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A 6-month, open-label study of memantine in patients with frontotemporal dementia.

Int J Geriatr Psychiatry. 2008 Jul;23(7):754-9

Authors: Diehl-Schmid J, Förstl H, Perneczky R, Pohl C, Kurz A

OBJECTIVE: To evaluate safety and effects on cognition and behavior of memantine 20 mg/day in the treatment of patients with frontotemporal dementia (FTD). METHODS: This was a single-center, 6-month, open, uncontrolled study. Sixteen outpatients with a diagnosis of FTD were enrolled. RESULTS: On the CIBIC plus 26 weeks after baseline four of the 16 patients were minimally improved, four were unchanged, seven were minimally worse and one patient was moderately worse. Neither the Neuropsychiatric Inventory nor the Frontal Behavioral Inventory demonstrated statistically significant differences in behavior between baseline and final visit. There was an increase in the total Alzheimer’s Disease Assessment Scale score, reflecting a decline in cognitive performance. Executive functions as well as activities of daily living and extrapyramidal motor symptoms (EPMS) remained unchanged during the trial. CONCLUSION: The number of patients was small, so that the evidence given by statistical tests is limited. Thus, the present study can only show trends regarding drug effects. As memantine is well-tolerated, further randomized and controlled studies should be conducted to evaluate drug efficacy.

PMID: 18213609 [PubMed - indexed for MEDLINE]

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Cognitive-behavioral therapy, exercise, and older adults’ quality of life.

West J Nurs Res. 2008 Oct;30(6):704-23

Authors: Schneider JK, Cook JH, Luke DA

This study examined health-related quality of life (HRQL) at baseline and 6, 9, and 12 months after initiating exercise training in three groups of older adults. The conditions were cognitive-behavioral therapy, attention-control health promotion education, and a control group. Participants (N = 332) were mainly women (n = 252, 75.9%) with a mean age of 71.8 (SD = 5.1) years. Therapy participants were trained to modify their negative interpretations of exercise. Participants in the education group received information unrelated to exercise. After controlling for exercise behavior over time, the therapy group reported lower general health, more role limitations because of emotional problems, and somewhat less vitality than the control group did. The education group also reported lower general health and vitality than the control group did. Social interaction and discussion may heighten participants’ awareness of these health aspects and influence their appraisal of HRQL. Findings demonstrate the complexities of HRQL and the challenge in developing effective methods for helping older adults adopt and maintain an active lifestyle.

PMID: 18270313 [PubMed - indexed for MEDLINE]

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Reduction of pain-related fear and disability in post-traumatic neck pain: a replicated single-case experimental study of exposure in vivo.

J Pain. 2008 Dec;9(12):1123-34

Authors: de Jong JR, Vangronsveld K, Peters ML, Goossens ME, Onghena P, Bulté I, Vlaeyen JW

For patients with acute post-traumatic neck pain (PTNP), pain-related fear has been identified as a potential predictor of chronic disability. If such is the case, fear reduction should enhance the prevention of further pain disability and distress after traumatic neck pain disability. However, exposure-based treatments have not been tested in patients with PTNP. Using a replicated single-case crossover phase design with multiple measurements, this study examined whether the validity of a graded exposure in vivo, as compared with usual graded activity, extends to PTNP. Eight patients who reported substantial pain-related fear were included in the study. Daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement were assessed. Before and after each intervention, and at 6-month follow-up, standardized questionnaires of pain-related fear and pain disability were administered, and, to quantify daily physical activity level, patients carried an ambulatory activity monitor. The results showed decreasing levels of self-reported pain-related fear, pain intensity, disability, and improvements in physical activity level only when graded exposure in vivo was introduced, and not in the graded activity condition. The results are discussed in the context of the search for customized treatments for PTNP. PERSPECTIVE: This is the first study showing that the effects of graded exposure in vivo generalize to patients with chronic PTNP reporting elevated levels of pain-related fear. This could help clinicians to customize treatments for PTNP.

PMID: 18722818 [PubMed - indexed for MEDLINE]

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[Modern rehabilitation for vestibular disorders using neurofeedback training procedures]

HNO. 2008 Oct;56(10):990-5

Authors: Basta D, Ernst A

The conservative therapy of long-lasting vestibular disorders has been changed over the last few years by the introduction of neuro(bio-)feedback procedures. A technical neurofeedback system applies an additional (acoustic, galvanic, vibrotactile) stimulus to the patient while performing vestibular exercises. This stimulus is dependent on the extent of postural deviation of the patient from a normal (ideal) position in space. The neurofeedback system is body worn and continuously registers any postural deviation from the normal position so that it can apply suitable stimuli to the patient. This new way of rehabilitating patients with vertigo seems to be a promising addition in the therapy of long-lasting, complex vestibular disorders as recent studies have demonstrated.

PMID: 18806973 [PubMed - indexed for MEDLINE]

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The relationship between the Dimensions of Change Instrument and retention in therapeutic community treatment: the moderating influence of time in treatment.

Am J Drug Alcohol Abuse. 2008;34(6):667-72

Authors: Miles JN, Wenzel S, Mandell W

OBJECTIVES: The Dimensions of Change Instrument (DCI) (1) assesses aspects of the therapeutic community treatment process. More positive scores on two of the eight dimensions of treatment process assessed at the beginning of treatment, Clarity and Safety, and Resident Support, Sharing and Enthusiasm predict retention in treatment at 30, 90, 180, and 270 days as well as overall length of stay. This study explored whether these process subscales assessed at different phases predicted retention at the next phase, and of treatment. METHODS: Five-hundred nineteen individuals, aged 18 to 62, undergoing therapeutic community treatment completed the DCI at baseline, one, three, six, and nine months of the therapeutic community treatment. RESULTS: DCI scale scores at each stage of treatment predicted dropout in the subsequent period. In the early stages of treatment, higher scores predicted a higher probability of retention in the subsequent stage of treatment. In later stages, lower DCI scores predicted a higher probability of retention. CONCLUSIONS: We conclude that predictions about retention made using the DCI scale scores are treatment stage dependent–the DCI predicts retention at the next stage but the direction of the scale prediction varies as a function of client tenure in treatment. This suggests that treatment processes that influence clients to remain early in treatment may change their valence for clients more advanced in treatment.

PMID: 18850499 [PubMed - indexed for MEDLINE]

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Genetic variation in the schizophrenia-risk gene neuregulin1 correlates with differences in frontal brain activation in a working memory task in healthy individuals.

Neuroimage. 2008 Oct 1;42(4):1569-76

Authors: Krug A, Markov V, Eggermann T, Krach S, Zerres K, Stöcker T, Shah NJ, Schneider F, Nöthen MM, Treutlein J, Rietschel M, Kircher T

Working memory dysfunctions are a prominent feature in schizophrenia. These impairments have been linked to alterations in prefrontal brain activation with studies reporting hypo- and hyperactivations. Since schizophrenia has a high heritability, it is of interest whether susceptibility genes modulate working memory and its neural correlates. The aim of the present study was to test the influence of the NRG1 schizophrenia susceptibility gene on working memory and its neural correlates in healthy subjects. 429 healthy individuals performed a verbal and a spatial working memory task. A subsample of 85 subjects performed a 2-back version of the Continuous Performance Test (CPT) in a functional MRI study. The NRG1 SNP8NRG221533 (rs35753505) carrier status was determined and correlated with working memory performance and brain activation. There were no effects of genetic status on behavioural performance in the working memory tasks in the 429 subjects and in the fMRI task (n=85). A linear effect of NRG1 SNP8NRG221533 carrier status on neuronal activation emerged in the fMRI experiment. Hyperactivation of the superior frontal gyrus (BA 10) was correlated with the number of risk alleles. The fMRI data suggest that performance measures between groups did not differ due to a compensational activation of BA 10 in risk-allele carriers. Our results are in line with functional imaging studies in patients with schizophrenia, which also showed a differential activation in lateral prefrontal areas.

PMID: 18606232 [PubMed - indexed for MEDLINE]

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Recent developments in the psychosocial treatment of adult ADHD.

Expert Rev Neurother. 2008 Oct;8(10):1537-48

Authors: Knouse LE, Cooper-Vince C, Sprich S, Safren SA

Adult attention-deficit/hyperactivity disorder (ADHD) is an increasingly recognized Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV psychiatric disorder associated with significant functional impairment in multiple domains. Although stimulant and other pharmacotherapy regimens have the most empirical support as treatments for ADHD in adults, many adults with the disorder continue to experience significant residual symptoms. In the present manuscript, we review the published studies examining group and individual psychosocial treatments for adult ADHD. We include a discussion of coaching interventions and how they differ from cognitive-behavioral therapy. We conclude that the available data support the use of structured, skills-based psychosocial interventions as a viable treatment for adults with residual symptoms of ADHD. Common elements across the various treatment packages include psychoeducation, training in concrete skills (e.g., organization and planning strategies) and emphasis on outside practice and maintenance of these strategies in daily life. These treatments, however, require further study for replication, extension and refinement. Finally, we suggest future directions for the application of psychosocial treatments to the problems of adults with ADHD.

PMID: 18928346 [PubMed - indexed for MEDLINE]

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Organizational-skills interventions in the treatment of ADHD.

Expert Rev Neurother. 2008 Oct;8(10):1549-61

Authors: Langberg JM, Epstein JN, Graham AJ

Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD.

PMID: 18928347 [PubMed - indexed for MEDLINE]

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Multimodal treatment for childhood attention-deficit/hyperactivity disorder.

Expert Rev Neurother. 2008 Oct;8(10):1573-83

Authors: Kaiser NM, Hoza B, Hurt EA

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, characterized by developmentally inappropriate levels of inattention and/or hyperactivity/impulsivity. These core symptoms lead to impairment in home, school and peer contexts. Evidence-based treatments for ADHD include medication management (generally with stimulant medications), behavioral interventions (such as behavioral parent training, school consultation, and direct contingency management), or the combination of pharmacological and behavioral approaches. This review outlines each of these treatment strategies, reviews the rationale and evidence base currently existing for the use of multimodal rather than unimodal treatments (i.e., medication or behavioral intervention alone), and discusses potential moderators of multimodal treatment efficacy, as well as future directions for research, that may better inform clinical practice.

PMID: 18928349 [PubMed - indexed for MEDLINE]

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Dysphagia in stroke and neurologic disease.

Phys Med Rehabil Clin N Am. 2008 Nov;19(4):867-88, x

Authors: González-Fernández M, Daniels SK

Dysphagia is a common problem in neurologic disease. The authors describe rates of dysphagia in selected neurologic diseases, and the evaluation and treatment of dysphagia in this population. Applicable physiology and aspects of neural control are reviewed. The decision-making process to determine oral feeding versus alternative means of alimentation is examined.

PMID: 18940646 [PubMed - indexed for MEDLINE]

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