Clinical observations have shown that some older patients are unable to learn to use a metered dose inhaler (MDI) despite having a normal abbreviated mental test (AMT) score, possibly because of dyspraxia or unrecognised cognitive impairment. Thirty inhaler-naive inpatients (age 76-94) with an AMT score of 8-10 (normal) were studied. Standard MDI training was given and the level of competence reached was scored (inhalation score). A separate observer performed the minimental test (MMT), Barthel index, geriatric depression score (GDS), ideational dyspraxia test (IDT), and ideomotor dyspraxia test (IMD). No correlative or threshold relationship was found between inhalation score and Barthel index, GDS, or IDT. However, a significant correlation was found between inhalation score and IMD (r = 0.45, p = 0.039) and MMT (r = 0.48, p = 0.032) and threshold effects emerged in that no subject with a MMT score of less than 23/30 had an inhalation score of 5/10 or more (adequate technique requires 6/10 or more), and all 17/18 with an inhalation score of 6/10 or more had an IMD of 14/20 or more.The three patients with a MMT >22 and inhalation score <6 had abnormal IMD scores. Inability to learn an adequate inhaler technique in subjects with a normal AMT score appears to be due to unrecognised cognitive impairment or dyspraxia. The MMT is probably a more useful screening test than the AMT score in this context.

Background: Fibromyalgia syndrome (FMS) is a chronic condition that causes pain, stiffness, and tenderness in muscles, tendons, and joints. It is also characterized by disturbed sleep, fatigue, anxiety, depression, and disturbances in bowel function. Management of FMS is at present very challenging as it contains multiple etiological factors and psychological tendencies; though, a patient-centered approach is essential to deal with this problem. Objective: To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in improving pain and related disabilities in patients with primary (1ry) FM. Patients and Methods: Thirty patients with 1ry FM, 18 to 50 years old were randomized into 2 groups. Group I included 15 patients, who received 8 sessions (2/week for 4 consecutive weeks) of high frequency rTMS (10 Hz frequency) and Group II included 15 patients received 8 daily sessions of anodal tDCS (2 mA for 20 minutes) applied over the left primary motor cortex (M1). Results: Pain visual analogue scale (VAS), the revised Fibromyalgia Impact Questionnaire (FIQR), tender point scale, and Hospital Anxiety and Depression Scale (HADS) showed a significant decrease between baseline and follow-up assessments for both groups. Moreover, a significant change in all assessment scales was observed posttreatment when compared between both groups with more significant improvement in the group that received rTMS. Conclusion: Both rTMS and anodal tDCS of the left primary motor cortex showed marked improvement in symptoms of pain, functional disabilities and psychological status in patients with 1ry fibromyalgia. Both neuromodulator techniques can be considered as promising alternatives therapeutic options in the management of pain and related disabilities in FM.

Background Fibromyalgia syndrome (FMS) is a complex disorder where a widespread musculoskeletal pain (without a clear lesion basis) is associated with a great variety of symptoms including affective disturbances, central fatigue, cognitive dysfunction and even a particular skin reactivity to several chemical substances. Despite intense research effort, especially in the last years, the pathophysiology of the disease remains to be explained. The treatment recommendations were classified as pharmacological therapies, non-pharmacological treatments, and complementary non-pharmacological therapies. Also, particular interest has been raised by techniques able to perform effective modulation of brain areas through magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation such as direct current (TMS and tDCS). Objective: To compare the efficacy of Repetitive transcranial magnetic stimulation (r-TMS) and transcranial direct current stimulation (t-DCS) as non- invasive brain stimulation techniques in the rehabilitation of patients with primary (1ry) fibromyalgia (FM). Patients and Methods The present study included 30 patients with 1ry FM, equally divided into 2 groups. Group I included 15 patients who received 8 sessions of rTMS and Group II included 15 patients who received 8 sessions of anodal tDCS. Differences in visual analogue scale (VAS) of pain, tender point scale, Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Scale (HADS) were assessed before and after completion of assigned treatment sessions. Results Pain VAS, tender point scale, FIQ and HADS showed significant decrease between baseline and follow-up assessments for both groups. Moreover, a significant change in all assessment scales was observed post treatment when compared between both groups with more significant improvement in the group received rTMS. Conclusion Both rTMS and tDCS techniques showed marked improvement in symptoms of pain, functional status and quality of life in patients with 1ry fibromyalgia. Both techniques can be considered as promising alternatives therapeutic options in the treatment of FM in order to reduce side effects of long-term use of drugs.