Biomedical subjects

J D Fisk

Publications and source records attributed to J D Fisk.

At least 37 records · Page 2Linked to original sources

PubMed1994

Functional competence of community-dwelling persons with multiple sclerosis using the assessment of motor and process skills.

The Assessment of Motor and Process Skills (AMPS) is an observational measure of functional competence in instrumental activities of daily living (IADL) that was designed to overcome the limitations of self reports and proxy reports. The AMPS allows simultaneous evaluation of the underlying motor and process (organizational/adaptive) skills necessary for competent task performance. We examined the IADL performance of 22 community-dwelling patients with mild to moderate MS in comparison to nondisabled subjects matched for age and gender. Functional competence of the MS subjects, as measured by the AMPS, was poorer than that of the control group. Many MS subjects who would not have been expected to have IADL difficulties on the basis of ratings of neurologic impairment were impaired in their IADL performance. For some patients, IADL impairment reflected deficits in their motor and process skills, whereas for others, process skill impairments alone were responsible for deficient task performance.

Activities of Daily Living↗

PubMed1994

Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients.

Previous studies have reported variable prevalence of pain in multiple sclerosis (MS) and have not documented the impact of pain on daily living. In this consecutive series, we report on data collected from structured interviews with 85 patients seen within a 16-month period at a regional referral clinic. The prevalence of pain for the month preceding assessment was 53%. There were no significant differences between patients who did and those who did not report pain on the basis of patient demographics (age, gender) and disease characteristics (disease subtype, duration and neurologic symptom severity). Disease duration and neurologic symptom severity were significantly correlated with the number of hours of pain per week but were not correlated with pain severity, the number of pain sites or pain-related distress. There was wide variability in the number of pain hours/week reported with 17.6% of the sample reporting continuous pain for the month preceding assessment. Sixty-five percent of patients with pain reported taking medications for pain and 90% of these patients evaluated their medication(s) as 50% effective or better. Nevertheless, patients with pain reported poorer mental health and more social-role handicap. Discussion focuses on the need for routine assessment of pain and the comprehensive evaluation of the effectiveness of pain interventions in the therapeutic management of patients with MS.

Adult↗

PubMed1994

Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

Adult↗

PubMed1994

Brain reactive autoantibodies and cognitive impairment in systemic lupus erythematosus.

Nervous system involvement in SLE encompasses a wide array of clinical manifestations which may reflect multiple etiologic factors including autoantibodies to nervous tissue antigens. The aim of the present study was to examine the association between autoantibodies to a wide range of brain antigens and cognitive abnormalities in an unselected population of 70 SLE patients. Using a battery of standardized neuropsychological tests, cognitive impairment was identified in 15/70 (21%) SLE patients compared with 1/25 (4%) patients with rheumatoid arthritis and 1/23 (4%) healthy subjects (P = 0.04). Integral membrane proteins were isolated from dissociated brain cells by temperature-induced phase separation with Triton X-114. Synaptosomes were isolated by differential centrifugation and membrane enriched fractions were prepared by lectin affinity chromatography. Western blotting identified IgG reactivity to a wide range of proteins (MW 22-52 K) in SLE patients. The proteins identified were distinct from well-characterized intracellular antigens including ribosomal P proteins. There was no significant difference in the prevalence of anti-brain antibodies between SLE patients who were cognitively impaired and those who were not impaired. Furthermore, there was no association between the presence of autoantibodies and subsets of cognitive dysfunction. These results suggest that circulating autoantibodies to brain antigens are not responsible for the abnormalities in cognitive function in SLE patients.

Adolescent↗

PubMed1994

Clinical course of cognitive dysfunction in systemic lupus erythematosus.

OBJECTIVE: To prospectively evaluate changes in cognitive function in a cohort of unselected patients with systemic lupus erythematosus (SLE) and controls over a 12 month period. METHODS: Seventy female patients with SLE, 25 patients with rheumatoid arthritis (RA) and 23 healthy subjects (age and sex matched) were evaluated using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Wechsler Memory Scale-Revised (WMS-R), the California Verbal Learning Test (CVLT) and the National Adult Reading Test-Revised to identify impairment in 8 areas of cognitive function. Cumulative disease manifestations and current medications were documented, and disease activity was expressed using the SLE disease activity index (SLEDAI). Decision rules were determined for overall cognitive impairment. RESULTS: At baseline, 21% (15/70) of patients with SLE were impaired compared to 4% (1/25) of patients with RA and 4% (1/23) of healthy subjects (p = 0.042). After a mean interval of 12.8 months (range: 11-17) 84% (59/70) of patients with SLE, 44% (11/25) of patients with RA and 80% (17/23) of healthy subjects were reassessed. This included all subjects who were impaired at the initial assessment. Using the same decision rules as at baseline, 12% (7/59) of patients with SLE were impaired at followup compared to none of the patients with RA and healthy subjects. Over the period of study cognitive impairment persisted in 3 patients with SLE, resolved in 12 and evolved in 4 others. There was no apparent association between changes in cognitive function and concurrent changes in generalized disease activity, overt neuropsychiatric disease or corticosteroid medication. CONCLUSION: Our results suggest that cognitive dysfunction in patients with SLE is evanescent, does not necessarily lead to irreversible neurologic compromise and changes independently of other clinical variables.

Adult↗

PubMed1994

The impact of fatigue on patients with multiple sclerosis.

Although fatigue is recognized as a symptom of MS, there have been insufficient methods for evaluating this symptom. We administered the Fatigue Impact Scale to 85 MS patients and 20 hypertensive patients. Neurologic impairment, mental health, and general health status were also assessed. MS patients reported significantly higher fatigue impact than hypertensive patients. Most MS patients reported fatigue as either their worst (14%), or one of their worst (55%) symptoms. Disease classification and neurologic impairment had little bearing on Fatigue Impact Scale scores in the MS sample. The best predictive models for mental health and general health status in the MS sample both included the Fatigue Impact Scale as a significant factor. This study demonstrates that: 1) fatigue is a very prevalent and severe problem in MS, 2) fatigue impact cannot be predicted by clinical measures of neurologic impairment, 3) fatigue has a significant effect on the mental health and general health status of MS patients.

Adult↗

PubMed1993

Cognitive impairment and autoantibodies in systemic lupus erythematosus.

Nervous system involvement in systemic lupus erythematosus (SLE) includes a wide array of manifestations some of which have been associated with specific autoantibodies. These include reactivity to surface neuronal and lymphocyte antigens, ribosomal P and cardiolipin. The aim of the present study was to examine the association between cognitive abnormalities and these autoantibodies in an unselected female population of SLE patients. Using a battery of standardized neuropsychological tests, cognitive impairment was identified in 15/70 (21%) SLE patients compared to 1/25 (4%) patients with rheumatoid arthritis and 1/23 (4%) healthy subjects (P = 0.04). Circulating antineuronal antibodies were measured by indirect immunofluorescence using human neuroblastoma cell lines IMR-6 and SK-N-SH. Lymphocytotoxic antibodies were measured by microcytotoxicity. Antibodies to ribosomal P and cardiolipin were measured by ELISA. Antineuronal antibodies were detected in 34%, lymphocytotoxic antibodies in 47%, anti-P antibodies in 17% and anticardiolipin antibodies in 24% of patients. In the cognitively impaired and unimpaired SLE patients there was no significant difference in the prevalence of antineuronal antibodies (33 vs 35%), lymphocytotoxic antibodies (40 vs 50%), anti-P antibodies (20 vs 17%) or anticardiolipin antibodies (7 vs 29%). The titre and isotype of autoantibodies were also similar in both groups. These results suggest that autoantibodies which have previously been associated with nervous system manifestations of SLE are not likely to be directly involved in the pathogenesis of cognitive dysfunction.

Antibodies, Anticardiolipin↗

PubMed1993

Patterns of cognitive impairment in patients with systemic lupus erythematosus.

This study examined neuropsychological test performance in a representative sample of 70 female patients with SLE. The influence of current or past clinically overt central nervous system involvement, use of corticosteroid medications and overall disease activity were evaluated. The results suggest two distinct patterns of cognitive dysfunction. Impaired delayed recognition memory was associated with past or current nervous system involvement, suggesting the presence of a residual neurologic deficit. Increased disease activity was associated with impaired immediate memory and concentration which may represent transient and diffuse central nervous system effects. Although corticosteroid use was associated with poor word list recall, group differences were not statistically significant when disease activity was considered as a covariate in the analysis. Follow-up studies are required to determine if these abnormalities persist or fluctuate with changes in disease activity and concurrent medications.

Adrenal Cortex Hormones↗

PubMed1993

Cognitive deficits in systemic lupus erythematosus.

Several independent studies have now demonstrated the presence of significant cognitive impairment in SLE patients. Such impairment, whether it precedes or follows overt NP events, suggests compromise of the neural substrate, irrespective of overt clinical NP symptomatology. The association between cognitive impairment and brain cross-reactive autoantibodies suggests one mechanism for CNS involvement in SLE that warrants further study; the data relating specific cognitive deficits to the presence of specific antibodies raise the intriguing possibility of system- or structure-specific immune-mediated involvement in the CNS. Whatever the mechanism, cognitive impairment in SLE may have significant implications for daily functioning of some lupus patients and requires the selection of appropriate psychosocial and somatic treatment strategies.

Central Nervous System Diseases↗

PubMed1992

Cognitive impairment in patients with systemic lupus erythematosus.

Seventy unselected patients with systemic lupus erythematosus (SLE) were studied to determine the prevalence of cognitive impairment and the association with other clinical variables. Twenty-five patients with rheumatoid arthritis (RA) and 23 healthy subjects were used as controls. All patients were evaluated with a battery of standardized neuropsychological tests to determine ability in 8 areas of cognitive function. Clinically overt neuropsychiatric (NP) SLE, cumulative disease manifestations and concurrent medications were documented. In patients with SLE, generalized disease activity was expressed using the SLE disease activity index. Cognitive impairment was identified in 15/70 (21%) patients with SLE, 1/25 (4%) patients with RA and in 1/23 (4%) healthy subjects (p = 0.042). The prevalence was higher in patients with active NP-SLE at the time of assessment (2/5, 40%) compared to patients with inactive NP-SLE (2/10, 20%) but was also increased in those patients who had never had known clinical NP-SLE (11/55, 20%). A history of serositis (p = 0.015), active SLE (p = 0.064) and corticosteroid use (p = 0.027) at the time of assessment were more common in patients with cognitive impairment. The results suggest that cognitive impairment is increased in patients with SLE. It may occur independently of clinically overt NP-SLE and is more common in patients with active disease who are receiving corticosteroids.

Adult↗

PubMed1991

Contribution of perceptual and lexical-semantic errors to the naming impairments in Alzheimer's disease.

The contribution of perceptual and semantic processing deficits to naming-test performance by Alzheimer's Disease subjects was examined. Groups of 34 Alzheimer subjects and 25 elderly controls completed tests of naming standard line drawings and naming perceptually degraded figures, and a test of verbal fluency for a specific semantic category. Alzheimer subjects were impaired on all measures and, when their naming-test errors were analyzed, they showed higher proportions of perceptual errors and failures to respond. Further, considerable variability in the proportions of different types of error was found both among subjects and among test items. These findings indicate that poor naming-test performance cannot necessarily be attributed to a specific deficit in semantic processing. Also, the discrepancies between previous reports of the naming deficits in Alzheimer's Disease may reflect differences in task difficulty and item selection that were apparent in this study.

Aged↗

PubMed1989

The effects of instructions to subjects on the programming of visually directed reaching movements.

Numerous studies of human motor control have examined the effects of constraints on the programming and execution of visually directed limb movements. Only a few studies, however, have explored how the subject's objective in making the movement affects the coordinated sequence of eye and limb movements that unfolds as the subject points to or grasps an object in space. In the present study, the characteristics of the targets and the environment remained constant while the demands for speed and accuracy were varied across blocks of trials by changing the instructions to the subject. In other words, the constraints operating in the situation were kept constant, but the objective of the movement was systematically varied by changing the relative demands for speed and accuracy. All subjects were required to point to visual targets presented on a screen in front of them. Eye position was monitored by infrared reflection. The position of each subject's hand in three-dimensional space was reconstructed by a computer-assisted analysis of the images provided by two rotary-shutter video cameras. The speed and accuracy demands of the task were varied in blocks of trials by requiring the subjects to point to the target "as quickly as you can" (speed condition); "as accurately as you can" (accuracy condition); or both "quickly and accurately" (speed/accuracy condition). The time to initiate an eye movement to the target was found to be reduced by increasing either the speed or accuracy demands of the task although the time to initiate the hand movement was reduced only in the speed condition. While the duration of the acceleration phase of the reach remained constant in real time, the duration of the deceleration phase was increased with increased demands for accuracy. As expected, both variable and absolute errors were largest in the speed condition. The findings indicated that the programming of the limb movement and its coordination with the associated eye movements were affected by varying the objective of the task.

Journal Article↗

PubMed1988

The effects of unilateral brain damage on visually guided reaching: hemispheric differences in the nature of the deficit.

Groups of patients suffering from unilateral damage to the left or right cerebral hemisphere were compared to a group of age-matched normal controls in a visually guided pointing task. Subjects were required to reach quickly and accurately to small visual targets as soon as they appeared on the screen in front of them. All reaches, which were quite unrestricted, were videotaped by rotary-shutter cameras and analyzed by a computer-assisted system which allowed analysis of the kinematic parameters of the movement in three-dimensional space. The groups were compared on the basis of their latency to initiate a reaching movement, the accuracy with which they achieved the target's position, and various measures derived from the instantaneous velocity of the movement. Both patient groups were found to be less accurate than controls and to require more time after the target was illuminated to complete the reach. But while the right-hemisphere group took longer to initiate a reach, the kinematic parameters of the movements they produced did not differ from those of the control group. In contrast, the left-hemisphere group did not differ from the control group in the time required to initiate a reaching movement but did require a greater period of time to execute the reach once it had been initiated. It is suggested that the right hemisphere group were deficient in the speed with which they could determine the spatial position of the target, while the left hemisphere group were deficient in their ability to select an appropriate motor program to achieve the target position and/or to monitor the movement and update the motor program as it was being executed.

Adult↗

PubMed1985

The organization of eye and limb movements during unrestricted reaching to targets in contralateral and ipsilateral visual space.

The spatial and temporal organization of unrestricted limb movements directed to small visual targets was examined in two separate experiments. Videotape records of the subjects' performance allowed us to analyze the trajectory of the limb movement through 3-dimensional space. Horizontal eye movements during reaching were measured by infrared corneal reflection. In both experiments, the trajectories of the different reaches approximated straight line paths and the velocity profile revealed an initial rapid acceleration followed by a prolonged period of deceleration. In Experiment 1, in which the target light was presented to the right or left of a central fixation point at either 10 degrees or 20 degrees eccentricity, the most consistent differences were observed between reaches directed across the body axis to targets presented in the contralateral visual field and reaches directed at ipsilateral targets. Ipsilateral reaches were initiated more quickly, were completed more rapidly, and were more accurate than contralateral reaches. While these findings suggest that hemispherically organized neural systems are involved in the programming of visually guided limb movements, it was not clear whether the inefficiency of the contralateral movements was due to reaching across the body axis or reaching into the visual hemifield contralateral to the hand being used. Therefore, in Experiment 2, the position of the fixation point was varied such that the effects of visual field and body axis could be disembedded. In this experiment, the kinematics of the reaching movement were shown to be independent of the point of visual fixation and varied only as a function of the laterality of the target position relative to the body axis. This finding suggests that the kinematics of a reaching movement are determined by differences in the processing of neural systems associated with motor output, after the target has been localized in space. The effect of target laterality on response latency and accuracy, however, could not be attributed to a single frame of reference, or to a simple additive effect of both. These findings illustrate the complex integration of visual spatial information which must take place in order to reach accurately to goal objects in extrapersonal space. Comparison of ocular and manual performance revealed a close relationship between movement latency for both motor systems. Thus, rightward-going eye movements to a given target were initiated more quickly when accompanied by reaches with the right hand than when they were accompanied by reaches with the left hand.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1985

The unprotected parasphenoidal carotid artery studied by high-resolution computed tomography.

A retrospective review was made of 500 consecutive thin-section axial CT scans of the adult sphenoid sinus using contrast enhancement and the bone algorithm to determine whether there was exposure of the cavernous sinus and the carotid arteries along their parasphenoidal course. At least one cavernous-carotid complex that could be considered at risk during sphenoid sinus surgery was seen in 31.4% of the patients. Of this group, 14.4% of the patients had no bony covering on one or both sides at some point along the parasphenoidal course. In 17% the bony covering was so thin it would give minimal, if any, protection from surgical trauma. A patient who had laceration of an unprotected carotid artery with development of post-traumatic aneurysm is discussed.

Aneurysm↗

PubMed1984

Eye movements of human albinos.

Albino mammals are known to suffer from misrouted optic projections and there is a growing body of evidence suggesting that human albinos have similar aberrant anatomical pathways. The present study examined the possible consequences of such aberrant pathways on the oculomotor performance of five adult human albinos. Optokinetic nystagmus to drifting grating patterns and pursuit eye movements were measured. The subjects' congenital nystagmus was also measured under different conditions of gaze position and ambient room illumination. Two of the subjects showed clear instances of an inversion in the optokinetic response and there were probable inversions observed for a third subject. The magnitude of the optokinetic nystagmus was appropriate for the rate of pattern drift, but inverted in direction. In all cases smooth pursuit was severely impaired, but reversals of the appropriate direction of pursuit eye movements were not observed. Changes in the congenital nystagmus under conditions of light and darkness were found for four of the five subjects and varied greatly between subjects. The results suggest that human albinos share many of the oculomotor deficits found in other albino species.

Albinism↗

PubMed1983

Computed tomographic detection of sinusitis responsible for intracranial and extracranial infections.

Computed tomography (CT) is now used extensively for the evaluation of orbital, facial, and intracranial infections. Nine patients are presented to illustrate the importance of detecting underlying and unsuspected sinusitis. Prompt treatment of the sinusitis is essential to minimize the morbidity and mortality associated with complications such as brain abscess, meningitis, orbital cellulitis, and osteomyelitis. A review of the literature documents the persistence of these complications despite the widespread use of antibiotic therapy. Recognition of the underlying sinusitis is now possible with CT if the region of the sinuses is included and bone-window settings are used during the examination of patients with orbital and intracranial infection.

Adolescent↗

PubMed1982

Progressive supranuclear palsy: the relationship between ocular motor dysfunction and psychological test performance.

The performance of patients with progressive supranuclear palsy on visual search and scanning tasks was related to the pattern of ocular deficits observed in these patients during horizontal refixation. Comparisons were made to age-matched normals and patients with Parkinson disease or cerebellar damage. The poor performance of the progressive supranuclear palsy group on visual search and scanning could not be attributed to the restricted range of vertical gaze or the large number of hypometric saccades during horizontal refixation. Instead, we believe that their impaired scanning resulted from the presence of square-wave jerks during attempted fixation.

Bulbar Palsy, Progressive↗