The WISC-III Freedom from Distractibility factor: Its utility in identifying children with attention deficit hyperactivity disorder.

This study examined the construct validity and diagnostic utility of the Wechsler Intelligence Scale for Children—Third Edition (WISC-III; Wechsler, 1991) Freedom From Distractibility (FFD) factor within a sample of 40 clinic-referred children having attention deficit hyperactivity disorder (ADHD). For the group as a whole, the FFD factor index score was significantly lower than either the Verbal Comprehension (VC) or Perceptual Organization (PO) factor index scores. Group-level correlational analyses also revealed significant associations between the FFD factor and teacher ratings of inattention. Nevertheless, when analyzed at an individual level, the FFD factor was not significantly lower than either the VC or PO factors for a substantial number of children and so may not be suitable for identifying children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral deficits in groups with cerebral vascular lesions.

Established 3 groups of patients with cerebrovascular disease (right hemisphere, left hemisphere, or generalized involvement) by matching 15 triads for age, sex, education, and duration of diagnosed cerebrovascular disease. Intergroup and intragroup comparisons were made of results on a large battery of measures, including psychometric intelligence, motor strength and speed, psychomotor performance, and sensory functions. Tests given included halstead's finger tapping test, halstead's tactual performance test, and wechsler-bellevue, form i, verbal and performance iq values. Significant differences were found between groups with lateralized lesions, whereas the group with generalized involvement tended to occupy an intermediate position. The group with left cerebral damage had a significantly lower verbal than performance iq, whereas this relationship was reversed in the group with right cerebral damage. Motor, psychomotor, and sensory functions were consistently impaired on the side contralateral to the damage hemisphere for the groups with lateralized lesions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological Correlates of Diffusion Tensor Imaging in Schizophrenia.

Patients with schizophrenia (n = 41) and healthy comparison participants (n = 46) completed neuropsychological measures of intelligence, memory, and executive function. A subset of each group also completed magnetic resonance diffusion tensor imaging (DTI) studies (fractional anisotropy and cross-sectional area) of the uncinate fasciculus (UF) and cingulate bundle (CB). Patients with schizophrenia showed reduced levels of functioning across all neuropsychological measures. In addition, selective neuropsychological-DTI relationships emerged. Among patients but not controls, lower levels of declarative-episodic verbal memory correlated with reduced left UF, whereas executive function errors related to performance monitoring correlated with reduced left CB. The data suggested abnormal DTI patterns linking declarative-episodic verbal memory deficits to the left UF and executive function deficits to the left CB among patients with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lateralization of Epileptic Foci by Neuropsychological Testing in Mesial Temporal Lobe Epilepsy.

This study investigated the lateralizing value of neuropsychological testing in presurgical evaluation of mesial temporal lobe epilepsy (MTLE). This study differed from previous ones in that the cutoff values were determined to yield high positive predictive values (PPVs), multiple neuropsychological predictors were considered in combination, and patients with atypical language dominance or low intelligence were not excluded from the sample. The participants were 92 patients with MTLE (left, n = 47; right, n = 45) who showed good postoperative seizure control. With a stringent cutoff criterion, the multiple neuropsychological predictors considered in combination yielded a sensitivity of 15% and a PPV of 93%, and with a less stringent cutoff criterion, a sensitivity of 37% and a PPV of 83%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ILAE-defined epilepsy syndromes in children: correlation with quantitative MRI

PURPOSE: The role of quantitative magnetic resonance imaging (MRI) in evaluation of childhood epilepsy remains poorly defined, with minimal published data. Previous work from our center questioned the specificity of hippocampal asymmetry (HA) in an outpatient group whose epilepsy was defined by using clinical and interictal data only. By using childhood volunteer controls and defining epilepsy syndromes using video-EEG monitoring, we readdressed the utility of HA in differentiating mesial temporal lobe epilepsy (MTLE) from other partial and generalized epileptic syndromes in children. METHODS: Seventy children were enrolled; entry criteria were age younger than 18 years with predominant seizure type recorded on video-EEG telemetry with volumetric MRI in all cases. Thirty healthy child volunteers had volumetric MRI. Epilepsy syndrome classification was according to ILAE. RESULTS: Control data revealed symmetric hippocampi, mean smaller/larger ratio of 0.96 (0.95-0.97, 95% CI) with no gender or right/left predominance. Overall 23% of patients had significant HA. Mean hippocampal ratio for MTLE was 0.78 (95% CI, 0.70-0.86), significantly lower than controls and from all other epilepsy syndromes. HA was highly specific (85%) to the syndrome of MTLE. Other potential epileptogenic lesions were found in 27 (39%) patients, lowest yield in frontal and mesial temporal syndromes. Dual pathology was present in 10% of patients. There was no significant association between HA and risk factors. CONCLUSIONS: In this study, we found that HA in children with a well-defined epilepsy syndrome is highly sensitive and specific for MTLE. Whether this will correlate with surgical outcome, as in adults, is the subject of ongoing study.     

Coexisting psoriatic arthritis, gout, and chondrocalcinosis

BACKGROUND: Constructional impairment following left vs. right hemisphere damage has been extensively studied drawing tasks. A confounding factor in these studies is that right-handed patients with left hemisphere damage (LHD) are often forced by weakness to use their non-dominant (left) hand or hemiparetic dominant hand. Qualitative differences in the drawing characteristics of left and right hand drawings by normal subjects have not previously been characterized. The present study was undertaken to determine the qualitative differences between left and right hand drawings of normal subjects. METHODS: Thirty right-handed, elderly subjects without a history of neurological disease were asked to draw, from memory, seven objects using the right and left hand. Half of the subjects were randomly assigned to draw with the left hand first, and half the right hand first. Right and left hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Each drawing was scored on eighteen criteria. Right and left hand drawing scores were then compared using the t-test for paired samples or the Wilcoxon matched-pairs test. RESULTS: Drawings made using the left hand were found to be significantly simpler, more tremulous and of poorer overall quality than drawings made by the same subjects using the right hand. CONCLUSIONS: The deficits found in left versus right hand drawings of normals are similar to those found in patients with LHD, suggesting that much of the drawing impairment seen following LDH is due to an elementary motor disturbance related to use of the non-dominant hand.     

Hand preference and components of I.Q

An account is given of the hand preferences (measured by questionnaire) of 687 individuals living in a Cambridge suburb. The proportions of right, mixed and left handers differed according to the classification used. Verbal and Performance I.Q. component scores were examined in relation to hand preference. For all classifications, left handers' overall Verbal I.Q. was significantly higher than their Performance I.Q. score, whereas right and mixed handers' Performance I.Q. scores were greater than their Verbal I.Q.s. Left handers scored higher than right and mixed handers on Verbal I.Q. but lower on Performance I.Q. The relationships between patterns of handedness, I.Q. component scores and cerebral dominance are discussed.     

Violent behavior and differential WAIS characteristics.

Used Q-factor analytic techniques to analyze the WAIS profiles of 30 17-73 yr old white males recently admitted to a maximum security unit for the criminally insane at a midwestern state hospital. The 15 Ss incarcerated for commission of violent crimes tended to have similar subtest score configurations. Subsequent investigation indicated that these WAIS profiles could be described as a simple ratio of the Similarities score to the total of all 11 subtest scores. The mean Similarities ratio score for the violent group was significantly lower than that of the nonviolent group in both the original and cross-validation samples. Results indicate the potential value of research efforts that simultaneously evaluate measures of related deficits in abstract reasoning, left temporal lobe dysfunctioning, and violent behavior on the same Ss. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amygdalar Lateralization in Fear Conditioning: Evidence for Greater Involvement of the Right Amygdala.

The relative contribution of left and right amygdalae in the acquisition and retention of fear conditioning was investigated in rats. Pretraining bilateral electrolytic lesions blocked the acquisition of conditioned fear to tone and context, whereas unilateral lesions induced partial impairments with no left-right amygdala differences. In contrast, posttraining bilateral and unilateral lesions produced significant deficits in the retention of conditioned fear to tone and context. Although no left-right difference was observed to tone, the right amygdala lesions generated greater deficits in contextual fear than the left amygdala lesions. These results indicate that fear conditioning is partially disrupted with unilateral amygdalar lesions, but that the right amygdala has greater involvement than the left amygdala when conditioning occurs under a normal brain state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynorphin and the kappa 1 ligand [3H]U69,593 binding in the human epileptogenic hippocampus

The distribution of dynorphin (DYN), one of its binding sites (kappa 1 receptor) and their relationship to neuronal loss and granule cell hyperexcitability was examined in hippocampi from patients with temporal lobe epilepsy (TLE). In hippocampi that were not the seizure focus (mass associated temporal lobe epilepsy, MaTLE; and paradoxical temporal lobe epilepsy, PTLE) DYN-like immunoreactivity was localized in the dentate granule cells and their mossy fiber terminals within the hilus and area CA3. In hippocampi that were the seizure focus (MTLE), 89% showed an additional band of immunoreactivity confined to the inner molecular layer (IML) of the dentate gyrus, representing recurrent mossy fiber collaterals. In 11% of MTLE patients no staining was found in the IML (MTLE/DYN-). The MTLE/DYN- hippocampi were also characterized by a significantly lower degree of cell loss than in MTLE hippocampi in the dentate granule cell layer, the hilus and CA3. Both MTLE and MTLE/DYN- hippocampi showed evoked epileptiform bursting in granule cells while MTLE showed greater polysynaptic EPSPs and spontaneous excitatory activity. Thus granule cell recurrent collateral sprouting may account for only some aspects of hyperexcitability. In 30% of the MTLE group, hilar neurons of a variety of morphological types expressed DYN immunoreactivity in their somata and dendrites. The density of [3H]U69,593 binding sites in MaTLE and PTLE patients was highest in areas CA1 and the subiculum-regions having little or no DYN-staining. In the dentate molecular layer, hilus and CA3--regions with the most DYN immunoreactivity--there was a low density of ligand binding. The significance of this transmitter/receptor mismatch is yet unknown.     

Relations between neuropsychological findings and lateral asymmetries of cerebral blood flow measured by SPECT in dementia of Alzheimer type

We studied 16 right-handed patients clinically diagnosed as dementia of Alzheimer type (6 men, 10 women; aged 63-85, mean 72.8 years). The average duration of symptoms was 2.7 years. Dementia ranged from mild to moderately severe. None had clinical or laboratory evidence of cerebrovascular disease (Hachinski ischemic scores for all patients were 4 or below 4). All received the Wechsler Adult Intelligence Scale (WAIS), Mini-mental State Test (MMS) and Western Aphasia Battery (WAB, First Japanese edition, 1986). Regional cerebral blood flow (rCBF) was evaluated by single photon emission CT (SPECT) with 123I-N-isopropyl-p-iodoamphetamine (123I-IMP), using the Matsuda's quantitative method (Am J Physiol Imag 1: 186, 1986). Regional tracer uptake was measured in regions of interests (ROIs) over right and left frontal, temporal, parietal and occipital cortical regions; basal ganglia; and cerebellar hemispheres. The subjects were divided into three groups on the basis of lateral asymmetries in the temporal and parietal cortexes of rCBF (left < right, n = 5; right < left, n = 3; left = right, n = 8). We decided that lateral asymmetry was present when rCBF for each ROI between left and right sides differs by more than 10%. General score (MMS, T-IQ) was not correlated with asymmetry of cerebral blood flow. Verbal IQ in patients with predominant hypoperfusion of left temporal and parietal lobe was significantly lower than other group, while performance IQ and WAB constructive scores were lower in those with right hemispheric hypoperfusion (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Revision knee arthroplasty with patella replacement versus bony shell

A study was undertaken to assess the clinical results of revision total knee arthroplasty in which an unresurfaced bony shell was left after removing a patellar component versus those in which a patellar component was implanted. Followup was obtained in 123 of 130 consecutive revision total knee replacements (94%) from three centers. In 21 knees a shell of patellar bone was left and 92 knees had a patellar component in place. Ten patients had a patellectomy and were excluded from consideration. The group with the bony shell had a lower postoperative knee score but the preoperative Knee Society clinical score was significantly lower as well in this group of patients. Compared with the group of patients with the patellar component in place, the group of patients with knees left with a bony shell had a significantly higher percentage of patients who had difficulty using stairs, a higher percentage of patients who were not satisfied with their surgery, and a higher percentage of patients who rated their surgery as unsuccessful in returning them to normal daily activities. When a patellar component was not able to be implanted in revision total knee arthroplasty, a lower quality result was observed.     

Temporal discounting of rewards in patients with bipolar disorder and schizophrenia.

Patients with bipolar disorder (BD) and schizophrenia (SZ) often show decision-making deficits in everyday circumstances. A failure to appropriately weigh immediate versus future consequences of choices may contribute to these deficits. We used the delay discounting task in individuals with BD or SZ to investigate their temporal decision making. Twenty-two individuals with BD, 21 individuals with SZ, and 30 healthy individuals completed the delay discounting task along with neuropsychological measures of working memory and cognitive function. Both BD and SZ groups discounted delayed rewards more steeply than did the healthy group even after controlling for current substance use, age, gender, and employment. Hierarchical multiple regression analyses showed that discounting rate was associated with both diagnostic group and working memory or intelligence scores. In each group, working memory or intelligence scores negatively correlated with discounting rate. The results suggest that (a) both BD and SZ groups value smaller, immediate rewards more than larger, delayed rewards compared with the healthy group and (b) working memory or intelligence is related to temporal decision making in individuals with BD or SZ as well as in healthy individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pentoxifylline versus placebo in the treatment of infertility associated with minimal or mild endometriosis: a pilot randomized clinical trial

The long-term outcome of pulmonary function was evaluated in farmer's lung (FL) patients compared to representative control farmers. This is, to our knowledge, the first such study which has included a control group. Clinical examinations were conducted in 89 FL patients and 84 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yrs. The mean transfer factor of the lung for carbon monoxide (TL,CO) was on average 12% lower (p < 0.001) in FL patients compared to control farmers. In spirometry, the mean maximum expiratory flow at 50% of vital capacity (MEF50) was lower (p = 0.08) in FL patients but there were no differences in mean vital capacity (VC) or forced expiratory volume in one second (FEV1) between FL patients and control farmers. However, airway obstruction, defined as an FEV1/VC less than 88% of predicted, was more common in FL patients than in control farmers (33 versus 17%; p = 0.02). Patients who had had recurrent episodes of FL had a significantly lower mean TL,CO compared to those FL patients who had experienced only a single episode. In conclusion, impairment of the pulmonary transfer factor is the most important long-term consequence of farmer's lung. However, farmer's lung may also lead to development of airway obstruction.     

Predictors for the massive thrombi occurring in the right coronary artery related to acute myocardial infarction

Acute myocardial infarction (AMI) related to the right coronary artery (RCA) is associated with a lower reperfusion rate and higher reocclusion rate in the acute phase than AMI related to the left coronary artery. The greater susceptibility of the RCA to development of large thrombi makes successful reperfusion more difficult to achieve. This study investigated predictive factors for massive thrombus in the RCA before the selection of the treatment to achieve better rates of reperfusion. We classified 51 patients with AMI related to RCA into the massive (linear intraluminal radiolucency > 3 cm) thrombus group (9 patients) and the non-massive thrombus group (42 patients). 1) History: Patients in the massive thrombus group had a greater incidence of hypertension than the non-massive thrombus group, with more left ventricular hypertrophy (p < 0.05). There were no significant differences in other coronary risk factors. 2) RCA morphology: The maximum RCA diameter was significantly greater in the massive thrombus group than that in the non-massive thrombus group [proximal to the right ventricular branch, 4.2 vs 3.2 mm (median); distal to the right ventricular branch, 4.2 vs 3.4 mm, p < 0.05]. 3) Conditions of onset: The elapsed time was significantly longer in the massive thrombus group (15 hours) than that in the non-massive thrombus group (2.5 hours, p < 0.05). More massive thrombus cases were observed in summer (p < 0.05), but there was no evident correlation between massive thrombus formation and the onset time of day, weather, Hct and coagulation factor at the onset, left ventricular ejection fraction or left ventricular end-diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Response to exercise in patients after repair of tetralogy of Fallot

Cardiac catheterization and submaximal exercise testing was performed in 38 patients after repair of tetralogy of Fallot (TF), and compared to 6 control patients who had functional murmurs. Cardiac index, heart rate, and stroke volume index were significantly lower in the TF group than in the control group. Right and left ventricular end-diastolic pressure increased significantly during exercise, which was not found in the control group. Total pulmonary vascular resistance (TPVR), which decreased significantly with exercise in the control group, did not change remarkably during exercise. TPVR was significantly higher in the TF group than in the control group both at rest and during exercise. Several factors were compared between patients with good cardiac index (> 5.0 l/min/m2; Group 1) and poor cardiac index (< 5.0 l/min/m2; Group 2) during exercise. Stroke volume index, right ventricular ejection fraction at rest were significantly higher in Group 1 than Group 2. TPVR, right and left ventricular end-diastolic and end-systolic volume index were significantly lower in Group 1 than in Group 2. There was no significant difference in heart rate, left ventricular ejection fraction, residual pulmonary stenosis, right to left ventricular systolic pressure ratio, and severity of pulmonary regurgitation between two groups. These findings indicate that abnormalities of exercise tolerance in patients after repair of TF were related to poor response of heart rate, pulmonary vascular resistance, and systolic and diastolic ventricular function.     

Clinical and electrographic manifestations of lesional neocortical temporal lobe epilepsy

To determine whether lesional neocortical temporal lobe epilepsy (NTLE) can be differentiated from mesial temporal lobe epilepsy (MTLE) during the noninvasive presurgical evaluation, we compared the historical features, seizure symptomatology, and surface EEG of 8 patients seizure free after neocortical temporal resection with preservation of mesial structures and 20 patients after anterior temporal lobectomy for MTLE. Seizure symptomatology of 107 seizures (28 NTLE, 79 MTLE) was analyzed. One hundred one ictal EEGs (19 NTLE, 82 MTLE) were reviewed for activity at seizure onset; presence, distribution, and frequency of lateralized rhythmic activity (LRA); and distribution of postictal slowing. Seizure symptomatology and EEG data were compared between groups, and sensitivity, specificity, and positive and negative predictive values were determined for variables that differed significantly. Multiple logistic regression was used to determine whether patients could be correctly classified as having MTLE or NTLE. MTLE patients were younger at onset of habitual seizures and more likely to have a prior history of febrile seizures, CNS infection, perinatal complications, or head injury. NTLE seizures lacked features commonly exhibited in MTLE, including automatisms, contralateral dystonia, searching head movements, body shifting, hyperventilation, and postictal cough or sigh. NTLE ictal EEG recordings demonstrated lower mean frequency of LRA that frequently had a hemispheric distribution, whereas LRA in MTLE seizures was maximal over the ipsilateral temporal region. We conclude that it may be possible to differentiate lesional NTLE from MTLE on the basis of historical features, seizure symptomatology, and ictal surface EEG recordings. This may assist in the identification of patients with medically refractory nonlesional NTLE who frequently require intracranial monitoring and more extensive or tailored resections.     

Doors and People: Visual and verbal memory after unilateral temporal lobectomy.

The study investigated the ability of the A. D. Baddeley et al (1994) Doors and People Memory Battery to discriminate between patients with left and right unilateral temporal lobectomy (TL). Patients, 47 of whom had undergone en bloc resection (23 left TL and 24 right TL), were tested on the memory battery. The results showed that verbal memory functioning was significantly more impaired in the left TL group, whereas visual memory was more impaired in the right TL group. Recall memory was slightly more impaired than recognition memory overall in the 2 patient groups. It is concluded that the test provides a neuropsychologically valid and sensitive measure of visual and verbal memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuromotor functioning in children with Tourette syndrome with and without attention deficit hyperactivity disorder

Neuromotor function was assessed in 94 children of normal intelligence with Tourette syndrome, Tourette syndrome and attention-deficit hyperactivity disorder (ADHD), or ADHD only, using the Physical and Neurological Examination of Subtle Signs (PANESS). Time to complete six motor movements was analyzed separately by side (left and right) and complexity (simple and patterned). All groups performed faster on their preferred, dominant side. Although all groups took longer to complete patterned versus simple movements, the group with ADHD had a larger discrepancy for complexity than the other two groups. The speed for simple and patterned tasks was at or faster than age expectations for 54% of tasks in the group with Tourette syndrome but only 15% of tasks in the other two groups. More children in the group with Tourette syndrome (76%) than the groups with Tourette syndrome with ADHD (54%) or ADHD (54%) or ADHD only (65%) performed movements within normal time limits for age. Findings suggest that Tourette syndrome is not associated with motor slowing.     

The effect of goal-subgoal conflict on planning ability after frontal- and temporal-lobe lesions in humans

Twenty-one patients with unilateral prefrontal cortical neurosurgical lesions (11 left and 10 right) and 38 patients with unilateral temporal lobectomy (19 left and 19 right) were compared to 44 matched control subjects on their performance on the 3-D Computerized Tower of Hanoi (3-D CTOH) test. The problems were split into those with or without a significant goal-subgoal conflict determined by whether the correct first move in each problem took the subject apparently away or towards the final goal state. The left frontal lesion and right temporal lobectomy groups were significantly impaired on problems with goal-subgoal conflicts. In the left frontal group, this deficit was confined to earlier four-move problems, whereas the right temporal group showed a more general deficit on later five-move problems. The left frontal lesion deficit is explained in terms of an inability to inhibit the response compatible with achieving a final goal, whereas the impairment in the right lesion group was related to a specific impairment in spatial memory.