Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease.

Previous research has demonstrated neuropsychological deficits in moderately to severely hypoxemic, chronic obstructive pulmonary disease (COPD) patients. The present article reports on the neuropsychological functioning of mildly hypoxemic COPD patients. 100 patients (mean age 61.5 yrs) and 25 controls (mean age 59.6 yrs) matched on relevant variables were given extensive neuropsychological tests including the WAIS, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Test Battery. Mild neuropsychological impairment was observed in the COPD Ss, with overall indexes of neuropsychological dysfunction correlating with resting partial pressure of oxygen. Depression and motivation to perform could not account for the results. Long-term reduced oxygen supply to the brain may account for these observed deficits. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures

Eighteen patients with chronic obstructive pulmonary disease (COPD) were administered a series of pulmonary, neurological, and neuropsychological measures to test if there was an effect of COPD on neurological and cognitive functioning. Overall, there was no evidence of general dementia in this sample. Measures of immediate and delayed memory, complex attention, and speed of information processing correlated highly with arterial carbon dioxide partial pressure and, to a lesser extent, with oxygen partial pressure. Measures of language abilities, perceptual-motor functioning, and simple attention generally were not related to arterial gas pressures. A similar pattern of findings was obtained when group differences were examined between participants classified as severely hypoxic or mildly hypoxic, although group differences were mitigated by premorbid IQ differences. Hypoxia in COPD results in a relatively focused pattern of impairment in measures of memory function and tasks requiring attention allocation. The memory dysfunction may be related to involvement of limbic memory regions necessary for explicit memory. The attentional deficits were attributed to diffuse brain involvement resulting in reduced resource allocation. Early diagnosis and treatment of the hypoxia is essential.     

Identification of neuropsychological deficits in epilepsy using the Luria-Nebraska Neuropsychological Battery.

80 hospitalized patients, 22 diagnosed as having idiopathic seizures, 18 who developed epilepsy secondary to brain trauma or another CNS disorder, and 40 who demonstrated no evidence of CNS involvement, were given the Luria-Nebraska Neuropsychological Battery. Mean ages of Ss were 38.3, 35.2, and 41.1 yrs, respectively. Results demonstrate that the standardized Luria test may be useful in the evaluation of neuropsychological deficits in adult epileptics. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional decline in the early stages of Alzheimer's disease.

Reports a 2-yr follow-up of 15 Alzheimer's disease (AD) patients (mean age 67.8 yrs) characterized by mild functional impairment and 22 age-, sex-, and education-matched controls. In a previous cross-sectional study by P. Prinz et al (see record 1983-30633-001) of these 37 Ss and 16 AD patients (mean age 70.2 yrs) with moderate functional impairment, measures of memory and attention deficits accounted for much of the impairment observed in functional competence. The current longitudinal study found that these same initial assessments could be used to predict functional decline in the 15 mildly impaired Ss, who were observed to decline to levels similar to those of the 16 moderate patients. In contrast, the controls exhibited little decline during the same period. Results affirm that it is possible to diagnose AD in its mild form and demonstrate the validity of the initial diagnosis. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic respiratory insufficiency: evaluation, evolution, prognosis

Chronic respiratory failure (CRF) is a major cause of morbidity and mortality. It is estimated that in France at least 60,000 patients exhibit severe CRF and that about 15,000 patients die each year from CRF. Chronic obstructive pulmonary disease (COPD) (chronic obstructive bronchitis, emphysema and their association) is by far the first cause of CRF (90% of the cases). The clinical picture of CRF depends on the causal disease, but exertional dyspnea is observed in almost all patients. Pulmonary function testing allows to assess whether the ventilatory defect is obstructive (COPD), restrictive or mixed. Severe CRF is usually defined by a Pa02 < 55 mmHg, in a stable state of the disease, with or without hypercapnia (PaC02 > 45 mmHg). The two major complications of CRF are acute exacerbations of the disease, with clinical and gasometric worsening, and pulmonary hypertension which may lead with time to right heart failure. Prognosis is poor in CRF since the 5 year survival rate is of 50% in COPD patients. Under long-term oxygen therapy (LTOT) the survival rate has been somewhat improved, being of 60-65% at 5 years. The best prognostic indices in CRF complicating COPD are the level of FEV1, Pa02, PaC02, the level of pulmonary artery mean pressure (PAP) and age. In COPD patients under LTOT the best prognostic indices are PAP and age.     

Short-duration nocturnal hypoxemia and persistent pulmonary hypertension

Can daily short-duration hypoxemia (4-8 hours) induce pulmonary hypertension and right ventricular hypertrophy? A clinical model of this type of hypoxemia does exist: isolated nocturnal hypoxemia in patients with obstructive sleep apnea syndrome (OSAS) or chronic obstructive pulmonary disease (COPD). By investigating the pulmonary hemodynamics of these patients, it should be possible to determine whether nocturnal hypoxemia alone can induce pulmonary hypertension. Although nocturnal hypoxemia (in OSAS as well as in COPD) can induce acute episodes of pulmonary hypertension, it would not appear that nocturnal hypoxemia alone would be sufficient to provoke permanent diurnal pulmonary hypertension. This is the conclusion of recent studies concerning diurnal pulmonary hemodynamics in OSAS and COPD patients exhibiting minimal hypoxemia during the day but significant nocturnal desaturation. The therapeutic consequences of these data, particularly in COPD are important: current evidence is insufficient to treat with nocturnal oxygen therapy COPD patients who have minimal diurnal hypoxemia but significant nocturnal desaturation.     

Diagnostic validity of a standardized neuropsychological battery derived from Luria's Neuropsychological Tests.

A. R. Luria has devised an extensive set of procedures used for neuropsychological evaluation. His tests permit the full identification of the specific deficits underlying a disorder and can be completed in about 2 hrs. The most significant flaw in the battery is a lack of standard administration and scoring that has precluded an assessment of its validity. The present study attempted to overcome these deficiencies by developing an objective form, combining Luria's procedures with the advantages of a standard test battery. The resultant test, the Luria-South Dakota Neuro-psychological Test Battery, was evaluated using 50 medical patient controls, average age 42.0 yrs, and 50 neurological patients, average age 44.3 yrs. Of the 285 measures in the battery, 253 significantly discriminated at the .05 level, and only 16 failed to discriminate at the .2 level. A discriminant analysis, using the 30 most effective items, yielded a hit rate of 100%. The battery's potential and the future research necessary are discussed. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced mechanical efficiency in chronic obstructive pulmonary disease but normal peak VO2 with small muscle mass exercise

We studied six patients with chronic obstructive pulmonary disease (COPD) (FEV1 = 1.1 +/- 0.2 L, 32% of predicted) and six age- and activity level-matched control subjects while performing both maximal bicycle exercise and single leg knee-extensor exercise. Arterial and femoral venous blood sampling, thermodilution blood flow measurements, and needle biopsies allowed the assessment of muscle oxygen supply, utilization, and structure. Maximal work rates and single leg VO2max (control subjects = 0.63 +/- 0.1; patients with COPD = 0.37 +/- 0.1 L/minute) were significantly greater in the control group during bicycle exercise. During knee-extensor exercise this difference in VO2max disappeared, whereas maximal work capacity was reduced (flywheel resistance: control subjects = 923 +/- 198; patients with COPD = 612 +/- 81 g) revealing a significantly reduced mechanical efficiency (work per unit oxygen consumed) with COPD. The patients had an elevated number of less efficient type II muscle fibers, whereas muscle fiber cross-sectional areas, capillarity, and mitochondrial volume density were not different between the groups. Therefore, although metabolic capacity per se is unchanged, fiber type differences associated with COPD may account for the reduced muscular mechanical efficiency that becomes clearly apparent during knee-extensor exercise, when muscle function is no longer overshadowed by the decrement in lung function.     

Concomitant therapy with anxiolytics or hypnotics and maintenance of initial SSRI therapy

BACKGROUND: Depletion of fat-free mass (FFM) occurs in a considerable number of patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The goal of the study was to determine whether dual-energy X-ray absorptiometry (DXA) is an applicable method in the clinical evaluation of body composition in COPD. DESIGN: In a cross-sectional study in 79 COPD patients participating in a pulmonary inpatient program and in 23 healthy volunteers, DXA was compared with deuterium dilution (Deu) in the estimation of FFM. Bone mineral density (BMD), a DXA measurement, was also compared between the 2 groups. RESULTS: FFM(DXA) was highly related to FFM(Deu) in men (R2 = 0.93, P < 0.001) and women (R2 = 0.91, P < 0.001). On average, DXA resulted in higher FFM values than did Deu in COPD patients (3.4 kg; P < 0.001) and in healthy volunteers (2.1 kg; P < 0.001). Furthermore, the intramethod difference in FFM was higher in men than in women in the COPD group (P < 0.05) and in healthy volunteers (P < 0.001). BMD was lower in the COPD group than in the healthy, age-matched volunteers (P < 0.001). In 56% of the COPD patients, there were indications of bone mineral loss, defined as a BMD <1 SD of a matched reference population provided by the software. BMD was <2 SDs in 36% of the COPD patients. CONCLUSIONS: DXA appears to be a suitable alternative method to Deu for assessing body composition and is also of value in identifying bone mineral loss in COPD patients, and is therefore applicable in the clinical evaluation of these patients.     

Patterns of neuropsychological ability in brain-disordered versus normal children.

Examined the pattern of higher level vs lower level deficits in 25 brain-impaired children (aged 9–14 yrs) compared with 25 normal children (aged 9–24 yrs). It was hypothesized that measures of higher level abilities, such as abstract reasoning, would show greater differences between the groups than would measures of lower level abilities. Higher level functions measured included general neuropsychological functioning and verbal/academic skills; lower level functions measured included sensory and motor skills. Tests were selected from the Halstead-Reitan Neuropsychological Test Battery for Children, the Wechsler-Bellevue Intelligence Scale, the Wechsler Intelligence Scale for Children (WISC), and the Wide Range Achievement Test. Results show that the brain-impaired group was significantly poorer in each area of ability except sensory measures. Measures of motor functioning and general neuropsychological abilities best discriminated the brain-damaged group from the controls. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of beta blockade with metoprolol on simple and complex task performance.

[Correction Notice: An erratum for this article was reported in Vol 8(5) of Health Psychology (see record 2008-09113-001). The reference and citations for Merrill, Robbins, Schultz, Streeten, and Elias (1987) were incorrect. The correct reference is: Elias, M. F., Robbins, M. A., Schultz, N. R., Streeten, D. H. P., & Elias, P. K. (1987). Clinical significance of cognitive performance by hypertensive patients. Hypertension, 9, 192-197.] Measured the effect of treatment with the beta-blocker metoprolol on several indicants of task performance in 25 mildly to moderately hypertensive men (aged 24–63 yrs) treated for 2 wks each with drug and placebo, compared with 25 untreated normotensive men (aged 23–64 yrs). Ss responded twice to the Mood Adjective Check List (MACL) and the Stroop Color and Word Test. In addition, Ss participated in 2 parallel decision-making simulations. Results indicate that normotensives and hypertensives on drug or placebo did not differ on MACL and Stroop scores. Comparisons on 12 validated simulation measures showed that treatment with metoprolol aided complex task performance. Treatment improved strategic capacity and the ability to deal effectively with emergencies. Preliminary evidence that treatment with metoprolol might help restore performance capacity that may have been lost due to hypertensive disease was also obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD

To explain how symptoms, lung function, mood, and social support affect level of functioning, patients (N = 143) with chronic obstructive pulmonary disease (COPD) completed measures assessing their symptoms (Bronchitis-Emphysema Symptom Checklist), mood (Profile of Mood States), social support (Personal Resource Questionnaire), and functioning (Sickness Impact Profile). Those who were receiving oxygen therapy (n = 52) had significantly lower FEV1 scores and experienced significantly poorer functioning than those who were not receiving oxygen therapy (n = 91). Results of path analyses indicated that symptoms and mood directly, and social support indirectly, influenced the functioning of those who were not receiving oxygen. For those who were receiving oxygen, only symptoms directly, and FEV1 indirectly, influenced their functioning. These models need to be confirmed using other samples of patients with COPD.     

Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia

It has been hypothesized but not firmly established that sleep-related hypoxaemia could favour the development of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) patients without marked daytime hypoxaemia. We have investigated the relationships between pulmonary function data, sleep-related desaturation and daytime pulmonary haemodynamics in a group of 94 COPD patients not qualifying for conventional O2 therapy (daytime arterial oxygen tension (Pa,O2) in the range 7.4-9.2 kPa (56-69 mmHg)). Nocturnal desaturation was defined by spending > or = 30% of the recording time with a transcutaneous O2 saturation < 90%. An obstructive sleep apnoea syndrome was excluded by polysomnography. Sixty six patients were desaturators (Group 1) and 28 were nondesaturators (Group 2). There was no significant difference between Groups 1 and 2 with regard to pulmonary volumes and Pa,O2 (8.4+/-0.6 vs 8.4+/-0.4 kPa (63+/-4 vs 63+/-3 mmHg)) but arterial carbon dioxide tension (Pa,CO2) was higher in Group 1 (6.0+/-0.7 vs 53+/-0.5 kPa (45+/-5 vs 40+/-4 mmHg); p<0.0001). Mean pulmonary artery pressure (Ppa) was very similar in the two groups (2.6+/-0.7 vs 2.5+/-0.6 kPa (19+/-5 vs 19+/-4 mmHg)). No individual variable or combination of variables could predict the presence of pulmonary hypertension. It is concluded that in these patients with chronic obstructive pulmonary disease with modest daytime hypoxaemia, functional and gasometric variables (with the noticeable exception of arterial carbon dioxide tension) cannot predict the presence of nocturnal desaturation; and that mean pulmonary artery pressure is not correlated with the degree and duration of nocturnal hypoxaemia. These results do not support the hypothesis that sleep-related hypoxaemia favours the development of pulmonary hypertension.     

Neuropsychological performance and positive and negative symptoms in schizophrenia.

Examined cognitive functions in 11 positive-symptom (mean age 36 yrs), 10 negative-symptom (mean age 33.8 yrs), and 23 mixed-symptom (mean age 31.4 yrs) schizophrenics; 15 bipolar patients (mean age 34.7 yrs); and 12 normal controls (mean age 34.8 yrs) to explore the relation between symptoms and performance. Ss were administered a neuropsychological test battery including the Purdue Pegboard, the Revised Visual Retention Test, and the Block Design subtest of the Wechsler Adult Intelligence Scale—Revised (WAIS—R). Group comparisons revealed generalized deficits in schizophrenics. Positive-symptom schizophrenics scored below normal Ss and negative-symptom Ss on 2 measures tapping verbal memory. Multiple regression analyses revealed that negative symptom ratings were inversely associated with performance on visual-motor tasks, whereas positive symptoms were inversely associated with verbal memory performance. Findings are not consistent with the notion that cognitive deficits are uniquely associated with negative symptoms. Instead, results suggest that there may be specific cognitive correlates of both the positive and negative symptom dimensions. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhanced thromboxane biosynthesis in patients with chronic obstructive pulmonary disease. The Chronic Obstructive Bronchitis and Haemostasis Study Group

Thrombotic complications of pulmonary circulation occur in patients with chronic obstructive pulmonary disease (COPD). In the present study, we sought to evaluate in vivo platelet activation through the measurement of 11/dehydro-thromboxane (Tx) B2 TxA2 major metabolite in the urine, in 29 patients with COPD, compared with 29 sex- and age-matched healthy subjects. The urinary excretion of 11-dehydro-TxB2 was significantly higher in patients with COPD than in control subjects: median (range), 753 (277-4,409) and 275 (129-612) pg/mg creatinine, respectively; p < 0.0001). Moreover, 11-dehydro-TxB2 excretion was inversely related with arterial oxygen tension (rho = -0.46; p = 0.0145). In five of the 29 patients a short-term therapeutic course with oxygen supplementation induced a significant decrease of urinary 11-dehydro-TxB2 excretion: median range, 941 (452-2,640) to 445 (166-1,560) pg/mg creatinine. Moreover, selective inhibition of platelet cyclooxygenase activity by low-dose aspirin was associated with more than 90% inhibition of thromboxane metabolite excretion, demonstrating its being of platelet origin. Plasma levels of prothrombin fragment F1 + 2 were higher in patients than in control subjects (2.6 +/- 1.5 versus 0.9 +/- 0.4 nM, p = 0.0001). No relation between 11-dehydro-TxB2 excretion and plasma F1 + 2 levels was found. We conclude that platelet TxA2 biosynthesis is enhanced in patients with COPD and may be influenced by arterial oxygen tension changes.     

MRI evaluation of right ventricular pressure overload in chronic obstructive pulmonary disease

In chronic obstructive pulmonary disease (COPD), the development of pulmonary hypertension is common. This study was performed to assess the signs of right ventricular (RV) pressure overload and RV failure in COPD. In 8 COPD patients without primary cardiac disease, RV wall thickness, mass, and end-diastolic volume were measured by cardiac-triggered cine MRI. MR phase-contrast velocity quantification was used to measure stroke volume and the patterns of flow into and out of the RV. Data of patients were tested versus those of a control group matched for age (n = 8). Results showed that the RV wall thickness was increased (.6 +/- 0.1 vs 0.4 +/- 0.1 cm, P < .001). RV mass was increased (67 +/- 11 vs 57 +/- 5 g, P < .005). RV stroke volume was decreased (57 +/- 13 vs 71 +/- 13 ml, P < .01), but RV ejection fraction was not different. In the main pulmonary artery flow, the quotient of acceleration time divided by ejection time was decreased (33 +/- 5% vs 38 +/- 4%, P < .05), which is indicative of pulmonary hypertension. In conclusion, this MRI protocol provides a tool to assess the effects of RV pressure overload in COPD before heart failure has become manifest.     

Antibodies to prothrombin crossreact with plasminogen in patients developing myocardial infarction

This study aimed to determine the differences in haemodynamic responses to a standard incremental exercise test between outpatients with chronic obstructive pulmonary disease (COPD) and age-matched controls and to discover the relationship between severity of airflow obstruction and exercise haemodynamics in COPD. Twenty-two male patients with COPD (forced expiratory volume in one second (FEV1)/vital capacity (VC))<80% predicted) and 20 age-matched male controls performed an incremental exercise test (10 W x min(-1)) with ventilatory function and changes in stroke volume (deltaSV) and cardiac output (deltaCO) measured by means of electrical impedance cardiography (EIC). Submaximal deltaSV and deltaCO were lower in COPD patients. Peak exercise deltaSV were equal in patients and controls (128+/-33 versus 129+/-29%, p=0.98), whereas peak deltaCO was lower in patients (COPD versus controls: 232+/-71 versus 289+/-54%, p<0.005). In COPD patients, FEV1 (% pred) was significantly correlated to deltaSV at all submaximal exercise intensities, to peak exercise deltaSV and to peak exercise deltaCO. FEV1/VC (% pred) was significantly correlated to deltaSV at 30 and 60 W. In conclusion, in chronic obstructive pulmonary disease an aberrant haemodynamic response to exercise was found, especially in patients with severe airflow obstruction. This aberrant response is related to the degree of airflow obstruction and may limit exercise performance in patients with severe chronic obstructive pulmonary disease.     

Localization of cerebral dysfunction with a standardized version of Luria's Neuropsychological Battery.

Determined if the Luria-Nebraska Neuropsychological Battery, a standardized, comprehensive version by C. J. Golden et al (1979) of A. R. Luria's neuropsychological battery, can discriminate among patients with localized brain injuries. 24 right hemisphere and 36 left hemisphere patients were divided into 8 groups depending on hemisphere and location within the hemisphere (frontal, temporal, sensorimotor, or parietal–occipital). The average age of the sample was 42.5 yrs, with no significant differences in age or education among the groups. It was found that 14 summary scores derived from the Luria battery could identify clinical patterns characteristic of each group as well as suggest implications for modern theories of brain function. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)