To establish the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) when screening externally validated cognition in Parkinson disease (PD), by comparison with a PD-focused test (Scales ...for Outcomes in Parkinson disease-Cognition SCOPA-COG) and the standardized Mini-Mental State Examination (S-MMSE) as benchmarks.
A convenience sample of 114 patients with idiopathic PD and 47 healthy controls was examined in a movement disorders center. The 21 patients with dementia (PD-D) were diagnosed using Movement Disorders Society criteria, externally validated by detailed independent functional and neuropsychological tests. The 21 patients with mild cognitive impairment (PD-MCI) scored 1.5 SD or more below normative data in at least 2 measures in 1 of 4 cognitive domains. Other patients had normal cognition (PD-N).
Primary outcomes using receiver operating characteristic (ROC) curve analyses showed that all 3 mental status tests produced excellent discrimination of PD-D from patients without dementia (area under the curve AUC, 87%-91%) and PD-MCI from PD-N patients (AUC, 78%-90%), but the MoCA was generally better suited across both assessments. The optimal MoCA screening cutoffs were <21/30 for PD-D (sensitivity 81%; specificity 95%; negative predictive value NPV 92%) and <26/30 for PD-MCI (sensitivity 90%; specificity 75%; NPV 95%). Further support that the MoCA is at least equivalent to the SCOPA-COG, and superior to the S-MMSE, came from the simultaneous classification of the 3 PD patient groups (volumes under a 3-dimensional ROC surface, chance = 17%: MoCA 79%, confidence interval CI 70%-89%; SCOPA-COG 74%, CI 62%-86%; MMSE-Sevens item 56%, CI 44%-68%; MMSE-World item 62%, CI 50%-73%).
The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.
The purpose of this study was to expand our previously published sweat normative data/analysis (n = 506) to establish sport-specific normative data for whole-body sweating rate (WBSR), sweat Na
+
, ...and rate of sweat Na
+
loss (RSSL). Data from 1303 athletes were compiled from observational testing (2000-2017) using a standardized absorbent sweat patch technique to determine local sweat Na
+
and normalized to whole-body sweat Na
+
. WBSR was determined from change in exercise body mass, corrected for food/fluid intake and urine/stool loss. RSSL was the product of sweat Na
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and WBSR. There were significant differences between sports for WBSR, with highest losses in American football (1.51 ± 0.70 L/h), then endurance (1.28 ± 0.57 L/h), followed by basketball (0.95 ± 0.42 L/h), soccer (0.94 ± 0.38 L/h) and baseball (0.83 ± 0.34 L/h). For RSSL, American football (55.9 ± 36.8 mmol/h) and endurance (51.7 ± 27.8 mmol/h) were greater than soccer (34.6 ± 19.2 mmol/h), basketball (34.5 ± 21.2 mmol/h), and baseball (27.2 ± 14.7 mmol/h). After ANCOVA, significant between-sport differences in adjusted means for WBSR and RSSL remained. In summary, due to the significant sport-specific variation in WBSR and RSSL, American football and endurance have the greatest need for deliberate hydration strategies.
Abbreviations: WBSR: whole body sweating rate; SR: sweating rate; Na
+
: sodium; RSSL: rate of sweat sodium loss
We investigate the degree to which neurons are fractal, the origin of this fractality, and its impact on functionality. By analyzing three-dimensional images of rat neurons, we show the way their ...dendrites fork and weave through space is unexpectedly important for generating fractal-like behavior well-described by an 'effective' fractal dimension D. This discovery motivated us to create distorted neuron models by modifying the dendritic patterns, so generating neurons across wide ranges of D extending beyond their natural values. By charting the D-dependent variations in inter-neuron connectivity along with the associated costs, we propose that their D values reflect a network cooperation that optimizes these constraints. We discuss the implications for healthy and pathological neurons, and for connecting neurons to medical implants. Our automated approach also facilitates insights relating form and function, applicable to individual neurons and their networks, providing a crucial tool for addressing massive data collection projects (e.g. connectomes).
Based on the NICE guideline 27 and the experience of the GDG. -unintentional and unexplained weight loss -rectal bleeding -a recent change in bowel habit to looser and/or more frequent stools that ...has persisted for more than six weeks in a patient aged over 60 years -a family history of bowel or ovarian cancer Patients should be assessed and clinically examined for the following red flag indicators and be referred to secondary care for further investigation if any of these are present (if cancer is suspected, see the NICE guideline 27 5 ). Based on moderate and high quality diagnostic test data and cost effectiveness data. -ultrasonography -rigid or flexible sigmoidoscopy -colonoscopy -barium enema -thyroid function test -microscopy and culture for faecal ova and parasite -faecal occult blood test -hydrogen breath test (for lactose intolerance and bacterial overgrowth).
Objectives: The question of whether any adverse cognitive or psychosocial outcomes occur after mild head injury in early childhood has evoked considerable controversy. This study examined mild head ...injury before age 10 and potential differences in late childhood/early adolescence as a function of severity of mild injury and age at injury. Methods: A fully prospective longitudinal design tracked a large birth cohort of children. Confirmed cases of mild head injury before age 10 were divided on the basis of outpatient medical attention (n=64–84) or inpatient observation (hospital overnight; n=26–28 ) and compared with the non-injured remainder of the cohort (reference group; n=613–807). A range of pre-injury and post-injury child and family characteristics were used to control for any potential confounds. Outcome after injury before and after age 5 was also assessed. Results: After accounting for several demographic, family, and pre-injury characteristics, the inpatient but not the outpatient group displayed increased hyperactivity/inattention and conduct disorder between ages 10 to 13, as rated by both mothers and teachers. Psychosocial deficits were more prevalent in the inpatient subgroup injured before age 5. No clear effects were evident for various cognitive/academic measures, irrespective of severity of mild injury or age at injury. Conclusions: Most cases of mild head injury in young children do not produce any adverse effects, but long term problems in psychosocial function are possible in more severe cases, perhaps especially when this event occurs during the preschool years. The view that all mild head injuries in children are benign events requires revision and more objective measures are required to identify cases at risk.
Summary
Background
The extent of episodic diarrhoea in the community is relatively unknown.
Aim
To ascertain the prevalence, symptoms and management behaviours associated with self‐reported diarrhoea ...across 11 countries.
Methods
Community screening surveys were conducted using quota sampling of respondents to identify a nationally representative sample of individuals suffering from ‘episodic’ diarrhoea (occurring once a month or more often). Second‐phase in‐depth surveys provided data on epidemiology, symptoms, attributed causes and management of episodic diarrhoea.
Results
A total of 11 508 phase 1 and 6613 phase 2 surveys were completed. The prevalence of self‐reported episodic diarrhoea ranged from 16% to 23% across the 11 countries. The majority of episodic diarrhoea sufferers were female (57%) and were not diagnosed with pre‐existing irritable bowel syndrome (IBS); IBS diagnosis ranged from 9% in Mexico to 44% in Italy. Diarrhoea was frequently attributed to anxiety/stress, food‐related causes, gastrointestinal ‘sensitivity’ and menstruation. Accompanying symptoms included ‘stomach pain/cramping’ (35–62%), ‘stomach grumbling’ (29–68%) and ‘wind’ (18–74%). The proportion of episodic sufferers who reported treating their symptoms with remedies or medications ranged between 46% in Belgium and Canada and 90% in Mexico.
Conclusions
A substantial proportion of the population in middle‐ to high‐income countries report episodic diarrhoea in the absence of a pre‐existing diagnosis. These symptoms are likely to be associated with substantial social and economic costs, and have implications on how best to configure and guide self‐led, pharmacist‐led and primary care management.
The purpose of this study was to determine the effect of stretching on peak jump height during a series of vertical jumps, specifically focusing on a) static stretching (SS), b) dynamic stretching ...(DS) and c) no stretching (NS) performed immediately before a series of countermovement vertical jumps (CMJ). Twelve female collegiate volleyball players (mean +/- SD; age 19.5 +/- 1.1 yr; height 1.71 +/- 0.06 m; mass 71.3 +/- 8.54 kg) volunteered for this study. Data collection lasted a total of 3 weeks, and each subject performed all 3 stretching protocols, 1 session per week, with 1 week between sessions. The order of the stretching protocols was randomized for each subject. During each testing session, all subjects performed a 5-minute light jog as a warm-up, followed by 8 minutes of 1 of the stretching protocols. One minute after the completion of each protocol, 5 maximal CMJ were performed on a force platform, with each jump separated by 1 minute of passive recovery. Jump heights were calculated by integrating the vertical force trace. There were no significant differences between the SS, DS, and NS conditions for any of the jumps (p > 0.05). Despite the lack of significant effects for the group, there were notable individual responses to each of the warm-up conditions. Practitioners should be aware of the individual responses of their athletes to different types of warm-up protocols before athletic performance and the possible impact of prescribing or eliminating certain exercises.
The aim of this study was to describe maximal fat oxidation (MFO) rates in an athletic population.
In total, 1121 athletes (933 males and 188 females), from a variety of sports and competitive level, ...undertook a graded exercise test on a treadmill in a fasted state (≥5 h fasted). Rates of fat oxidation were determined using indirect calorimetry.
The average MFO was 0.59 ± 0.18 g·min, ranging from 0.17 to 1.27 g·min. Maximal rates occurred at an average exercise intensity of 49.3% ± 14.8% V˙O2max, ranging from 22.6% to 88.8% V˙O2max. In absolute terms, male athletes had significantly higher MFO compared with females (0.61 and 0.50 g·min, respectively, P < 0.001). Expressed relative to fat-free mass (FFM), MFO were higher in the females compared with males (MFO/FFM: 11.0 and 10.0 mg·kg·FFM·min, respectively, P < 0.001). Soccer players had the highest MFO/FFM (10.8 mg·kg·FFM·min), ranging from 4.1 to 20.5 mg·kg·FFM·min, whereas American Football players displayed the lowest rates of MFO/FFM (9.2 mg·kg·FFM·min). In all athletes, and when separated by sport, large individual variations in MFO rates were observed. Significant positive correlations were found between MFO (g·min) and the following variables: FFM, V˙O2max, FATMAX (the exercise intensity at which the MFO was observed), percent body fat, and duration of fasting. When taken together these variables account for 47% of the variation in MFO.
MFO and FATMAX vary significantly between athletes participating in different sports but also in the same sport. Although variance in MFO can be explained to some extent by body composition and fitness status, more than 50% of the variance is not explained by these variables and remains unaccounted for.
Cognitive deficits are common in Parkinson's disease (PD), but the range of deficits is variable. The aim of this study was to identify different cognitive subgroups associated with PD.
A broad range ...of neuropsychological measures and cognitive domains were used in a cluster analysis to identify subgroups of patients.
Three subgroups of patients were identified. Compared to controls, one PD subgroup showed no or minimal cognitive impairment (PD-NCI), a second group showed a variable or uncertain pattern of mild to severe cognitive impairments (PD-UCI), and a third group had evidence of severe cognitive impairment across most cognitive domains (mild cognitive impairment; PD-MCI). The subgroups did not differ with regard to age, motor impairment, or disease duration.
Patients with PD are heterogeneous with regard to cognitive presentation and it may be possible to identify patients in the preclinical stage of dementia. The identification of preclinical dementia in PD patients (PD-MCI) provides an opportunity to understand cognitive decline in PD and its progression to dementia.
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