Stacey McCraw

Functional Alterations in Brain Activation and Deactivation in Mild Cognitive Impairment in Response to a Graded Working Memory Challenge

Aim: To investigate dynamic changes in functional brain activity in mild cognitive impairment (MCI) in response to a graded working memory (WM) challenge with increasing memory load. Methods: In an event-related functional magnetic resonance imaging (fMRI) study, 35 MCI and 22 cognitively normal subjects performed a visuospatial associative WM task with 3 load levels. Potential performance differences were controlled for by individually calibrating the number of items presented at each load. Results: An interaction between group and WM load was observed during stimulus encoding. At lower loads, greater activity in the right anterior cingulate and right precuneus was observed in MCI subjects. As the load increased to higher levels, reduced activation in these regions and greater deactivation in the posterior cingulate-medial precuneus were observed in MCI compared to control subjects. Stronger expression of load-related patterns of activation and deactivation in MCI subjects was associated with greater clinical severity and a more abnormal pattern of performance variability. Conclusion: Patterns of overactivation, underactivation and deactivation during successful encoding in MCI subjects were dependent on WM load. This type of graded cognitive challenge may operate like a ‘memory stress test’ in MCI and may be a useful biomarker of disease at the predementia stage.

Costs of the principal mood disorders: A study of comparative direct and indirect costs incurred by those with bipolar I, bipolar II and unipolar disorders

BACKGROUND While there have been many studies comparing direct and indirect costs engendered individually and nationally by those with unipolar (UP) and bipolar (BP) disorders, there has been no previous study comparing costs across the bipolar I (BP I) and bipolar II (BP II) disorders. METHODS We examine direct and indirect costs attributable to a mood disorder in a sample of 44 BP I, 102 BP II and 279 UP patients attending a tertiary referral clinic, and with comparable illness durations of some 20 years and comparable treatment durations. We calculated direct and indirect costs incurred for their lifetime of illness based on relevant cost structures, in Australian dollars. RESULTS The mean lifetime indirect costs for BP I patients was

Differentiation of bipolar I and II disorders by examining for differences in severity of manic/hypomanic symptoms and the presence or absence of psychosis during that phase

134,318, as against

The duration of undiagnosed bipolar disorder: effect on outcomes and treatment response.

76,821 for BP II and

The ‘disconnect’ between initial judgments of lamotrigine vs. its real‐world effectiveness in managing bipolar disorder. A tale with wider ramifications

68,347 for UP patients, joining with respective health care costs of

The hypomanic personality scale: a measure of personality and/or bipolar symptoms?

26,353,

The properties and utility of the CORE measure of melancholia

17,580 and

Is cognitive behaviour therapy of benefit for melancholic depression

27, 237, to generate total costs of

Unipolar and bipolar patient responses to a new scale measuring the consequences of depression

160,671/BP I patient,

Is ‘subthreshold’ bipolar II disorder more difficult to differentiate from borderline personality disorder than formal bipolar II disorder?

94,401/BP II patient and