Brief cognitive tests as a decision-making tool in primary care. A population and validation study

INTRODUCTION AND OBJECTIVES

Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program.

MATERIAL AND METHODS

In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample.

RESULTS

260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26.

CONCLUSION

BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.

Prognostic value of serum progesterone and LH values on the day of hCG administration in IUI GnRH antagonist cycles

OBJECTIVE

to evaluate the effect of LH surge and progesterone rise in IUI cycles under gonadotropin stimulation with GnRH antagonist coadministration on pregnancy rates (PR).

STUDY DESIGN

The population under study consisted of 152 women prospectively studied and subjected to IUI.

RESULTS

The higher the progesterone cutoff value, the lower the PR were 26.5% and 10.9% when the cutoff was 1 ng/mL, 26.0% and 8.6% when the cutoff was 1.2 ng/mL, 25.6% and 7.1% when the cutoff was 1.4 ng/mL and 25.3% and 0% when the cutoff was 1.6 ng/mL.

CONCLUSION

In IUI cycles under GnRH antagonist coadministration, serum progesterone levels over 1.0 ng/mL are associated with lower PR, the higher the progesterone levels, the lower the PR.

Changes in brain enkephalin immunostaining after acute carbon disulfide exposure in rats

Carbon disulfide neurotoxic mechanism in the brain is still not completely clear. In this work, the effect of carbon disulfide exposure in rats on the enkephalinergic neuromodulatory system is described. Caudatus-putamen showed no changes in immunostaining for met-enkephalin when compared with controls. However, a marked reduction in met-enkephalin immunostaining in the central amygdaloid nuclei and the globus pallidus was measured, with a parallel elevation in the lateral septal nucleus and the parietal cortex. It is suggested that enkephalinergic neuromodulatory system could play a role in carbon disulfide neurotoxicity.

Effect of phenobarbital administration on the activity of two neuropeptide-degrading enzymes in several brain areas of the rat

Phenobarbital (CAS 50-06-6) is widely used as an effective anticonvulsant drug. Many attempts have been made to elucidate the neurochemical basis of its therapeutic action, but with little success. In the present paper, research has been focused on analyzing the effect of phenobarbital administration on two neuropeptide-degrading enzymes, the Lys- and Leu-aminopeptidases, in several brain areas of the rat. The study was performed by measuring the rate of hydrolysis of the substrates Lys- and Leu-2-naphthylamides, by neutral and basic aminopeptidase activities, respectively. Significant increases after phenobarbital administration, for both kinds of aminopeptidase activities, in the frontal, parietal and occipital cortices and the hippocampus were observed. It is suggested that these enzymes play a part in the neurochemical mechanism of the barbiturate, possibly by regulating the activity of several neuroactive peptides in the above mentioned cerebral regions.

[Cerebral aminopeptidase activity: effect of the administration of imipramine]

Imipramine is widely accepted as an effective antidepressant treatment. In this paper, changes in Lys- and Leu-aminopeptidase activities in several rat brain regions after imipramine treatment are described. Decreases of Lys-aminopeptidase activity in the olphactory bulbus, cerebellum, hypothalamus and pituitary gland were observed. In the same way, there were a decreases in Leu-aminopeptidase activity in the parietal and occipital cortices, cerebellum thalamus, hypothalamus and pituitary gland. It is suggested that these enzyme activities play a part in the imipramine action mechanism, possibly by regulating the activity of several neuroactive peptides.

[Leucine aminopeptidase activity levels in various brain regions in the rat. Effect of the acute administration of lithium]

Lithium is widely accepted as an effective treatment in acute mania. However, the neurochemical mechanism of action of the ion still remains relatively obscure. In this work, the effect of acute lithium administration on Leu-aminopeptidase activity in discrete areas of the rat brain is described. Decreases in enzyme activity in the striatum and pituitary gland were observed. It is suggested that this enzyme plays a part in the mechanism of action of lithium through regulation of the activity of some neuroactive peptides.

[Possible mechanism of action of a water-soluble tissue extract on arterial pressure in the rat]

A double hypo-hypertension effect is seen when a hydrosoluble splenic extract at pH 5 is injected to rats intravenously. The hypotensive effect may be caused by local vasodilating agents, such as histamine. The hypertensive one does not appear in adrenoprive animals or in rats treated with inhibitors of prostaglandin synthesis which suggests that the mechanism for this effect is complex.

[Acute meningococcal infection (author's transl)]

Authors report 49 patients bacteriologicallyly diagnosed of acute meningococcal infection collected during a 12 months period out of a series of 76 cases diagnosed on clinical grounds. "N. meningitidis" was found in 18 blood and 43 CSF cultures. 31 cases were of the B-group, one was A-group and 17 were not typed. All of them were sulphamide resistant. Hyperthermia with vomiting, cephalea, arthralgia and seizures were the initial symptoms. All patients showed pettechiae, purpura and/or ecchymoses. Endotoxic shock was diagnosed in 26,5% of the cases. In them systolic blood pressures were under p-5. Overall mortality was 14%, and that of endotoxic patients 53%. Therapeutic routines and chemoprophylaxis are reviewed.