth rates similar to those of uninfected low protein-fed lambs. Inclusion of dietary QT did not depress liveweight gain. Total daily faecal egg counts declined after feeding the high protein diet. Inclusion of QT into the low protein diet also reduced faecal egg counts to similar levels observed in the high protein-fed lambs. The inclusion of QT into the high protein diet did not further reduce faecal egg counts. No significant differences in the haematological parameters measured were observed between infected animals (groups 1–5), suggesting that the beneficial effect of dietary QT in the low protein diet is unlikely to be mediated through an immune response. These data suggest that the inclusion of QT in low protein diets may be an alternative to feeding high protein diets to reduce nematode burden in lambs.