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ABSTRACT:Background:Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard.Methods:The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54.Results:23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (zscore < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27.Conclusion:A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

Patients with Alzheimer's disease (AD) and semantic variant primary progressive aphasia (svPPA) can present with similar language impairments, mainly in naming. It has been hypothesized that these deficits are associated with different brain mechanisms in each disease, but no previous study has used a network approach to explore this hypothesis. The aim of this study was to compare resting-state functional magnetic resonance imaging (rs-fMRI) language network in AD, svPPA patients, and cognitively unimpaired elderly adults (CTRL). Therefore, 10 AD patients, 12 svPPA patients and 11 CTRL underwent rs-fMRI. Seed-based functional connectivity analyses were conducted using regions of interest in the left anterior temporal lobe (ATL), left posterior middle temporal gyrus (pMTG) and left inferior frontal gyrus (IFG), applying a voxelwise correction for gray matter volume. In AD patients, the left pMTG was the only key language region showing functional connectivity changes, mainly a reduced interhemispheric functional connectivity with its right-hemisphere counterpart, in comparison to CTRL. In svPPA patients, we observed a functional isolation of the left ATL, both decreases and increases in functional connectivity from the left pMTG and increased functional connectivity form the left IFG. Post-hoc analyses showed that naming impairments were overall associated with the functional disconnections observed across the language network. In conclusion, AD and svPPA patients present distinct language network functional connectivity profiles. In AD patients, functional connectivity changes were restricted to the left pMTG and were overall less severe in comparison to svPPA patients. Results in svPPA patients suggest decreased functional connectivity along the ventral language pathway and increased functional connectivity along the dorsal language pathway. Finally, the observed connectivity patterns are overall consistent with previously reported structural connectivity and language profiles in these patients.

The basal forebrain cholinergic system, which is impaired in early Alzheimer’s disease, is more crucial for the activation of rapid-eye-movement (REM) sleep electroencephalogram (EEG) than it is for wakefulness. Quantitative EEG from REM sleep might thus provide an earlier and more accurate marker of the development of Alzheimer’s disease in subjects with mild cognitive impairment (MCI) subjects than that from wakefulness. To assess the superiority of the REM sleep EEG as a screening tool for preclinical Alzheimer’s disease, 22 subjects with amnestic MCI (a-MCI; 63.9 ± 7.7 years), 10 subjects with nonamnestic MCI (na-MCI; 64.1 ± 4.5 years) and 32 controls (63.7 ± 6.6 years) participated in the study. Spectral analyses of the waking EEG and REM sleep EEG were performed and the [(delta + theta)/(alpha + beta)] ratio was used to assess between-group differences in EEG slowing. The a-MCI subgroup showed EEG slowing in frontal lateral regions compared to both na-MCI and control groups. This EEG slowing was present in wakefulness (compared to controls) but was much more prominent in REM sleep. Moreover, the comparison between amnestic and nonamnestic subjects was found significant only for the REM sleep EEG. There was no difference in EEG power ratio between na-MCI and controls for any of the 7 cortical regions studied. These findings demonstrate the superiority of the REM sleep EEG in the discrimination between a-MCI and both na-MCI and control subjects.

ABSTRACT:Memory assessment represents an important part of the clinical neuropsychologist’s duties in a geriatric context. In fact, in Canada, about one-third of seniors report memory complaints, with different causes. Based on the underlying etiology, different components of memory may be affected in older adults. Nonautobiographical retrograde memory (public or semantic) is an important aspect of memory to assess; nevertheless, there is currently no reliable and standardized clinical tool to evaluate this aspect of memory in the elderly Quebecer population. The aims of this research were therefore: (1) to develop a protocol specifically aimed at assessing non-autobiographical retrograde memory in this population, the PUB-40; (2) to obtain reference data among 105 healthy subjects; and (3) to develop a short version based on the items which discriminated a group of 20 patients with amnestic Mild cognitive impairment (aMCI) from older healthy subjects. RÉSUMÉ:L’évaluation de la mémoire représente une partie importante du travail des neuropsychologues cliniciens oeuvrant en gériatrie. En effet, au Canada, environ le tiers des aînés rapporte une plainte mnésique dont les causes sont variées. Selon l’étiologie, différentes composantes du système mnésique peuvent être atteintes; toutefois, l’évaluation de la mémoire rétrograde non autobiographique (publique ou sémantique) n’est souvent effectuée que de manière superficielle, puisqu’aucun outil d’évaluation fiable, valide et standardisé n’est disponible pour la population québécoise vieillissante. Les objectifs de cette recherche étaient donc (1) d’élaborer un protocole d’évaluation de la mémoire rétrograde non autobiographique spécifiquement adapté à cette population, le PUB-40, (2) de recueillir des données de référence auprès de 105 participants âgés sains et (3) de développer une version abrégée à partir des items permettant de discriminer un groupe de 20 patients atteints de troubles cognitifs légers de type amnésique (TCLa) des participants âgés sains.

ABSTRACTMemory assessment represents an important part of the clinical neuropsychologist’s duties in a geriatric context. In fact, in Canada, about one-third of seniors report memory complaints, with different causes. Based on the underlying etiology, different components of memory may be affected in older adults. Nonautobiographical retrograde memory (public or semantic) is an important aspect of memory to assess; nevertheless, there is currently no reliable and standardized clinical tool to evaluate this aspect of memory in the elderly Quebecer population. The aims of this research were therefore: (1) to develop a protocol specifically aimed at assessing non-autobiographical retrograde memory in this population, the PUB-40; (2) to obtain reference data among 105 healthy subjects; and (3) to develop a short version based on the items which discriminated a group of 20 patients with amnestic Mild cognitive impairment (aMCI) from older healthy subjects.

ABSTRACTProvided test characteristics are adequate, point-of-care rapid antigen detection tests for influenza could improve the timeliness and appropriateness of clinical decisions. Our objective was to estimate the field sensitivity and specificity of the Quidel QuickVue Influenza A+B test in an ambulatory setting. The sensitivity and specificity of the Quidel QuickVue test was evaluated against reverse-transcriptase PCR (RT-PCR) on nasopharyngeal specimens collected over two consecutive influenza seasons from ambulatory patients consulting for influenza-like illness (ILI) within 7 days of ILI onset. A total of 491 patients with ILI (180 in 2006 to 2007 and 311 in 2007 to 2008) provided specimens that were tested both by PCR and by the Quidel QuickVue test. Among the 267 patients positive by PCR (55%), 52 were also positive by the QuickVue test, for an overall sensitivity of 19.5% (95% confidence interval [95% CI], 14.7% to 24.2%). Among the 221 PCR-negative patients, 2 were positive for influenza B virus by the rapid test (<1%), for an overall specificity of 99.1% (95% CI, 97.9 to 100%). The field sensitivity of the test varied little with the age or gender of the patient, immunization status, delay since the onset of symptoms, or influenza season. The sensitivity of the test was slightly but nonsignificantly higher for influenza B virus (23%) than for influenza A virus (18%). Despite its high specificity, the low sensitivity of the Quidel QuickVue Influenza A+B test is too poor to direct clinical decisions for ambulatory patients with ILI. Negative results cannot rule out the diagnosis of influenza, and in that context, this test is of questionable utility for routine application in the clinical setting.

Glascher and Adolph (2003) proposed that both amydalae are specialized for fear, but that the right one is a fast, short, and relatively automatic fear processor, whereas the left one is more detail‐oriented and perceptual‐cognitive. According to this model, early ictal fear should occur more often in cases with a right temporal lobe epileptic focus. Several authors have tried to find a hemispheric specialization for ictal fear, but have not reached the power to attain a statistically significant effect of focus side. In this study, using previously published cases of unilateral epileptic focus causing early ictal symptoms of fear, we found 144 cases, of which 98 had a right hemisphere focus (68%) and 46 having left hemisphere focus (32%, p < 0.0005). Several control variables were assembled to verify possible alternative explanations of the main effect.

The intracarotid amobarbital test (IAT) is the most widely used procedure for pre‐surgical evaluation of language lateralization in epileptic patients. However, apart from being invasive, this technique is not applicable in young children or patients who present mental retardation and/or language deficits. Functional magnetic resonance imaging (fMRI) is increasingly employed as a non‐invasive alternative. Again, this method is more difficult to use with young children, especially hyperactive ones, since they have to remain motionless during data acquisition. The aim of this study was to determine whether near‐infrared spectroscopy (NIRS) can be used as an alternative technique to investigate language lateralization in children and special populations. Unlike Wada test, NIRS is non‐invasive, and it is more tolerant to movement artefacts than fMRI. In the present study, NIRS data were acquired in four epileptic children, a 12‐year‐old boy with pervasive developmental disorder and a 3‐year‐old, healthy child, as well as three healthy and two epileptic adults, while they performed a verbal fluency task and a control task. When applicable, the results were compared to the subjects' fMRI and/or IAT findings. Clear laterality of speech was obtained in all participants, including the two non‐epileptic children, and NIRS results matched fMRI and IAT findings. These results, if replicable in larger samples, are encouraging and suggest that NIRS has the potential to become a viable, non‐invasive alternative to IAT and fMRI in the determination of speech lateralization in children and clinical populations that cannot be submitted to more invasive techniques.

Objective: To determine hormone replacement therapy (HRT) use among women at high risk for breast cancer and ovarian cancer, before genetic testing for the cancer susceptibility genes BRCA1and BRCA2, and 1 year following disclosure of the test results.

To better characterize the cognitive deficits observed in obstructive sleep apnea syndrome (OSAS) by examining procedural skill learning abilities.

Abstract: We compared habitat use, home range size, movements, and activity during summer between rural (12 animals km-2) and forest (<; 1 animal km-2) white-tailed deer populations, hypothesizing that competition for natural forage at high density would influence deer behaviour. Biomass of preferred forage at forester sites was 6 times greater in the forest than in the rural landscape. Forest deer avoided conifer and mixed stands, whereas rural deer tended to avoid stands of shade-tolerant hardwoods. Rural deer intensified their use of cultivated fields at night and ate a greater variety of native plants than forest conspecifics, including species rarely consumed by forest deer (e.g.,ferns). Rural deer used smaller home ranges but moved at a greater rate than forest counterparts. Activity pattern of deer did not differ between the two landscapes, with peaks at dawn and dusk. Our results suggest that rural deer adapted to the rarity of natural forage by exploiting agricultural crops.

•pwMS present lower emotion recognition for both facial emotions and vocal emotional bursts.•pwMS report lower socioemotional sensitivity, which is however not confirmed by the informants.•Advancing age has an impact on these measures, but does not accentuate impairments in pwMS.•Emotion recognition did not correlate with socioemotional sensitivity in pwMS.•Emotion recognition correlated with global cognitive severity in pwMS.

We tested the validity of the 48-Pictures Test, a 2-alternative forced-choice recognition test, in detecting exaggerated memory impairments. This test maximizes subjective difficulty, through a large number of stimuli and shows minimal objective difficulty. We compared 17 suspected malingerers to 39 patients with memory impairments (6 amnesic, 15 frontal lobe dysfunctions, 18 other etiologies), and 17 normal adults instructed to simulate malingering on three memory tests: the 48-Pictures Test, the Rey Auditory Verbal Learning Test (RAVLT), and the Rey Complex Figure Test (RCFT). On the 48-Pictures Test, the clinical groups showed good recognition performance (amnesics: 85%; frontal dysfunction: 94%; other memory impairments: 97%), whereas the two simulator groups showed a poor performance (suspected malingerers: 62% correct; volunteer simulators 68% correct). The two other tests did not show a high degree of discrimination between the clinical groups and the simulator groups, except in 2 measures: the 2 simulator groups tended to show a performance decrement from the last recall trial to immediate recognition of the RAVLT and also performed better than the clinical groups on the immediate recall of the RCFT. A discriminant analysis with the latter 2 measures and the 48-Pictures Test correctly classified 96% of the participants. These results suggest that the 48-Pictures Test is a useful tool for the detection of possible simulated memory impairment and that when combined to the RAVLT recall–recognition difference score and to the immediate recall score on the RCFT can provide strong evidence of exaggerated memory impairment. (JINS, 1997, 3, 545–552.)

Longitudinal changes in the role of conceptual, spatial, and graphic processes in the drawing deficits of patients with Alzheimer's disease (AD) were assessed over a 2-year period. Both the drawing-to-command and copy conditions of the Clock Drawing Test were administered to 33 AD patients as part of three consecutive annual examinations. The drawings from each administration were evaluated for overall accuracy and the types of errors manifested. Although the patients showed a gradual decline in overall accuracy on both command and copy conditions over the three test sessions, they performed more poorly and evidenced a steeper decline on the command condition. Conceptual errors in the command condition were noted in the early stages of AD and increased over the three administrations. Stimulus-bound errors were usually associated with conceptual errors in the same or in a contiguous year. When the patients' performances on the first test session were correlated with their yearly scores on Mattis' Dementia Rating Scale, the presence of conceptual errors was associated with a steep decline on this measure of mental status. These results suggest that drawing deficiencies in AD often reflect impairments in conceptualization and semantic knowledge and that such losses may prove useful in predicting the disease's rate of progression.

The obstructive sleep apnea syndrome is characterized by nocturnal sleep disturbance, excessive daytime sleepiness and neuropsychological deficits in the areas of memory, attention, and executive tasks. In the present study, these clinical manifestations were assessed in apneic patients before and 6 months after treatment with nasally applied continuous positive airway pressure (CPAP). CPAP treatment was found to restore normal respiration during sleep and to normalize sleep organization. Daytime vigilance greatly improved with treatment but some degree of somnolence as compared to normal controls persisted. Similarly, most neuropsychological deficits normalized with treatment. The exception was for planning abilities and manual dexterity, two neuropsychological deficits that have been found to be highly correlated with the severity of nocturnal hypoxemia. These results raise the possibility that anoxic brain damage is a pathogenic factor in severe obstructive sleep apnea syndrome.

Neuropsychological deficits have been documented in patients with obstructive sleep apnea syndrome (OSSA). Both nocturnal hypoxemia and impairment of daytime vigilance have been suggested as the pathogenesis of these deficits, yet it remains difficult to find good correlations between cognitive deficits and either of these physiological parameters. In the present study, 10 normal controls were compared to 10 moderately and 10 severely apneic patients, all recorded in a sleep laboratory for two consecutive nights, with a vigilance and neuropsychological assessment made during the intervening day. Relative to the controls, moderate and severe OSAS showed differences in many cognitive functions, although the severely affected showed the greater differences. Moreover, severe apneics were also worse than moderate apneics on tests that were found to be normal in the latter group. This suggests a discontinuity in the appearance of neuropsychological deficits as OSAS progresses. Further analyses revealed that reductions in general intellectual measures, as well as in executive and psychomotor tasks were all attributable to the severity of hypoxemia, while other attention and memory deficits were related to vigilance impairment. Therefore, both vigilance impairment and nocturnal hypoxemia may differentially contribute to the cognitive dysfunctions found in OSAS.

Despite the use of stimuli that can be processed by both hemispheres, a number of studies have reported lower memory scores after the left intracarotid amobarbital procedure (IAP) than after the right IAP. Because of that, failure after ipsilateral IAP is observed more often in patients with a left temporal seizure focus (LT) than in right temporal patients (RT), possibly needlessly excluding some LT patients from surgery. In order to overcome the deleterious effects of anesthetizing the dominant hemisphere, we designed an IAP protocol that did not promote verbal encoding of the stimuli. For this purpose, a large number of visual and tactile stimuli (colored pictures and real objects) were presented to be recognized later. The effect of seizure focus lateralization was examined in 82 temporal lobe epileptic patients who underwent IAP as part of their presurgical evaluation. As expected, for both RT and LT patients, long-term recognition of pictures presented under the effect of amobarbital was highly sensitive to the presence of a contralateral epileptic focus. However, contrary to what is generally reported, LT patients performed better than RT patients when their left (ipsilateral) hemisphere was anesthetized. In RT patients, although memory scores were lower after the left contralateral injection, the disparity in memory scores between the right and left injection was not as marked as in LT patients. These results are discussed in terms of the influence of type of processing required during the initial encoding on later recognition during IAP.

ABSTRACTSerology improves influenza diagnosis by capturing cases missed by reverse transcriptase PCR (RT-PCR). We prospectively evaluated microneutralization and hemagglutination inhibition assays for 2009 influenza A (H1N1) virus diagnosis among 24 RT-PCR-confirmed cases and 98 household contacts. Compared to hemagglutination inhibition, microneutralization demonstrated a higher level of concordance with RT-PCR (kappa = 0.69 versus kappa = 0.60) and greater sensitivity (83% versus 71%; P= 0.016).

ABSTRACTBackground: Neuropsychological alterations co-occur with Posttraumatic Stress Disorder (PTSD); yet, the nature and magnitude of such alterations in police officers remains unknown despite their high level of trauma exposure.Objective: The current research sought to examine (1) cognitive functioning among police officers with and without PTSD; (2) the clinical significance of their cognitive performance; and (3) the relationship between PTSD symptoms and cognition.Method: Thirty-one police officers with PTSD were compared to thirty age- and sex-matched trauma-exposed officers without PTSD. Clinical assessment and self-report questionnaires established PTSD status. All participants underwent a neuropsychological evaluation.Results: Police officers with PTSD displayed lower cognitive performance across several domains, notably executive functioning, verbal learning and memory, and lexical access, compared to controls. The neuropsychological decrements in the PTSD group were mild compared to normative data, with average performances falling within normal limits. Among officers with PTSD, higher levels of intrusion symptoms were associated with reduced efficacy in executive functioning, as well as attention and working memory. Moreover, increased intrusion and avoidance symptoms were associated with slower information processing speed.Conclusion: Considering that even mild subclinical cognitive difficulties may affect their social and occupational functioning, it appears important to integrate neuropsychological assessments in the clinical management of police officers diagnosed with PTSD.

We compared the trip characteristics of 84 child and 99 adult cases with travel-acquired hepatitis A (HA). Most pediatric cases had traveled in Asia for more than 30 days and had stayed and eaten most of their meals in the homes of friends and relatives in a country where they had not been born. In contrast, the adults with travel-acquired HA had visited Latin America or the Caribbean for 14 days or less and had stayed primarily in hotels. Specific public health interventions should be undertaken to prevent HA in traveling children.

The Joint Task Force on Practice Parameters (JTFPP) guidelines for the investigation and reimmunization of patients who experienced allergic-like events (ALEs) after immunization are predicated on the likelihood of anaphylaxis, assessed through the time to symptom onset (≤ or >4 hours) and number of systems involved.