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Transfer of persistence across behaviors.

Two experiments tested the applicability to human beings of findings with animals that the number of performances required for the reinforcement of one behavior affects the subsequent effort expended in other instrumental behaviors. In the first experiment, adult depressed psychiatric patients worked on a sorting task for the approval of a staff psychologist. The time spent and the work completed were increased by prior approval from a ward attendant for each completion of several custodial tasks, as compared to the ward attendant's approval for each completion of a single task or a no-pretreatment control condition. In the second experiment, preadolescent learning-disabled students who were required to read and spell correctly a greater number of words per reward token later spent more time and completed more work for reward tokens in mathematics, and handwriting. Two alternative interpretations of these results are evaluated: (a) The degree of accustomed effort per reinforcer becomes a learned component of behavior, or (b) high effort increases the habituation of frustration-produced disruptive responses. The results suggest that individual differences in general persistence may arise, in part, from an accumulation of effort training in the natural environment.

Adult↗

The purely neuroleptic effects and its relation to the "neuroleptic threshold".

Since 1953 when for the first time author pointed at correlation between clinical-neuroleptic effectiveness and the extrapyramidal system, more than 50,000 investigations with 30 different short-term and long-term neuroleptics have been carried out on approximately 850 schizophrenics whose extrapyramidal fine movements were tested according to author's handwriting-test. The results have been comprehended by author as follows: 1. the neuroleptic threshold; 2. the neuroleptic potency according to the neuroleptic threshold; 3. the neuroleptic therapeutic range; 4. the disposition to the neuroleptic threshold-dosage.

Basal Ganglia Diseases↗

The anterior interosseous nerve syndrome (the Kiloh-Nevin syndrome). Report and follow-up study of three cases.

Three surgically treated cases demonstrate that this syndrome is a compressive neuropathy of the anterior interosseous branch of the median nerve rather than a neuritis, as originally believed. All symptoms were in the dominant hand and included deterioration of handwriting, pain, weakness of the flexor policis longus, the flexor digitorum longus to the index finger, and the pronator quadratus. Electromyograms were abnormal in two of the three cases. All forms of conservative treatment failed over a three- to five-month period. All lesions were demonstrable at surgery, and recovery was complete in all cases within five months of surgery. At an average follow-up evaluation of seven years there was no recurrence in any case. The loss of ability to write was characteristic of all three cases and is being reported for the first time.

Accidents, Occupational↗

[Psychosomatic sterility. Search for a hypothesis for personaity structure using Moretti's graphology method].

Over the past three years the authors have performed a random clinical study on couples who came to the aim of identifying the possible presence, in those cases in which it was not possible to pinpoint an organic or functional etiological factor, of a relationship between personality structure and so-called "sterility sine cause" which according to the recent studies by Pancheri and Zichella on reproductive emotionality, is thought to caused by a factor of psychosomatic origin, The substantiality of the concept of reproductive emotionality, otherwise referred to as sexual instinct, was put forward in 1962 by Padre Gerolamo Moretti, a leading figure of Italian graphology. Research to date, carried out using traditional methods of clinical psychology, interview and tests, in an attempt to determine a particular personality profile, has not produced completely satisfactory results. From the literature it does not appear that graphological analysis has been applied in research of this nature. Graphology, if used by competent and appropriately trained persons, is certainly a powerful and refined diagnostic method which enables an idiographic, holistic and integrated personality profile (intelligence and temperament) tp be obtained for the subject in question. Moretti's temperament classification was used to define the personality structure of patients: assault, resistance, assignment and expectation. Research using graphological techniques has revealed that it is possible to define a personality structure within which suspected "sine cause" patients may be classified. In comparison to the control group, there was a prevalent attitude expressing a tendency to reserve, introversion, diffidence, anxiety, excessive and sometimes unmotivated concern regarding persons and things, attachment to one's own ideas, inflexibility of one's own position, scarce capacity to make oneself available, excessive attention to formal aspects. A number of practical considerations also emerged from the research: the good level of acceptance and compliance with the diagnostic instrument used and the fact that the patient in question does not necessarily have to be present. Due to the ease of obtaining an example of the patient's handwriting, graphological analysis could be outinely requested as the first approach in suspected cases of sterility due to psychosomatic causes.

Female↗

Liver transplantation: treatment of choice for hepatic and neurological manifestation of Wilson's disease.

Liver transplantation (LTX) is an approved method to treat patients with end-stage liver cirrhosis and acute liver failure due to Wilson's disease. Initially, there was some consideration about the indication for LTX in the case of Wilson's disease with severe neurological impairment but normal liver function. From 1988 until 1995, 13 out of 700 LTX (1.9%) were performed for Wilson's disease. Indications for LTX were (I) intractable neurological impairment with normal liver function (n = 4; including one patient with Child A cirrhosis), (II) fulminant hepatic failure (n = 3), and (III) end-stage liver cirrhosis (n = 6) (Child B, n = 1; Child C, n = 5). There were 8 females and 5 males with a mean age of 27 yr (range 15-34 yr). All patients of group I required continuous nursing care before LTX, in spite of pretreatment with d-penicillamine and zinc. The most frequent symptoms in these patients were dysphagia (n = 4), dysarthria (n = 4), tremor (n = 4), sialorrhea (n = 3), ataxia (n = 3), dystonia (n = 3) and handwriting difficulties (n = 3). All patients of group II presented with hemolytic anemia. The survival rate was 100%, and all patients were doing well after a mean follow-up period of 32.8 months (range 8-68 months). The postoperative course was without severe infectious and other complications. All patients of group I revealed the first signs of improvement for all types of neurological symptoms 4-6 wk after LTX. One patient has been without any symptoms from 18 months until 5.5 yr after LTX. Two patients with short-term follow-up also had noticeable improvement of neurological impairment, but residual symptoms are still present. One patient showed only slight improvement. We conclude that Wilson's disease may be a good indication for LTX for both neurological manifestation with stable liver function and hepatic manifestation with cirrhosis or acute liver failure.

Adolescent↗

Using writing instruments: invariances in young children and adults.

In 2 studies, developmental changes in variability associated with handwriting were investigated. In Study 1, variability in grip patterns and pen positioning relative to a flat surface were examined in 3- and 5-year-olds and adults. The results indicated that between 3 and 5 years of age there is a reduction in the number of grips that individual children routinely use and a reduction in variability associated with pen-surface positioning. In Study 2, the 3-year-old children who participated in Study 1 were tested 6 months later. In comparison to young 3-year-old children, older 3-year-olds use an adult grip pattern more often and are less variable in pen-surface positioning, although the use of multiple grip patterns is still common. The findings from both studies are considered in relation to prior research that emphasized modal patterns of motor development and newer work that uses developmental changes in variability to understand the acquisition of motor skill.

Adult↗

Motor disturbances in normal-pressure hydrocephalus. Special reference to stance and gait.

Motor disturbances in 16 patients with normal-pressure hydrocephalus were assessed by quantitative registration of handwriting, fine movements of the hand, hand tremor, postural instability, and gait. Tremor intensity was measured using an accelerometer and electronic integration of the accelerometer curves. Postural instability was measured on a computer-assisted force-plate, and computerized analysis of gait was made using an instrumented treadmill. Severe disturbances in motor performance in the upper extremities and postural stability were found. The gait of the hydrocephalic patients was characterized by a very low speed, short steps, ataxia (especially in the vertical direction), and high energy consumption. After shunt operation, significant improvement was found in motor performance in the upper extremities and postural stability, and gait ataxia decreased in all patients to values within the 95% confidence interval of age-matched controls.

Adult↗

Lacunar infarct of the tegmentum of the lower lateral pons.

A stroke with a somewhat unusual neurologic formula was correlated with a small linear high-intensity T2 focus in the lateral tegmentum of the lower third of the pons. The clinical features included dysarthria, staggering gait, incoordination of handwriting, right facial weakness, nystagmus, ocular overshoot, right appendicular ataxia, and left-sided dissociated sensory loss for pain and temperature. Lacunar lesions of the tegmentum in the region of the pontomedullary junction, while not uncommon, have not been studied pathologically and have not been reported in the magnetic resonance imaging literature, to my knowledge.

Cerebral Infarction↗

Functional decline in Parkinson disease.

OBJECTIVES: To determine the overall rate of functional decline and to assess the progression of different signs of Parkinson disease (PD). PATIENTS AND METHODS: Patients with clinically diagnosed PD followed up for at least 3 years were included in this study. Demographic and clinical data (including the Unified Parkinson's Disease Rating Scale [UPDRS]) were analyzed by the multivariate unbalanced repeated-measurements design using the mixed-effects model to study the association between different symptoms and various demographic variables. Regression models helped estimate the rates of progression of the disease in relationship to the various components of the UPDRS. Patients were categorized as having tremor-dominant or postural instability-gait difficulty-dominant PD and the 2 categories were compared for progression of their total UPDRS scores. DESIGN: A multivariate mixed-effects model was used to study the relationship between the different symptoms and various demographic variables. Nonparametric statistical tests were used to compare the progression of symptoms in the "on" (good function) state and the "off" (poor function) state groups for 2 age-at-onset categories (< or =57 and >57 years). RESULTS: Data from 1731 visits on 297 patients (181 men) followed up for an average of 6.36 years (range, 3-17 years) were analyzed. The annual rate of decline in the total UPDRS scores was 1.34 when assessed during the on state and 1.58 when assessed during the off state. Patients with an older age at onset had more rapid progression of PD than those with a younger age at onset. Furthermore, the older-onset group had statistically significantly more progression in mentation, freezing, and parts I (mentation) and II (activities of daily living) UPDRS subscores. Handwriting was the only component of the UPDRS score that did not notably deteriorate during the observation period. Regression analysis of 108 patients whose symptoms were rated during their off state showed a faster rate of cognitive decline as age at onset increased. The slopes (ie, the annual rates of decline) of progression in the UPDRS scores, when adjusted for age at the initial visit, were steeper for the postural instability--gait difficulty--dominant group compared with the tremor-dominant group. CONCLUSION: Based on longitudinal follow-up data, our findings provide evidence for a variable course of progression of the different PD symptoms, thus implying different biochemical or degenerative mechanisms for the various clinical features associated with PD.

Adolescent↗

Electronic prescribing via the internet for a coronary artery disease and hypertension megatrial.

A unique feature of the International Verapamil SR/Trandolapril Study (INVEST) is the Internet-based, electronic data capture system developed at the University of Florida for this trial. This system allows for direct collection of patient enrollment data, randomization, study drug prescribing, and real-time monitoring of patient data online. In this trial, immediate transmission of patient-specific data occurs using online data collection forms. Investigators only need a personal computer with access to the Internet: no complicated hardware, software systems, or paper storage files are necessary. INVEST is the first large randomized clinical trial to use electronic prescribing systems in the research setting. Electronic prescribing eliminates errors associated with illegible handwriting, inappropriate dosing, and inappropriate medication choice. Because the INVEST protocol allows flexibility of medication choice and dosage range within randomly assigned treatment strategies based on patient tolerance and blood pressure response, physician investigators may use individual practice patterns and preferences. The electronic system provides guidance to physicians relative to the addition of medication or dosage adjustments within the protocol. Electronic tracking and reporting mechanisms have enabled investigators in this complex megatrial to enroll, randomize, and manage patients in real time with great accuracy.

Coronary Artery Disease↗

The association of abnormal cerebellar function in children with developmental coordination disorder and reading difficulties.

Children with developmental coordination disorder/dyspraxia (DCD) are at high risk of reading and writing delay. The difficulties with motor skills are heterogeneous and many children have features of poor cerebellar function, reflected in problems with posture, balance and fast accurate control of movement. This study confirmed a high level of parental reporting of reading and writing delay in a clinical group of 23 children with DCD, defined on the basis of both clinical examination and standardized testing of motor function. Direct measurement of reading delay, identified still further children in the group. Those children with reading delay had associated findings typical of phonological awareness difficulties. The children also underwent a standardized test of neurological function and although they all had difficulties with cerebellar function, no distinctive pattern emerged for those whose presentation was complicated by delayed reading and writing. Both the children with DCD and 136 typically developing children, completed the pilot parental questionnaire on gross motor skills. The three skills of catching a ball, jumping on a moving playground roundabout and handwriting, distinguished the children with DCD. This study therefore confirms that children with DCD should be assessed for difficulties in phonological awareness. Additionally, children aged between 7 and 12 years are on the whole, highly competent in a range of gross motor skills and further study might determine whether a simple parental questionnaire might detect children who would benefit from further assessment. The study also suggests that all the children with DCD have cerebellar dysfunction and further work with a larger group might determine particular patterns associated with reading delay.

Cerebellum↗

Application of neural networks to pharmacodynamics.

Neural networks (NN) are computational systems implemented in software or hardware that attempt to simulate the neurological processing abilities of biological systems. A synopsis is presented of the operational characteristics, structures, and applications of NN. The NN technology has primarily been aimed at recognition science (e.g., handwriting, voice, signal, picture, image, pattern, etc.). It is pointed out that NN may also be particularly suitable to deal with pharmacokinetic (PK) and pharmacodynamic (PD) systems, especially in cases such as multivariate PK/PD population kinetics when the systems are so complex that modeling by a conventional structured model building technique is very troublesome. The main practical advantage of NN is the intrinsic ability to closely emulate virtually any multivariate system, including nonlinear systems, independently of structural/physiologic relevance. Thus, NN are most suitable to model the behavior of complex kinetic systems and unsuitable to model the structure. In a practical sense, this structure limitation may be inconsequential because NN in its multivariate formulation may consider any physiologic, clinical, or population variable that may influence the kinetic behavior. The application of NN in PD is demonstrated in terms of the ability of an NN to predict, by extrapolation, the central nervous system (CNS) activity of alfentanil. The drug was infused by a complex computer-controlled infusion scheme over 180 min with simultaneous recording of the CNS effect quantified by a fast Fourier transform power spectrum analysis. The NN was trained to recognize (emulate) the drug input-drug effect behavior of the PD system with the input-effect data for the 180 min as a training set.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗

Acupuncture therapy for the symptoms of Parkinson's disease.

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Activities of Daily Living↗

Feasibility and validity of a modified finger-nose-finger test.

In essential tremor (ET) research, it is important to obtain standardized, objective data on tremor severity. Often, it is not possible to carry out in-person or videotaped neurological examinations. In place of these, handwriting samples can be collected, but they do not capture all of the variance in tremor severity. Although additional tests of tremor severity (finger-nose-finger [FNF] test) might be of use, these would need to be modified to allow ET patients to mail their results to the study investigator for rating. We modified the standard FNF test (sFNF) by asking subjects to hold a pen during this activity and mark a paper target. The purpose of this report was to determine whether the modified FNF (mFNF) test was feasible and valid. Of 70 subjects, 65 (92.9%) were able to complete the mFNF, demonstrating that it was feasible. The scores of the mFNF correlated highly with those of the sFNF (r = 0.56-0.85; all P < 0.001), indicating the mFNF is a valid measure of tremor severity. In addition, using the regression equation, sFNF = 0.174(mFNF) + 0.743, a sFNF score can be derived easily from the mFNF score. The mFNF may be used to collect valuable data on tremor severity in pathological, genetic, and epidemiological field studies of ET, in which in-person or videotaped neurological examinations are not possible.

Essential Tremor↗

Throat clicking as the initial symptom of Parkinson's disease.

The presenting manifestations of Parkinson's disease (PD) are variable, but a majority of patients note tremor as the initial symptom. Others complain of slowing of movements, loss of dexterity, fatigue, or changes in handwriting as initial symptoms. We describe a patient who developed an unusual clicking sound emanating from his throat as the initial manifestation of PD.

Aged↗

Double-blind controlled trial of gabapentin in essential tremor.

Gabapentin has been reported to be effective for essential tremor (ET) based on open-label trials. We studied gabapentin (1800 mg/day) and placebo in a double-blind crossover design in 20 ET patients. Eighteen patients completed the study and two patients dropped out as a result of adverse effects which resolved when the medication was discontinued. Tremor was assessed at baseline and after 2 weeks of gabapentin and placebo treatment. One patient was mildly improved and another was moderately improved with placebo. Similarly, one patient reported mild improvement and another patient had marked improvement with gabapentin. All the remaining patients either reported no change or were worse with both treatment arms. There was no significant difference for total tremor score, hand tremor score, handwriting scores, or pouring scores. Sickness Impact Profile scores were no different between placebo and gabapentin. Our results suggest that as an adjuvant therapy in ET, gabapentin has limited benefit.

Acetates↗

Spatial agraphia.

Twenty-one patients with right hemisphere damage were studied (11 men, 10 women; average age = 41.33; age range 19-65). Subjects were divided into two groups: pre-Rolandic (6) and retro-Rolandic (15) right hemisphere damaged patients. A special writing test was given to each patient. The writing errors observed included literal substitutions, feature omissions and additions, letter omissions and additions, inability to maintain horizontal writing, inappropriate grouping and fragmentation of elements, and changes in handwriting style. Associated disorders included left-hemiparesis, visual field defects, spatial hemi-neglect, constructional apraxia, spatial alexia, and spatial acalculia. It is proposed that spatial agraphia is related to: (1) left hemi-neglect, (2) constructional deficits, (3) general spatial defects, and (4) some motor disautomatization and tendency to perseverate. In cases of right frontal damage, motor-associated deficits (iterations of features and letters) predominated, whereas in cases of posterior right hemisphere damage, spatial defects (inappropriate distribution of written material in the space, grouping of letters belonging to different words, and splitting of words) were more evident. Writing impairments are in general more noticeable in cases of retro-Rolandic damage.

Adult↗

Finger-tapping interference as produced by concurrent verbal and nonverbal tasks: an analysis of individual differences in left-handers.

Verbal cerebral asymmetry was examined in 96 right- and left-handed college students using dual-task methods. The manual task was finger-tapping; verbal tasks were anagram-solution in silent and aloud conditions; nonverbal tasks were solution of Raven's Progressive Matrices and forms memory. Both handedness groups were sensitive to the task manipulation, i.e., verbal tasks produced a significant change in tapping rate from a no-change rate of zero; nonverbal tasks produced no significant change in tapping rate. Right-handers experienced the expected asymmetric manual performance indicative of left-hemisphere language laterality. Left-handers as a group experienced no asymmetric pattern but rather a percentage decrease in both hands which suggested bilateralization of language functions. Only when examining manual performance patterns within specific left-handed subpopulations (composed of a complete crossing of handwriting posture, familial sinistrality, and sex) did laterality patterns emerge. Specifically, asymmetric manual performance was found only in familial sinistral inverted posture females. Results demonstrate the advantage of controlling for subject characteristics when assessing cerebral laterality in left-handers.

Adult↗