Poor growth in school entrants as an index of organic disease: the Wessex growth study.

OBJECTIVE--To establish whether poor height or height velocity, assessed during the year of school entry, might identify children with previously undiagnosed organic disease. DESIGN--Observation of a total population and their case controls. SETTING--Community base. SUBJECTS--All 14,346 children in two health districts entering school during two consecutive years were screened for height by school nurses, and those whose height lay below the 3rd centile according to Tanner and Whitehouse standards (n = 180) were identified. After excluding 32 with known organic disease, five from ethnic minorities, and three who refused to take part, the remaining 140 short normal children were matched with 140 age and sex matched controls of average height (10th-90th centile) and their height velocities over 12 months measured. MAIN OUTCOME MEASURES--Height, height velocity, previously diagnosed organic disease, and organic disease diagnosed as a result of blood tests and specialist examination. RESULTS--Twenty five of the 180 short children (14%) were already known to have chronic organic disease which could explain their poor growth. Blood tests and specialist examination revealed a further seven with organic disease, which was acquired rather than congenital in three, and a second cause of short stature in one with known organic disease. These eight conditions had been missed at the school entry medical examination. The shorter the child, the more likely an underlying organic disorder, with seven of the 12 children whose heights were more than 3 standard deviations below the mean having some organic disease. Height velocity measured over 12 months, however, did not distinguish short normal children from those with disease or from their matched controls. CONCLUSIONS--Height, but not height velocity, is a useful index for identifying unrecognised organic disease at school entry. The shorter the stature the greater the prevalence of organic disease. The frequency of newly diagnosed remediable disease in this study (1 in 3-4000) is similar to that of neonatal hypothyroidism, which is routinely screened for. Routine investigation of all very short school entrants is recommended.     

Background activity of the brain in healthy mental aging

The EEG mapping study tested age-related changes in power of EEG rhythms from delta to gamma ranges under healthy cognitive aging associated with preserved cognitive abilities and involvement in complex professional activity. 32 subjects of higher age group (HAG, mean age 65.1 +/- 1.18, 14 men and 18 women) and 33 subjects of lower age group (LAG mean age 22.1 +/- 0.38, 18 men and 15 women) participated in the study. Mean power of slow (delta, theta and alpha2) activity decreased and of fast activity (beta, gamma) increased as subject age increased. Compared to subjects of LAG subjects of HAG displayed a reduction in heterogeneity of EEG activity across recording sites. Centro-temporal gradients of power for frequency ranges from delta to beta2 and frontoparietal gradients and hemispheric asymmetry for alpha and beta1 rhythms were smoothed in subjects of HAG. These results suggest that observed age-related changes in baseline EEG may be the prerequisite for compensatory neural recruitment that may be associated as with allocation of more resources in cognitive processes so with reorganization of cortical networks including areas susceptible to physiological changes with aging.     

Recognition of organic mental disorders by physicians.

To test the ability of nonpsychiatrist physicians to correctly diagnose organic mental disorders in patients who present with psychiatric symptoms a multiple-choice questionnaire was distributed. Given six brief case histories, little more than half (55%) of the respondents made the right choice even half of the time. The results strongly suggest a need among physicians for increased familiarity with the psychiatric manifestations of medical-surgical conditions.     

Decoding mental states from brain activity in humans

Recent advances in human neuroimaging have shown that it is possible to accurately decode a person's conscious experience based only on non-invasive measurements of their brain activity. Such 'brain reading' has mostly been studied in the domain of visual perception, where it helps reveal the way in which individual experiences are encoded in the human brain. The same approach can also be extended to other types of mental state, such as covert attitudes and lie detection. Such applications raise important ethical issues concerning the privacy of personal thought.     

Confirmatory tests in the diagnosis of brain death: the role of the radioisotope brain scan

Brain death can be determined by clinical examination and the diagnosis confirmed by a variety of laboratory studies. While the most widely used has been the EEG, newer tests are playing an increasingly important role in confirming brain death. The authors discuss the role of one of these tests, the radioisotope brain scan (RIBS), which measures cerebral blood flow. Advantages and limitations of this procedure are outlined and compared with those of the EEG.     

Understanding the brain in health and disease

Today, Karl Deisseroth was awarded the 4 million euro 2017 Else Kröner Fresenius Prize for his discoveries of optogenetics and of hydrogel‐tissue chemistry, and for developing circuit‐level insight into depression. We asked him how his and related work enhances our understanding of the brain and psychiatric diseases at the molecular level.     

Clinical psychoacoustics in Alzheimer's disease central auditory processing disorders and speech deterioration

BACKGROUND: Difficulty in speech understanding in the presence of background noise or competing auditory signals is typically present in central auditory processing disorders. These disorders may be diagnosed in Alzheimer's disease as a result of degeneration in the central auditory system. In addition perception and processing of speech may be affected. MATERIAL AND METHODS: A MEDLINE research was conducted in order to answer the question whether there is a central auditory processing disorder involved in Alzheimer's disease. A second question to be investigated was what, if any is the connection, between central auditory processing disorders and speech deterioration?Articles were retrieved from the Medline to find relevance of Alzheimer's dis ease with central auditory processing disorders, they summed up to 34. Twelve papers were studied that contained testing for CAPD through psychoacoustic investigation. An additional search using the keywords 'speech production' and 'AD' produced a result of 33 articles, of them 14 are thoroughly discussed in this review as they have references concerning CAPD. The rest do not contain any relavent information on the central auditory system. RESULTS: Psychoacoustic tests reveal significantly lower scores in patients with Alzheimer's disease compared with normal subjects. Tests concerning sound localization and perception of tones as well as phoneme discrimination and tonal memory reveal deficits in Alzheimer's disease. Central auditory processing disorders may exist several years before the onset of clinical diagnosis of Alzheimer's disease. Segmental characteristics of speech are normal. Deficits exist concerning the supra-segmental components of speech. CONCLUSIONS: Central auditory processing disorders have been found in many cases when patients with Alzheimer's disease are tested. They may present as an early manifestation of Alzheimer's disease, preceding the disease by a minimum of 5 and a maximum of 10 years. During these years changes in the central auditory system, starting in the temporal lobe, may produce deficits in speech processing and production as hearing and speech are highly connected human functions. Another theory may be that spread of degeneration of the central nervous system has as a consequence, speech deterioration. Further research and central auditory processing disorders testing in the elderly population are needed to validate one theory over the other.     

Zinc and disease of the brain

Zinc is one of the most abundant transition metals in the brain. A substantial fraction (10-15%) of brain zinc is located inside presynaptic vesicles of certain glutamatergic terminals in a free or loosely bound state. This vesicle zinc is released with neuronal activity or depolarization, probably serving physiologic functions. However, with excess release, as may occur in a variety of pathologic conditions, zinc may translocate to and accumulate in postsynaptic neurons, events which may contribute to selective neuronal cell death. Intracellular mechanisms of zinc neurotoxicity may include disturbances in energy metabolism, increases in oxidative stress, and activation of apoptosis cascades. Zinc inhibits glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and depletes nicotinamide adenine dinucleotide (NAD(+)) and adenosine triphosphate (ATP). On the other hand, zinc activates protein kinase C (PKC) and extracellular signal-regulated kinase (Erk-1/2), and induces NADPH oxidase; these events result in oxidative neuronal injury. Zinc can also trigger caspase activation and apoptosis via the p75(NTR) pathway. Interestingly, the converse-depletion of intracellular zinc-also induces neuronal death, but in this case, exclusively via classical apoptosis. In addition to the neurotoxic effect, zinc may contribute to the pathogenesis of chronic neurodegenerative disease. For example, in Alzheimer's disease (AD), mature amyloid plaques, but not preamyloid deposits, are found to contain high levels of zinc, suggesting the role of zinc in the process of plaque maturation. Further insights into roles of zinc in brain diseases may help set a new direction toward the development of effective treatments.     

Ki-67 labelling index in human brain tumours

The proliferative potential in 157 brain tumours was investigated using Ki-67 labelling index (Ki-67LI). There were 46 patients with low grade gliomas (Al & All), 82 with high grade gliomas (AIII & AIV) and 29 with metastatic tumours. Tumour fragments used for assessment of Ki-67LI were fixed in formalin. Ki-67 antigen was visualised on paraffin sections using DAKO Rabbit Anti-Human Ki-67 antigen. The Ki-67LI was calculated as the percentage of Ki-67 labelled cells. The tumours showed variability in the Ki-67LI values. Significantly higher mean Ki-67LI was found for highly malignant (AIII & AIV) than for low grade gliomas (Al & All). For metastatic tumours, the mean values of Ki-67LI were significantly higher than for gliomas. Moreover, Ki-67LI of metastatic tumours were significantly higher than for high grade gliomas.