We aimed to refine the hypothesis that motoric cognitive risk (MCR), a syndrome combining measured slow gait speed and self-reported cognitive complaints, is prognostic of incident dementia and other major causes of morbidity in older age. We propose mechanisms on the relationship between motor and cognitive function and describe a roadmap to validate these hypotheses. We systematically searched major electronic databases from inception to August 2021 for original longitudinal cohort studies of adults aged ≥60 years that compared an MCR group to a non-MCR group with any health outcome. Fifteen cohorts were combined by meta-analysis. Participants with MCR were at an increased risk of cognitive impairment (adjusted hazard ratio [aHR]

Clozapine is a potent antipsychotic commonly used for refractory schizophrenia. Adverse effects are well recognised including constipation, intestinal obstruction, agranulocytosis and cardiomyopathy. We present a case of paradoxical refractory hypotension following epinephrine administration in a patient taking clozapine. A psychiatric inpatient who had been taking clozapine for many years developed paralytic ileus and obstruction requiring surgical intervention. Following initiation of epinephrine administration intraoperatively he developed refractory hypotension which improved only when epinephrine was weaned off. This effect is likely due to uninterrupted β2-agonist activity in the presence of clozapine-induced α-blockade. Clinicians need to have greater awareness of this serious interaction and avoid the use of epinephrine in patients taking clozapine.

Syringomyelia is a common and chronic neurological disorder affecting Cavalier King Charles Spaniels. The condition is putatively painful, but evaluating the affective component of chronic pain in non-human animals is challenging. Here we employed two methods designed to assess animal affect – the judgement bias and reward loss sensitivity tests – to investigate whether Cavalier King Charles Spaniels with syringomyelia (exhibiting a fluid filled cavity (syrinx) in the spinal cord of ≥2mm diameter) were in a more negative affective state than those without the condition. Dogs with syringomyelia did not differ in age from those without the condition, but owners reported that they scratched more (P<0.05), in line with previous findings. They also showed a more negative judgement of ambiguous locations in the judgement bias task (P<0.05), indicating a more negative affective state, but did not show a greater sensitivity to loss of food rewards. These measures were unaffected by whether the dog was or was not receiving pain-relieving medication. Across all subjects, dogs whose owners reported high levels of scratching showed a positive judgement bias (P<0.05), indicating that scratching was not directly associated with a negative affective state. Tests of spontaneous behaviour (latency to jump up to or down from a 30cm high platform) and physiology (thermography of the eye) did not detect any differences. These results provide initial evidence from the judgement bias task that syringomyelia may be associated with negative affect in dogs, and open the way for further and larger studies to confirm findings and investigate the effects of medication in more detail