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PubMed1987

Systematic dyskinesia examination of profoundly mentally retarded persons: cooperation and assessment.

Performance of 344 institutionalized mentally retarded adults was measured to assess the applicability of the Dyskinesia Identification System Condensed User Scale. A larger proportion of profoundly retarded persons cooperated with Dyskinesia Identification examination procedures than has previously been found. Performance deficits were observed on activation tasks (APA, 1979) that precede assessment of lingual abnormal involuntary movements. Intelligence quotients, neuroleptic dosage, gender, and ambulatory and visual impairments were associated with performance of activation tasks. Results suggest the difficulty of implementing standardized tardive dyskinesia assessments and that client behavior problems may threaten the valid assessment of this disorder among institutionalized profoundly retarded persons.

Adolescent↗

PubMed1998

Low-dose weekly methotrexate for progressive neuropsychiatric manifestations in Behcet's disease.

The most serious central nervous system (CNS) manifestation in Behcet's disease is a slowly progressive dementia (progressive NB), which may ultimately lead to the deterioration of the personality of patients. An open trial was designed to investigate the efficacy of low dose weekly methotrexate (MTX) therapy for progressive NB. Six patients with Behcet's disease, whose neuropsychiatric manifestations were judged to be progressive (4 females and 2 males, aged 55.0+/-8.2 years), were given oral MTX (7.5-12.5 mg/week) until the end of the 12-month trial. The clinical responses of the patients to MTX were judged by neuropsychiatric findings, intelligence test, brain MRI scans and cerebrospinal fluid (CSF) IL-6 levels. After the 12-month trial, CSF IL-6 levels were found to be significantly decreased. Accordingly, the neuropsychological manifestations as well as the findings on MRI scans and intelligence quotients were not significantly worsened after the trial. Three patients presented with mild liver dysfunction, which returned to normal by decreasing the dose of MTX. However, 6 months after discontinuation of MTX, all the six patients showed significant exacerbation of the manifestations as evidenced by a decrease in verbal intelligence quotients along with the marked elevation of CSF IL-6. These results suggest that low dose weekly MTX therapy might have a beneficial effect in the treatment of progressive NB, although a trial for a longer period would be necessary.

Aged↗

PubMed1990

Acetylcholinesterase activities and monoamine metabolite levels in the cerebrospinal fluid of patients with Alzheimer's disease.

We measured cholinesterase (ChE) activity and monoamine metabolite levels in the cerebrospinal fluid (CSF) of 22 patients with early-onset Alzheimer type dementia (Alzheimer's disease; AD) and of 32 controls. Acetylcholinesterase (AChE) activity, 5-hydroxyindoleacetic acid (5-HIAA), and homovanillic acid (HVA) levels were significantly lower in AD patients than in controls. However, there was an overlap in values of each CSF parameter. The measurement of various CSF parameters rather than one alone was more useful as a diagnostic aid. CSF ChE activities correlated with scores on the GBS rating scale, Hasegawa dementia scale, and Wechsler Adult Intelligence Scale, but the monoamine metabolite levels did not. Although cholinergic and monoaminergic deficits may coexist in AD patients, cholinergic deficits tend to be more often associated with cognitive decline than the monoaminergic deficits.

Acetylcholinesterase↗

PubMed2006

Periventricular leukomalacia and retinopathy in a term infant born to a mother with asthma.

A male child, born at 37+5 gestational weeks (GWs) (birthweight 2000g) after intrauterine growth retardation (IUG; -3 SD), to a mother treated during pregnancy for asthma, developed periventricular leukomalacia and retinopathy with total retinal detachment in the left eye and partial detachment in the right eye. Apart from basic asthma treatment with terbutalin, budesonid, and fenoterolhydrobromid throughout the pregnancy, she was treated with intravenous or oral cortisone for 6.5 weeks from 28+5 GWs. In addition she developed deep venous thrombosis at 29 GWs and was treated with heparin until delivery. Psychotic symptoms during the 31st GW were treated with diazepam, haloperidol, and levomepromazin. Functional sequelae for the child were visual impairment (visual acuity 5/60), uneven intellectual profile (Wechsler Pre-school and Primary Scale of Intelligence, Verbal IQ 94 and Performance IQ 32 at 8y of age), and autistic-like behaviour. The possibility that pre- and perinatal risk factors (e.g. severe maternal illness, IUGR, and cortisone treatment) in a term infant may create conditions for developing eye and brain pathologies commonly closely related to preterm birth should be considered.

Anti-Asthmatic Agents↗

PubMed2000

Antipsychotic medication and smoking prevalence in acutely hospitalized patients with chronic schizophrenia.

The atypical antipsychotic, clozapine, has been reported to reduce smoking in schizophrenic patients. We sought to determine whether other atypical antipsychotics would also be associated with a decreased prevalence of smoking in this population. Data were obtained from three groups of chronic, hospitalized, schizophrenic patients, receiving either a typical antipsychotic (n=15), clozapine (n=6), or another atypical antipsychotic (n=18). In addition to smoking prevalence, the groups were compared with regard to demographics (age, education), medication (doses, duration of treatment, side-effects), clinical (diagnosis, duration of illness) and behavioral (Wide-Range Achievement Test, Wechsler Adult Intelligence Scale) variables. Smoking prevalence differed significantly among the three groups (P<0.001). Clozapine was associated with a significantly lower incidence of smoking than either typical drugs (P<0.003) or other atypical antipsychotics (P=0. 042). The groups did not differ on demographic or other medication variables or on any of several behavioral measures. However, a diagnosis of paranoid schizophrenia was also significantly correlated with smoking (P<0.01), but not with medication class. Although the cause is still unknown, these results are consistent with reports that clozapine reduces smoking and provide new data on smoking prevalence associated with other atypical agents.

Acute Disease↗

PubMed1998

Web-based health care agents; the case of reminders and todos, too (R2Do2).

This paper describes efforts to develop and field an agent-based, healthcare middleware framework that securely connects practice rule sets to patient records to anticipate health todo items and to remind and alert users about these items over the web. Reminders and todos, too (R2Do2) is an example of merging data- and document-centric architectures, and of integrating agents into patient-provider collaboration environments. A test of this capability verifies that R2Do2 is progressing toward its two goals: (1) an open standards framework for middleware in the healthcare field; and (2) an implementation of the 'principle of optimality' to derive the best possible health plans for each user. This paper concludes with lessons learned to date.

Artificial Intelligence↗

PubMed1996

A longitudinal study of factors predicting change in cognitive test scores over time, in an older hypertensive population.

This study aims to describe factors associated with cognitive decline among 2584 subjects, aged 65-74, who were followed up for 54 months in the Medical Research Council Elderly Hypertension Trial (1982-1989). The subjects completed a cognitive test, the Paired Associate Learning Test (PALT), five times over this period. Decline on the PALT was associated with advanced age, male sex, rural residence, depression and low intelligence. These effects were modified by gender and level of pre-morbid intelligence. Advanced age, rural residence and number of cigarettes smoked daily were only associated with PALT decline among women of below median intelligence. The association between depression and PALT decline was only apparent in women of below median intelligence and men of above median intelligence. While these findings are consistent with other research into cognitive decline, they differ in some ways from reported risk factors for dementia, suggesting aetiological separateness. That women were more vulnerable than men to the effects of age and smoking raises the question of the impact on cognition of accelerated atherosclerosis after the menopause.

Aged↗

PubMed2006

Karl Pribram, The James Arthur lectures, and what makes us human.

BACKGROUND: The annual James Arthur lecture series on the Evolution of the Human Brain was inaugurated at the American Museum of Natural History in 1932, through a bequest from a successful manufacturer with a particular interest in mechanisms. Karl Pribram's thirty-ninth lecture of the series, delivered in 1970, was a seminal event that heralded much of the research agenda, since pursued by representatives of diverse disciplines, that touches on the evolution of human uniqueness. DISCUSSION: In his James Arthur lecture Pribram raised questions about the coding of information in the brain and about the complex association between language, symbol, and the unique human cognitive system. These questions are as pertinent today as in 1970. The emergence of modern human symbolic cognition is often viewed as a gradual, incremental process, governed by inexorable natural selection and propelled by the apparent advantages of increasing intelligence. However, there are numerous theoretical considerations that render such a scenario implausible, and an examination of the pattern of acquisition of behavioral and anatomical novelties in human evolution indicates that, throughout, major change was both sporadic and rare. What is more, modern bony anatomy and brain size were apparently both achieved well before we have any evidence for symbolic behavior patterns. This suggests that the biological substrate underlying the symbolic thought that is so distinctive of Homo sapiens today was exaptively achieved, long before its potential was actually put to use. In which case we need to look for the agent, perforce a cultural one, that stimulated the adoption of symbolic thought patterns. That stimulus may well have been the spontaneous invention of articulate language.

Journal Article↗

PubMed1993

Mental retardation in ten-year-old children in relation to their mothers' employment during pregnancy.

We conducted a case-control study to examine relationships between potential risk factors in women's prenatal occupational histories and subsequent mental retardation in their 10-year-old children. Children with mental retardation (intelligence quotient less than 71) were identified from special education records maintained by the public school systems in the metropolitan Atlanta area and from records of various medical and social service agencies serving children with special needs. Control children were chosen from the rosters of 10-year-olds who were enrolled in regular education classes in the local public school systems. To obtain occupational histories, sociodemographic data, and other information, we interviewed 352 natural mothers (67%) of 525 case children and 408 natural mothers (64%) of 636 control children. We computed odds ratios for each of 25 selected occupation, industry, and agent categories controlling for maternal education, birth order, and race. Most comparisons yielded odds ratios that were not indicative of unusual risks, but we did find lower than expected risks among children of teachers and health-care professionals. We also found a strong, positive association between mental retardation and maternal employment in the textile and apparel industries. The findings are useful for planning the direction of future studies of childhood cognitive ability to focus on specific parental occupations or industries.

Adult↗

PubMed1983

Expert Systems Research.

Artificial intelligence, long a topic of basic computer science research, is now being applied to problems of scientific, technical, and commercial interest. Some consultation programs, although limited in versatility, have achieved levels of performance rivaling those of human experts. A collateral benefit of this work is the systematization of previously unformalized knowledge in areas such as medical diagnosis and geology.

Anti-Bacterial Agents↗

PubMed1995

Neurobehavioural dysfunction following mild traumatic brain injury in childhood: a case report with positive findings on positron emission tomography (PET).

The present case study describes the neurobehavioural, neurodiagnostic, and positron emission tomography (PET) scan findings in a child who sustained a whiplash-type injury in a motor vehicle accident. Although neck and back pain were reported immediately, neurobehavioural symptoms, such as staring spells, gradually increased in frequency over a 2-year period following the accident. At 4 years after the accident the patient's symptoms persisted, as reported by teachers and parents, and more extensive diagnostic work-up was initiated. Standard EEG was normal while two ambulatory EEGs were abnormal and interpreted as epileptiform. A PET scan showed evidence of marked hypometabolism in both temporal lobes. Neuropsychological findings were consistent with PET findings and reflected verbal and visual memory deficits in the context of high average intelligence. Treatment with carbamazepine, verapamil, and fluoxetine greatly improved the patient's symptoms. The present case illustrates an example of a poor outcome in a paediatric case of mild traumatic brain injury, the importance of PET in demonstrating definitive evidence of brain dysfunction, and the child's positive response to anticonvulsant medication.

Accidents, Traffic↗

PubMedDate not supplied

Performance on the Hooper Visual Organizational Test in patients diagnosed with subcortical vascular dementia: relation to naming performance.

OBJECTIVE: To examine the performance of individuals with vascular dementia (VaD) on the Hooper Visual Organization Test (HVOT) and to determine the influence of naming on HVOT performance in this population. BACKGROUND: The HVOT is commonly administered to assess visuospatial perception among neurologic patients, but the test requires verbal identification of stimuli as well as spatial ability. Previous studies have examined the influence of naming on the HVOT, but the issue has not been systematically addressed in individuals with subcortical VaD. METHOD: Individuals with a diagnosis of VaD were administered the HVOT, three additional measures of visuospatial function (Block Design and Picture Completion subtests of the Wechsler Adult Intelligence Scale-Revised, Rey-Osterrieth Complex Figure Test copy trial), and the Boston Naming Test (BNT). RESULTS: On average, the VaD patients performed poorly compared with normative data on each of the cognitive measures, with the most pronounced deficit evident on the BNT. Regression analyses revealed that more than 60% of the variance in performance on the HVOT was accounted for by performance on the Block Design subtest of the Wechsler Adult Intelligence Scale-Revised; performance on the BNT did not contribute significantly. CONCLUSIONS: The results suggest that VaD patients perform below expectations on the HVOT and that the measure is robust to naming deficits in this population.

Brain↗

PubMedDate not supplied

Thyrotropin receptor autoantibodies (TSHRAbs): epitopes, origins and clinical significance.

Epitopes for > 95% stimulating thyrotropin receptor autoantibodies (TSHRAbs) causally implicated in Graves' disease (Basedow's disease or primary hyperthyroidism) have been identified on on the N-terminal portion of the TSHR extracellular domain, residues 8-165. If the stimulating TSHRAb activity is solely dependent on this region, it is termed homogeneous; if its activity is only largely related to this region, it is termed heterogeneous. The presence of a heterogeneous stimulating TSHRAb in a patient is associated with rapid responses to propylthiouracil or methimazole and may be predictive of long term remission with these oral immunosuppressives. Epitopes for two different Graves' autoantibodies that inhibit TSH binding, TSH binding inhibition immunoglobulins or TBIIs, have also been identified on this region of the TSHR. They do not increase cAMP levels, although one may activate the inositol phosphate, Ca++, arachidonate release signal system. The epitope of blocking TSHRAbs with the ability to inhibit TSH binding (TBII activity), TSH activity, and stimulating TSHRAb activity, and that are causally implicated in the primary hypothyroidism of patients with idiopathic myxedema or some patients with Hashimoto's disease have, in contrast, been largely identified largely on the C-terminal portion of the TSHR extracellular domain, residues 270-395. They have been implicated as important in pregnancy where they attenuate the signs and symptoms of Graves' hyperthyroidism. The appearance of these blocking TSHRAbs during pregnancy in Graves' patients might cause overt or occult hypothyroidism, with resultant effects on fetal development and postnatal intelligence levels. The different TSHRAbs can exist in the same patient at any moment in time, potentially making disease expression a sum of their activities. Assays taking advantage of the epitope mapping findings enable us to detect individual TSHRAbs within a single patient and to better understand their clinical significance.

Autoantibodies↗

PubMed1999

The simulated evolution of biochemical guilds: reconciling Gaia theory and natural selection.

Gaia theory, which states that organisms both affect and regulate their environment, poses an interesting problem to Neo-Darwinian evolutionary biologists and provides an exciting set of phenomena for artificial-life investigation. The key challenge is to explain the emergence of biotic communities that are capable, via their implicit coordination, of regulating large-scale biogeochemical factors such as the temperature and chemical composition of the biosphere, but to assume no evolutionary mechanisms beyond contemporary natural selection. Along with providing an introduction to Gaia theory, this article presents simulations of Gaian emergence based on an artificial-life model involving genetic algorithms and guilds of simple metabolizing agents. In these simulations, resource competition leads to guild diversity; the ensemble of guilds then manifests life-sustaining nutrient recycling and exerts distributed control over environmental nutrient ratios. These results illustrate that standard individual-based natural selection is sufficient to explain Gaian self-organization, and they help clarify the relationships between two key metrics of Gaian activity: recycling and regulation.

Algorithms↗

PubMedDate not supplied

NES test performance in a large US Army veteran sample: relationships with both demographic factors and traditional neuropsychological measures.

A large sample of Vietnam-era US Army veterans completed a set of 16 neuropsychological tests, including six computer-based tests from the Neurobehavioral Evaluation System (NES), during medical examinations supervised by the US Centers for Disease Control (CDC). Data for 881 participants of the Agent Orange Validation Study (AOV) and Vietnam Experience Study (VES) were available for analysis from public access data tapes provided by CDC. Information was available for several potential covariates from demographic questionnaires, a medical examination, and a medical history. Explorator, principal components factor analysis of 16 test variables yielded four factors, including one on which most of the NES tests loaded. The single best predictor of most neuropsychological performance variables was an index of general intellectual level as measured at entry into the Army almost 20 years before the neuropsychological examinations. Alcohol drinking variables were not related to neuropsychological performance. Several measures of general intelligence were compared for use as covariates of neuropsychological test performance. All were superior to years of education in statistically controlling for general intellectual level.

Adult↗

PubMed1998

Identification of drug metabolites in biological matrices by intelligent automated liquid chromatography/tandem mass spectrometry.

A rapid and systematic strategy for the identification of drug metabolites in biological matrices based on liquid chromatography-tandem mass spectrometry (LC/MS/MS) techniques was utilized for the identification of drug metabolites of the HIV protease inhibitor Indinavir. This strategy integrates intelligent realtime mass spectrometry with HPLC detection and a predictive strategy for detecting metabolites arising from common biotransformations, to rapidly elucidate structures of drug metabolites. Structures of metabolites generated from in vitro incubation mixtures of Indinavir were characterized from a single chromatographic analysis using the automated LC/MS/MS methodology, thus reducing data acquisition time and improving efficiency.

Animals↗

PubMed2003

Diabetic foot infections and antibiotic therapy.

Diabetic foot infections are associated with high morbidity and mortality rates as well as significant financial impact on the health care system. Improved patient outcomes and intelligent use of resources should determine the selection of diagnostic procedures and the therapeutic modalities used. Diabetic patients who develop lower extremity infections require a multidisciplinary approach in the management of their infections and other disorders. Aggressive surgical debridement and appropriate and adequate antibiotic therapy are necessary to successfully treat severe foot infections and permit faster recovery.

Anti-Bacterial Agents↗

PubMed2001

Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.

A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.

Adult↗