This independent confirmation of data from phase 3 trials suggests that donepezil therapy modestly improves cognition in patients with Alzheimer disease who are encountered in clinical practice.
Summary: Basic fibroblast growth factor (bFGF) is a polypeptide that supports the survival of brain cells (in cluding neurons, glia, and endothelia) and protects neu rons against a number qf toxins and insults in vitro. This factor is also a potent dilator of cerebral pial arterioles in vivo. In previous studies, we found that intraventricularly administered bFGF reduced infarct volume in a model of focal cerebral ischemia in rats. In the current study, bFGF (45 I-lg/kg/h) in vehicle, or vehicle alone, was in fused intravenously for 3 h, beginning at }O min after permanent middle cerebral artery occlusion by intralumi nal suture in mature Sprague-Dawley rats. After 24 h, neurological deficit (as assessed by a 0-to 5-point scale, with 5 = most severe) was 2.6 ± 1.0 in vehicle-treated "Neurotrophic" growth factors are polypeptides that, acting through specific receptors, initiate cas cades of signal transduction resulting in increased neuronal survival. Recently, it has been appreciated that these factors also protect neurons against var ious insults and toxins. In particular, basic fibro blast growth factor (bFGF) is a 154-amino acid, 18-kD polypeptide that supports the survival of a wide
Functional MRI (fMRI) is often used for presurgical language lateralization. The most common approach calculates a laterality index (LI) based on suprathreshold voxels. However, strong dependencies between LI and threshold can diminish the effectiveness of this technique; in this study we investigated an original methodology that is independent of threshold. We compared this threshold-independent method against the common threshold-dependent method in 14 epilepsy patients who underwent Wada testing. In addition, clinical results from eletrocortical language mapping and post-operative language findings were used to assess the validity of the fMRI laterality method. The threshold-dependent methodology yielded ambiguous or incongruent lateralization outcomes in 4 of 14 patients in the inferior frontal gyrus (IFG), and in 6 of 14 patients in the supramarginal gyrus (SMG). Conversely, the threshold-independent method yielded unambiguous lateralization in all the patients tested, and demonstrated lateralization outcomes incongruent with clinical standards in 2 of 14 patients in IFG, and in 1 of 14 patients in SMG. This validation study demonstrates that the threshold-dependent LI calculation is prone to significant within-patient variability that could render results unreliable; the threshold-independent method can generate distinct LIs that are more concordant with gold-standard clinical findings.
Lyme encephalopathy, primarily manifested by disturbances in memory, mood, and sleep, is a common late neurologic manifestation of Lyme disease. We compared 20 patients with Lyme encephalopathy with 11 fibromyalgia patients and 11 nonpsychotically depressed patients using the California Verbal Learning Test, Wechsler Memory Scale, Rey-Osterrieth Complex Figure Test, Minnesota Multiphasic Personality Inventory (MMPI), and Beck Depression Inventory. Compared with patients with fibromyalgia or depression, the Lyme encephalopathy group showed mild, but statistically significant, memory deficits on two of the three memory tests. In contrast, the patients with fibromyalgia scored significantly higher than both other groups on the MMPI scale most sensitive to somatic concerns (scale 1), while the depressed patients scored higher than the Lyme patients on the scales most sensitive to depression (scale 2) and anxiety (scale 7). Physical complaints and depression were not major factors in memory performance among Lyme patients. These data support the hypothesis that Lyme encephalopathy is caused by CNS dysfunction and cannot be explained as a psychological response to chronic illness.
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