Nancy Berman

A study of the Lund‐Manchester research criteria for frontotemporal dementia Clinical and single‐photon emission CT correlations

We evaluated the Lund-Manchester research criteria (LMRC) for frontotemporal dementia (FTD). With single-photon emission CT, we diagnosed 30 patients with FTD. These patients were compared with 30 with a research diagnosis of Alzheimers disease (AD). We scored every patient on each LMRC item and compared the two groups. A discriminant function showed that loss of personal awareness, hyperorality, stereotyped and perseverative behavior, progressive reduction of speech, and preserved spatial orientation differentiated 100% of FTD and AD subjects. Items relating to affect and physical findings were not different in FTD versus AD. Loss of personal awareness, eating, perseverative behavior, and reduction of speech are the LMRC items that most clearly differentiate FTD from AD.

Meta-analysis: neither quick nor easy.

BackgroundMeta-analysis is often considered to be a simple way to summarize the existing literature. In this paper we describe how a meta-analysis resembles a conventional study, requiring a written protocol with design elements that parallel those of a record review.MethodsThe paper provides a structure for creating a meta-analysis protocol. Some guidelines for measurement of the quality of papers are given. A brief overview of statistical considerations is included. Four papers are reviewed as examples. The examples generally followed the guidelines we specify in reporting the studies and results, but in some of the papers there was insufficient information on the meta-analysis process.ConclusionsMeta-analysis can be a very useful method to summarize data across many studies, but it requires careful thought, planning and implementation.

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

This study was aimed at resolving the time course of clinical action of antidepressants (ADs) and the type of early behavioral changes that precede recovery in treatment-responsive depressed patients. The first goal was to identify, during the first 2 weeks of treatment, the onset of clinical actions of the selective serotonin reuptake inhibitor (SSRI), paroxetine, and the selective noradrenergic reuptake inhibitor, desipramine (DMI). The second aim was to test the hypothesis that the two pharmacologic subtypes would induce different early behavioral changes in treatment-responsive patients. The design was a randomized, parallel group, placebo-controlled, double-blind study for 6 weeks of treatment following a 1-week washout period. The study utilized measures of the major behavioral components of the depressive disorder as well as overall severity. The results indicated that the onset of clinical actions of DMI ranged from 3 to 13 days, averaged 13 days for paroxetine, and was 16–42 days for placebo. Furthermore, as hypothesized, the different types of ADs initially impacted different behavioral aspects of the disorder. After 1 week of treatment, DMI produced greater reductions in motor retardation and depressed mood than did paroxetine and placebo, and this difference persisted at the second week of treatment. Early improvement in depressed mood–motor retardation differentiated patients who responded to DMI after 6 weeks of treatment from those that did not. Paroxetine initially reduced anxiety more in responders than in nonresponders, and by the second week, significantly improved depressed mood and distressed expression in responders to a greater extent. Depressed patients who responded to placebo showed no consistent early pattern of behavior improvement. Early drug-specific behavioral changes were highly predictive of ultimate clinical response to the different ADs, results that could eventually be applied directly to clinical practice.

Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term.

ABSTRACT. To determine fetal growth and the incidence of withdrawal symptoms in term infants exposed to methamphetamine in utero, we retrospectively identified neonates whose mothers used methamphetamine during pregnancy and matched them to unexposed newborns. Exclusion criteria included multiple and preterm gestations. Although there were no differences in infant growth parameters between the methamphetamine-exposed and methamphetamine-unexposed neonates, methamphetamine exposure throughout gestation was associated with decreased growth relative to infants exposed only for the first two trimesters. In addition, there were significantly more small for gestational age infants in the methamphetamine group compared with the unexposed group. Methamphetamine-exposed infants whose mothers smoked had significantly decreased growth relative to infants exposed to methamphetamine alone. Withdrawal symptoms (as determined by a previously reported scoring system) requiring pharmacologic intervention were observed in 4% of methamphetamine-exposed infants. These preliminary findings indicate that methamphetamine use is associated with growth restriction in infants born at term.

Effects of transdermal testosterone gel on bone turnover markers and bone mineral density in hypogonadal men

OBJECTIVE Androgen replacement has been reported to increase bone mineral density (BMD) in hypogonadal men. We studied the effects of 6 months of treatment with a new transdermal testosterone (T) gel preparation on bone turnover markers and BMD.

Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia

Neuropsychological changes distinguishing mild Alzheimers disease (AD) from frontotemporal dementia (FTD) have been described, but empirical verification of differential cognitive characteristics is lacking. Archival neuropsychological data on 15 FTD patients, 16 AD patients, and 16 controls were compared. Controls outperformed both patient groups on measures of verbal and nonverbal memory, executive ability, and constructional skill, with AD patients showing more widespread memory decline. No differences were found between the 3 groups in confrontation naming, recognition memory, or basic attention. Patient groups differed only in nonverbal memory, with FTD patients performing significantly better than AD patients. However, patient groups also differed in pattern of performance across executive and memory domains. Specifically, AD patients exhibited significantly greater impairment on memory than executive tasks, whereas the opposite pattern characterized the FTD group. These findings suggest that examination of relative rankings of scores across cognitive domains, in addition to interpretation of individual neuropsychological scores, may be useful in differential diagnosis of FTD versus AD.

Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression

To investigate the clinical specificity of mixed affective states, we compared clinical characteristics of mixed (dysphoric) manics to those of agitated depressed patients. The subjects were inpatients studied in the NIMH Clinical Research Branch Collaborative Study on the Psychobiology of Depression, Biological Studies. Behavior and symptom ratings for depressive and manic symptoms were obtained during a 15-day placebo washout period. Patients with agitated depression were compared to those in acute manic episodes with and without prominent depressive symptoms. Mania ratings clearly distinguished agitated depressed from mixed manic patients. Concerning depression and general psychopathology, mixed manics had more severe agitation, hostility and cognitive impairment than did agitated depressed patients. Depressed mood and anxiety did not differ significantly between the two groups. Nurse ratings for depression and anxiety, based on ward behavior, were similar for mixed manics and agitated depressed patients, while physician-interview rated depression and anxiety were higher in agitated depressed patients. These data support the existence of superimposed depressive and manic syndromes in mixed manics.

Wisconsin card sorting test performance in healthy, older adults: Relationship to age, sex, education, and IQ

We obtained Wisconsin Card Sorting Test (WCST) scores on 91 (35 male and 56 female) healthy, well-educated individuals aged 45 to 83. Women scored better than men on six WCST scores (categories, errors, perseverative responses, % perseverative errors, % conceptual level responses, and trials to first category), while subjects with more than 16 years of education outscored those limited to high school education on four measures (perseverative responses, errors, % perseverative errors, % conceptual level responses). Individuals older than 70 years of age scored less well than younger subjects on only two indices (errors, % conceptual level responses). Full Scale IQ was not related to WCST scores. Our findings suggest that WCST scores should be interpreted within the context of patient gender, education, and age.

Rey-osterrieth complex figure performance in healthy, older adults: Relationship to age, education, sex, and IQ

Abstract Despite the widespread use of the Rey-Osterrieth Complex Figure Test (RO) in clinical practice and research protocols, minimal information is available regarding the influence of demographic factors and intellectual level on test performance, particularly in older individuals. The purpose of the present study was to provide data regarding the relationship of age, IQ, education, and sex to RO copy, 3-min recall, and percent retention in healthy middle-aged and older individuals. Data were obtained on 91 individuals screened for the absence of significant medical, neurologic, and psychiatric illness. RO performance was most closely associated with age and FSIQ; sex and education were not predictive of RO scores. Significantly poorer RO scores did not emerge until age 70 and older.

SPECTRAL AND BOUT DETECTION ANALYSIS OF PHYSICAL ACTIVITY PATTERNS IN HEALTHY, PREPUBERTAL BOYS AND GIRLS

Little is known about the frequency‐intensity patterns of naturally occurring physical activity in children. A data set obtained previously by direct observation of physical activity in 8 girls and 7 boys (all prepubertal, ages 6–10) was analyzed with spectral analysis to detect significant frequency‐intensity relationships. Pulse detection algorithms were used to characterize the number of exercise bouts, their duration and relative intensity. Spectral analysis revealed that physical activity bouts were frequent, pulsatile, and random with no significant frequencies detected during many 24‐min periods of observation. An average of 83 ± 11 bouts per hour were observed in boys and 89 ± 12 bouts per hour in girls, and the mean duration of an exercise bout was 21 ± 5 sec for boys and 20 ± 4 sec for girls (NS). While high‐intensity exercise bouts comprised less than 20% of the time spent in physical activity, duration of high intensity exercise bouts tended to be longer and accounted for about 40% of the energy expenditure associated with physical activity. Spontaneous physical activity in prepubertal children is characterized by frequent bouts of brief, mostly low intensity exercise, randomly interspersed with less frequent, but metabolically substantial high intensity bouts. These findings are potentially useful in assessing the impact of disease on quality of life in children, investigating the relationship between physical activity and mechanisms of growth and development, and creating new approaches for in‐laboratory exercise testing in children. Am. J. Hum. Biol. 10:289–297, 1998.