Screening for cognitive dysfunction in Huntington's disease with the clock drawing test.

Background: The aim of the study is to investigate the performance of the clock drawing test as a screening tool for cognitive impairment in Huntington's disease (HD) mutation carriers.

Methods: The performance of the clock drawing test was assessed in 65 mutation carriers using the Shulman and the Freund scoring systems. The mini-mental state examination, the Symbol Digit Modalities Test, the Verbal Fluency Test, and the Stroop tests were used as comparisons for the evaluation of cognitive functioning.

Neuropsychiatric symptoms in a European Huntington's disease cohort (REGISTRY).

Background: The majority of Huntington's disease (HD) mutation carriers experience some psychopathology during their lifetime, varying from irritability to psychosis, but prevalences of particular symptoms vary widely due to diverse study populations in different stages of HD and the use of different assessment methods.

Methods: The study population consisted of 1993 HD mutation carriers from 15 European countries, all participating in the observational REGISTRY study. The behavioural section of the Unified HD Rating Scale was used to examine the prevalence and correlates of five neuropsychiatric features: depression, irritability/aggression, obsessive/compulsive behaviours, apathy and psychosis.

Course of irritability, depression and apathy in Huntington's disease in relation to motor symptoms during a two-year follow-up period.

Background: Irritability, depression and apathy are frequently reported neuropsychiatric symptoms of Huntington's disease (HD).

Objective: This study investigated the course of irritability, depression and apathy in HD during a 2-year follow-up period.

Methods: In 121 HD mutation carriers the presence of irritability, depression and apathy was measured with the Problem Behaviours Assessment (PBA).

Patient, treatment, and anatomical predictors of outcome in electroconvulsive therapy: a prospective study.

Objectives: Baseline predictors of effectiveness and cognitive adverse effects of electroconvulsive therapy (ECT) were prospectively examined.

Methods: Before and after ECT, the Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini Mental State Examination (MMSE) were assessed. Before ECT, a magnetic resonance imaging of the head was performed.

MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy: a prospective study.

Background: In electroconvulsive therapy (ECT), the electrical current must pass the scalp, skull, cerebrospinal fluid (CSF) and brain tissues, to sufficiently exceed the seizure threshold (ST).

Objective: To investigate the relationship between these anatomical strata of the head and the level of the ST, in both right unilateral (RUL) and bifrontotemporal (BL) ECT.

Methods: Observational prospective study among 74 mainly depressed patients.

Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study.

At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration.

Effects on intracranial pressure of electroconvulsive therapy.

Electroconvulsive therapy (ECT) is thought to raise intracranial pressure (ICP) after an increase of blood pressure. In depressed patients (n=17) treated with ECT, using transcranial Doppler, pulsatility index (PI; as indicator of ICP) and blood pressures were prospectively measured. The highest PI was measured just after anesthesia induction and muscle relaxation.

Irritability in Huntington's disease.

Irritability is a frequent neuropsychiatric symptom in patients with Huntington's disease (HD). The Irritability Scale (IS) and the irritability factor of the Problem Behaviours Assessment (PBA) was used to assess irritability among 130 HD mutation carriers and 43 verified non-carriers. The IS was tested using receiver operating characteristic analysis against different cut-offs of the PBA irritability factor.

High preoperative plasma neopterin predicts delirium after cardiac surgery in older adults.

Objectives: To examine the association between plasma levels of pterins and amino acids and postoperative delirium.

Design: Prospective cohort study.

Setting: Cardiothoracic service in an university hospital in Rotterdam, the Netherlands.

Hypothalamic-pituitary-adrenal axis functioning in Huntington's disease mutation carriers compared with mutation-negative first-degree controls.

Neurodegeneration in Huntington's disease (HD) occurs in various brain regions including the hypothalamus. In this cross-sectional study, hypothalamic-pituitary-adrenal (HPA) axis functioning was studied in 26 presymptomatic and 58 symptomatic HD mutation carriers, and 28 controls. HPA axis functioning was measured through salivary cortisol in the day curve, the cortisol awakening response (CAR), the area under the curve (AUC), the morning rise, and the dexamethasone suppression test (DST).

Hypokinesia in Huntington's disease co-occurs with cognitive and global dysfunctioning.

Besides chorea, hypokinesia is an important motor disturbance in Huntington's disease (HD) but its clinical, neuropsychiatric, and cognitive functioning correlates are largely unknown. This cross-sectional study investigates correlates of hypokinesia in HD and its effect on global functioning. Among 150 HD gene carriers, 96 patients were clinically motor manifest.

Measurement of psychopathology in Huntington's disease: the critical role of caregivers.

Assessment of psychopathology in Huntington's disease (HD) using formal DSM-IV criteria is complex because of comorbid somatic and cognitive disturbances and diminished disease awareness. Using dimensional tests in 152 HD mutation carriers, both the total score of the Problem Behaviors Assessment (PBA) scale and the behavioral section of the Unified Huntington's Disease Rating Scale (UHDRS-b) corresponded with presence of DSM-IV diagnoses. Receiver operating characteristic curves showed an area under the curve of 0.

Retrospective study of continuation electroconvulsive therapy in 50 patients.

Objectives: To examine patient and treatment characteristics in continuation electroconvulsive therapy (c-ECT), defined as prolonged treatment with ECT with a maximum frequency of once a week to prevent relapse.

Methods: Medical charts of 50 patients (mean age, 59 years; 74% were female) undergoing c-ECT were examined retrospectively for patient and treatment characteristics. Electrical stimulus dosage, seizure duration, and postictal suppression indices between the first and the last 4 ECT sessions were compared, and their associations with the time interval between c-ECT sessions were analyzed.

Electroconvulsive therapy for catatonia: treatment characteristics and outcomes in 27 patients.

Objectives: Electroconvulsive therapy (ECT) has been described as an effective treatment option for catatonia in retrospective case series. We aimed to investigate treatment characteristics and outcomes of patients with catatonia who were treated with ECT.

Methods: The medical records of 27 patients with catatonia treated with ECT (between 1991 and 2009) were scrutinized for clinical and treatment characteristics.

Exceptionally high initial seizure threshold in a catatonic patient treated with electroconvulsive therapy.

Objectives: Seizure threshold in electroconvulsive therapy (ECT) is generally defined as the smallest electrical stimulus dose that produces a generalized seizure of at least 25 to 30 seconds on electroencephalography. Seizure thresholds vary considerably among patients, and some patients have an exceptionally high initial seizure threshold. We describe a patient with catatonia who showed an initial seizure threshold exceeding 500 milliCoulombs.

Meta-analysis of initial seizure thresholds in electroconvulsive therapy.

In electroconvulsive therapy (ECT), electrical dosage is determined using 'fixed-dose', 'age-based' dose, or empirical titration methods. Estimation of initial seizure threshold (IST) has been claimed to be imperative for suprathreshold dosing. This systematic review aimed to determine common levels of IST, to define cut-off values for high IST, and to summarize reported IST associated factors.

Electroconvulsive therapy in the Netherlands: a questionnaire survey on contemporary practice.

Objective: To investigate contemporary Dutch practice of electroconvulsive therapy (ECT) and adherence to national and international ECT guidelines.

Methods: Among psychiatrists from all Dutch ECT sites in university and general hospitals (n = 24) and psychiatric hospitals (n = 11), a survey was conducted regarding (1) characteristics of practitioners and institutions, (2) clinical practice of ECT, and (3) technical aspects of ECT. Adherence to 16 criteria selected from (inter)national guidelines was scored.

Cross-sectional study on prevalences of psychiatric disorders in mutation carriers of Huntington's disease compared with mutation-negative first-degree relatives.

Objective: To investigate the prevalences of formal DSM-IV diagnoses in pre-motor- symptomatic and motor-symptomatic mutation carriers at different stages of Huntington's disease compared to a control group of first-degree noncarrier relatives and the general population.

Method: Between May 2004 and August 2006, 154 verified mutation carriers and 56 verified noncarriers were recruited from the outpatient clinics of the Neurology and Clinical Genetics departments of Leiden University Medical Center and from a regional nursing home. To assess the 12-month prevalences of DSM-IV diagnoses, the sections for depression, mania, anxiety, obsessive-compulsive disorder, and psychosis/schizophrenia of the Composite International Diagnostic Interview were used.

Behavioural problems in Huntington's disease using the Problem Behaviours Assessment.

Objective: To investigate behavioural problems in Huntington's disease (HD).

Method: In 152 HD mutation carriers and a control group of 56 noncarriers at initial 50% risk, the Dutch version of the Problem Behaviours Assessment (PBA) was administered. Mutation carriers were divided into three groups according to the motor section of the Unified Huntington's Disease Rating Scale (UHDRS): pre-(motor) symptomatic, early and advanced symptomatic subjects.

Delirium in elderly people: an update.

Purpose Of Review: To review recent studies on epidemiology, diagnosis, pathophysiology, treatment and prevention of delirium in elderly people.

Recent Findings: There is no evidence that the clinical picture of delirium in elderly people differs from that in younger patients, although it may run a more chronic course. Diagnosing delirium in demented patients, however, may be difficult due to overlap in symptoms of delirium and dementia.

Depression in vascular dementia.

Objective: To study the presence of different dimensions of depression in subjects with vascular dementia.

Background: After a stroke, cognitive, affective and behavioural disturbances are common. It has been suggested that the nature of affective symptomatology can help to differentiate organic from psychological depression.