Michelle Mattingly

Does the arousal system contribute to near death experience

The neurophysiologic basis of near death experience (NDE) is unknown. Clinical observations suggest that REM state intrusion contributes to NDE. Support for the hypothesis follows five lines of evidence: REM intrusion during wakefulness is a frequent normal occurrence, REM intrusion underlies other clinical conditions, NDE elements can be explained by REM intrusion, cardiorespiratory afferents evoke REM intrusion, and persons with an NDE may have an arousal system predisposing to REM intrusion. To investigate a predisposition to REM intrusion, the life-time prevalence of REM intrusion was studied in 55 NDE subjects and compared with that in age/gender-matched control subjects. Sleep paralysis as well as sleep-related visual and auditory hallucinations were substantially more common in subjects with an NDE. These findings anticipate that under circumstances of peril, an NDE is more likely in those with previous REM intrusion. REM intrusion could promote subjective aspects of NDE and often associated syncope. Suppression of an activated locus ceruleus could be central to an arousal system predisposed to REM intrusion and NDE.

Factors Leading Patients to Discontinue Multiple Sclerosis Therapies

OBJECTIVESnTo determine the percentages of patients who discontinued treatment with the multiple sclerosis medications intramuscular interferon beta-1a (IFN-beta-1a; Avonex-Biogen), interferon beta-1b (IFN-beta-1b; Betaseron-Berlex), and glatiramer acetate (Copaxone-Teva) and to determine the factors that led to discontinuation of the medications.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based neurology clinic.nnnPATIENTSn108 patients with multiple sclerosis who were prescribed intramuscular interferon beta-1a, subcutaneous interferon beta-1b, or subcutaneous glatiramer acetate.nnnINTERVENTIONnTelephone survey.nnnMAIN OUTCOME MEASURESnDiscontinuation percentages and the factors that contributed to discontinuation.nnnRESULTSnThere was no significant difference between the percentages of patients who discontinued and did not restart treatment with the products (interferon beta-1b, 41%; intramuscular interferon beta-1a, 34%; and glatiramer acetate, 28%). Four main reasons for medication discontinuation emerged: adverse effects (52%), physician-documented disease progression (40%), patient perception of drug ineffectiveness (20%), and cost (4%). No statistical differences were identified among the three agents for any of the reasons for discontinuation.nnnCONCLUSIONnPatient education on adverse effects and realistic patient expectations may be potential areas of study to improve discontinuation percentages with these agents.

Out-of-body experience and arousal

In a study of more than 13,000 Europeans, 5.8% reported the out-of-body experience (OBE) form of autoscopy.1 Occurring in diverse clinical settings, OBE is also typical of near death experience (NDE). NDE are responses to life-threatening crisis characterized by a combination of dissociation from the physical body, euphoria, and transcendental or mystical elements. Persons with NDE may have an arousal system predisposed to allowing intrusion of REM sleep elements during the transition between wakefulness and sleep.2 The arousal system is comprised of brainstem structures controlling or influencing sleep-wake states, alertness, and attention. REM intrusion manifests as the atonia of sleep paralysis (or cataplexy), as well as visual or auditory hallucinations. Although not considered REM intrusion, OBE and the REM state have an established relationship that is incompletely understood. In the state boundary disorder of narcolepsy, individuals often give accounts of OBE,3,4 which diminish after the narcolepsy is treated.4 In this study, we investigated if OBE in subjects with NDE could be regarded an arousal phenomenon by occurring during sleep transition or corresponding to REM intrusion.nnStructured interviews were conducted and REM intrusion measured in 55 subjects with NDE, and compared to age- and gender-matched controls as previously described.2 All gave informed consent as approved by the institutional review board. OBE during NDE was determined by the Greyson questionnaire asking if the respondent “Clearly left the body and existed outside it.” For OBE of sleep transition, subjects …

Cognitive change on the repeatable battery of neuropsychological status (RBANS) in parkinson's disease with and without bilateral subthalamic nucleus deep brain stimulation surgery

Cognitive change following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in those with Parkinsons disease (PD) has led to equivocal results. The current study applied a standardized regression-based (SRB) method based on 20 medically managed PD patients and 20 STN DBS PD surgical patients who were administered the Repeatable Battery of Neuropsychological Status (RBANS). Of the medically managed PD participants, 94% remained stable compared to 73% of the DBS group. In the DBS group cognitive change was noted on the Total scale and the Immediate Memory Index. A secondary analysis also revealed reliable change on several subtest scores. Although preliminary, the current study provides change parameters for post DBS surgery on this brief battery.

Assessing Reliable Change Using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for Patients with Parkinson's Disease Undergoing Deep Brain Stimulation (DBS) Surgery

Parkinsons disease (PD) is progressive neurological disease characterized by resting tremor, rigidity, akinesia, postural instability and cognitive changes. The symptoms of PD are debilitating and often become unsatisfactorily treated by medication. Deep brain stimulation (DBS) is an effective treatment to significantly reduce the cardinal motor symptoms of PD. However, the neuropsychological effects of this treatment are less clear. This study examined pre- to post-DBS scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) using Reliable Change Indices (RCIs) derived from 20 patients with PD who were medically managed, and then compared to 20 patients with PD treated with DBS and medication. When using group statistical analyses and false discovery rate correction, no significant differences between or within groups were evident at baseline or at follow-up. However, when using the RCIs more patients in the DBS group exhibited reliable change in RBANS scores than did the Med Tx group. Although preliminary, these RCIs provide clinicians and researchers a foundational tool for assessing the effects of interventions (e.g., DBS) independent of the effects of PD and measurement error when using the RBANS.

Verbal Fluency Patterns in Mild Cognitive Impairment and Alzheimer's Disease

Background/Aims: Verbal fluency patterns can assist in differential diagnosis during neuropsychological assessment and identify individuals at risk for developing Alzheimers disease (AD). While evidence suggests that subjects with AD perform worse on category fluency than letter fluency tasks, the pattern in mild cognitive impairment (MCI) is less well known. Methods: Performance on the Controlled Oral Word Association Test (COWAT) and Animal fluency was compared in control, amnestic MCI, non-amnestic MCI, and AD groups. The sample included 136 participants matched for age, education, and gender. Results: Both MCI groups performed similarly with a category > letter fluency pattern rather than a category < letter fluency pattern typically observed in AD. The pattern in MCI, albeit relatively more impaired than in controls, was more similar to healthy controls who exhibited a category > letter fluency pattern. Conclusion: MCI using a category < letter fluency pattern may not represent AD; however, future research requires longitudinal studies of pattern analysis.

Clinical utility of the Wechsler Memory Scale—Fourth Edition (WMS-IV) in predicting laterality of temporal lobe epilepsy among surgical candidates

This study evaluated the accuracy of the Wechsler Memory Scale--Fourth Edition (WMS-IV) in identifying functional cognitive deficits associated with seizure laterality in localization-related temporal lobe epilepsy (TLE) relative to a previously established measure, the Rey Auditory Verbal Learning Test (RAVLT). Emerging WMS-IV studies have highlighted psychometric improvements that may enhance its ability to identify lateralized memory deficits. Data from 57 patients with video-EEG-confirmed unilateral TLE who were administered the WMS-IV and RAVLT as part of a comprehensive presurgical neuropsychological evaluation for temporal resection were retrospectively reviewed. We examined the predictive accuracy of the WMS-IV not only in terms of verbal versus visual composite scores but also using individual subtests. A series of hierarchal logistic regression models were developed, including the RAVLT, WMS-IV delayed subtests (Logical Memory, Verbal Paired Associates, Designs, Visual Reproduction), and a WMS-IV verbal-visual memory difference score. Analyses showed that the RAVLT significantly predicted laterality with overall classification rates of 69.6% to 70.2%, whereas neither the individual WMS-IV subtests nor the verbal-visual memory difference score accounted for additional significant variance. Similar to previous versions of the WMS, findings cast doubt as to whether the WMS-IV offers significant incremental validity in discriminating seizure laterality in TLE beyond what can be obtained from the RAVLT.

Utility of Green's Word Memory Test Free Recall Subtest as a Measure of Verbal Memory: Initial Evidence from a Temporal Lobe Epilepsy Clinical Sample

This study investigated the Word Memory Test (WMT) Free Recall (FR) subtest as a conventional memory measure. Nineteen participants with pharmacoresistant left temporal lobe epilepsy (LTLE) and 16 with right temporal lobe epilepsy (RTLE) completed the WMT, Rey Auditory Verbal Learning Test (RAVLT), and Wechsler Memory Scale-Fourth Edition Logical Memory (LM) subtest during presurgical evaluation. LTLE participants performed significantly worse on FR subtest (p < .05, [Formula: see text]) and RAVLT Trial 7 (p < .01, [Formula: see text]), but not on LM subtest. Age was a significant covariate for FR (p < .01, [Formula: see text]). Logistic regression revealed FR plus age and RAVLT age-adjusted T-scores both yielded 77.1% classification accuracy and respective diagnostic odds ratios of 11.36 and 11.84. Receiver operating characteristic curves to classify seizure laterality found that RAVLT and FR were significant (area under the curve [AUC] = 0.82 and 0.74), whereas LM was nonsignificant (AUC = 0.67). Cut scores and positive/negative predictive values were established for improved clinical classification.

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The Influence of Literacy on Cognitive Functioning in Unimpaired Older Adults, Mild Cognitive Impairment, and Dementia

Older Adults, Mild Cognitive Impairment, and Dementia Kara A. Bottiggi*, Marta Mendiondowz, Michelle Mattinglyy, Charles Smithzy, Gregory Cooperzy, Gregory Jichazy, and Frederick SchmittzyJ. *Graduate Center for Gerontology; Departments of wStatistics; yNeurology; JBehavioral Science and Psychiatry; and zSanders-Brown Center on Aging, University of Kentucky, Lexington, KY. Objective: The purpose of this study was to investigate the ability of literacy to predict global cognitive function and memory in a group of normal older adults and older adults with mild cognitive impairment (MCI) or dementia. Background: The literature shows that older adults with low education are diagnosed with dementia earlier and exhibit a slower progression than those with higher education, often proposed to reflect varying levels of cognitive reserve. Recent studies have shown that literacy may be a more accurate proxy of cognitive reserve than education due to qualitative differences in educational experiences. Design/Methods: This study consisted of older adults (N=100) referred to a memory disorders clinic for evaluation. The predictive ability of education, literacy (National Adult Reading Test Full Scale IQ: NARTFSIQ), and diagnosis on global cognitive ability (Wechsler Adult Intelligence Scale Full-Scale IQ; WAIS-FSIQ) and memory [Logical Memory I (LMI) and Visual Reproduction I (VRI) of the Wechsler Memory Scale; WMS] were examined using 3 general linear models. Results: The NART-FSIQ (P<0.001), education (P=0.007), and diagnostic group (P<0.001) were significant predictors of WAIS-FSIQ (R=0.67). The NART-FSIQ (P<0.001) and diagnostic group (P<0.001) were significant predictors of VRI (R=0.28) scores. The NART-FSIQ (P<0.001) and diagnostic group (P<0.001) were significant predictors of LMI (R=0.32) scores. Conclusions: Literacy was found to be a more robust predictor than education for measures of intellectual and memory function in normals, MCI, and dementia cases. The strongest predictive model was found for the WAIS-FSIQ followed by the LMI and VRI, which can be explained by the domains evaluated and the pattern of cognitive deficits for MCI and dementia. The results of this pilot study suggest that age and literacy, as opposed to age and education, should be used to interpret neuropsychological test results in older adults regardless of level of cognitive function. This research is supported by National Institute on Aging AG05144, and R01 AG19241.