Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and non-parametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, patients with PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired PD patients without dementia, and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all PD patients with cognitive impairment.
e objective of this study was to assess the use of HIV-oral lesions (OLs) as markers of virologic failure (VF) in response to antiretroviral therapy (ART). Concurrent virologic status was compared between 744 individuals with and without OL ( 2 ). Time to VF between OL groups was compared (Kaplan-Meier), and baseline factors associated with VF were determined (Cox Hazard models). Sensitivity, speci�city, positive predictive value, and negative predictive value were also computed. At baseline and 12 months, individuals with OL were more likely to have viral load ≥ 10, 000 copies/ml compared to patients without OL ( 0 01). Time to VF between patients with baseline OL (mean: 17 months, 95% CI 16-18) and patients without baseline OL (mean: 19 months, 95% CI: 18-20) was statistically different. Patients who were African-American (HR 1.356; 95% CI: 1.045-0.759), ARTexperienced (HR 2.298; 95% CI: 1.743-3.030), had mental disorders (HR 1.410; 95% CI: 1.078-1.843), and had high baseline viral load (HR 2.82; 95% CI: 1.661-3.137), were more likely to have VF a�er the �rst six months of ART. OL had a moderate positive predictive value for concurrent VF at 6 months (45.5%) and 18 months (33.3%), but a strong positive predictive value at 12 months (80.0%) and 24 months (100.0%). Findings of this study suggest that OLs could be poor predictors of VF in HIV-infected patients on ART therapy.
Purpose
This study compared the clinical outcome of dental implants and their implant‐supported restorations over a 3‐year period involving patients both positive and negative for the human immunodeficiency virus.
Materials and Methods
Twenty patients testing positive for the human immunodeficiency virus were recruited for this study. Twenty‐one negative control patients were also selected, for a total of forty one patients. Diagnostic impressions were collected and cone beam computed tomography images were obtained. Implant size and positioning were planned using cone beam computed tomography software. Two stage or single surgery was performed as determined by the surgeon (periodontist). After a 6‐month healing period, definitive impressions were fabricated using polyvinyl siloxane impression material. Implant stability quotient values were obtained at the time of surgery and placement of the restoration. Screw‐retained custom titanium abutments were designed, milled, and placed with 25 N·cm torque using a calibrated torque controller. Porcelain fused‐to‐metal complete coverage restorations were then cemented with elastomeric resin implant cement. Implants and restorations were assessed at 6‐month intervals over a period of 3 years for stability, peri‐implant health, and patient satisfaction.
Results
Over the 3‐year period, 25 of 42 implants placed in the negative control group were assessed, and 17 of 27 implants placed in the positive control group were evaluated. The overall patient retention rate was 77%. At the 3‐year follow up, restorations examined were fully functional and causing no pain. Overall implant retention within the positive group was 96%. Implant retention within the negative control group was 100%. No differences were noted between groups for bone loss based on statistical tests.
Conclusion
Within the limitations of this clinical investigation, the presence of human immunodeficiency virus per se was not a contraindication to dental treatment with implant‐supported restorations.
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