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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes an initial evaluation of a new method for assessing transient states of cognitive impairment associated with intoxication or fatigue: neural network pattern recognition applied to features of the electroencephalogram (EEG) recorded from subjects performing a standardized task. Nine subjects performed a working memory task during an extended testing session occurring over the course of one night, and encompassing an alert baseline period, a state of mild acute intoxication, and a state of fatigue compounded by "hangover" or intoxication after-effects. Relative to the alert baseline, task performance was less accurate in the other test conditions, providing evidence of transient cognitive impairment. These states of impairment were associated with changes in spectral characteristics of the EEG. Neural network-based EEG pattern recognition techniques were used to develop and test detectors of these changes. Brief testing data samples originating from the alert baseline condition could be discriminated from those recorded during the state of acute intoxication with 98% accuracy (p < 0.0001), and from those recorded during the state of fatigue/hangover with 92% accuracy (p < 0.001). Furthermore, networks trained on data from a group of subjects were found to accurately classify data from test subjects who were not part of the training group. These results demonstrate the feasibility of using neurophysiological monitoring methods for detecting transient cognitive impairment.
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PMID:Detecting transient cognitive impairment with EEG pattern recognition methods. 1051 82

Chronic Fatigue Syndrome (CFS) is characterized by debilitating fatigue, somatic symptoms and cognitive impairment. An infectious basis has been proposed; candidate agents include enteroviruses, herpesviruses, retroviruses and Borna disease virus (BDV), a novel neurotropic virus associated with neuropsychiatric disorders. Sera and peripheral blood mononuclear cells (PBMC) from Swedish CFS patients were assayed for evidence of infection using ELISA and Western immunoblot for detection of antibodies to BDV proteins N, P and gp18; and using nested reverse transcriptase polymerase chain reaction (RT-PCR) for detection of BDV N- and P-gene transcripts. No specific immunoreactivity to BDV proteins was found in sera from 169 patients or 62 controls. No BDV N- or P-gene transcripts were found through RT-PCR analysis of PBMC from 18 patients with severe CFS. These results do not support a role for BDV in pathogenesis of CFS.
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PMID:Absence of evidence of Borna disease virus infection in Swedish patients with Chronic Fatigue Syndrome. 1056 86

Fibromyalgia is a chronic soft tissue pain syndrome characterized by the presence of widespread musculosceletal aching, tender points at characteristic sites, fatigue and poor sleep. Associated disorders are restless leg syndrome, irritable bowel syndrome, irritable bladder syndrome, cognitive dysfunction, cold intolerance, multiple sensitivities and dizziness. Despite the superficial appearance of normality, many fibromyalgia patients have difficulties with remaining competitive in the work force. Impressive resurgence of research had been done about fibromyalgia in a better understanding in the neurobiology of chronic pain. The results demonstrate that sensory disorders processing at a central level are in part involved in fibromyalgia. These findings also influence the management of the disease with the tendency to a multidisciplinary therapeutical concept.
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PMID:[Panalgesia and the fibromyalgia concept]. 1063 67

Head upright tilt table testing has become an accepted method to measure an individual's predisposition to autonomically mediated periods of hypotension and bradycardia severe enough to cause frank syncope. At the same time it has become increasingly apparent that less profound falls in blood pressure, while not sufficient to result in loss of consciousness, may cause symptoms such as near syncope, vertigo, and dizziness. We describe a subgroup of adolescents that have a mild form of autonomic dysfunction that exhibit disabling symptoms such as postural tachycardia and palpitations, extreme fatigue, lightheadedness, exercise intolerance, and cognitive impairment. During baseline tilt table testing at a 70 degrees angle, these patients demonstrated a heart rate increase of > or = 30 beats/min (or a maximum heart rate of > or = 120 beats/min) within the first 10 minutes upright (not associated with profound hypotension), which reproduced their clinical symptom complex. Similar observations have been made in the adult population and has been termed the postural orthostatic tachycardia syndrome (POTS). We report that POTS may also occur in adolescents and represents a mild, potentially treatable form of autonomic dysfunction that can be readily identified during head upright tilt table testing.
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PMID:The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. 1075 Jan 35

We wanted to find out if psychotherapy may influence the course of the physical aspects of multiple sclerosis and the consequences of psychotherapy for coping processes. 46 patients diagnosed with multiple sclerosis who had chosen to undergo a 1-yr. group psychotherapy treatment were compared with a control group of 24 multiple-sclerosis patients without such treatment. They were given the Giessen test (personality test), the Achievement Capacities Questionnaire by Kesselring, an intensive interview as well as the content analysis scales of verbal behavior by Gottschalk and Gleser. The various tests were carried out at each of four times of measurement with a 2-yr. follow-up. There were significant changes in the area of relationships and aggressive loosening (interview) between the Therapy and Control groups. Several changes were also found with regard to physical symptoms (Achievement Capacities Questionnaire) in the Therapy group compared to the Control group, e.g., increases in physical mobility and decreases in care of the body. The decreases appear to be a known effect of therapy with psychosomatic disorders. We interpret it psychoanalytically as resistance against releasing anxiety of counter-cathected motives which multiple sclerosis helps to keep unconscious. In a follow-up, the Therapy group showed greater optimism and physical improvements, e.g., decrease in feeling cold and lack of energy. Some positive changes appeared in both groups, such as, for example, an improvement of cognitive impairment (Gottschalk & Gleser). It appears that the attention from the research itself may have affected both groups because some members of both groups were in contact and hence the Control group was also informed about the research project and its underlying hypothesis.
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PMID:Psychotherapy with multiple-sclerosis patients. 1084 Sep 3

Behavioral and psychiatric problems associated with idiopathic Parkinson's disease (PD) include cognitive dysfunction, drug-related psychosis, depression, anxiety, apathy, fatigue and sleep disturbance. These nonmotor symptoms are a significant cause of disability at all stages of illness. Cognitive dysfunction spans a continuum from circumscribed cognitive impairments to severe global dementia which can occur in up to 10-30% of advanced PD patients. Psychosis develops in 20-30% of PD patients receiving chronic antiparkinsonian therapy. Visual hallucinations and paranoid delusions are the most frequent symptoms. The gradual elimination of drugs of lesser priority that may affect cognition and/or cloud the sensorium constitutes the first step in the management of cognitive and psychotic symptoms. Atypical neuroleptic agents are an invaluable tool in those cases in which maximum drug regimen simplification is not adequate or results in unacceptable immobility. Depression and anxiety often go unrecognized although they are eminently treatable and may be important contributors to the morbidity of PD. They are present in 30-40% of PD patients and frequently occur together in association with other nonmotor symptoms such as apathy, fatigue and sleep disturbance. A combination of early recognition, counseling, antidepressant therapy, antianxiety and well-balanced antiparkinsonian therapy sets the stage for improved quality of life for patients with PD.
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PMID:Management of behavioral and psychiatric problems in Parkinson's disease. 1100 95

Mild cognitive impairment is found in many cases of depression, and it is mostly assumed to improve during the time course of depression remission. Recent data question the reversibility of low cognitive test performance in depression. The aim of this study is to determine the degree of reversibility and the proportion of patients who will not demonstrate reversibility of cognitive dysfunction. Consecutive inpatients suffering from depression (N=102) were investigated and N=82 matched control subjects. N=57 of the patients were diagnosed as major depression according to DSM-IV. A total of N=67 could be retested after remission of depression (N=32 of the patients with major depression) and a matched control group (N=62). Neuropsychological tests were applied in a test session which avoids the effects of fatigue in the patients by the short duration of strenuous tests. For most neuropsychological tests an impaired performance in the depressed patients was found. About one third of the depression subjects performed at an impaired level in tests of averbal memory and verbal fluency (below 5th percentile). In the follow-up investigation, a slight improvement in performance could be assessed for both the depression and the control group, which was, however, attributed to a general test training effect. No normalization of cognitive test performance was found in spite of complete recovery of the affective symptoms. No correlation between the duration of the disease before the index episode or number of episodes and cognitive deficits could be found. The data of the neuropsychological deficits of depressed patients, which are stable in the time course of the affective disorder, may indicate that these patients may suffer from comorbidity of both depression and mild cognitive disorder. The findings are discussed as 1) indicating only a minor impact of the depressed mood on the cognitive performance and 2) they are consistent with a role of brain lesions which have been reported in several studies in a subgroup of depression.
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PMID:Comorbidity of mild cognitive disorder and depression--a neuropsychological analysis. 1100 71

Patients with cancer experience multiple symptoms including pain, dyspnea, fatigue, depression, and cognitive impairment. These symptoms impair patients' daily functioning and their quality of life. Symptoms that can be well managed are often undertreated. A major barrier to adequate symptom treatment is poor assessment. The use of simple measurement scales greatly improves the symptom assessment process, helps direct treatment choices, and provides information about the effectiveness of treatment. Recently, better methods for symptom assessment have been developed, including brief self-report tools for the assessment of multiple symptoms and interactive voice response systems for assessing symptoms at home. Symptom assessment can be linked to evidence-based or best practice guidelines to expedite optimal symptom treatment. Because patients with cancer receiving radiotherapy are seen in the clinic frequently, the radiation oncologist can play an integral role in a comprehensive approach that involves both the medical and radiotherapeutic treatment of cancer-related symptoms.
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PMID:Cancer-related symptoms. 1103 29

Up to 10% of children and adolescents in the United States may have asthma and up to 40% may be affected by allergic rhinitis. Most people know that asthma is a serious disease, but "hay fever" is often mistakenly considered trivial. However, hay fever symptoms can significantly influence a patient's quality of life, causing fatigue, headache, and even cognitive impairment. Both asthma and allergic rhinitis can result in lost sleep, many missed school days, and the inability to participate in sports and other recreational activities in which young people engage. An appropriate diagnosis is the first step toward improving quality of life for these young patients. This article reviews diagnostic procedures for allergic disease, and-because compliance is frequently an issue with school-aged patients-it also reviews current thinking on allergen immunotherapy, a treatment that provides effective long-term control in appropriately selected patients.
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PMID:Allergy evaluation and immunotherapy. 1106 May 51

Depression is very common in Parkinson's disease (PD), but its severity and particular symptoms vary. It can often be difficult to diagnose because many of the symptoms typically associated with depression (eg, sleep difficulties, fatigue) can be seen in nondepressed patients with PD, and signs thought to represent depression (eg, lack of facial expression, slowness) can be produced by PD itself. Apathy, although a possible feature of depression, can exist apart from depression and is often associated with cognitive impairment. Therefore, when evaluating patients with PD for possible depression, one should concentrate on the psychological or ideational aspects of the illness. One must determine whether the patient feels sad or hopeless or has a marked inability to enjoy life. Once it has been determined that the patient has clinically significant depressive symptoms, it is important to let him or her know that depression is an aspect of PD requiring treatment, just like the motor manifestations of the disease. The idea of adding antidepressant medications and the possibility of psychotherapy should be introduced. A very reasonable first-choice antidepressant is either sertraline or paroxetine. Because of isolated case reports of worsening motor function associated with institution of a selective serotonin reuptake inhibitor (SSRI), one should keep track of when the medication was started so that the patient can be seen again within a month. It is important from a psychological perspective to have regular follow-up visits when treating depression. If the SSRIs are ineffective or not tolerated, nortriptyline is a good next choice. It has fewer anticholinergic effects and is less likely to cause or worsen orthostatic hypotension than other tricyclic antidepressants. Amitriptyline, although an old favorite of neurologists, is very sedating and has too much anticholinergic activity to be well tolerated in the higher doses needed to treat depression. If a patient could benefit from a dopamine agonist from a motor standpoint and his or her depressive symptoms are mild, consider using pramipexole, which may improve mood and motivation (although this has not yet been proven in a well-controlled trial). It is a good idea to keep patients on antidepressant therapy at least 6 months; many patients require long-term treatment. If a patient is severely depressed, he or she should be referred to a psychiatrist, who may consider admission to the hospital and possible electroconvulsive therapy.
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PMID:Depression in Parkinson's Disease. 1109 53


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