1. The goal of this study was to quantitatively characterize the response properties of somatosensory and multisensory neurons in cortical area 7b (or PF) of monkeys that were behaviorally trained to perform an appetitive tolerance-escape task. Particular emphasis was given to characterizing nociceptive thermal responses and correlating such responses to thermal pain tolerance as measured by escape frequency. 2. A total of 244 neurons that responded to somatosensory stimulation alone or to both somatosensory and visual stimulation (multisensory) were isolated and studied in the trigeminal region of cortical area 7b. Thirty neurons responded only to visual stimulation. Thermoreceptive neurons formed approximately 13% (31 of 244) of the neurons that had somatosensory response properties. Thermal nociceptive neurons made up approximately 9% (21 of 244) of the neurons that had somatosensory response properties or approximately 68% (21 of 31) of the neurons that had thermoreceptive response properties. Thermal nociceptive neurons responded either exclusively to noxious thermal stimuli (high-threshold thermoreceptive, HTT) or differentially to nonnoxious and noxious thermal stimuli (wide-range thermoreceptive, WRT). Multimodal HTT neurons had nonnociceptive (low-threshold mechanoreceptive, LTM) and/or nociceptive (nociceptive-specific, wide-dynamic-range) mechanical receptive fields, whereas multimodal WRT neurons had only nonnociceptive (LTM) mechanical receptive fields. Thermal nonnociceptive neurons (low-threshold thermoreceptive, LTT) made up approximately 3% (8 of 244) of the neurons that had somatosensory properties or approximately 26% (8 of 31) of the neurons that were thermoreceptive. The background discharge of two thermoreceptive neurons (6%, 2 of 31) was inhibited by innocuous thermal stimulation. 3. Thermal nociceptive neurons (HTT and WRT) were functionally differentiated by statistical analyses into subpopulations that did encode (HTT-EN, WRT-EN) and did not encode (HTT-NE, WRT-NE) the magnitude of noxious thermal stimulus intensities. The mean slopes and median regression coefficients for the stimulus-response (S-R) functions of HTT-EN and WRT-EN neurons, respectively, were significantly greater than those for the S-R functions of HTT-NE and WRT-NE neurons. In contrast to HTT-NE and WRT-NE neurons, HTT-EN and WRT-EN neurons reliably encoded the magnitude of noxious thermal intensity by grading their mean discharge frequency. 4. The S-R functions of HTT-EN and WRT-EN neurons, unlike those of HTT-NE and WRT-NE neurons, closely approximated stimulus intensity-escape frequency functions.(ABSTRACT TRUNCATED AT 400 WORDS)

Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination. Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement. Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome.

Twenty-nine elderly patients who failed treatment with clozapine, risperidone, or olanzapine entered this 24-week, single-center, open-label trial to assess the efficacy of quetiapine (12.5-400 mg/day) for psychosis in patients with Parkinson's disease (PD). Psychiatric, motor, and cognitive assessments were administered at baseline and at periodic intervals for 24 weeks. These included the Brief Psychiatric Rating Scale (BPRS), Neuropsychiatric Inventory (NPI), Unified Parkinson's Disease Rating Scale (UPDRS) and tests of intellectual functioning, attention, and memory. Repeated measures statistical analysis was used to assess change from baseline. The results revealed significant improvements in the 24-week BPRS total score and NPI psychosis subscale scores, with no decline in UPDRS total or motor subscale scores. There was also significant improvement in recall scores on cognitive measures. These results indicate that quetiapine may treat psychotic symptoms and improve cognition without worsening motor function in patients with PD, suggesting that quetiapine is an effective and well-tolerated antipsychotic in this population.

We examined the ability to produce, repeat, and comprehend emotional prosody in 20 patients with Alzheimer's disease (AD) and in 11 elderly normal control subjects. In addition, caregivers of AD patients completed affective and behavioral measures with reference to the patient. Relative to control subjects, comprehension of emotional prosody was marginally impaired in mildly demented AD patients, whereas production, comprehension, and repetition of emotional prosody were significantly impaired in moderately demented AD patients. The moderately demented patients performed significantly poorer than the mildly demented patients on the production and repetition tasks. In contrast, there was no significance difference between the two groups on the prosody comprehension task. Additional analyses revealed an inverse relationship between the ability to correctly produce and repeat emotional prosody and the frequency of agitated behaviors and depressive symptomatology in moderately demented patients. This latter findings suggests that the inability to communicate emotional message is associated with disturbances in mood and behavior in AD patients. Implications for the management of disruptive behavior in agitated and aprosodic AD patients include the development of caregiver sensitivity to unexpressed emotion and caregiver assistance with emotional expression.

The Judgment of Line Orientation Test (JLO; Benton, Hamsher, Varney, & Spreen, 1983) is frequently used as a motor-free method of evaluating visuospatial processing but can be time-consuming to administer. We investigated the internal consistency, validity, and utility of two parallel JLO short forms in a mixed clinical sample of 386 patients. Mean scores were equivalent, and correlational analyses supported the internal consistency and validity of both short forms. When compared to the standard JLO, the odd- and even-item short forms demonstrated good sensitivity, specificity, overall hit rate and predicted positive and negative accuracy. We conclude that the JLO short forms possess sufficient internal consistency, validity, and utility for serial assessment in research studies. The JLO short forms may potentially be used in clinical screening situations by applying a single cut-off score to differentiate levels of performance. However, more detailed clinical use of these JLO short forms will necessitate collection of normative data in order to generate accurate percentile rankings.

Recent studies from our laboratory have characterized the response properties of trigeminal nociceptive neurons located in the posterior parietal cortex of awake monkeys, particularly in the rostral portion of the inferior parietal lobule and parietal operculum within the lateral sulcus. The stimulus intensity-response functions of some nociceptive neurons were significantly correlated to the stimulus intensity-escape frequency functions. The present study provides evidence that trauma to the posterior parietal cortex alters pain sensibility to the contralateral face. Although thermal pain tolerance was dramatically altered, the discriminative aspect of thermosensitivity may have remained intact. Our results complement the recent findings of clinical studies concerned with pain and damage to the posterior parietal cortex and of experimental studies concerned with painful stimulation and changes in regional cerebral blood flow. The role of the posterior parietal cortex in nociception and pain is discussed in relation to the first somatosensory area and to unilateral spatial neglect (inattention).

Previous studies have shown that the thalamic nucleus submedius (SM) contains nociceptive neurons and is interconnected with spinal, brain-stem and cortical regions associated with nociception. The present study was performed to examine the role of the SM in nociceptive-related behaviors. The effect of SM lesions on nociceptive responding in rats was assessed using both the radiant-heat tail-flick (TF) and the tail-shock 'pain-induced' vocalization (PIV) tests. The results of Exp. 1 indicated that the intensity of electrical shock required for vocalization responses was significantly decreased following SM lesions. No changes in vocalization responses were present in the sham-lesion group. In contrast, both the sham- and SM-lesion groups exhibited a significant post-lesion increase in TF latencies. A second experiment was performed to determine whether the effects of SM lesion on the tail flick may have been masked by conditioned antinociception associated with noxious electrical stimulation of the tail to produce PIV. The results indicated that there was no post-lesion change in TF latencies in either the SM- or sham-lesion group when the antecedent PIV test was omitted. The results suggest that the SM may play a role in supraspinally mediated inhibition of nociceptive input but not in spinally mediated responses to noxious stimuli.

In this study, neuropsychological profiles of 14 older adult patients with mild or moderate closed head injury (CHI), 14 patients with probable Alzheimer's disease (AD), and 14 community-residing elderly controls were compared. The groups were similar in demographic features, and the CHI and AD patients had comparable Mini-Mental State Examination scores. Tests of verbal learning and memory, letter and category fluency, and naming were administered. Relative to the CHI group, AD patients exhibited more devastated memory and did not show a normal facilitation on the category retrieval task. The patient groups exhibited similar levels of categorical clustering and naming accuracy for both high-and low-frequency words. These results suggest that neuropsychological markers of memory and semantic processing may be useful in differentiating the cognitive effects from AD versus early recovery from CHI.