Objective: Limb apraxia is a common early sign of Alzheimer’s disease (AD) and is thought to occur specifically in early-onset (before the age of 65) AD. The Dementia Apraxia Test (DATE), a test of limb and face praxis developed to support the differential diagnosis of dementia, has shown good diagnostic accuracy in detecting AD in older patients, but it has not been validated for younger age groups. We investigated how accurately DATE can detect AD in middle-aged individuals and whether apraxia is a distinctive feature in early-onset AD. Method: A sample of mild-stage AD patients (n = 24; Mage = 61, SD = 4) was drawn from a prospective consecutive series of individuals referred to our neurology clinic for dementia investigations. A healthy comparison group (HC) of comparable age (n = 22; Mage = 61, SD = 7), sex distribution, and education was recruited. DATE was administered as a blinded experimental measure, and a receiver operating characteristic (ROC) analysis was used to define the optimal diagnostic cutoff point. Results: The DATE classified 93% of the participants correctly as AD or HC (sensitivity 0.88, specificity 1.00, area under curve 0.968). The optimal diagnostic cutoff point was higher (49 points) than in a previous sample of older patients (45 points). Early onset did not seem to be associated with worse praxis performance in AD. Conclusions: DATE is an accurate tool for detecting early-onset AD within 2 years of symptom onset. The diagnostic cutoff point should be higher for middle-aged populations than for late-onset AD.
Background and purpose: Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures.Methods: We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention.Results: Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise.Conclusion: The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
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