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Mild Severity (mild + severity)
Selected AbstractsDiagnostic performance of clinical motor and non-motor tests of Parkinson disease: a matched case,control studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2008N. I. Bohnen Background and purpose:, The diagnosis of Parkinson disease (PD) is made typically on the basis of motor abnormalities. PD is now recognized to have both motor and non-motor manifestations, indicating a need for the development of reliable non-motor diagnostic tests for PD. The aim of the present study was to compare the accuracy of various clinical motor and non-motor tests for the diagnosis of PD. Methods:, Forty-five PD patients (Hoehn and Yahr stages 1,3; mean age 59.5 ± 10.0 years) and 45 healthy controls matched for gender and age completed a clinimetric motor test battery to assess limb bradykinesia, tremor and balance. Non-motor tests consisted of depression, anxiety and smell identification ratings. Area under the receiver operator characteristic curve (AUC) analysis was used. Results:, We found that smell identification was the most accurate predictor of the presence of PD within the overall group of patients and matched control subjects (AUC = 0.886) and also in the subgroups of mild severity (Hoehn and Yahr stages 1,1.5; AUC = 0.923), young-onset (AUC = 0.888) and female PD patients (AUC = 0.797). The second best diagnostic test was the grooved pegboard test for the clinically most affected body side. Conclusions:, We conclude that olfactory function is the most accurate diagnostic predictor within a heterogeneous sample of patients with PD. [source] Effects of Alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving testINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2009Cristina Frittelli Abstract Objective To assess the effects of Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) on simulated car driving ability. Methods Twenty patients with a probable AD of mild severity (Clinical Dementia Rating, CDR,=,1) were compared with 20 subjects with MCI (CD,=,0.5), and a group of age-matched neurologically normal controls on a driving simulation task. Measures of driving competence included the length of run, the number of infractions (omission of stop at pedestrian crossings, speed limits violation), the number of stops at traffic lights, the mean time to collision, and the number of off-road events. Results in the driving competence measures were correlated with scores obtained from simple visual reaction times and mini-mental state examination (MMSE). Results The patients with mild AD performed significantly worse than MCI subjects and controls on three simulated driving measures, length of run and mean time to collision (p,<,0.001), and number of off-road events (p,<,0.01). MCI subjects had only a significantly shorter time-to-collision than healthy controls (p,<,0.001). Simple visual reaction times were significantly longer (p,<,0.001) in patients with AD, compared to MCI and healthy controls, and showed a borderline significant relation (p,=,0.05) with simulated driving scores. Driving performance in the three groups did not significantly correlate with MMSE score as measure of overall cognitive function. Conclusions Mild AD significantly impaired simulated driving fitness, while MCI limitedly affected driving performance. Unsafe driving behaviour in AD patients was not predicted by MMSE scores. Copyright © 2008 John Wiley & Sons, Ltd. [source] Donepezil for the symptomatic treatment of patients with mild to moderate Alzheimer's disease: a meta-analysis of individual patient data from randomised controlled trialsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2004Anne Whitehead Abstract Background The objective was to evaluate the efficacy and tolerability of donepezil (5 and 10,mg/day) compared with placebo in alleviating manifestations of mild to moderate Alzheimer's disease (AD). Method A systematic review of individual patient data from Phase II and III double-blind, randomised, placebo-controlled studies of up to 24 weeks and completed by 20 December 1999. The main outcome measures were the ADAS-cog, the CIBIC-plus, and reports of adverse events. Results A total of 2376 patients from ten trials were randomised to either donepezil 5,mg/day (n,=,821), 10,mg/day (n,=,662) or placebo (n,=,893). Cognitive performance was better in patients receiving donepezil than in patients receiving placebo. At 12 weeks the differences in ADAS-cog scores were 5,mg/day,placebo: ,,,2.1 [95% confidence interval (CI), ,,,2.6 to ,,,1.6; p,<,0.001], 10,mg/day,placebo: ,,,2.5 (,,,3.1 to ,,,2.0; p,<,0.001). The corresponding results at 24 weeks were ,,,2.0 (,,,2.7 to ,,,1.3; p,<,0.001) and ,,,3.1 (,,,3.9 to ,,,2.4; p,<,0.001). The difference between the 5 and 10,mg/day doses was significant at 24 weeks (p,=,0.005). The odds ratios (OR) of improvement on the CIBIC-plus at 12 weeks were: 5,mg/day,placebo 1.8 (1.5 to 2.1; p,<,0.001), 10,mg/day,placebo 1.9 (1.5 to 2.4; p,<,0.001). The corresponding values at 24 weeks were 1.9 (1.5 to 2.4; p,=,0.001) and 2.1 (1.6 to 2.8; p,<,0.001). Donepezil was well tolerated; adverse events were cholinergic in nature and generally of mild severity and brief in duration. Conclusion Donepezil (5 and 10,mg/day) provides meaningful benefits in alleviating deficits in cognitive and clinician-rated global function in AD patients relative to placebo. Increased improvements in cognition were indicated for the higher dose. Copyright © 2004 John Wiley & Sons, Ltd. [source] Anti-inflammatory treatment for recurrent wheezing in the first five years of lifePEDIATRIC PULMONOLOGY, Issue 4 2003Athanasios G. Kaditis MD Abstract Medications identified for the treatment of recurrent wheezing in preschool children by the Expert Panel Report of the NHLBI Guidelines for the Diagnosis and Management of Asthma include inhaled corticosteroids, chromones, theophylline, and leukotriene pathway modifiers. However, these various agents differ in their mechanism, extent of action on the airway inflammatory process, and degree of clinical efficacy. Inhaled corticosteroids can control symptoms in many young children with even severe persistent wheezing, but data on their long-term safety when administered in preschool-age children are scarce. There is some information on the uninterrupted use of inhaled corticosteroids in school-age children and the absence of an adverse effect on ultimate adult height. Despite laboratory evidence of adrenal suppression in some studies, few pediatric cases of clinical adrenal insufficiency have been reported. Low-dose inhaled corticosteroid (<400 mcg/day for beclomethasone), which is adequate for controlling mild persistent symptoms, is generally safe. Chromones have a remarkable safety profile, but they are most effective for symptoms of mild severity. Promising data have been published on the efficacy and safety of leukotriene pathway modifiers when used in young children with persistent symptoms. It is uncertain whether early introduction and long-term administration of inhaled corticosteroids prevent development of irreversible airway obstruction. Nevertheless, they may be especially useful for patients with moderate to severe disease in whom other agents (chromones or leukotriene pathway modifiers) will most likely fail to control symptoms. Pediatr Pulmonol. 2003; 35:241,252. © 2003 Wiley-Liss, Inc. [source] Prognostic factors associated with severe leptospirosisCLINICAL MICROBIOLOGY AND INFECTION, Issue 4 2006B. Doudier Abstract Leptospirosis is an anthropozoonosis caused by Leptospira interrogans. It occurs worldwide and is endemic in French Polynesia. Leptospirosis is associated with a large variety of clinical symptoms. Most infections caused by leptospires are either sub-clinical or of very mild severity, but 5,10% of infections result in multiple organ damage, including kidney, liver and lung lesions. Among 71 patients hospitalised in Papeete for severe leptospirosis during a period of 2 years, the main risk-factors for a severe outcome were hypotension, oliguria and an abnormal chest auscultation at the first physical examination. Survival depends on rapid diagnosis and early appropriate management. Well-defined criteria may help physicians to improve the timely treatment of high-risk patients. [source] |