Space and the hippocampal formation in humans.
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Hippocampus↗
Biomedical subjects
A Pickering
Publications and source records attributed to A Pickering.
Mood disorder and chronic hypercalcemia.
Fifty-five patients with chronic hypercalcemia were compared with test norms, and two comparison groups of orthopedic patients and hypertensive patients on objective and subjective tests of mood. Sixteen percent of the hypercalcemic patients were found to score over the cut-off point for anxiety on the anxiety subsection of the Hospital Anxiety and Depression Scale, and 16% were diagnosed as suffering from depression on the Paykel Clinical Interview for Depression. There were, however, no significant differences between the comparison groups and those with hypercalcemia on the scales used. There has been debate about the management of individuals with hypercalcemia. This study supports a conservative rather than a surgical approach as far as psychological symptoms are concerned.
Adult↗
Are we making the most of the Stanford Health Assessment Questionnaire?
For many years, the Stanford Health Assessment Questionnaire (HAQ) has provided an effective measure of disability. Recently, some debate has emerged about whether or not the HAQ is an "ordinal' or "interval' scale. The opportunity to test its level of measurement arose when the scale was applied in a community survey which undertook a two-stage random sample using postal questionnaires to ascertain the health care needs of those with arthritis. The HAQ data are fitted to the Rasch model which tests for the presence of certain desirable characteristics of measurement, e.g. unidimensionality. The fit of the data to the model for those self-reporting rheumatoid arthritis (RA) was adequate. The transformed HAQ score, derived from the Rasch analysis, is compared with the ordinary HAQ (raw) score. This shows that, for those with RA, incremental units of the raw score at the margins of the scale reflect an increasing level of (dis)ability compared to similar units in the centre of the scale. Thus, the traditional HAQ score (range 0-3) is an ordinal score. The findings also indicate that scoring all 20 items may lead to greater sensitivity. Questions are also raised about the construct validity for those with other types of arthritis. For osteoarthrosis, the grip item does not appear to belong to the same underlying construct as the other items.
Activities of Daily Living↗
Prevalence of self reported stroke in a population in northern England.
STUDY OBJECTIVE: The aim of this study was to determine the prevalence of stroke survivors in a health district population aged 55 years and over. DESIGN: This was a point prevalence study using two-stage postal questionnaires sent to an age stratified random sample of the population. SETTING: A district health authority in northern England with a resident population of 723,000. SUBJECTS: Altogether 18,827 residents aged 55 years or over. MAIN RESULTS: Prevalence was found to increase with age and, apart from the very elderly, males had a higher prevalence than females. Overall prevalence was found to be 46.8/1,000 (95% CI 42.5, 51.6). 23% of respondents reported full recovery from stroke. Cognitive impairments (33%), problems with lower limbs (33% for right leg; 27% for left leg) and speech difficulties (27%) were the most common residual impairments. CONCLUSIONS: Current guidelines to purchasers on the provision of services to those who have had a stroke may under-estimate prevalence rates by as much as 50%. This could lead to a shortfall in provision of services designed to support people in the months and years following their stroke.
Age Distribution↗
Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty.
OBJECTIVE: To determine the prevalence of knee problems in people aged 55 years and over and identify those who should be considered for knee arthroplasty. DESIGN: Postal survey; questionnaires were sent to a multistage stratified probability sample of residents of North Yorkshire Health Authority aged 55 and over. SETTING: A health district with a population of 210,000 aged 55 and over. RESULTS: An initial four page postal questionnaire produced an 86% response rate among 18,827 eligible patients. A subsequent detailed questionnaire sent to 1277 patients with knee problems (with a response rate of 78%) then determined the prevalence of severe pain and severe disability. Pain and disability consistent with the need to consider arthroplasty was found in 20.4/1000 (95% confidence interval 18.0 to 23.1); of these, 4.1 (2.7 to 5.8)/1000 had extreme disability. Age and sex specific rates in men who might benefit from arthroplasty were, in those aged 55-64, 12.9 (8.4 to 19.0)/1000; aged 65-74, 12.1 (7.4 to 18.4)/1000; aged 75 and over, 20.3 (12.9 to 30.5)/1000. In women aged 55-64 the rates were 12.9 (8.6 to 18.7)/1000; aged 65-74, 19.6 (13.9 to 26.7)/1000; aged 75 years and over, 42.6 (34.3 to 52.4)/1000. CONCLUSIONS: Total knee replacement has until recently been considered unreliable and often seen as a last resort for many with severe knee problems. Advances in prosthesis design and surgical and anaesthetic techniques have transformed this procedure into a reliable option with a potential for reducing disability and dependency in a large number of people in the community. Understandably, the prevalence pool of those who may benefit is large; health authorities and, increasingly, general practitioners should consider purchasing more total knee replacement surgery to offer real choice to those in need.
Aged↗
Lack of cognitive recovery following withdrawal from long-term benzodiazepine use.
Twenty-one patients with significant long-term therapeutic benzodiazepine (BZ) use, who remained abstinent at 6 months follow-up after successfully completing a standardized inpatient BZ withdrawal regime, and 21 normal controls matched for age and IQ but not for anxiety, were repeatedly tested on a simple battery of routine psychometric tests of cognitive function, pre- and post-withdrawal and at 6 months follow-up. The results demonstrated significant impairment in patients in verbal learning and memory, psychomotor, visuo-motor and visuo-conceptual abilities, compared with controls, at all three time points. Despite practice effects, no evidence of immediate recovery of cognitive function following BZ withdrawal was found. Modest recovery of certain deficits emerged at 6 months follow-up in the BZ group, but this remained significantly below the equivalent control performance. The implications of persisting cognitive deficits after withdrawal from long-term BZ use are discussed.
Adult↗
The effects of anti-hypertensive medication on learning and memory.
1. The aim of the study was to investigate whether there were differential effects of three different anti-hypertensive medications (cilazapril, atenolol, nifedipine) on cognitive function. 2. A sub-group of patients participating in a large clinical trial of these three drugs, randomly allocated between the three drug conditions, received cognitive assessment at two points before the commencement of treatment and then after 12 and 24 weeks of treatment. Seventy-six patients began treatment, and 55 completed the full course. 3. Tests of learning and memory were designed specially for the study, with a different but comparable version administered on each assessment occasion, in a fixed order. 4. No significant differences between drug groups were found in any index of learning or memory, at any testing occasion. The results were the same whether or not treatment non-completers were included in the analysis.
Adult↗
Korsakoff amnesics are poor at judging the sequence of two tones.
Alcoholic amnesics were given a test of temporal sequencing ability devised by Efron which has practically no memory component. These amnesics were very impaired on the task. However, the extent of this impairment did not relate to the magnitude of their "target memory" deficit nor did it relate to the ability to make temporal judgements from memory. Two other groups of amnesics (3 post-encephalitis and 4 with ruptured aneurysms of the anterior communicating artery) did not show impairments on the sequencing task. Data from the amnesic patient N.A. (who was unimpaired on the task), three other amnesics (who showed a tendency to be poor at the task) and two frontally damaged patients (one of whom performed especially badly on the sequencing task but had no obvious memory difficulties) were also presented. It is argued that deficits in temporal discrimination may not be found in all amnesics but, when they are observed, are an incidental feature related to additional (possibly cortical damage. Implications of the results for the view that amnesia results from a deficit in the use of contextual information (including temporal information) are considered.
Adult↗
Performance on tests sensitive to frontal lobe lesions by patients with organic amnesia: Leng & Parkin revisited.
Groups of amnesics with aetiologies that included chronic alcoholism, encephalitis and ruptured anterior communicating artery aneurysm (ACoAA) were examined on the Cognitive Estimation Test (CET), FAS Word Fluency Test (FAS) and the full and Nelson (1976) versions of the Wisconsin Card Sorting Test (WCST). The alcoholic amnesics were impaired on all four tests, whereas the post-encephalitic amnesics were impaired on the FAS and CET but performed normally on both versions of the WCST. The ACoAA amnesics were impaired on both the FAS and the CET, and scored at a level in between the other amnesic subgroups on the WCST.
Adult↗
Why are amnesic judgements of recency and frequency made in a qualitatively different way from those of normal people?
The Huppert and Piercy (1978) test of recency and frequency judgements was given to a group of 12 non-Korsakoff amnesics of mixed aetiology and to four non-amnesic patients with selective frontal lobe lesions. The results confirmed that non-Korsakoff amnesics show a significant tendency to base their recency and frequency judgements on memory strength and that amnesics with medial temporal lobe damage show this tendency at least with recency judgements. The patients with frontal lobe lesions performed like normal subjects. Patients who were dysexecutive or impaired in cognitive resources were less likely to base recency judgements on trace strength. Such a recency bias was not however, correlated with measures of amnesic severity. The tendency to base frequency judgements on memory strength was not related to either degree of amnesia or reduction of cognitive resources.
Adult↗
Location of lesions in Korsakoff's syndrome: neuropsychological and neuropathological data on two patients.
Psychometric and neuropathological findings on two Korsakoff amnesics are described. Both patients showed anterograde and retrograde amnesia, poor performance on the Peterson short-term memory task, on the Wisconsin card sort test and on certain visuo-spatial tasks. Patient J.W. performed consistently worse on tests of anterograde, but not retrograde amnesia, whereas patient B.C. showed more perseverative difficulties and, unlike J.W., his measured intelligence seemed to have declined from its premorbid level. Both patients showed marked neuronal loss from the medial mammillary bodies and a narrow band of gliosis in the medial thalamus, adjacent to the wall of the third ventricle, a region known as the paratenial nucleus. Only B.C. showed visible signs of cortical atrophy. Morphometric measures did, however, reveal reduced nucleolar volumes in layers III and V of the frontal cortex, with B.C. also showing more marked neuronal loss from these layers. B.C. also showed neuronal loss from the CA1 region of the hippocampus and reduced nucleolar volumes in the septum. Significantly, both patients had normal neuronal numbers and nucleolar volumes in the nucleus basalis of Meynert. J.W. only showed greater dysfunction than B.C. in one region: the locus caeruleus. This finding was related to his more severe amnesia.
Aged↗
Amnesic sensitivity to proactive interference: its relationship to priming and the causes of amnesia.
A group of alcoholic amnesics was compared with a group of controls on an A-B, A-C word pairs interference paradigm. With memory instructions the amnesics needed 5 presentation trials to their controls' single trials to match the groups on A-B cued recall. Under these conditions they still showed more proactive interference on the A-C list. When both groups were given five presentation trials for each list and 'free association' instructions, then they both showed this level of interference. This suggested that the amnesic interference effect only occurs because priming is not modulated by conscious memory, i.e. it is an effect of poor conscious memory. This interpretation was further supported by the finding that amnesics forgot the A-B list faster over 2 hr than their controls, when memory instructions were given.
Aged↗
Recency and frequency judgements in alcoholic amnesics and normal people with poor memory.
Alcoholic amnesics have been reported to confuse when an event occurred with how frequently it occurred and conversely, how frequently something took place with when it happened. This lack of independence of recency and frequency judgements, shown by these amnesics (but not shown by normal people) has been interpreted as reflecting a selective amnesic failure in memory for contextual information; this failure, in turn, leading to poor recall and recognition memory. The effect is replicated on another group of Korsakoff patients and, by manipulations of retention intervals and of learning opportunity, it is also shown that normal people with memory that is as poor overall as that of amnesics still have specific contextual memory with which to make temporal judgements independently of frequency of presentation and (somewhat less obviously) frequency judgements independently of recency of presentation. The qualitative differences between amnesic and normal people cannot therefore be an artefact of testing generally poor memory in amnesics. While it is possible that the unavailability or inaccessibility of contextual information may cause amnesia, an alternative hypothesis, that poor contextual knowledge is an incidental feature in alcoholic amnesia (related to frontal lobe dysfunction), is also considered.
Alcohol Amnestic Disorder↗
Is organic amnesia caused by a selective deficit in remembering contextual information?
An influential view of amnesia is that the recognition and recall failure is a consequence of a selective loss of memory for contextual, rather than target, information. The various forms of this viewpoint are outlined and one is considered in more detail. This hypothesis claims that amnesics suffer from a selective inability to remember background context i.e. spatiotemporal or extrinsic context. The evidence cited in support of this hypothesis is then critically reviewed and assessed in relation to two methodological problems. The first problem shows that when weak amnesic memory is compared with good normal memory qualitative differences in contextual memory may arise artefactually. The second problem is that contextual memory deficits, found in amnesics, may be incidental consequences of frontal cortex damage rather than essential to the core memory deficit. In the light of these problems it is concluded that currently there is no convincing support for the contextual memory deficit hypothesis of amnesia. Finally, guidelines are laid down which should enable the hypothesis to be more appropriately assessed, and an alternative kind of hypothesis is briefly outlined.
Alcoholism↗
Fatty acid composition of erythrocytes in hereditary spherocytosis.
The fatty acid distribution of the four major phospholipids has been determined in the erythrocytes of five patients with hereditary spherocytosis and in five control subjects. In contrast to a report by other workers, we are unable to confirm their findings of a defect in fatty acid chain lengthening activity leading to disappearance of long chain fatty acid conjugates of more than 20 carbon atoms in some of the phospholipid fractions.
Erythrocytes↗
Peripheral neuromuscular changes in Parkinson's disease.
The muscle, nerve terminal and end plates of 3 patients suffering from idiopathic Parkinson's disease have been studied electrophysiologically, histologically, histochemically and electron microscopically. No characteristic neuromuscular features of parkinsonism were discernible. Four additional patients suffering from idiopathic parkinsonism complicated by diabetes, myasthenia gravis and spinal atrophy were also studied.
Aged↗
The muscles in club foot--a histological histochemical and electron microscopic study.
In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of neurogenic disease was seen in most instances and was more obvious in the older patients. The pattern of abnormality was similar in both muscle groups. It is thought that shortening of the postero-medial muscles may result from a small increase of fibrosis due to minor innervation changes occurring in intra-uterine life. There is evidence that immobilisation, stretching or relaxation of muscles does not account for the anomalies observed. This study of the extrinsic muscles in talipes equino-varus indicates a dominant neurogenic factor in its causation.
Biopsy↗
Structural abnormalities of muscle tissue in ankylosing spondylitis.
Muscle tissue of patients with ankylosing spondylitis has been studied by means of histology, histochemistry and electron microscopy and has been shown to be grossly abnormal. The underlying basis of the muscle changes is probably neuropathic and we believe that these changes form part of the over-all pathology of this disease.
Adult↗