Changes in thyroid function in primary degenerative dementia processes

To overcome diagnostic uncertainties in early phases of Alzheimer's disease (pre-senile dementia), the analysis of T-3 and T-4 concentration can be usefully employed. Arising out of the localisation neuropathological findings in Alzheimer type dementia, it could be that hormonal findings perform a useful function as indicators of a change in neurotransmitter activity in this disease.     

The generalizability of training gains in dementia: effects of an imagery-based mnemonic on face-name retention duration

The generalizability of the results from a case study on the effects of an imagery mnemonic on face-name recall in dementia was examined (Hill, Evankovich, Sheikh, & Yesavage, 1987). Seven patients with Alzheimer's disease (AD) and 1 patient with multi-infarct dementia (MID) were trained by using the method devised by Hill et al. Application of the mnemonic increased the time during which face-name associations could be held in memory for 1 AD patient, and this improvement was maintained in a 1-month follow-up assessment. However, no training gains were observed for the remaining 7 patients, thus questioning the generalizability of this method in enhancing memory in dementia.     

Progressive agraphia can be a harbinger of degenerative dementia

By investigating three patients with progressive agraphia, we explored the possibility that this entity is an early sign of degenerative dementia. Initially, these patients complained primarily of difficulties writing Kanji (Japanese morphograms) while other language and cognitive impairments were relatively milder. Impairments in writing Kana (Japanese syllabograms), verbal language, executive function, visuo- and visuospatial cognition and memory were identified by neuropsychological testing. The agraphia was compatible with a peripheral type, based on deficits at the interface between the central letter selection and the graphemic motor execution (Patient 1) or at the stage of central letter selection as well (Patients 2 and 3). Agraphia was generally more prominent, although not exclusive, for Kanji probably because of later acquisition and larger total number of Kanji letters leading to lower frequency of use and familiarity per letter. Concurrent or subsequent emergence of non-fluent aphasia, ideomotor apraxia, executive dysfunction and asymmetric akinetic-rigid syndrome in two patients suggested degenerative processes involving the parietal-occipital-temporal regions, basal ganglia and striato-frontal projections. We propose that progressive agraphia may be one of the early symptoms of degenerative dementia such as corticobasal degeneration.     

Improving memory performance in the aged through mnemonic training: a meta-analytic study.

The effectiveness of memory training for the elderly was examined through a meta-analysis of pre-to-posttest gains on episodic memory tasks in healthy subjects aged 60 or above. Pre-to-posttest gains were found to be significantly larger in training groups (0.73 SD, k = 49) than in both control (0.38 SD, k = 10) and placebo (0.37 SD, k = 8) groups. Treatment gains in training groups were negatively affected by age of participants and duration of training sessions and positively affected by group treatment, pretraining, and memory-related interventions. No differences in treatment gain were obtained as a function of type of mnemonic taught nor the kind of pretraining used.     

Intellectual, mnemonic, and frontal functions in dementia with Lewy bodies: A comparison with early and advanced Parkinson's disease

Both Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share a common neuropathological marker, the presence of Lewy bodies in brain stem and basal forebrain nuclei. DLB, in addition, is associated with Lewy bodies in the neocortex, and, in it's more common form, with Alzheimer-type pathological markers, particularly amyloid plaques. Published neuropsychological studies have focused on the differential profiles of DLB and Alzheimer's disease (AD). However, it is presently unclear whether DLB should be classified as a variant of AD or PD. In the present study we compare a healthy age-matched control group with three groups of patients, one with DLB, and two with PD. One of the PD groups was early in the course (PD-E) and the second, more advanced group (PD-A), was matched on severity of cognitive impairment with the DLB group. The results show that DLB was associated with a different pattern of neuropsychological impairment than the PD-A group, particularly in tests believed to be mediated by prefrontal cortical regions.     

Intellectual, mnemonic, and frontal functions in dementia with Lewy bodies: A comparison with early and advanced Parkinson's disease

Both Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share a common neuropathological marker, the presence of Lewy bodies in brain stem and basal forebrain nuclei. DLB, in addition, is associated with Lewy bodies in the neocortex, and, in it's more common form, with Alzheimer-type pathological markers, particularly amyloid plaques. Published neuropsychological studies have focused on the differential profiles of DLB and Alzheimer's disease (AD). However, it is presently unclear whether DLB should be classified as a variant of AD or PD. In the present study we compare a healthy age-matched control group with three groups of patients, one with DLB, and two with PD. One of the PD groups was early in the course (PD-E) and the second, more advanced group (PD-A), was matched on severity of cognitive impairment with the DLB group. The results show that DLB was associated with a different pattern of neuropsychological impairment than the PD-A group, particularly in tests believed to be mediated by prefrontal cortical regions.     

Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

A DBT Skills training group for family caregivers of persons with dementia

A Dialectical Behavior Therapy Skills training manual (DBT Skills) was adapted for use with caregivers of individuals with dementia. Implementation occurred in a community clinic with a heterogeneous caregiver group at risk for elder abuse. Sixteen caregivers completed the 9-week group. The results point to improved psychosocial adjustment, particularly increased problem-focused coping, enhanced emotional well-being, and less fatigue. Caregivers tended to utilize individual therapeutic services at a higher rate during the period of group attendance, indicative of appropriate help-seeking behavior in highly demanding situations. Six of the 16 caregivers repeated the training sequence in “booster” groups. Follow-up data from the booster groups suggest that high-risk caregivers may require continuing support to maintain treatment gains. In addition to demonstrating the feasibility of DBT Skills with caregivers, the results warrant a controlled outcome evaluation.     

Efficacy of cognitive training programs based on new software technologies in patients with Alzheimer-type dementia

The study aims to assess the efficacy of the Big Brain Academy (BBA), a computerized cognitive training program (CT) based on video games, compared to the Integrated Psychostimulation Program (IPP), a classical CT tool for patients with Alzheimer's disease (AD). A total of 45 patients with AD at the mild stage were randomly assigned to three experimental conditions. Two treatment groups were established, in which patients received either a stimulation program with BBA (EABB) or a traditional stimulation program (EAPI), based on paper-and-pencil tasks, for twelve weeks. A third group, the control group (EANT), did not receive any treatment during this period. The differential effectiveness of the programs was evaluated through pre-post design, considering neuropsychological, behavioral, and functional standard measures as outcome variables. The EABB group showed significantly slower rates of cognitive decline compared to the EAPI and EANT groups. Furthermore, the EABB group reported significantly greater decrease in depressive symptoms in comparison with the EAPI and EANT groups. The BBA program was more effective than IPP to reduce cognitive decline and depressive symptoms in patients with AD.     

Effects of a waking schedule on primary enuretic children treated with full-spectrum home training

Examined the effects of adding a waking schedule to full-spectrum home training (FSHT) for primary enuresis. Twenty children received FSHT, and 17 children received FSHT plus a waking schedule. The groups did not reliably differ in average bedwettings per week in treatment and length of treatment. Also, the groups did not reliably differ with respect to proportion of treatment successes and proportion of relapses at 1-year follow-up. Further, across both treatment groups, 76% achieved a dry bed, and only 16% experienced a relapse by 1-year follow-up. Although results support the efficacy of FSHT, the beneficial effects of a waking schedule reported previously were not replicated. The findings suggest the need for closer examination of individual differences among children with primary nocturnal enuresis.     

Generation and mnemonic encoding induce a mirror effect in the DRM paradigm

Encoding tasks that increase memory accuracy are appealing from both practical and theoretical perspectives. Within the Deese/Roediger-McDermott (DRM) paradigm, we found that generating list words from anagrams (relative to reading) produced a mirror effect: enhanced recognition of studied words coupled with a reduction in false recognition. Signal detection analyses suggest that the increase in correct recognition was due to enhanced item-specific encoding of the list words, whereas the reduction in false recognition was due to enhanced strategic monitoring at test (i.e., a distinctiveness heuristic), rather than to reduced relational encoding at study. Further support for a distinctiveness heuristic account was obtained using both "theme judgment" instructions and within-group conditions. In our final experiment, we replicated this mirror effect using a purely mnemonic (self-referential) encoding task, showing that extra perceptual cues are not necessary to induce participants to adopt a successful memory-improvement strategy at test.     

Vascular (arteriosclerotic) and Alzheimer's dementia in neurologic-psychiatric patient sample

Despite the obviously more important degeneratively conditioned dementias, particularly of the Alzheimer-type, dementias due to vascular disorders are still of considerable relevance. They are even predominant among autopsies in a neurological-psychiatrical hospital, showing, however, a decreasing tendency. Though this cannot reflect the real incidence of a disease, because many cases of dementia die in geriatric or nursing homes, mostly not autopsied, exact epidemiological examinations of autopsy-cases seem to be advisable, limited temporarily and locally for economic reasons. Topographical specialities and modern methods of investigation in living persons increasingly enable a differentiation of vascular and degenerative dementias and thus frequently an effective treatment.     

Running a counselling project in primary schools: The role of training and supervision

The provision of mental health resources for young children within a school setting is a challenging proposal. An early project by Kolvin et al. (1981) showed the efficacy of a number of interventions for disturbed children selected by assessment criteria. This highlighted the gap between mental health and education. A small-scale project operating in inner London utilizing volunteer counsellbrs is evaluated to examine the training and supervision needs of such counsellors if they are to be used to provide counselling services for children and, at the same time, further their own qualifications.     

Prioritization in visual search: visual marking is not dependent on a mnemonic search

Visual marking (VM) refers to our ability to completely exclude old items from search when new stimuli are presented in our visual field. We examined whether this ability reflects an attentional scan of the old items, possibly allowing observers to apply inhibition of return or maintain a memory representation of already seen locations. In four experiments, we compared performance in two search conditions. In the double-search (DS) condition, we required participants to pay attention to a first set of items by having them search for a target within the set. Subsequently, they had to search a second set while the old items remained in the field. In the VM condition, the participants expected the target only to be in the second (new) set. Selection of new items in the DS condition was relatively poor and was always worse than would be expected if only the new stimuli had been searched. In contrast, selection of the new items in the VM condition was good and was equal to what would be expected if there had been an exclusive search of the new stimuli. These results were not altered when differences in Set 1 difficulty, task switching, and response generation were controlled for. We conclude that the mechanism of VM is distinct from mnemonic and/or serial inhibition-of-return processes as involved in search, although we also discuss possible links to more global and flexible inhibition-of-return processes not necessarily related to search.     

Intrusive Imagery Experiences in a High Dysmorphic Concern Population

Intrusive imagery may be an important factor in cognitive-behavioural models of body image. Some research has examined the role of imagery within body image disorders; however, little is known about the association between intrusive imagery and body image concern in the general population. The aims of the present study were threefold: 1) to document the content and contexts of intrusive appearance-related images experienced by individuals high in dysmorphic concern, 2) to investigate the relationship between dysmorphic concern and appearance-related imagery, and 3) to investigate the relationships between dysmorphic concern and image suppression. Sixty-five (55 female) undergraduates participated in semi-structured interviews on imagery. Intrusive appearance-related images were common, and mostly involved negative self-imagery and/or images of other people showing disgust toward the individual. Many of the images occurred within social contexts, and depicted present and future selves in undesirable terms and past or ideal selves in desirable terms. There was no relationship between dysmorphic concern and the quality or frequency of intrusive appearance-related images. Importantly, attempts to suppress imagery predicted dysmorphic concern, controlling for general psychopathology.     

Symbolism and Imagery in a Group of Chronic Schizophrenics

Block training in group psychotherapy makes it possible to train professionals living far apart and to import conductors to an area or country lacking sufficient expertise. This article reports experience with such a training program in Norway. Training is given in blocks of 5 weekends a year, each weekend containing small group therapy, supervision, theory courses, lectures, and large group experiences. The participants were questioned about their personal and professional gains from the training. These findings and the effect of the program in relation to stated goals are discussed.     

Augmented input reveals word deafness in a man with frontotemporal dementia

We describe a 57 year old, right handed, English speaking man initially diagnosed with progressive aphasia. Language assessment revealed inconsistent performance in key areas. Expressive language was reduced to a few short, perseverative phrases. Speech was severely apraxic. Primary modes of communication included gesture, pointing, gaze, physical touch and leading. Responses were 100% accurate when he was provided with written words, with random or inaccurate responses for strictly auditory/verbal input. When instructions to subsequent neuropsychological tests were written instead of spoken, performance improved markedly. A comprehensive audiology assessment revealed no hearing impairment. Neuroimaging was unremarkable. Neurobehavioral evaluation utilizing written input led to diagnoses of word deafness and frontotemporal dementia, resulting in very different management. We highlight the need for alternative modes of language input for assessment and treatment of patients with language comprehension symptoms.