Impact of different diagnostic measures on drug class association with dementia progression risk: a longitudinal prospective cohort study

Background: Clinical Dementia Rating Sum of Boxes (CDRSOB) scale is known to be highly indicative of cognitive-functional status, but it is unclear whether it is consistent with clinician diagnosis in evaluating drug class associations with risk of progression to mild cognitive impairment (MCI) and dementia. Methods: We employed multivariate logistic regression on longitudinal NACC data, to identify drug classes associated with disease progression risk, using clinician diagnosis and CDRSOB as the outcome. Results: Non-steroidal anti-inflammatory drugs, anxiolytics, antidiabetics, and Parkinson's medications were significantly associated with decreased progression to mild cognitive impairment (MCI)/dementia, and antihypertensives and Alzheimer's medications significantly associated with increased progression risk. Associations were however dependant on the diagnostic measure used, e.g., antihypertensives were associated with increased Healthy-to-Dementia risk using clinical diagnosis as the outcome (OR:2.05, FDR p<0.001), but not for CDRSOB. Additionally, some associations appear to be gender specific; for instance, antidiabetics had lower MCI-to-Dementia risk for women (OR:0.58, FDR p=0.006) using CDRSOB. Further, in accordance with existing literature, acetylcholinesterase inhibitors were not beneficial in delaying dementia. Conclusions: Overall, we demonstrate that choice of diagnostic measure can influence the magnitude of risk or protection attributed to drug classes. A consensus must be reached within the research community with respect to the most accurate diagnostic outcome to identify risk and improve reproducibility.

The Violent Origins of Psychic Trauma: Frantz Fanon's Theory of Colonial Trauma and Catherine Malabou's Concept of the New Wounded

This paper contends that Catherine Malabou’s concepts of cerebrality and the new wounded extend Frantz Fanon’s theory of colonial trauma to illuminate the link between violent oppression and contemporary profile of psychic disorders, as they relate to the diagnostic measure of PTSD. It begins by demonstrating colonial psychoanalyst Octave Mannoni’s failure to engage psychoanalytic theory to negate the racial theses of French colonial psychiatry. Next, it explicates Fanon’s refutation of both Mannoni’s use of the idea of dependence and his theory of social evolutionism to describe the colonial relation. In brief, Fanon critiques Mannoni for neglecting to integrate the psychic effects of colonial violence into his analysis of unconscious complexes in the colonized. Finally, this paper shows that Malabou corelates violent ruptures with the PTSD diagnosis, in order to better understand the relation between sociopolitical violence and neuropsychiatric trauma. This paper proposes that both Fanon and Malabou be mobilized to theorize the violent origins of psychic trauma.

Fast and Robust Diagnostic Technique for the Detection of High Leverage Points

High Leverage Points (HLPs) are outlying observations in the X -directions. It is very imperative to detect HLPs because the computed values of various estimates are affected by their presence. It is now evident that Diagnostic Robust Generalized Potential which is based on the Minimum Volume Ellipsoid (DRGP(MVE)) is capable of detecting multiple HLPs. However, it takes very long computational running times. Another diagnostic measure which is based on Index Set Equality denoted as DRGP(ISE) is put forward with the main aim of reducing its running time. Nonetheless, it is computationally not stable and still suffers from masking and swamping effects. Hence, in this paper, we propose another version of diagnostic measure which is based on Reweighted Fast Consistent and High Breakdown (RFCH) estimators. We call this measure Diagnostic Robust Generalized Potential based on √n RFCH and it is denoted by DRGP(RFCH). The results of simulation study and real data indicate that our proposed method outperformed the other two methods in term of having the least computing time, highest percentage of correct detection of HLPs and smallest percentage of swamping and masking effects compared to the DRGP(MVE) and DRGP (ISE).