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Objective: The aim of this study was to evaluate the diagnostic accuracy and clinical usability of a Dutch translation of the Test Your Memory (TYM) test in patients with mild cognitive impairment (MCI) and dementia as compared to the Mini-Mental State Examination (MMSE), in the setting of the memory clinic of a general hospital., Methods: Fourty-two participants referred to the memory clinic with memory problems and fourty-two healthy controls were assessed using the TYM and the MMSE. We evaluated the sensitivity, specificity and diagnostic accuracy of the TYM and MMSE. Both instruments were tested against recently established clinical diagnostic criteria of MCI, Alzheimer's disease (AD) and vascular dementia (VD)., Results: The TYM demonstrated to be more sensitive in detecting dementia than the MMSE. The TYM also was better at discriminating between healthy controls and patients with MCI than the MMSE., Conclusion: Our data suggest that the TYM is more suitable as a practical tool for the early detection of dementia than the MMSE., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objective: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living. The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP)., Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis. This synthesis is based on the type of design, the methodological quality, the type of outcome measures and the statistical significance of the findings., Results: Seventeen studies were included in this review, seven of which were randomized controlled trials (RCTs). One RCT had a high methodological quality. The analyses resulted in insufficient evidence of the efficacy of occupational therapy in all intervention categories, due to the low methodological quality of studies presenting statistically nonsignificant results., Conclusion: Despite the reasonable number of studies identified, the inconclusive findings regarding the efficacy of occupational therapy for children with cerebral palsy may be a reflection of the difficulties in efficacy research in OT for children with CP. Future research should critically reflect on methodological issues.

Background: Glucosamine and chondroitin sulfate preparations are widely used as food supplements against osteoarthritis, but critics are skeptical about their efficacy, because of the lack of convincing clinical trials and a reasonable scientific rationale for the use of these nutraceuticals. Most trials were on osteoarthritis of the knee, while virtually no documentation exists on spinal disc degeneration. The purpose of this article is to highlight the potential of these food additives against cartilage degeneration in general, and against symptomatic spinal disc degeneration in particular, as is illustrated by a case report. The water content of the intervertebral disc is a reliable measure of its degeneration/ regeneration status, and can be objectively determined by Magnetic Resonance Imaging (MRI) signals., Case Presentation: Oral intake of glucosamine and chondroitin sulfate for two years associated with disk recovery (brightening of MRI signal) in a case of symptomatic spinal disc degeneration. We provide a biochemical explanation for the possible efficacy of these nutraceuticals. They are bioavailable to cartilage chondrocytes, may stimulate the biosynthesis and inhibit the breakdown of their extracellular matrix proteoglycans., Conclusion: The case suggests that long-term glucosamine and chondroitin sulfate intake may counteract symptomatic spinal disc degeneration, particularly at an early stage. However, definite proof requires well-conducted clinical trials with these food supplements, in which disc de-/regeneration can be objectively determined by MRI. A number of biochemical reasons (that mechanistically need to be further resolved) explain why these agents may have cartilage structure- and symptom-modifying effects, suggesting their therapeutic efficacy against osteoarthritis in general.

Background and Purpose: Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients., Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed., Results: Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (ADL) (0.46; CI, 0.04 to 0.88), extended ADL (0.32; CI, 0.00 to 0.64), and social participation (0.33; CI, 0.03 to 0.62) favored treatment. For the training of skills intervention, some evidence for improvement in primary ADL was found. Insufficient evidence was found to indicate that the provision of splints is effective in decreasing muscle tone., Conclusions: This review identified small but significant effect sizes for the efficacy of comprehensive OT on primary ADL, extended ADL, and social participation. These results correspond to the outcome of a systematic review of intensified rehabilitation for stroke patients. The amount of evidence with respect to specific interventions, however, is limited. More research is needed to enable evidence-based OT for stroke patients.

Background: Multiple sclerosis (MS) patients are referred to occupational therapy with complaints about fatigue, limb weakness, alteration of upper extremity fine motor coordination, loss of sensation and spasticity that causes limitations in performance of activities of daily living and social participation. The primary purpose of occupational therapy is to enable individuals to participate in self-care, work and leisure activities that they want or need to perform., Objectives: To determine whether occupational therapy interventions in MS patients improve outcome on functional ability, social participation and/or health related quality of life., Search Strategy: Relevant full length articles were identified by electronical searches in Medline, Cinahl, Embase, Amed, Scisearch and The Cochrane MS Group Trials Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002., Selection Criteria: Controlled (randomized and non-randomized) and other than controlled studies addressing occupational therapy for MS patients were eligible for inclusion., Data Collection and Analysis: The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. (Van Tulder 1997) was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best-evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures., Main Results: Only one randomized clinical trial was identified. Two other included studies were a controlled clinical trial and a study with a pre-post test design. The studies included 271 patients in total. Two studies evaluated an energy-conservation course for groups of patients and one study evaluated a counselling intervention. The results of the energy conservation studies could be biased because of the designs used, the poor methodological quality and the small number of included patients. The high quality RCT on counselling reported non-significant results., Reviewer's Conclusions: On basis of this review no conclusions can be stated whether occupational therapy improves outcome in MS patients. The lack of (randomized controlled) efficacy studies in most intervention categories of OT shows an urgent need for future research in occupational therapy for multiple sclerosis. Initially, a survey of occupational therapy practice for MS patients including the characteristics and needs of these patients is necessary to develop a research agenda for efficacy studies.

Objective: To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident., Design: Prospective, randomized clinical trial., Setting: St Lucas Hospital, Amsterdam., Method: Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20% solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infarction. All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg (SD 3) and a haematocrit (Ht) of 0.32 l/l (SD 0.02). The control group only received individually dosed rehydration with crystalline infusion fluids. Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning., Results: The results in the total haemodilution group and the control group did not differ significantly. However, in the subgroup with normal Ht (< 0.45 l/l; n = 201) there was a significant reduction (p < 0.05) of the mortality after 3 months (27% and 16%, respectively) and an increase of independence at home (35% and 48%, respectively) due to a reduction of the viscosity by means of haemodilution with albumin (a specific viscosity effect in the normovolaemic group). In the control group with raised Ht (dehydration; Ht > or = 0.45 l/l; n = 50) there was a significant decrease (p < 0.005) of the mortality after 3 months (27% and 8%, respectively) and an increase of independence at home (35% and 59%, respectively) compared with the control group with normal Ht without signs of dehydration (Ht < 0.045 l/l; n = 102), due to rehydration exclusively with crystalline infusion fluids (a specific rehydration effect in the dehydrated group)., Conclusion: In cerebrovascular accident patients haemodilution should be adjusted individually; in normovolaemic patients haemodilution should be carried out with an albumin solution; the higher the Ht, the more rehydration with crystalline infusion fluids is to be carried out.

Two patients with cysticercosis received praziquantel (PZQ) 75 mg/kg/day orally together with 30 mg prednisone daily for 3 weeks. The first patient presented with grand-mal seizures, a pyramidal tract syndrome and subcutaneous cysticerci, and the other had internal hydrocephalus necessitating drainage. Serial plasma samples were taken after the first dose of PZQ. Lumbar CSF was obtained from the first patient and ventricular CSF from the second. Subcutaneous cysticerci were removed from the first patient. PZQ in the specimens was assayed by GLC. For distribution between plasma and CSF a rate constant of 4.9 h-1 for free PZQ, corresponding to a t1/2 of 8 min or less for the non-protein bound fraction was calculated for Patient 1. In the second patient the distribution was so rapid that the rate constant could not be calculated. The difference in distribution rate might have been due to use of different sampling times or to a time lag in the entry of PZQ between the ventricles and the lumbar sac. The rate constant for distribution of the drug between plasma and parasites was 1.4 h-1, corresponding to a t1/2 of 30 min or less. Thus PZQ penetrates rapidly into the CSF. It enters the parasite more slowly, although still more rapidly than the plasma half-life of PZQ (1-1 1/2 h).