Monthly Archives: May 2010

News Round-Up: May 2010 – 4th Edition

Technology has been used in a variety of innovative ways to improve patient care in different settings. For people with schizophrenia, text messaging to the person helped them to achieve more of their goals in one study (15). In another study, the use of kinematic data collected while people were completing the clock drawing test was helpful in disease categorisation (69). A Chinese study showed benefits for virtual reality cognitive training in  older adults with schizophrenia (18). Also the US Heart Association has approved the use of video games (47). There has also been a call for a discussion of the ethical issues involved in using surveillance technology in homes for people with dementia (71). Other findings of interest included an estimated age of 76 for accelerated hippocampal atrophy in those without dementia (72), the importance of the Hippocampal subfields in PTSD (57), Alzheimer’s Disease and Mild Cognitive Impairment (8) (which is a marker for just how much the resolution of imaging technology is improving), the benefits of cognitive enhancers in reducing grey matter loss in people with schizophrenia, an increase in hippocampal volume after a period of exercise in people with schizophrenia (61), apathy was associated with both functional decline at 13 year follow-up in the Baltimore ECA Longitudinal study (66) and also with risk of cardiovascular events (52). A useful finding was that greater purpose in life was associated with a lower risk of Alzheimer’s Disease at 7-year follow-up (56). An increasing prevalence of dementia is being found in the oldest old (38).  Brain capillaries have been found to clear debris (29). The RedUSE study found benefits from a pharmacist led program in examining prescribing for residents in care homes (73).

The benefits of brushing the teeth on cardiovascular health were identified in one study (45) and this might perhaps be relevant to another study in which there was a high prevalence of dental health problems in community dwelling older adults with mental illnesses compared to a control group (68). There was a finding that I was surprised by – that although grey matter reduces with weight in Anorexia Nervosa, it increases with an increase in weight and it will certainly be interesting to see if these findings are replicated and then to investigate the underlying physiology (26). There is a useful chemistry news resource identified by David Bradley – Chem voice while over at PLOS One there is a paper on how imaging figures are presented in the medical literature. Mind Hacks has another Spike Activity in which VB looks at a recent debate on Dangerous Severe Personality Disorder, as well as looking at ancient Egyptian neuroscience in this article and Inca neuroscience in this article.

A reinterpretation of Mesoamerican civilisation is being brought about by the finding that while Mesoamericans were producing rubber 3600 years ago  they had developed further chemical processes to refine the rubber at this time. They used the rubber in shoes among other applications. There is also an ongoing debate about Ardi (13) – the ‘find of the century’ – around the issue of whether he was more man than ape and whether he was living in woodland or savannah. There is good coverage here. Also an ambitious scientist is attempting to detail the wiring of the brain in what is referred to as the connectome project.

  1. Lit review comparing memantine and ACHEI’s tolerability data
  2. Planning ability predicts cortical thickness in memory-type mild cognitive impairment
  3. EEG + Statistical pattern recognition helpful in identifying Alz D more res needed
  4. Delayed memory index not other tests helpful in distinguishing Alz D and SVasc Dem
  5. Squirrel monkeys develop senile plaques but NE enzyme distribution now characterised
  6. Diffuse Tensor Imaging findings predict risk of Alzheimer’s Disease in small study
  7. cardiovascular risk associated with memory in elderly women
  8. Fascinating – prediction of AD and MCI using hippocampal subdivisions
  9. Genetics and neuroimaging predict memory in Alzheimer’s Disease
  10. Predicting cognitive scores from MRI – ADNI
  11. Automated hippocampal measurement ADNI
  12. Benefits of understanding evolution
  13. Oldest human ancestor or not?
  14. Von Economo cells enable connections with multiple brain regions Small study finds Von Economo neuron density reduced in ACC in early onset schizophrenia compared to controls http://bit.ly/bTyGKu
  15. service SMS txt messgs improve goals achieved for people with schizophrenia in small trial n=62 http://bit.ly/cWu7zv
  16. case-control study – schizophrenia associated with thinner entorhinal cortex http://bit.ly/96glq5
  17. Review of gamma-osciallations, NMDA and schizophrenia http://bit.ly/aRGyrI
  18. small chinese study shows benefit of virtual reality cognitive training in older adults with schizophrenia http://bit.ly/dB1ZBZ
  19. 17% of consecutive outpatients in Co Tyrone study prescribed multiple antipsychotics http://bit.ly/9TIPbl
  20. Diabetes and patterns of antipsychotic prescribing in Japan http://bit.ly/bZYXdH
  21. Spanish study on prevalence of smoking in Schizophrenia and cardiovascular risk (n=1704)
  22. Venkatasubramanian study – case control corpus callosum body/genu smaller in schizophrenia http://bit.ly/br7YCt
  23. rating voices for male dominance http://bit.ly/aNEpiv
  24. complex results of experience in driving for detecting hazards http://bit.ly/aWFy9X
  25. software – Powerpoint – has democratised strategy suggests one researcher http://bit.ly/cHg600
  26. Intriguing! Grey matter volume decreases and increases with weight in this study of Anorexia Nervosa http://bit.ly/aYHJmM
  27. GGA3 protein prevents build up of Alzheimer D related enzyme BACE http://bit.ly/cRwzJj
  28. small study with continuous arterial spin labelling shows reduced frontal + parietal flow in pple with schizophrenia http://bit.ly/cO78zf
  29. murine study suggests that brain capillaries clear debris http://bit.ly/dBOZjd
  30. Nature study reveals new cell involved in neurodevelopment + possibly big human evolution role http://bit.ly/9Y9fxa
  31. ‘Neuron’ study suggests that ‘Junk’ EEG data holds big secrets http://bit.ly/cthEET
  32. German researchers turn astrocytes into neurons http://bit.ly/dakH1z
  33. Amyloid imaging conference http://bit.ly/aZaKjw
  34. Memory stored in DNA via methylation – Nat Neurosci http://bit.ly/9uE2K4
  35. Different causes of psychomotor slowing in Alz D and Lewy Body Dementia http://bit.ly/dgDaoC
  36. 35-year longitudinal study – Assoc between psychological stress in midlife females and later dementia http://bit.ly/aOL78N
  37. small (1)H magnetic resonance spectroscopy imaging suggests involvement of hippocampus in panic disorder http://bit.ly/cEpJP1
  38. Date from 90+ study suggests increasing prevalence of dementia in oldest old http://bit.ly/axowwB
  39. cortical ACh low in PD, MSA- PD and SNP subcortical ACh lower in MSA-PD and PSP http://bit.ly/auKc2C
  40. study suggests more autopsy studies needed to assess FDG-PET in antemortem dementia diagnosis http://bit.ly/cwXPbe
  41. upper + lower extremity performance related to functional performance in Alz D (n=371) http://bit.ly/d2OlcS
  42. comparison of progression in Lewy Body Dementia and Alzheimer’s Disease http://bit.ly/9df8Z6
  43. Kaplan-Meier analysis in Dementia using MMSE scores http://bit.ly/bJt5IQ
  44. Very small study (n=4) shows evidence of benefits of spaced-retrieval on name-face-occupation in ppl with Alz D http://bit.ly/bcxR4S
  45. Brushing teeth and cardiovascular risk http://bit.ly/djFx0b
  46. Should health policy focus on exercise rather than obesity BMJ commentary http://bit.ly/c2g4fH
  47. US heart association approves video games http://bit.ly/bUJgdc
  48. preventing falls in the community BMJ full article http://bit.ly/bCnnJh
  49. Small study finds reduced grey matter loss over 2 years in ppl with schizophrenia on cognitive enhancers http://bit.ly/92buEe
  50. War in Balkans associated with mood disorders http://bit.ly/bgRiwn but not substance misuse.
  51. TMS v Sham. Benefit of TMS in depression (n=199) http://bit.ly/9MRcgT
  52. Is anhedonia another risk factor for cardiac events? http://bit.ly/asZL5u
  53. Facebook group aims to collect 100,000 samples from oil spill http://bit.ly/beHaC5
  54. Evidence for Mild cognitive impairment prodrome in subj mem imp – I suspect there will be many false +ve’s http://bit.ly/99vafk
  55. IOP study grey matter and vulnerability for psychopathy traits http://bit.ly/dkxkkl
  56. Greater purpose in life associated with reduced risk of Alz Dis in 7 year f/u study http://bit.ly/9tluWZ
  57. MRI study shows hippocampus subfield deficits in PTSD http://bit.ly/ddnsOC
  58. Vascular depression hypothesis supported by study – categorisation by wm hyperintensities and neuropsych http://bit.ly/d7vyTS
  59. Frontal striatal and visual systems altered activity in fMRI study of body dysmorphic disorder http://bit.ly/cT8b93
  60. Small placebo-controlled trial – escit assoc with increased cog function post-cva http://bit.ly/b26Byz
  61. Hippocampal volume increase in ppl with schizophrenai after exercise http://bit.ly/cQQX5C
  62. Comparing salaries assoc with less contentment http://bit.ly/bWXoL2
  63. Psychiatrist visit to confused Gorilla in Zoo http://bit.ly/aqTCaU
  64. Higher prevalence of apathy & depression in Alz D than Mild Cog Imp in this study (n=245) http://bit.ly/avSHzo
  65. Brazilian community older adult study (n=15491), prev: Dep – 7%, clin sig dep sx 26%, sig assoc both with cv dis http://bit.ly/czOyeX
  66. Baltimore ECA Long Study – Apathy sig assoc with functional decline at 13-y f/u http://bit.ly/9eookK
  67. Replication needed but systemic rv suggests persistent delirium assoc with hypoxia, del severity among others http://bit.ly/aEXsiw
  68. UK study finds increased dental problems associated with mental illness in community-living older adults http://bit.ly/bODtIk
  69. Kinematic data during clock drawing helpful in classifying disease in older adults http://bit.ly/aNFwkU
  70. Homocysteine assoc with hippocampal atrophy in older adults with hypertension (n=80) http://bit.ly/cs7BXT
  71. Call for discussion of ethical implications of using surveillance technologies in res homes for ppl with dementia http://bit.ly/d9cScU
  72. Age at which hippocampal atrophy accelerates estimated in ppl without dementia (n=544) http://bit.ly/dD2DHq
  73. Australian pharmacist-led RedUse project shows reduction in benzo and antipsych use in nursing homes http://bit.ly/af9NQw
  74. ceiling and floor effects of MMSE explored in Mexican study http://bit.ly/b5vzqc
  75. Systematic review concludes that clock drawing test should not be used as screening tool for mild cog impairment http://bit.ly/beKKVM
  76. Educational theories and older adult liaison psychiatry training provision http://bit.ly/8YQBPN
  77. Interruption of doctors impact on tasks detailed http://bit.ly/cINch6
  78. study looking at supported employment efficacy – free full text http://bit.ly/baO2JC
  79. study shows benefit of early intervention in panic disorder http://bit.ly/9vdj0K
  80. study finds significant differences between psychiatric and non-psychiatric drug adverts in two journals http://bit.ly/aaaca2


Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Dunbar’s Theory on Grooming, Language, Laughter and Music in Human Evolution

I made this short video centred around Professor Dunbar’s very interesting theories on the evolution of language, laughter and music.

[Youtube=http://www.youtube.com/watch?v=jCMXS-ZKf1A]

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Blog Review: Neuroskeptic

The blog reviewed here is the ‘Neuroskeptic‘ blog. In the About section, we learn that the Neuroskeptic is a male neuroscientist in the Uk who describes the blog thus:-

A neuroscientist takes a skeptical look at his own field, and beyond

Appearance and Design

There is a dark/light blue striped background with a central white pane featuring the articles. The title pane lists the blog title in white font on a dark blue background. The articles are titled, dated, comment enabled, tagged and featuring an e-mail option as well as a research blogging icon. The blog can be navigated using the options on the right side of the central pane – chronological archived links and label links. There is an RSS subscription option and external links. Articles are generously and aesthetically illustrated and the overall site design is simple and effective.

Content

There are 250 articles at the time of writing. The Neuroskeptic typically reports on studies in an accessible and engaging style. Here are some of my favourites

Serotonin: Interesting evidence about the effects of a presumed absence of Serotonin from a Plos One paper.

Critiquing Neuroscience explanations: Looking at a study investigating perceptions of psychological and neuroscience explanations.

Voodoo Correlations: I’ve covered this elsewhere but this is part of a classic neuroscience blogosphere episode. I’ve missed of the updates but they’re well worth a look as well.

Ephebiphobia: Worth reading for the 6000 year old comment alone.

The Neuroscience of Niceness: Positive neuroscience.

Salmon fMRI: Reviewing a recent study by Bennett who reports on the fMRI findings in a dead salmon.

Placebo coffee: Self-explanatory.

No more interesting: Umm interesting to note that haven’t been as successful!

Armchair Neuropathologists: Sharing neuropathology data

More on Serotonin deficits.

How I Write. Tips on blogging.

New approach to analysing fMRI: New approach using overlapping areas of functional activation in groups of subjects.

Conclusions

The Neuroskeptic is a well established neuroscience blogger who as the title suggests, takes a skeptical view of the neuroscience research for the purposes of the blog and produces some very interesting engaging posts. The posts above are the ones I found interesting but there are a number of other categories which look at more controversial areas within (clinical) neuroscience and which initiate a lot of discussion. Well worth a look.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Challenges of Personalised Genomics Information for Health Management

The paper reviewed here is ‘From Utopia to Science: Challenges of Personalised Genomics Information for Health Management and Health Enhancement’ by  Hub Zwart, Professor of Philosophy and which is freely available here. I thought it would be interesting to look at this paper because the sequencing of human genomes is becoming increasingly accessible as sequencing technologies improve. Zwart addresses the use of information from the genome and gene therapy. I was particularly interested in the former. Zwart broadens the initial part of his inquiry by examining various forms of biotechnology and referencing Huxley’s classic ‘Brave New World’. He raises some intriguing questions about the evolution of culture and a move away from anthropomorphism. After reading this paper, there were a number of questions that seemed to suggest themselves.

What happens if a person has access to their full genome sequence outside of the medical environment?

Speculating, there are a number of possibilities

- A person will respond appropriately to this knowledge. The appropriate response will vary according to context. Having this level of information is unprecedented and it will take some time to identify what an ‘appropriate’ response is. For instance, it might be usual for a person to have an initial period of focusing on the information followed by a sharp decline in this focus but research will be needed to characterise this response.

- A person might become overly anxious about having this information. Even if they have no known illness disease  related alleles, they might anticipate further information becoming available about their alleles. The information might be incorporated into a prior somatoform disorder. I did a quick medline search combining ‘genetic counselling’ and ‘somatoform’ which produced one reference which didn’t seem too relevant. However a more detailed search might have picked up some relevant papers.

- A person might feel a loss of control if they are found to have a predisposition to a certain illness. Indeed this has been well explored and genetic counselling has been utilised for a number of genetic conditions. Outside of a supportive medical environment if a person learns of newly identified relationships between their alleles and specific diseases they might be unable to judge the appropriate risk.

- There may be a number of reasons why the information may be more complex – genes are differentially expressed in different tissues, there may be small inaccuracies in a genome sequence, the interactions between gene products may be more important than having the disease allele.

How will Health Services respond to Personal Genomics?

While this isn’t the case at the moment, it wouldn’t be too unreasonable to suppose that in 10 years time, a sizeable proportion of the population will have access to their genome sequences. People might approach health services to help them interpret this information. Thus there might be an increasing role for geneticists in managing this aspect of healthcare although this will depend on health service configuration and responses. Additionally primary care may develop specialised services for managing this aspect of healthcare. Within mental health services there may be a role for prevention although any service responses would need to be evidence based. Various studies have identified degrees of risk associated with specific genes but also emphasise the importance of the environment.

How will this impact on culture?

If a person has information to about their genome sequence then one important question is how will this influence their relationship with others? Obviously this will become exceedingly complicated and there will be countless examples that could not have been anticipated. There are a number of broad possibilities. Many people will want to keep this information private as with other aspects of their healthcare information.  Others may advertise this information to others if they think it will be to their advantage and certain self-selected ‘types’ will be known by the genes they do or do not have and it may therefore confer an additional layer of identity.  Many aspects of an emerging genomics culture have been examined in the film ‘Gattaca‘. This information may combine in complex ways with other technologies such as the internet.

One thing is clear and that is that this field will need to be regulated and the ethical implications engaged in ongoing debate.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Behavioral Symptoms and Caregiver Burden in Dementia

The paper reviewed is ‘Behavioral Symptoms and Caregiver Burden in Dementia’ by Shaji and colleagues and freely available here.

Aims: The authors write that

The present study examines the prevalence of BPSD in a community sample of patients with dementia and its impact on the caregivers

Method: The study took place in a rural area in Kerala, India. Trained healthworkers identified cases which were then screened by clinicians using DSM-IV criteria and the Clinical Dementia Rating (CDR) scale. Subjects rated as moderate to severe on the CDR were included in the study. I didn’t notice any exclusion criteria and the population might therefore be representative of a clinical population (albeit with selection bias influencing the sample population characteristics). The subjects were also included in two other studies and three outcome measures were collected

  • BEHAVE-AD.
  • General Health Questionnaire-12.
  • Zaret Burden Interview (ZBI).

The statistical tests used for different data types are clearly stated.

Results:

  • 29 people were included in the study with a mean age of 78.3 and all living at home with their families.
  • The characteristics of the sample are described in table 1. 43.8% of the people received a diagnosis of Alzheimer’s Disease and 34.5% were diagnosed with Vascular Dementia. The other diagnosis or combinations are described. 79.3% of the sample were female.
  • The scores on BEHAVE-AD are described in table 2 with 28 of the subjects meeting the criteria for Behavioural and Psychological Symptoms in Dementia (BPSD). I noted that the standard deviations were relatively large.
  • Table 3 displays the prevalence of items on the BEHAVE-AD subscales. Particularly prominent are delusional ideation and disturbances of activity.
  • In Table 4 the researchers detail the incidence of delusion types.
  • Table 5 shows a comparison of vascular dementia and Alzheimer’s Disease.
  • Table 6 showed the characteristics of no/mild BEHAVE-AD symptoms v moderate/severe BEHAVE-AD symptoms. Here, I thought the significant results perhaps reflected their relationship to the BEHAVE-AD total as they are components.
  • Table 7 displayed the characteristics of 2 samples defined by GHQ score thresholds. There is a significant relationship between increasing GHQ scores and ZBI scores. I thought that causality might be difficult to interpret in view of the cross-sectional nature of the study.

Discussion:

The authors draw a number of conclusions. They note the absence of a relationship between BEHAVE-AD and GHQ-12 scores and suggest that a larger sample size may be helpful in exploring this relationship further.

Conclusions:

I thought this was a small but interesting study in a sample with family based care of people with moderate to severe dementia. There was found to be an association between GHQ scores in carers and ZBI scores although the direction of the link was unclear given the cross-sectional design of this study.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Systematic Review of Safety and Tolerability of Donepezil, Rivastigmine and Galantamine

The paper reviewed here is ‘Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence’ by Lockhart and colleagues and freely available here.

Aim: The aim of the study is clearly outlined and reflected in the title.

Method: The authors identify trials from the following sources

  • Medline database
  • EMBASE
  • Cochrane library

The researchers used the following search terms in MESH and the text of the abstract: Dementia, Alzheimer’s disease, Donepezil, Rivastigmine, Galantamine, cohort, retrospective, naturalistic. The researchers also hand-searched a number of conference proceedings. Primary outcome measures were

  • Incidence of individual AE’s reported
  • Withdrawal due to AE’s
  • Incidence of individual AE’s

The researchers opted for a qualitative analysis rather than a meta-analysis ‘due to potential heterogeneity in included studies’.

Study designs were assessed using the Newcastle-Ottawa Scale which is

designed to appraise the methodological quality of comparative cohort and case control studies

The researchers include a detailed list of inclusion and exclusion criteria in table 1. The impression I got from reading the criteria is that the diagnostic criteria, trial type (essentially randomised trials) and of course treatment were the most significant factors influencing inclusion. Thereafter the inclusion criteria were fairly broad meaning that there was an opportunity to include a relatively large number of papers.

Results: There were a number of steps involved in reaching the final number of 12 papers and the interested reader is referred to the original paper linked to above. The characteristics of the 12 studies are summarised in Table 2. In the identified studies, the numbers for the different acetylcholinesterase inhibitors were

Donepezil: Retrospective analysis – n=6294; Prospective analysis n=4034

Rivastigmine: Retrospective analysis n=1842; Prospective analysis n=2143

Galantamine: Retrospective analysis n=809; Prospective analysis n=418

Table 3 shows withdrawal from the medication to GI effects. There is a wide spread within the prospective study – withdrawal due to any GI AE category although the difference in sample sizes cause difficulties in interpretation. In a number of cases p values are given. I might have missed this, but I couldn’t identify what tests were being used to produce the p-values.

Table 4 shows withdrawal due to all non-GI adverse events. My impression from inspecting this table was that there was a broad range across the studies – both retrospective and prospective and this wasn’t summarised with mean and confidence intervals for aggregated data. Looking through the data further, the figures for withdrawal due to cardiovascular events ranged from 0 to 1.2%.

Table 5 shows an aggregation of GI and non-GI adverse events and here there are a number of consistent findings across various studies particularly in the GI studies although there are outliers in the dataset. Again the data is not pooled although this is explained in the methodology section.

Table 6 shows CNS adverse events. There were a lot of categories here but there were a relatively small number of data points for each category.

Table 7 shows ‘non-CNS-related AE’s’ which covers a number of cardiac and miscellaneous AE’s (excluding GI (with the exception of weight loss)). The De La Gastine study shows a higher incidence of cardiac arrythmias for the different ACHEI’s but has smaller sample sizes than the other studies. Here again I thought the use of confidence intervals and statistical comparison between groups would be helpful.

Conflict of Interest: I couldn’t identify a COI declaration and the authors identify their institutions as Pfizer and Abacus International, a health consultancy firm.

Conclusions: I thought the researchers had gathered a large amount of useful data. It would have been interesting to see the information displayed with the use of confidence intervals and for these to be used in a between-group comparison. Even a lack of difference between groups in itself would have been interesting and I thought would have been helpful in drawing firm conclusions. The researchers discuss why they have opted for a qualitative analysis.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Round-Up: May 2010 – 4th Edition

  • The insertion of artificially-synthesised DNA into a bacterial cell with subsequent establishment of viability has been widely reported in the media (see here, here, here, here and here) and will lead to substantial debate about the ethical implications as well as leading to a vast array of applications. An interesting soundbite from Venter’s presentation is

This is the first self-replicating species that we’ve had on the planet whose parent is a computer

  • One research group has identified a novel pathway involving amyloid plaque mediated excitotoxic cell death in a model of Alzheimer’s Disease which may lead to new therapeutic approaches.
  • There is evidence that build up of Amyloid Beta leads to cataracts in people with Down Syndrome as well as being associated with early onset of Alzheimer’s Disease.
  • One group has identified details of Lithium mediated anti-inflammatory pathways which may contribute to an understanding of Lithium’s mechanism(s) of action.
  • The authors of this study have called for psychiatrists to be included in ‘disaster first-response’ teams on the basis of their findings.
  • A JAMA paper outlines details of a successful suicide reduction program in people with depression. In this population, the suicide rate was reduced by 75% and over a 2.5 year period was 0.
  • A group of physicists have predicted that the magnetic fields associated with ball lightning would be sufficient to stimulate phosphenes, visual experiences secondary to cortical activation which would likely influence the perception of lightning.

Psychiatry 2.0

  • There’s an interesting piece on falling at ABC Therapeutics.
  • In this AJNR post there are useful links to articles on neuroimaging in autism, the development of the cerebral sulci and gyri as well as the neurosurgical uses of Diffuse Tensor Imaging.
  • Stephanie Allen links to online neuroscience videos in this post.
  • Dr Shock links to a video of Richard Dawkins speaking on ageing genes.
  • At the Neuropathology blog there is a look at a phase II study in which Nerve Growth Factor is being injected into the Basal Nucleus of Meynert in subjects with Alzheimer’s Disease.
  • There is a very interesting article on a social media tool for sharing scientific research data – My Experiment – discussed at ‘O’Really‘ and the blogger has been involved in the production of the videos.
  • There is a look at Telehealth at the Singularity Hub.
  • A study finding Thalamic D2 receptor density associations with creativity is covered at Nou Stuff.
  • At Corpus Callosum there is a brief piece on how average hours of TV watching exceeds average hours of working per week in US research.
  • The American Society of Human Genetics has produced an important position paper on genetic ancestry and this is discussed at the Genetic Genealogist blog. An excerpt reads:-

‘Leadership of the human-genetics community, diverse in its interests and its own identities, should develop mechanisms for promoting thoughtful and rigorous use of genetic ancestry estimation in academic research….Leadership of the human-genetics community, diverse in its interests and its own identities, should develop mechanisms for promoting thoughtful and rigorous use of genetic ancestry estimation in academic research’


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