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Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer’s disease (MCI-AD), and any performance deficits which emerged with sustained effort.
Method:
We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years).
Results:
While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1–4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3–2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2–8.8).
Conclusions:
Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.
I argue historical information on the relationship between Copernicus’s work and Islamicate astronomy, which came to light when Kuhn was writing The Copernican Revolution, complicates the depiction of Copernicus’s work as revolutionary, or discontinuous with previous astronomy. I consider Saliba’s claim that Tusi’s work was “a Scientific Revolution before the Renaissance.” I conclude that, although Tusi’s work is important, it is better understood as extending normal science. Similar arguments undermine the claim that Copernicus’s work was revolutionary. Earlier histories of the Copernican revolution have given too little credit to the innovations of Tycho Brahe, and his imitators and opponents, and the solid scientific reasons for preferring Tycho’s system over Copernicus’s as late as 1650. However, the situation in European astronomy and cosmology from the career of Copernicus to the death of Newton does look like a Kuhnian crisis state. It is also possible to locate incommensurabilities between heliocentric and geocentric cosmologies, especially beginning with Kepler. The concept of incommensurability remains an important resource for understanding the history of science.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
Aims
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
Method
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
Results
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Conclusions
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
The flow of blood to an organ is a fundamental physiological factor affecting tissue health, growth, and repair. Blood flow and volume are perturbed in many disease conditions, most notably in vascular disease and in tumors. The ability to determine non-invasively blood flow and blood volume using imaging methods therefore has important diagnostic and therapeutic implications. Since the early days of radiological imaging, scientists and physicians have been searching for methods that can accurately and non-invasively depict the major blood vessels of the body, and measure blood flow in tissue. For instance, X-ray projection imaging of blood vessels (angiography) was first demonstrated in 1927 by Moniz [1], using iodinated contrast agents injected intravascularly, while early measurements of tissue blood flow were based on the inhalation of freely diffusible tracers (e.g., nitrous oxide [N2O] [2], or radioactive xenon or krypton [3]). Subsequently, stable (i.e., non-radioactive) xenon was used in conjunction with X-ray computed tomography (CT) to image cerebral blood flow (CBF) [4], while other methods such as single-photon emission CT (SPECT) [5, 6] and positron emission tomography (PET) [7, 8] imaging using a variety of radiotracers also became available. More recently, dynamic CT perfusion imaging using bolus injection of iodinated contrast agents has been growing in popularity [9], particularly as fast multi-slice CT scanners have become widely available.
Blood flow is one of the most fundamental physiological parameters. Maintenance of adequate blood flow is vital for the health of biological tissue. The growth and function of many organ systems are linked tightly to their blood supply. In addition, many disease processes are associated with either increases or decreases in flow compared with normal values. The development and validation of non-invasive tools for the measurement of flow have been longstanding goals, both in biomedical research and in clinical practice.
Traditionally, the imaging of flow, or perfusion, has been accomplished using either nuclear medicine-based techniques involving radioactive isotopes, or X-ray computed tomography (CT) methods using radio-opaque contrast agents. However, soon after the introduction of magnetic resonance imaging (MRI) for anatomical imaging, research began on techniques for depicting flow. Since then, progress has been rapid, not least because MR methods have the advantage of not involving radiation, and in the case of arterial spin labeling-based techniques, are completely non-invasive. This makes them particularly appealing for use in a wide range of populations, including children and normal subjects. In addition, MR perfusion can be combined with the armamentarium of other structural, vascular, physiological, metabolic, and functional techniques available with MR to provide a comprehensive, “one-stop” examination for the patient.
MR perfusion imaging is an area of major research interest and rapid clinical growth. Clinical Perfusion MRI: Techniques and Applications provides a concise and comprehensive review of the principles and applications of the field, covering dynamic susceptibility contrast, dynamic contrast enhancement, and arterial spin labeling imaging techniques. Principles of blood-volume and oxygenation imaging are included. The clinical applications of perfusion imaging in neurological disease and neuroscience are discussed – major topics including its use in imaging cerebrovascular disease and brain tumors and other neurological and neurodegenerative disorders. Non-neurologic applications are also covered with chapters on cardiac disease, breast cancer and other organ systems. Use of MR perfusion imaging in pediatrics is also discussed. Throughout the book case reports are included illustrating representative clinical examples. This book will be of interest to any clinician who uses MR perfusion imaging in their clinical practice, as well as researchers in the field of MRI.
Clinical MR Neuroimaging, second edition, provides radiologists, neuroscientists and researchers with a clear understanding of each physiological MR methodology and their applications to the major neurological diseases. Section 1 describes the physical principles underlying each technique and their associated artefacts and pitfalls. Subsequent sections review the application of MRI in a range of clinical disorders: cerebrovascular disease, neoplasia, infection/inflammation/demyelination disorders, seizures, psychiatric/neurodegenerative conditions, and trauma. This new edition includes all recent advances and applications, with greatly increased coverage of permeability imaging, susceptibility imaging, iron imaging, MR spectroscopy and fMRI. All illustrations are completely new, taking advantage of the latest scan capabilities to give images of the highest possible quality. In addition, over 35 new case studies have been included. Editors and contributors are the leading neuroimaging experts worldwide; their unique combination of technical knowledge and clinical expertise makes Clinical MR Neuroimaging the leading text on the subject.
In vivo magnetic resonance spectrosopy (MRS) is increasingly being used in the clinical setting, particularly for neurological disorders. Clinical MR Spectroscopy – Techniques and Applications explains both the underlying physical principles of MRS and provides a perceptive review of clinical MRS applications. Topics covered include an introduction to MRS physics, information content of spectra from different organ systems, spectral analysis methods, recommended protocols and localization techniques, and normal age- and region-related spectral variations in the brain. Clinical applications in the brain are discussed for brain tumors, hypoxic and ischemic injury, infectious, inflammatory and demyelinating diseases, epilepsy, neurodegenerative disorders, trauma and metabolic diseases. Outside of the brain, techniques and applications are discussed for MRS in the musculosketal system, breast and prostate. Written by leading MRS experts, this is an invaluable guide for anyone interested in in vivo MRS, including radiologists, neurologists, neurosurgeons, oncologists and medical researchers.
The physiological magnetic resonance techniques of diffusion imaging, perfusion imaging and spectroscopy offer insights into brain structure, function and metabolism. Until recently, they were mainly applied within the realm of medical research, but with their increasing availability on clinical MRI machines, they are now coming into clinical practice for the evaluation of neuropathology in individual patients. This book provides the reader with a thorough review of the underlying physical principles of each of these methods, as well as comprehensive coverage of their clinical applications. Topics covered include single- and multiple-voxel MRS techniques, MR perfusion based on both arterial spin labelling and dynamic bolus tracking approaches, and diffusion-weighted imaging, including techniques for mapping brain white matter fiber bundles. Clinical applications are reviewed in depth for each technique, with case reports included throughout the book. Attention is also drawn to possible artifacts and pitfalls associated with these techniques.