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Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers are promising tools to help identify the underlying pathology of neurocognitive disorders. In this manuscript, we report our experience with AD CSF biomarkers in 262 consecutive patients in a tertiary care memory clinic.
We retrospectively reviewed 262 consecutive patients who underwent lumbar puncture (LP) and CSF measurement of AD biomarkers (Aβ1–42, total tau or t-tau, and p-tau181). We studied the safety of the procedure and its impact on patient’s diagnosis and management.
The LP allowed to identify underlying AD pathology in 72 of the 121 patients (59%) with early onset amnestic mild cognitive impairment (aMCI) with a high probability of progression to AD; to distinguish the behavioral/dysexecutive variant of AD from the behavioral variant of frontotemporal dementia (bvFTD) in 25 of the 45 patients (55%) with an atypical neurobehavioral profile; to identify AD as the underlying pathology in 15 of the 27 patients (55%) with atypical or unclassifiable primary progressive aphasia (PPA); and to distinguish AD from other disorders in 9 of the 29 patients (31%) with psychiatric differential diagnoses and 19 of the 40 patients (47%) with lesional differential diagnoses (normal pressure hydrocephalus, encephalitis, prion disease, etc.). No major complications occurred following the LP.
Our results suggest that CSF analysis is a safe and effective diagnostic tool in select patients with neurocognitive disorders. We advocate for a wider use of this biomarker in tertiary care memory clinics in Canada.
The Mini-Mental State Examination (MMSE) is widely used in schizophrenia, although normative data are lacking in this population. This review and meta-regression analysis studies the effect of aging on MMSE scores in schizophrenic patients.
We entered the search terms schizophrenia and MMSE in PubMed and PsychInfo. Bibliographies of pertinent articles were also examined. We included every study presenting the MMSE scores in schizophrenic patients along with a corresponding mean age. We conducted our analyses using simple linear regression weighted for the inverse of within-trial variance of the age variable, thus conferring more importance to studies with narrower age groups.
We identified 56 articles (n = 5,588) published between 1990 and 2012. The MMSE scores of schizophrenic patients decline by approximately 1 point for every four years (y = 34.939−0.247x, 95% Confidence Interval (CI) [−0.304, −0.189], R2 = 0,545), which is five times the rate in the general population. Institutionalized patients account for a large proportion of this decline (y = 37.603–0.308x, 95% CI [−0.349, −0.267], R2 = 0.622) whereas community-dwelling patients are relatively stable throughout aging (y = 27.591–0.026x, 95% CI [−0.074, 0.023], R2 = 0.037).
Subgroup analyses show different trajectories between institutionalized and outpatients with schizophrenia. The deterioration observed in institutionalized patients may have to do with greater illness severity, heavier medication load, vascular risk factors, and lack of stimulation in institutional settings. Studies documenting the role of these variables would be useful. Cognitive screening tools that assess executive functions would be interesting to study in schizophrenics, as they may reveal more subtle age-related cognitive changes not measured by the MMSE.
This article examines the legal characterization of the full-face veil worn by female users of Canadian government services. Considering how various Western states perceive full-face veils, we suggest that legally defining this piece of clothing as a “religious object” is key to guaranteeing freedom of conscience and religion by the courts. By drawing on constitutional law and legal theory, we examine the legal treatment of this religious object within the analytical framework of the Supreme Court of Canada in the NS case.
The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.
TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.
Eleven ICUs of a French university hospital.
We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.
Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.
ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.
To determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.
A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).
Over the 12 months of follow-up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P<0.001). They averaged 126 h of competitive work, v. 72 inthe control group (P<0.001).
Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.
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