Neurologists, Psychiatrist
34 years of experience

Maedgen Area
Texas Tech University
3601 4th St
Lubbock, TX 79430
806-743-2800
Locations and availability (1)

Education ?

Medical School Score Rankings
University of Michigan Medical School (1976)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Multiple Sclerosis
Appointments
Cleveland Clinic
Associations
American Board of Psychiatry and Neurology

Affiliations ?

Dr. Schiffer is affiliated with 2 hospitals.

Hospital Affilations

Score

Rankings

  • University Medical Center - Lubbock
    602 Indiana Ave, Lubbock, TX 79415
    • Currently 2 of 4 crosses
  • Covenant Health System
  • Publications & Research

    Dr. Schiffer has contributed to 65 publications.
    Title Psychiatry for Neurologists. Preface.
    Date August 2009
    Journal Seminars in Neurology
    Title Depression in Neurological Practice: Diagnosis, Treatment, Implications.
    Date August 2009
    Journal Seminars in Neurology
    Excerpt

    Ambulatory prevalence rates for significant depressive syndromes in general neurology clinics are quite high, in the range of 15 to 20% of clinic attendees. These depressive syndromes are a source of considerable morbidity and even mortality for the patients who suffer from them. Depression is a treatable syndrome, but there are not enough psychiatrists to administer all the treatments. Inevitably, many neurologists will become involved with some antidepressant therapies. In this article, I review a series of steps that can be used by neurologists to diagnose and treat the depressive disorders that occur in their practices. The Goldman algorithm for the treatment of depression is also presented as a therapeutic tool for practicing neurologists.

    Title Involvement of the Thromboxane A2 Receptor in the Regulation of Steroidogenic Acute Regulatory Gene Expression in Murine Leydig Cells.
    Date July 2009
    Journal Endocrinology
    Excerpt

    Recent studies suggested an involvement of thromboxane A2 in cyclooxygenase-2-dependent inhibition of steroidogenic acute regulatory (StAR) gene expression. The present study further investigated the role of thromboxane A2 receptor in StAR gene expression and steroidogenesis in testicular Leydig cells. The thromboxane A2 receptor was detected in several Leydig cell lines. Blocking thromboxane A2 binding to the receptor using specific antagonist SQ29548 or BM567 resulted in dose-dependent increases in StAR protein and steroid production in MA-10 mouse Leydig cells. The results were confirmed with Leydig cells isolated from rats. StAR promoter activity and StAR mRNA level in the cells were also increased after the treatments, suggesting an involvement of the thromboxane A2 receptor in StAR gene transcription. Furthermore study indicated that blocking the thromboxane A2 receptor reduced dosage sensitive sex reversal-adrenal hypoplasia congenita critical region on the X chromosome, gene 1 protein, a transcriptional repressor of StAR gene expression. Specific binding of the antagonists to the receptors on cellular membrane was demonstrated by binding assays using (3)H-SQ29548 and binding competition between (3)H-SQ29548 and BM567. Whereas SQ29548 enhanced cAMP-induced StAR gene expression, in the absence of cAMP, it was unable to increase StAR protein and steroidogenesis. However, when the receptor was blocked by the antagonist, subthreshold levels of cAMP were able to induce maximal levels of StAR protein expression, suggesting that blocking the thromboxane A2 receptor increase sensitivity of MA-10 cells to cAMP stimulation. Taken together, the results from the present and previous studies suggest an autocrine loop, involving cyclooxygenase-2, thromboxane A synthase, and thromboxane A2 and its receptor, in cyclooxygenase-2-dependent inhibition of StAR gene expression.

    Title Clustering and Modeling of Eeg Coherence Features of Alzheimer's and Mild Cognitive Impairment Patients.
    Date May 2009
    Journal Conference Proceedings : ... Annual International Conference of the Ieee Engineering in Medicine and Biology Society. Ieee Engineering in Medicine and Biology Society. Conference
    Excerpt

    Using multiple discriminant analysis (MDA) and k-means clustering, coherence features extracted from the EEGs of a group of 56 subjects were analyzed to assess how feasible an automated coherence-based pattern recognition system that detects Alzheimer's disease (AD) would be. Sixteen of the subjects were AD patients, 24 were mild cognitive impairment (MCI) patients while 16 were age-matched controls. With MDA, an overall classification rate (CR) of 84% was obtained for AD vs. MCI vs. Controls classifications. The high CR implies that it is possible to distinguish between the three groups. The coherence features were also statistically analyzed to derive a neural model of AD and MCI, which indicated that patients with AD may have a greater number of damaged cortical fibers than their MCI counterparts, and furthermore, that MCI may be an intermediary step in the development of AD.

    Title Inhibition of Thromboxane a Synthase Activity Enhances Steroidogenesis and Steroidogenic Acute Regulatory Gene Expression in Ma-10 Mouse Leydig Cells.
    Date March 2008
    Journal Endocrinology
    Excerpt

    The cyclooxygenase-2 (COX2)-dependent inhibition of Leydig cell steroidogenesis has been demonstrated. To understand the mechanism for this effect of COX2, the present study examined the role of an enzyme downstream of COX2, namely thromboxane A synthase (TBXAS), in steroidogenesis. Inhibition of TBXAS activity with the inhibitor furegrelate induced a concentration-dependent increase in cAMP-induced steroidogenic acute regulatory (StAR) protein in MA-10 mouse Leydig cells. The increase in StAR protein occurred concomitantly with a significant increase in steroid hormone production. Similar results were obtained in StAR promoter activity assays and RT-PCR analyses of StAR mRNA levels, suggesting that inhibition of TBXAS activity enhanced StAR gene transcription. These observations were corroborated when TBXAS expression was specifically inhibited by RNA interference. Although the RNA interference reduced mRNA levels of TBXAS, it increased StAR mRNA levels, StAR protein, and steroidogenesis. Additional studies indicated that inhibition of TBXAS activity reduced DAX-1 protein, a repressor in StAR gene transcription. In the absence of cAMP, inhibition of TBXAS activity did not induce a significant increase in steroid hormone and StAR protein. However, addition of a low level of cAMP analogs dramatically increased steroidogenesis. Lastly, inhibition of protein kinase A activity essentially abolished the steroidogenic effect of the TBXAS inhibitor. Thus, the results from the present study suggest that a minimal level of protein kinase A activity is required for the steroidogenic effect of the TBXAS inhibitor and that inhibition of TBXAS activity or its expression increase the steroidogenic sensitivity of MA-10 mouse Leydig cells to cAMP stimulation.

    Title Case-finding for Ms Prevalence Studies in Small Communities Requires a Community-based Approach.
    Date November 2007
    Journal Neuroepidemiology
    Excerpt

    In response to citizen concerns in 5 small Illinois towns, community-based case-finding determined the prevalence of multiple sclerosis (MS). Potential cases were identified through town meetings, publicity, advocacy groups and local volunteer outreach coordinators. Estimated prevalence based on available medical records for self-identifying individuals for 3 of the 5 communities was high (218-231 per 100,000 population) compared to other studies. Scanning databases in medical offices used in many other studies may miss MS cases; yet tracking medical records is labor-intensive and sometimes restricted by privacy guidelines. MS registries could improve case-finding accuracy and efficiency.

    Title The Involvement of Epoxygenase Metabolites of Arachidonic Acid in Camp-stimulated Steroidogenesis and Steroidogenic Acute Regulatory Protein Gene Expression.
    Date December 2006
    Journal The Journal of Endocrinology
    Excerpt

    The essential role of arachidonic acid (AA) in steroidogenesis has been previously demonstrated. The present study continues the investigation into how AA regulates steroidogenesis by examining the effects of epoxygenase-derived AA metabolites on cAMP-stimulated steroidogenic acute regulatory (StAR) gene expression and steroid hormone production in MA-10 mouse Leydig cells. The HPLC analysis of cell extracts from MA-10 cells treated with the cAMP analog dibutyryl cAMP (dbcAMP) demonstrated an increase in three epoxygenase-generated AA metabolites: 5,6-epoxyeicosatrienoic acid (EET), 8,9-EET, and 11,12-EET. Incubating MA-10 cells with each of the EETs induced a dose-dependent increase in StAR protein expression and steroid hormone production in the presence of dbcAMP. These metabolites also significantly enhanced StAR gene transcription as determined by luciferase assays of StAR promoter activity and reverse transcriptase-PCR analysis of StAR mRNA levels. While the EETs enhanced steroidogenesis, inhibiting the activity of protein kinase A (PKA) abolished the stimulatory effects of these AA metabolites on StAR expression and steroid hormone production. This study suggests that cAMP stimulation of MA-10 cells increases epoxygenase-generated AA metabolites and the co-action of these metabolites with PKA significantly increases StAR gene expression and steroid hormone production.

    Title Mexican-american Ethnicity and Cognitive Function: Findings from an Elderly Southwestern Sample.
    Date October 2006
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Relatively little is known about late-life patterns of cognitive function among Hispanics of Mexican heritage who reside in the United States. The authors designed a study to assess the association between Mexican-American ethnicity (defined in terms of childhood and adolescent developmental history) and cognitive function among elderly Mexican-American and non-Hispanic white residents of El Paso County, Texas. Our findings indicate significant associations between the degree of Mexican-American ethnicity and cognitive impairment on all three measures of cognitive function. These statistically significant findings remain after effects of education, age, and gender have been removed from the multiple regression equation. The authors conclude that a dependable and clinically meaningful negative association exists between Mexican-American ethnicity and late-life cognitive function in this region that is mediated by as yet unmeasured variables.

    Title Defining and Diagnosing Involuntary Emotional Expression Disorder.
    Date September 2006
    Journal Cns Spectrums
    Excerpt

    Uncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.

    Title The Differential Diagnosis of Pseudobulbar Affect (pba). Distinguishing Pba Among Disorders of Mood and Affect. Proceedings of a Roundtable Meeting.
    Date August 2005
    Journal Cns Spectrums
    Excerpt

    This monograph summarizes the proceedings of a roundtable meeting convened to discuss pseudobulbar affect (PBA). Two didactic lectures were presented followed by a moderated discussion among 11 participants. Post-meeting manuscript development synthesized didactic- and discussion-based content ad incorporated additional material from the neuroscience literature. A conceptual framework with which to distinguish between disorders of mood and affect is presented first, and disorders of affect regulation are then reviewed briefly. A detailed description of the most common of these disorders, PBA, is the focus of the remainder of the monograph. The prevalence, putative neuranatomic and neurochemical bases of PBA are reviewed, and current and emerging methods of evaluation and treatment of persons with PBA are discussed. The material presented in this monograph will help clinicians better recognize, diagnose, and treat PBA, and will form a foundation for understanding and interpreting future studies of this condition.

    Title Retrospective Review of Modafinil Use for Cerebral Palsy.
    Date April 2005
    Journal Journal of Child Neurology
    Excerpt

    A retrospective review was undertaken at Texas Tech University Health Sciences Center regarding the use of modafinil for the treatment of spasticity associated with cerebral palsy. Neurology clinic records were reviewed from January 1, 2000, until October 1, 2001. Thirty pediatric patients with cerebral palsy were identified who were treated empirically with modafinil during this time period. Twenty-three (76%) patients reported diminished spasticity with treatment, which was confirmed by physical examination; these patients had improved joint mobility. Seventeen (56%) patients continued treatment with modafinil by the end of the formal review period (September 30, 2001). Twenty-three percent (seven) of the patients stopped taking modafinil during the study owing to one of the following: decreased sleep time (four), decreased appetite (one), hyperactivity, and irritability (two). Thus, this retrospective review shows a reduction in spasticity from cerebral palsy, with only minor and reversible side effects noted from modafinil. A blinded, crossover study using modafinil for spastic cerebral palsy is planned.

    Title Neuropsychiatry: a Management Model for Academic Medicine.
    Date November 2004
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Neuropsychiatry has become the subject of a number of editorials and position papers in recent years. Historical, philosophical, clinical, scientific, and educational dimensions of neuropsychiatry have been discussed in these papers. The potential business aspects of this topic, however, have received little, if any, comment. In this paper, the authors describe the business performance characteristics of an integrated neuropsychiatry department, formed through the merger of two traditional departments of psychiatry and neurology. The merger of neurology and psychiatry to create an integrated neuropsychiatry department according to the model described produced significant improvement in financial performance.

    Title Copolymer 1 Reduces Relapse Rate and Improves Disability in Relapsing-remitting Multiple Sclerosis: Results of a Phase Iii Multicenter, Double-blind, Placebo-controlled Trial. 1995.
    Date April 2002
    Journal Neurology
    Title Extended Use of Glatiramer Acetate (copaxone) is Well Tolerated and Maintains Its Clinical Effect on Multiple Sclerosis Relapse Rate and Degree of Disability. 1998 [classical Article]
    Date April 2002
    Journal Neurology
    Title A Multiple Sclerosis Cluster Associated with a Small, North-central Illinois Community.
    Date January 2002
    Journal Archives of Environmental Health
    Excerpt

    The authors investigated a reported incidence cluster of multiple sclerosis (MS) cases in a small, north-central Illinois community to determine validity and statistical significance. DePue, Illinois--a small, north-central Illinois community--has previously been the site of significant environmental heavy-metal exposure from a zinc smelter. Significant contamination of soil and water with zinc and other metals has been documented in this community during the time period of interest. In the mid-1990s, several cases of MS were reported to the Illinois Department of Public Health within the geographic limits of this community. Available medical records from purported MS cases reported to the Illinois Department of Public Health were reviewed, and living individuals were seen and examined. Statistical analyses were conducted with clinically definite MS cases; onset dates were determined by first symptom, and expected incidence rates were determined from published epidemiologic studies. Nine new cases of clinically definite MS occurred among residents of DePue, Illinois, during the period between 1971 and 1990. Seven of the 8 living subjects included in the final analyses were examined by one author (RS). The computed incidence rate deriving from these cases within DePue Township, Illinois, represented a statistically significant excess of new MS cases over expected. During the period from 1971 through 1990, a significant excess of MS cases occurred within the population of DePue, Illinois. Significant exposure of this population to mitogenic trace metals, including zinc, was also documented during this time period.

    Title Recurrent Neural Network-based Approach for Early Recognition of Alzheimer's Disease in Eeg.
    Date August 2001
    Journal Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
    Excerpt

    OBJECTIVE: We explored the ability of specifically designed and trained recurrent neural networks (RNNs), combined with wavelet preprocessing, to discriminate between the electroencephalograms (EEGs) of patients with mild Alzheimer's disease (AD) and their age-matched control subjects. METHODS: Twomin recordings of resting eyes-closed continuous EEGs (as well as their wavelet-filtered subbands) obtained from parieto-occipital channels of 10 early AD patients and 10 healthy controls were input into RNNs for training and testing purposes. The RNNs were chosen because they can implement extremely non-linear decision boundaries and possess memory of the state, which is crucial for the considered task. RESULTS: The best training/testing results were achieved using a 3-layer RNN on left parietal channel level 4 high-pass wavelet subbands. When trained on 3 AD and 3 control recordings, the resulting RNN tested well on all remaining controls and 5 out of 7 AD patients. This represented a significantly better than chance performance of about 80% sensitivity at 100% specificity. CONCLUSION: The suggested combined wavelet/RNN approach may be useful in analyzing long-term continuous EEGs for early recognition of AD. This approach should be extended on larger patient populations before its clinical diagnostic value can be established. Further lines of investigation might also require that EEGs be recorded from patients engaged in certain mental (cognitive) activities.

    Title Anxiety Disorders in Parkinson's Disease: Insights into the Neurobiology of Neurosis.
    Date March 2000
    Journal Journal of Psychosomatic Research
    Title Parkinson's Disease: a Preliminary Study of Yohimbine Challenge in Patients with Anxiety.
    Date July 1999
    Journal Clinical Neuropharmacology
    Excerpt

    In this pilot study, we performed an oral yohimbine challenge in 6 patients with Parkinson's disease (PD) and anxiety or depression, 2 parkinsonian patients without psychiatric illness, and 2 healthy control subjects to determine whether patients with Parkinson's disease and anxiety respond to this adrenergic agent in the same way patients with idiopathic anxiety disorders respond. Given the atypical nature of depression in Parkinson's disease (characterized by prominent anxiety), we also wanted to see if patients with Parkinson's disease and depression (but no history of anxiety) are susceptible to yohimbine-induced panic. Parkinsonian patients with anxiety developed panic attacks at frequencies comparable to primary psychiatric patients with panic disorder. The one patient with PD and a history of major depression alone developed a panic attack. Regardless of their history of anxiety or depression, parkinsonian patients demonstrated a vulnerability to yohimbine-induced somatic symptoms.

    Title Neuropsychologic Status in Multiple Sclerosis After Treatment with Glatiramer.
    Date April 1999
    Journal Archives of Neurology
    Excerpt

    BACKGROUND: Glatiramer acetate (Copaxone) therapy reduces clinical disease activity in relapsing-remitting multiple sclerosis (MS). OBJECTIVE: To study the effect of glatiramer therapy on neuropsychologic function as part of a randomized, placebo-controlled, multicenter trial. METHODS: Two hundred forty-eight patients with relapsing-remitting MS and mild to moderate disability (Expanded Disability Status Scale score, <5.0) were tested before and 12 and 24 months after randomization to administration of glatiramer acetate, 20 mg/d, or matching placebo. Neuropsychologic tests examined 5 cognitive domains most often disrupted in patients with MS: sustained attention, perceptual processing, verbal and visuospatial memory, and semantic retrieval. RESULTS: Baseline neuropsychologic test performance was similar in both treatment groups and was within normal range, except for impaired semantic retrieval. Mean neuropsychologic test scores were higher at 12 and 24 months than at baseline, and no differences were detected between treatment groups over time. No significant interactions were detected between treatment and either time or baseline impairment. CONCLUSIONS: Our 2-year longitudinal study showed no effect of glatiramer therapy on cognitive function in relapsing-remitting MS. Although it is possible that glatiramer therapy has no effect on cognitive function, the lack of measurable decline in cognitive function in both patient groups for 2 years limits the opportunity for glatiramer to demonstrate a therapeutic effect by minimizing such decline. Emerging treatments for MS should continue to be examined for their effect on cognitive impairment because it can be a critical determinant of disability. A greater understanding of the natural history of cognitive decline in MS is essential for a rational design of these drug trials.

    Title Lewy Body Disease: Can We Diagnose It?
    Date February 1999
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    The authors assessed the accuracy of published clinical criteria and their own modifications of those criteria in diagnosing Lewy body disease (LBD). Clinical diagnoses were made by two clinicians, blinded to neuropathologic diagnoses, using the Rochester Alzheimer's Disease Center database and traditional medical records. Neuropathologic diagnoses were made according to published guidelines. Results from 21 Alzheimer's disease and 18 LBD patients indicated that no set of clinical criteria was accurate in diagnosing LBD. The only significant predictor of LBD in this population was depression, which was more common in LBD than in Alzheimer's disease. The authors conclude that clinical identification of LBD is an important but unresolved neurological problem.

    Title A Review of Lewy Body Disease, an Emerging Concept of Cortical Dementia.
    Date November 1998
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Dementia associated with cortical Lewy bodies on neuropathologic examination may comprise the second largest category of age-related cognitive impairment, after Alzheimer's disease. Despite its prevalence, a consensus has not yet been reached regarding the terminology, neuropathologic criteria, or clinical symptomatology of this postulated nosologic entity. Lewy body disease (LBD) is beginning to be diagnosed clinically in neuropsychiatric clinics, but universally accepted diagnostic criteria for LBD remain to be validated. In this article the authors review the literature on LBD, including both neuropathologic and clinical findings.

    Title Extended Use of Glatiramer Acetate (copaxone) is Well Tolerated and Maintains Its Clinical Effect on Multiple Sclerosis Relapse Rate and Degree of Disability. Copolymer 1 Multiple Sclerosis Study Group.
    Date April 1998
    Journal Neurology
    Excerpt

    When 251 relapsing-remitting patients with multiple sclerosis were randomized to receive daily subcutaneous injections of glatiramer acetate, previously called copolymer 1 (Copaxone; n = 125) or placebo (n = 126) for 24 months, there were no laboratory abnormalities associated with glatiramer acetate treatment and it was well tolerated with few side effects. Patients receiving glatiramer acetate had significantly fewer relapses and were more likely to be neurologically improved, whereas those receiving placebo were more likely to worsen. This study was extended for 1 to 11 months (mean of 5.2 months for the glatiramer acetate group and 5.9 months for the placebo group). The blinding and study conditions used during the core 24-month study were unchanged throughout the extension. The results of this extension study confirm the excellent tolerance and safety profile of glatiramer acetate for injection. The clinical benefit of glatiramer acetate for both the relapse rate and for neurologic disability was sustained at the end of the extension trial.

    Title Anxiety and Parkinson's Disease.
    Date April 1997
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Anxiety disorders, particularly generalized anxiety, panic, and social phobia, occur in up to 40% of patients with Parkinson's disease (PD). This rate is higher than in normal or other disease comparison populations. Current evidence suggests that anxiety may not be a psychological reaction to the illness but rather may be linked to specific neurobiologic processes accompanying PD. Anxiety in PD often coexists with depression. The optimal pharmacologic treatment for anxiety in patients with PD has not been established, but available information about the use of anxiolytics in PD is reviewed. Further study of the relationship between anxiety and PD may provide an excellent opportunity to clarify the neurobiologic substrate of anxiety itself.

    Title Conditioning of Cyclophosphamide-induced Leukopenia in Humans.
    Date April 1997
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    This study evaluated whether decrements in peripheral leukocyte counts induced by cyclophosphamide can be conditioned in humans. Ten subjects being treated for multiple sclerosis received four intravenous treatments with cyclophosphamide (unconditioned stimulus) paired with a conditioned stimulus. Subjects received conditioned stimulus plus 10 mg of cyclophosphamide during one of the next two treatments in a double-blind manner. Eight of 10 subjects (P = 0.044) displayed decreased peripheral leukocyte counts following conditioned stimulus. This change may have resulted from classical conditioning processes.

    Title Psychiatric Features in Diffuse Lewy Body Disease: a Clinicopathologic Study Using Alzheimer's Disease and Parkinson's Disease Comparison Groups.
    Date December 1996
    Journal Neurology
    Excerpt

    We conducted a retrospective study to determine the frequency of depression, hallucinations, and delusions in patients with diffuse Lewy body disease (DLBD) and to compare these findings with those in Alzheimer's disease (AD) and Parkinson's disease (PD). One hundred twelve subjects were included in the study. Of these, 28 subjects were diagnosed with DLBD, 58 with AD, and 26 with PD at autopsy. Main outcome measures included the percentages of subjects in each of the three categories in whom depression, hallucinations, or delusions were reported at any time during the course of the illness. Hallucinations and delusions were further classified by type. We found that depression was more common in DLBD (50.0%) than in AD (13.8%) (chi 2 = 13.00, p = 0.0003). There was no difference in the frequency of depression in DLBD and PD (57.7%) (chi 2 = 0.32, p = 0.57). Hallucinations were reported more frequently in DLBD (60.7%) than in AD (34.5%) (chi 2 = 5.30, p = 0.021). There was no difference in the frequency of hallucinations in DLBD and PD (53.8%) (chi 2 = 0.26, p = 0.61). Delusions were more common in DLBD (57.1%) than in PD (15.4%) (chi 2 = 10.08, p = 0.0015). There was no difference in the frequency of delusions in DLBD and AD (53.4%) (chi 2 = 0.10, p = 0.75). There was a male predominance of DLBD cases and PD cases; AD cases were predominantly women. We conclude that psychiatric features are very common in DLBD and should be a central diagnostic criterion for the disease.

    Title Incorrect Diagnosis of Alzheimer's Disease. A Clinicopathologic Study.
    Date April 1996
    Journal Archives of Neurology
    Excerpt

    OBJECTIVES: To examine the accuracy of clinical diagnoses of Alzheimer's disease (AD) in subjects enrolled in the Rochester Alzheimer's Disease Project (RADP) who were examined at autopsy, and to present a list of clinical "red flags." DESIGN: Autopsy examination of both prospective and retrospective subjects consecutively enrolled in this clinicopathologic study of the RADP. SETTING: University hospital and research center, using a multidisciplinary geriatric neurology clinic, satellite clinics, nursing home visits, and home visits. PATIENTS: One hundred seventy subjects clinically diagnosed as having AD who were enrolled in the RADP between 1983 and 1993 underwent neuropathologic examination. Of these, 93 had been enrolled prospectively and 77 retrospectively. MAIN OUTCOME MEASURES: Agreement between clinical and pathologic diagnoses. RESULTS: One hundred forty-nine subjects of 170 clinically diagnosed as having AD fulfilled the pathologic criteria for AD, yielding an accuracy rate of 88%. Of 93 subjects enrolled prospectively and diagnosed as having AD, 83 (90%) met the histologic criteria for AD. Of the 77 subjects enrolled retrospectively, neuropathologic examination indicated definite AD in 66 (86%). CONCLUSIONS: There was a high correlation between clinicians' diagnoses and final pathologic diagnoses. The most common clinical errors involved the misdiagnosis of dementias due to Parkinson's disease and cerebrovascular disease. There was no significant difference in the accuracy rates of subjects enrolled prospectively and retrospectively.

    Title The Interaction Between Depressive Affective Disorder and Neuropsychological Test Performance in Multiple Sclerosis Patients.
    Date December 1995
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Cognitive impairment of mild-to-moderate severity is known to occur among a large proportion of patients with multiple sclerosis (MS). Depressive affective disturbances are also known to occur commonly among these patients. In order to determine the degree of interaction between mood disturbance and cognitive impairment, we conducted a test-retest neuropsychological study of 11 MS patients with current major depression diagnosed by Research Diagnostic Criteria. Patients were tested while depressed and at another point while euthymic. Nine patients were assessed first in a depressed state, followed by a reevaluation in the euthymic state, and two were assessed first in the euthymic state. The mean time interval between assessments was 7 months. When cognitive performance in the depressed condition was compared with cognitive performance in the euthymic condition, no significant differences were found. There was evidence for a pattern of improvement in verbal memory tests that fell short of statistical significance. Some language-related cognitive functions actually deteriorated during the 6-month course of this study.

    Title Copolymer 1 Reduces Relapse Rate and Improves Disability in Relapsing-remitting Multiple Sclerosis: Results of a Phase Iii Multicenter, Double-blind Placebo-controlled Trial. The Copolymer 1 Multiple Sclerosis Study Group.
    Date August 1995
    Journal Neurology
    Excerpt

    We studied copolymer 1 (Copaxone) in a multicenter (11-university) phase III trial of patients with relapsing-remitting multiple sclerosis (MS). Two hundred fifty-one patients were randomized to receive copolymer 1 (n = 125) or placebo (n = 126) at a dosage of 20 mg by daily subcutaneous injection for 2 years. The primary end point was a difference in the MS relapse rate. The final 2-year relapse rate was 1.19 +/- 0.13 for patients receiving copolymer 1 and 1.68 +/- 0.13 for those receiving placebo, a 29% reduction in favor of copolymer 1 (p = 0.007) (annualized rates = 0.59 for copolymer 1 and 0.84 for placebo). Trends in the proportion of relapse-free patients and median time to first relapse favored copolymer 1. Disability was measured by the Expanded Disability Status Scale (EDSS), using a two-neurologist (examining and treating) protocol. When the proportion of patients who improved, were unchanged, or worsened by > or = 1 EDSS step from baseline to conclusion (2 years) was evaluated, significantly more patients receiving copolymer 1 were found to have improved and more receiving placebo worsened (p = 0.037). Patient withdrawals were 19 (15.2%) from the copolymer 1 group and 17 (13.5%) from the placebo group at approximately the same intervals. The treatment was well tolerated. The most common adverse experience was an injection-site reaction. Rarely, a transient self-limited systemic reaction followed the injection in 15.2% of those receiving copolymer 1 and 3.2% of those receiving placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Zinc and Multiple Sclerosis.
    Date November 1994
    Journal Neurology
    Title A Genetic Marker and Family History Study of the Upstate New York Multiple Sclerosis Cluster.
    Date March 1994
    Journal Neurology
    Excerpt

    We report nine additional cases of new-onset multiple sclerosis (MS) among employees of an upstate New York manufacturing plant that uses zinc as a primary metal. These cases, identified during the decade 1980 to 1989, had clinical onset of the disease between 1979 and 1987. The new cases confirm the increased incidence of MS previously reported in the plant population for the 1970 to 1979 decade. The MS subjects in this occupationally based cluster do not seem different from other MS patients with regard to rates of familial MS or the frequencies of alleles for human leukocyte (HLA-DR) antigens or transferrin. The frequency distribution of alleles for transferrin (an iron- and zinc-binding protein) may differ in these and other MS subjects compared with controls.

    Title Clinical Diagnosis of Multiple Sclerosis. The Impact of Magnetic Resonance Imaging and Ancillary Testing. Rochester-toronto Magnetic Resonance Study Group.
    Date February 1994
    Journal Archives of Neurology
    Excerpt

    OBJECTIVE: Magnetic resonance imaging, computed tomography, cerebrospinal fluid analysis, and evoked potential testing are used to assist in the diagnosis of patients suspected to have multiple sclerosis (MS). The impact of these tests on a clinician's diagnosis of patients suspected to have MS has not been studied systematically. DESIGN: Clinicians made a diagnosis of each patient following clinical evaluation, again after reviewing the results of magnetic resonance imaging, and finally after reviewing information from other laboratory testing. These diagnoses were compared with the criterion standard of a masked "gold standard" panel reviewing all information after a mean follow-up of 0.9 year. SETTING: The General Neurology Clinic and Multiple Sclerosis Clinic of the University of Rochester (NY). PATIENTS: A consecutive sample of 62 patients diagnosed as having either possible or probable MS following clinical evaluation. MAIN OUTCOME MEASURE: Changes in diagnostic certainty of clinicians following incremental presentation of new laboratory data and the accuracy of such diagnoses. RESULTS: Clinicians used magnetic resonance imaging findings to diagnose definite MS or to eliminate MS from diagnostic consideration in 44% of cases. In these cases, further laboratory testing did not alter clinicians' decisions. In the remaining 56% of cases, in which magnetic resonance imaging did not lead to a diagnosis of definite MS or eliminate MS from diagnostic consideration, further laboratory testing led to such diagnoses in an additional 13% of cases. Gold standard diagnoses were in agreement with the clinician's assessments. CONCLUSIONS: Magnetic resonance imaging aids in the evaluation of patients suspected to have MS; other subsequent studies (computed tomography, cerebrospinal fluid analysis, and evoked potential testing) have less impact. After all studies are performed, about half of such patients still have a tentative diagnosis.

    Title Perils and Pitfalls of Magnetic Resonance Imaging in the Diagnosis of Multiple Sclerosis. The Rochester-toronto Mri Study Group.
    Date July 1993
    Journal Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
    Excerpt

    Purpose. Magnetic resonance imaging (MRI) has come to assume a position of major importance in the diagnostic process for multiple sclerosis (MS). The authors believe that a tendency toward overreliance on MRI results in isolation from clinical findings continues to result in both false-positive and false-negative diagnostic errors. Methods. To evaluate this, MRI results in newly referred patients with clinical findings suggestive, but not diagnostic, for MS, were studied prospectively. Results. Of 99 consecutive referrals for suspected MS, there were 3 false-positive diagnoses of MS and 7 false-negatives, when the MRIs were read in isolation from specific clinical data. None of the scans in the false-negative groups were normal. Representative images of both groups are provided. Conclusion. In newly referred patients who fall short of criteria for definite MS, it remains dangerous for both clinicians and radiologists to rely too heavily only on MRI results.

    Title Defining Neuropsychiatry: Professional Activities and Opinions of Psychiatrist-neurologists with Dual Certification.
    Date August 1992
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    A computer-based search was conducted to locate physicians jointly certified by the American Board of Psychiatry and Neurology in both adult psychiatry and adult neurology since 1960. Eighty-six such physicians were found, and a survey concerning their practice patterns and opinions was conducted. From this survey, it appears that a number of "supraspecialized" neuropsychiatrists are involved in clinical activities that overlap the traditional limits of neurology and psychiatry.

    Title The Effects of Exposure to Dietary Nickel and Zinc Upon Humoral and Cellular Immunity in Sjl Mice.
    Date November 1991
    Journal Journal of Neuroimmunology
    Excerpt

    We are interested in potential interactions between environmental trace metal exposures and immune function. In particular, we have wondered whether dietary exposure to nickel and zinc cations can influence T and B cell proliferation and function. To study this question, we fed SJL female mice supplemental nickel and zinc sulfate from 4-8 weeks of age, and immunized the animals intraperitoneally (i.p.) with keyhole limpet hemocyanin (KLH) at 8 weeks. Eight days later, we measured antibody responses to KLH. Both IgG and IgM antibody responses to KLH were significantly depressed in vivo in the nickel fed animals (p less than 0.005). In vitro antigenic responsiveness to KLH of splenocytes from nickel fed animals was also depressed compared with control and zinc supplemented animals (p less than 0.002). This altered antigenic responsiveness persisted even after cells had been cultured for 5 days in standard media. The zinc supplemented diets did not seem to affect antibody responsiveness and proliferation. The proliferative responses of B cells to the mitogen lipopolysaccharide (LPS) were significantly depressed in Ni fed mice, but were not affected in the zinc fed animals. T cell mitogenic responses to concanavalin A were not affected in the nickel fed animals, and were enhanced in zinc fed animals. We conclude that dietary exposure to certain trace metals may induce persisting alterations in immunity in this animal model.

    Title Abnormal Vitamin B12 Metabolism in Human Immunodeficiency Virus Infection. Association with Neurological Dysfunction.
    Date April 1991
    Journal Archives of Neurology
    Excerpt

    An increased prevalence of vitamin B12 deficiency has been reported in patients infected by the human immunodeficiency virus (HIV). We report an unexpectedly high prevalence (20%) of such abnormal vitamin B12 metabolism in a population of HIV-infected patients referred for neurological evaluation. This abnormality was associated with both peripheral neuropathy and myelopathy. A majority of those treated with cyanocobalamin had a therapeutic response. Selected neuropathological results suggest a relationship between vitamin B12 deficiency and vacuolar myelopathy. Vitamin B12 deficiency may be a frequent and treatable cause of neurological dysfunction in patients with HIV infection.

    Title Effects of Altered Dietary Trace Metals Upon Experimental Allergic Encephalomyelitis.
    Date March 1991
    Journal Neurotoxicology
    Excerpt

    In this study, we report initial results concerning the effects of elevated dietary trace metals upon delayed relapsing experimental allergic encephalomyelitis (EAE) in SJL mice. Animals were assigned to a control diet as well as to diets with increased content of NiS0(4) and ZnS0(4) prior to immunization for EAE. During a six month follow-up period, trends appeared which indicated that the incidence of EAE might be lower in the nickel-fed animals than in the comparison groups. EAE onset also seemed to occur later in the nickel group. Histopathologic ratings of standardized tissue sections suggested more widespread inflammatory disease of the central nervous system in the high zinc group.

    Title Depressive Syndromes Associated with Diseases of the Central Nervous System.
    Date January 1991
    Journal Seminars in Neurology
    Title Antidepressant Pharmacotherapy of Depression Associated with Multiple Sclerosis.
    Date November 1990
    Journal The American Journal of Psychiatry
    Excerpt

    In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder, 14 patients were randomly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy. Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group. This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores. Side effects limited desipramine dosage in half of the treated patients. The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease.

    Title Affective Disorders in Multiple Sclerosis. Review and Recommendations for Clinical Research.
    Date February 1990
    Journal Archives of Neurology
    Excerpt

    This review of research on affective disorders in multiple sclerosis was prepared by members of the Cognitive Function Study Group of the National Multiple Sclerosis Society (New York, NY) to call attention to the prevalence and seriousness of emotional disturbances in multiple sclerosis, and to encourage further investigation of these syndromes. We present English-language studies of euphoria, pathological laughing and weeping, depression, and bipolar disorder, describe methodological limitations, and suggest areas for future clinical research.

    Title Neurologic Manifestations of Human Immunodeficiency Virus Infections.
    Date October 1989
    Journal Neurologic Clinics
    Excerpt

    HIV infection is becoming more common. The recognition of HIV-related neurologic disease is also increasing. Both the central and peripheral nervous systems are affected by HIV infection. Although much of the pathophysiology remains to be elucidated, some of the neurologic syndromes are probably due to direct HIV infection. The most common CNS syndrome, the subacute encephalopathy, appears to be caused by HIV infection. Other cerebral syndromes are caused by viral, fungal, and protozoan opportunistic infections. Current specific therapy is available for many of these infections. Aside from zidovudine, only experimental therapies are currently available for primary HIV infection. Less attention has been focused on the neuromuscular complications of HIV infection. They are probably more common than initially reported. Specific therapies for both inflammatory demyelinating neuropathies and myopathy related to HIV infection are reported. The pathophysiology of these disorders remains incompletely defined. As the population of HIV infected individuals continues to grow, the incidence of coincidental non-HIV neurologic disease will also rise. Attention must be directed to identifying coexistent remediable causes of neurologic dysfunction in this population.

    Title Multiple Sclerosis and Affective Disorder. Family History, Sex, and Hla-dr Antigens.
    Date December 1988
    Journal Archives of Neurology
    Excerpt

    To investigate a possible genetic cause underlying the clinical association between multiple sclerosis (MS) and affective disorder, we studied 56 patients with MS for psychiatric and genetic (family history, sex, and HLA-DR) characteristics. The 2:1 ratio of females to males expected for patients with MS was observed in this sample (40:16), but the excess of females occurred entirely among the 31 MS patients with major affective disorder (27 females and four males). Bipolar probands with MS had significantly more relatives with affective disorder or MS than did unipolar probands with MS. The HLA-DR antigen frequencies in patients with MS categorized by type and family history of affective disorder suggest that it may be possible to validate such clustering of patients. We concluded that sex and other genetic factors are related to the affective symptoms in MS and emphasize the importance of psychiatric evaluation of these patients.

    Title Drug Treatment of Multiple Sclerosis.
    Date October 1988
    Journal Seminars in Neurology
    Title Pharmacology of Behavioral Syndromes in Neurology.
    Date October 1988
    Journal Seminars in Neurology
    Title Evidence for Atypical Depression in Parkinson's Disease.
    Date August 1988
    Journal The American Journal of Psychiatry
    Excerpt

    The Research Diagnostic Criteria were applied to 16 depressed patients with Parkinson's disease and 20 depressed multiple sclerosis patients. Diagnoses of anxiety and panic disorder were significantly more frequent among the patients with Parkinson's disease. These patients may experience atypical depression.

    Title Multiple Sclerosis and the Workplace: Report of an Industry-based Cluster.
    Date November 1987
    Journal Neurology
    Excerpt

    Eleven cases of MS occurred within a 10-year period in a zinc-related manufacturing plant. The observed disease incidence was greater than expected from population data, using multiple approaches to statistical analysis (p less than or equal to 0.01). A case-control study, performed to examine several zinc parameters in blood, failed to indicate specific abnormalities among the MS patients, but all subjects (both MS and controls) working in the plant demonstrated higher serum zinc levels than all subjects (MS and controls) not working there.

    Title Quantitative Determination of Ms-induced Corpus Callosum Atrophy in Vivo Using Mr Imaging.
    Date September 1987
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    To quantitate the extent of corpus callosum atrophy in multiple sclerosis, midsagittal corpus callosum areas were determined in 48 controls with normal MR scans and 41 patients with definite multiple sclerosis. The mean midsagittal corpus callosum area was 601 mm2 (range 405-791), 641 mm2, and 561 mm2 for all adult controls, for adult males, and for adult females, respectively. Control values were significantly greater than the means determined for all multiple sclerosis (MS) patients (508 mm2, range 281-758), for MS men (528 mm2), or for MS women (498 mm2). The degree of corpus callosum atrophy paralleled the estimated volume of periventricular and corpus callosum high-signal lesions, suggesting a possible cause-effect relationship. The results indicate that corpus callosum atrophy occurs commonly in patients with typical clinical forms of multiple sclerosis.

    Title The Spectrum of Depression in Multiple Sclerosis. An Approach for Clinical Management.
    Date June 1987
    Journal Archives of Neurology
    Excerpt

    Twenty patients with clinically definite multiple sclerosis who experienced major depressive episodes according to Research Diagnostic Criteria are described. The heterogeneous quality of these depressive episodes is presented by categorizing the episodes according to ten Research Diagnostic Criteria depressive subtypes. Four interpersonal management strategies for such patients that are applicable within a neurologic practice setting are described. The most important feature concerning prognosis for these depressive episodes appears to be the relationship between the depressive episode and the underlying demyelinating disease. When depression occurred in the setting of clinically significant disease activity, the outcome was usually favorable.

    Title Epilepsy, Psychosis, and Forced Normalization.
    Date March 1987
    Journal Archives of Neurology
    Title Corpus Callosum and Subcallosal-periventricular Lesions in Multiple Sclerosis: Detection with Mr.
    Date August 1986
    Journal Radiology
    Excerpt

    Examination with magnetic resonance imaging of 40 patients with confirmed diagnoses of multiple sclerosis showed that corpus callosum involvement is common. Thirty percent of the patients had focal callosal lesions similar to those described in the pathology literature. Long, inner callosal-subcallosal lesions were found in 55% of patients. These lesions had signal characteristics similar to those of noncallosal periventricular lesions. Diffuse moderate to severe atrophy of the corpus callosum was noted in 40% of patients, with one exception concurrent with inner callosal lesions. The nature of the inner callosal lesions is not known, since these lesions are not typically described in the literature. These lesions may represent demyelination or increased water content and may be the precursor to atrophy that progresses from the ependymal surface toward the outer fibers of the corpus callosum.

    Title Multiple Sclerosis. The Problem of Incorrect Diagnosis.
    Date June 1986
    Journal Archives of Neurology
    Excerpt

    Various neurologic disorders may be diagnosed incorrectly as multiple sclerosis (MS) since there is no test that is entirely specific for the disease. We report ten patients who met clinical criteria for probable or definite MS and who were given incorrect diagnoses. All of the patients were subsequently shown to have alternative diagnoses, three of which were directly treatable. From these illustrative cases, five characteristics were identified that alerted us to the possibility of an alternative diagnosis. We have called these characteristics "red flags," and suggest that they may be useful as features casting doubt on the diagnosis of MS if used judiciously in conjunction with clinical diagnostic criteria.

    Title A Controlled Neuropsychological Comparison of Huntington's Disease and Multiple Sclerosis.
    Date March 1986
    Journal Archives of Neurology
    Excerpt

    This study compared the intellectual deficits of patients who had the earliest stages of Huntington's disease (HD) with those of mildly or moderately affected patients suffering from multiple sclerosis; both groups were matched for age, education, and ability to function. Twenty-one HD patients, 30 multiple sclerosis subjects, and 15 matched controls were evaluated neuropsychologically; all were free of psychoactive medications. The two patient groups showed similar overall patterns of impairment, though the HD group had greater verbal and nonverbal memory deficits. The HD patients also demonstrated significant dyscalculia and showed indications of developing problems in language usage and copying. These results are discussed in light of each disorder's neuropathologic substrate.

    Title Association Between Bipolar Affective Disorder and Multiple Sclerosis.
    Date February 1986
    Journal The American Journal of Psychiatry
    Excerpt

    Ten patients from Monroe County, N.Y., had both multiple sclerosis and bipolar affective disorder. Epidemiologic data indicate that the expected number would be 5.4. This difference may indicate an association between these disorders.

    Title Treatment of Pathologic Laughing and Weeping with Amitriptyline.
    Date June 1985
    Journal The New England Journal of Medicine
    Excerpt

    Patients with bilateral forebrain disease may commonly manifest the syndrome of pathologic laughing and weeping. We investigated the efficacy of low-dose amitriptyline in 12 patients in whom this syndrome was a consequence of multiple sclerosis. In a double-blind crossover study comparing amitriptyline with placebo, eight patients experienced dramatic and significant improvement with amitriptyline (P = 0.02). The mean dose of amitriptyline was 57.8 mg per day and did not exceed 75 mg per day in any patient. Concurrent measurements of depression showed no change during the study. We conclude that amitriptyline is effective in the treatment of this disturbance of affective expression, and that this effect is distinct from the antidepressant effect of the medication.

    Title Behavioral Disorders in Multiple Sclerosis, Temporal Lobe Epilepsy, and Amyotrophic Lateral Sclerosis. An Epidemiologic Study.
    Date October 1984
    Journal Archives of Neurology
    Excerpt

    Certain CNS diseases can produce specific behavioral abnormalities. We used a computer search technique to identify all inpatients at Strong Memorial Hospital, Rochester, NY, who had received diagnoses of multiple sclerosis (MS), temporal lobe epilepsy (TLE), and amyotrophic lateral sclerosis (ALS) between 1965 and 1978. We found 368 patients with MS, 402 patients with TLE, and 124 patients with ALS. These groups were matched against the Monroe County (New York) Psychiatric Register to determine patterns of behavioral pathology. Prevalence rates for psychiatric contact were not significantly different between MS and TLE (19.3% v 22.9%), but both were higher than the prevalence rate for ALS (4.8%). When behavioral patterns were assessed, patients with MS demonstrated a significantly higher rate of depressed affective disorders (61.97% of register matches) than patients with the other two diseases. Multiple sclerosis may present a neurologic model for mood disturbance.

    Title Treatment of Emotional Lability with Low-dosage Tricyclic Antidepressants.
    Date March 1984
    Journal Psychosomatics
    Title Depressive Episodes in Patients with Multiple Sclerosis.
    Date November 1983
    Journal The American Journal of Psychiatry
    Excerpt

    Thirty multiple sclerosis patients were assessed: 15 with predominantly cerebral involvement of their demyelinating disease and 15 with predominantly spinal cord and cerebellar involvement. The groups were matched with regard to age, duration of illness, and Kurtzke disability scores. Assessment included neuropsychological testing, the Beck Depression Inventory, and a psychiatric interview patterned after the Schedule for Affective Disorders and Schizophrenia. A group of normal volunteers served as controls for the neuropsychological testing. There were significantly more major depressive episodes in the cerebral group, as assessed by the patients' histories and by interview, and there was a trend toward more depressive symptoms in this group, as measured by the Beck inventory.

    Title Psychologic Aspects of Multiple Sclerosis.
    Date July 1983
    Journal New York State Journal of Medicine
    Title Psychiatric Aspects of Clinical Neurology.
    Date February 1983
    Journal The American Journal of Psychiatry
    Excerpt

    The author assessed 241 inpatients and outpatients on a neurology service for emotional disorders, using a systematic interviewing technique. DSM-III diagnoses were established in 101 of these patients (41.9%). The author presents a descriptive assessment of the patients' emotional disorders as well as data concerning the connections between neurologic and emotional illness.

    Title Sympathoadrenomedullary Hyperactivity in the Neuroleptic Malignant Syndrome: a Case Report.
    Date September 1981
    Journal The American Journal of Psychiatry
    Excerpt

    The authors describe a patient with the neuroleptic malignant syndrome whose excessive catecholamine excretion indicates hyperactivity of the sympathoadrenomedullary component of the autonomic nervous system. Their finding provides a physiological basis for using catecholamine blocking agents to treat some patients with this syndrome.

    Title The Concept of Death: Causes and Criteria.
    Date January 1980
    Journal The Journal of Medicine and Philosophy
    Title The Concept of Death: Tradition and Alternative.
    Date November 1978
    Journal The Journal of Medicine and Philosophy
    Title The Concept of Death: Tradition and Alternative.
    Date June 1978
    Journal The Journal of Medicine and Philosophy
    Title Mood Disorders Secondary to Demyelinating and Movement Disorders.
    Date
    Journal Seminars in Clinical Neuropsychiatry
    Excerpt

    Mood disorders are recognized in several neurologic diseases. This chapter reviews three specific disorders, Parkinson's disease, Huntington's disease, and multiple sclerosis. The demographics of mood disorders and unique clinical characteristics are discussed for each disease. The possible causes for neurobiologically based affective symptoms are explored.

    Title Chrysin, a Natural Flavonoid Enhances Steroidogenesis and Steroidogenic Acute Regulatory Protein Gene Expression in Mouse Leydig Cells.
    Date
    Journal The Journal of Endocrinology
    Excerpt

    During the aging process of males, testosterone biosynthesis declines in testicular Leydig cells resulting in decreases in various physiological functions. To explore the possibility of delaying the decline using food supplements, we have studied steroidogenic effects of a natural flavonoid, chrysin, in mouse Leydig cells. Chrysin dramatically increased cyclic AMP (cAMP)-induced steroidogenesis in MA-10 mouse Leydig tumor cells. This result was confirmed using Leydig cells isolated from mouse testes. The steroidogenic effect of chrysin is not associated with an increase in expression of the P450 side-chain cleavage enzyme, required for the conversion of cholesterol to pregnenolone. In addition, when 22(R)hydroxylcholesterol was used as a substrate, chrysin induced a non-significant increase in steroid hormone, suggesting that the majority of the observed increase in steroidogenesis was due to the increased supply of substrate cholesterol. These observations were corroborated by showing that chrysin induced a marked increase in the expression of steroidogenic acute regulatory (StAR) protein, the factor that controls mitochondrial cholesterol transfer. Also, chrysin significantly increased StAR promoter activity and StAR mRNA level. Further studies indicated that this compound depressed expression of DAX-1, a repressor in StAR gene transcription. In the absence of cAMP, chrysin did not increase steroidogenesis. However, when a sub-threshold level of cAMP was used, StAR protein and steroid hormone were increased by chrysin to the levels seen with maximal stimulation of cAMP. These results suggest that while chrysin itself is unable to induce StAR gene expression and steroidogenesis, it appears to function by increasing the sensitivity of Leydig cells to cAMP stimulation.

    Title Utility of the Rbans in Detecting Cognitive Impairment Associated with Alzheimer's Disease: Sensitivity, Specificity, and Positive and Negative Predictive Powers.
    Date
    Journal Archives of Clinical Neuropsychology : the Official Journal of the National Academy of Neuropsychologists
    Excerpt

    Although initially developed as a brief dementia battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not yet demonstrated its sensitivity, specificity, and positive and negative predictive powers in detecting cognitive impairment in patients with Alzheimer's disease (AD). Therefore, the current study examined the clinical utility of the RBANS by comparing two age-, education-, and gender-matched groups: patients with AD (n=69) and comparators (n=69). Significant differences (p<0.001) were observed on the RBANS Total score, all 5 Indexes, and all 12 subtests, with patients performing worse than the comparison participants. An optimal balance between sensitivity and specificity on RBANS scores was obtained when cutoffs of one and one and a half standard deviations below the mean of the comparison sample were implemented. Areas under the Receiver Operating Characteristic curves for all RBANS Indexes were impressive though Immediate and Delayed Memory Indexes were excellent (0.96 and 0.98, respectively). Results suggest that RBANS scores yield excellent estimates of diagnostic accuracy and that the RBANS is a useful screening tool in detection of cognitive deficits associated with AD.


    Similar doctors nearby

    Dr. Omar Elghawanmeh

    Internal Medicine
    Lubbock, TX

    Dr. Kenn Freedman

    Neurology
    21 years experience
    Lubbock, TX

    Dr. Daniel Hurst

    Pediatrics
    33 years experience
    Lubbock, TX

    Dr. Jongyeol Kim

    Emergency Medicine
    20 years experience
    Lubbock, TX

    Dr. David Edwards

    Family Medicine
    8 years experience
    Lubbock, TX

    Dr. Renato Gonik

    Neurology
    23 years experience
    Lubbock, TX
    Search All Similar Doctors