Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Accumulating evidence suggests that the pre-dementia syndrome mild cognitive impairment (MCI) is characterized by decrements in instrumental activities of daily living (IADL). The current review was a quantitative synthesis of the available literature to objectively characterize IADL disability in MCI while clarifying inconsistencies in findings across studies. It was hypothesized that individuals with MCI would display significantly greater functional impairment relative to cognitively intact controls. Candidate moderators specified a priori included functional assessment approach, MCI subtype, depressive symptoms, and language conducted. Online databases (PubMed/MEDLINE and PsycINFO) and reference lists were searched to identify peer-reviewed publications assessing IADL in MCI compared to normal aging. A total of 151 effect sizes derived from 106 studies met inclusionary criteria (N?=?62,260). Random effects models yielded a large overall summary effect size (Hedges’ g?=?0.76, 95 % confidence interval: 0.68???0.83, p?<?.001) confirmed in multi-level analyses adjusted for nesting of effect sizes within studies (g?=?0.78, 95 % confidence interval: 0.69???0.87). Functional assessment strategy and MCI subtype were significant moderators of effect size, whereas depressive symptoms and language were not. Results convincingly demonstrate that MCI is associated with significant difficulties in the performance of complex everyday tasks. It appears that functional decline, like cognitive decline, exists on a continuum from healthy aging to dementia onset. Implications for clinical practice and research priorities are discussed.     

Examining the Validity of ADHD as a Diagnosis for Adolescents with Intellectual Disabilities: Clinical Presentation

Children with intellectual and developmental disabilities are at heightened risk for mental disorders. Using current diagnostic criteria, disruptive behavior disorders, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), appear to be the most prevalent co-occurring disorders. However, the validity of ADHD as a diagnosis for children and adolescents with intellectual disabilities remains unclear. The present study examined the clinical presentation of ADHD (prevalence, sex differences, and comorbidity) among adolescents with and without intellectual disability (ID) as well as investigated the validity of ADHD for adolescents with ID by examining similarities in terms of symptom presentation, developmental course, and associated functional impairment. The sample included 142 adolescents and their families, about a third of whom were classified in the ID group and the remaining were in the typically developing (TD) group. Findings indicated that adolescents with ID continue to be at elevated risk for ADHD (risk ratio: 3.38:1) compared to their typically developing peers. Additionally, the presentation of ADHD appeared similar among adolescents with and without ID, supporting the validity of an ADHD diagnosis for this population of adolescents. Implications for public policy and intervention are discussed.     

The Early Presentation of Dementia in People with Down Syndrome: a Systematic Review of Longitudinal Studies

Adults with Down syndrome (DS) are at a very high risk of developing early onset Alzheimer’s disease (AD) due to trisomy of chromosome 21. AD is preceded by a prolonged prodromal “pre-clinical” phase presenting with clinical features that do not fulfil the diagnostic criteria for AD. It is important to clinically characterise this prodromal stage to help early detection of the disease as neuropathology of AD is almost universal by the fifth decade in DS. There is a lack of knowledge of the trajectory of decline associated with the onset of dementia in this population and early signs may be overlooked or misdiagnosed, negatively affecting the quality of life of those affected and the use of early pharmacological or psychosocial interventions. The objective of this systematic review is to evaluate the published literature on longitudinal data in order to identify the cognitive and behavioural changes occurring during the prodromal and early stages of AD in this population. Fifteen peer-reviewed articles met the inclusion criteria, including a total number of 831 participants, with the duration between baseline and follow up varying from 1 year to 47 years. Results suggest that, compared to the general population for which short-term (episodic) memory loss is the most common indicator associated with the onset of AD, in people with DS, executive dysfunction and Behavioural and Psychological Symptoms of Dementia (BPSD) are commonly observed during pre-clinical and early stages and may precede memory loss. The review highlights the importance of using a broad spectrum of assessments in the context of heterogeneity of symptoms. Theoretical and practical implications are discussed, as well as the need for further research.     

Unilateral Fatigue Affects the Unipedal Postural Balance in Individuals With Intellectual Disability

This study aimed to explore the effect of local muscle fatigue on the unipedal stance in men with intellectual disability (ID). The Centre of pressure (CoP) excursions and the isometric maximal voluntary contraction (MVC) were measured before and after a fatiguing exercise. Higher baseline values of CoP excursions and lower MVC values were recorded in the ID group. After the fatiguing exercise, this group showed higher MVC decrease and higher percentage of increase of the mean CoP velocity. In conclusion, men with ID are more vulnerable to the disturbing effects of fatigue during the unipedal stance compared to men without ID.     

Efficacy of Parent-Child Interaction Therapy with Parents with Intellectual Disability

Parents with intellectual disability (ID) face many parenting challenges that may affect their ability to parent effectively, and such deficits are often associated with various poor child outcomes. Research findings are inconsistent for interventions targeting systematic skills for parents with ID. Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment that incorporates performance-based training to enhance parenting ability. This study evaluated implementation of PCIT with parents with ID using a multiple baseline design across behaviors. Results suggest increases in positive parenting behaviors and consistent discipline. However, limitations related to poor maintenance and generalization warrant the need for future research.     

The Logic of Deferral: Educational Aims and Intellectual Disability

The educational aims described by educational philosophers rarely embrace the full range of differences in intellectual ability, adaptive behavior, or communication that children exhibit. Because envisioned educational aims have significant consequences for how educational practices, pedagogy, and curricula are conceptualized, the failure to acknowledge and embrace differences in ability leaves open the question of the extent to which students with intellectual disabilities are subject to the same aims as their “typically-developing” peers. In articulating and defending valued aims of education, educational philosophers tacitly or expressly concede that particular aims will be ill suited to many children with intellectual disabilities, and that separate aims will therefore apply to them. This paper evaluates the philosophical reasoning behind this conclusion that some people, by necessity, must be governed by separate educational aims, to be decided separately and secondarily. The author calls this the “deferral stance.” First, the paper outlines concerns about a particular ability-biased social and epistemic context in which theorizing about educational aims takes place. The author then examines assumptions that underpin the logic of deferral, arguing that the logic proves flawed when subjected to conceptual and empirical scrutiny. The paper concludes by outlining an inclusive approach—the affirmative stance—to theorizing about educational aims that resists the logic of exclusion and deferral.     

A Systematic Review of Ethnoracial Participation in Randomized Clinical Trials of Behavioral Activation

As of the last available NIH report, people of color (POC) constituted 28.1% of enrollment across all U.S. domestic clinical trials. The literature on prevalence rates of depression among POC is mixed. While the prevalence rates of depression may vary across POC, it remains unknown to what degree POC have been included in outcome clinical trials of depression since NIH’s mandates for inclusion of minorities in clinical outcome research. Following PRISMA guidelines, the present review identified randomized controlled trials of behavioral activation from 1989 to 2021 using the following search engines: PsycINFO, EMBASE, and Cochrane Central Register of Controlled Trials. We reviewed 5,247 articles and included 28 articles that met full inclusion criteria (n = 5,169 participants). Across studies included in this review, 70% were non-Latinx White, 14.1% were African American, 8.9% were Latinx, 0.5% were Asian, 2.9% were other, and 3.7% were unknown. Results indicated an increase in representation of ethnoracial inclusion rates across time and that recruitment method was not associated with adequate inclusion of POC. However, the university setting was associated with inadequate representation of POC.     

Understanding the Individual Cognitive Potential of Persons with Intellectual Disability in Workshops for Adapted Work

We aimed at using simple judgments of event segmentation to reveal cognitive problems in workers with intellectual disability regarding their assembly performance. We investigated event perception and assembly performance in 32 workers (mean IQ = 64.4). First, we assessed their ability to segment activity into meaningful events. The task involved segmenting four videos in coarse and fine events. We assessed event segmentation performance and compared it to 30 controls (IQ > 100). The workers detected fewer event boundaries than controls. A subgroup of the workers (12 of 32) defined more event boundaries in the coarse than the fine condition, indicating misconception of higher‐ and lower‐level content. The remaining 20 workers showed diminished hierarchical alignment compared to controls. Second, workers executed a Lego task. Better event segmentation performance was associated with enhanced assembly performance. These results suggest that the event segmentation task can serve as a diagnostic assessment for cognitive potential.Copyright © 2017 John Wiley & Sons, Ltd.     

精神分裂症病人来源记忆研究的回顾与展望

精神分裂症病人的来源记忆研究是颇受关注的认识心理学课题之一。本文围绕该类病人的来源记忆研究状况从如下几方面做出简要回顾和总结：一是精神分裂症病人的来源记忆较项目记忆更困难;二是精神分裂症病人的来源记忆成绩与其阳性症状和阴性症状之间存在一定的关联;三是智商、注意和药物等因素对精神分裂症病人的来源记忆成绩存在一定的影响;四是精神分裂症病人来源记忆的脑机制研究受到高度重视。文章最后对未来研究和临床应用进行了思考和展望。     

Authoritative Parenting of Chinese Mothers of Children with and without Intellectual Disability

The present study examined authoritative parenting and associations with parenting sense of competence and social support in Chinese mothers of children with intellectual disability and mothers of typically developing children. One hundred and sixty-seven mothers of children with intellectual disability with a mean age of 10.89 years (SD?=?1.74) and 119 mothers of typically developing children with a mean age of 10.55 years (SD?=?1.10) participated in a survey. Mothers of children with intellectual disability reported similar levels of parental warmth, and less use of reasoning and autonomy support compared with mothers of typically developing children. Parenting efficacy contributed uniquely to three dimensions of authoritative parenting for mothers of children with intellectual disability. By comparison, parenting efficacy did not contribute to use of reasoning and autonomy support for mothers of typically developing children. Social support made a unique but small contribution to parental warmth but not to parental reasoning and autonomy support for mothers of children with intellectual disability. For mothers of typically developing children, social support was associated with both parental warmth and autonomy support. This study suggests that child disability status is related to maternal authoritative parenting, and additionally, parenting efficacy plays a more critical role in predicting authoritative parenting of Chinese mothers of children with intellectual disability than mothers of typically developing children.     

An Ecological Approach to Reducing the Social Isolation of People With an Intellectual Disability

An ecological approach to understanding insecure attachments and social isolation among people with an intellectual disability is constructed using Gibson's (1979/1986) affordance-based theory. Although environmental affordances and individual limitations interact to limit the development of social competence, we believe that by focusing on the immediate environment, community-based approaches to helping people with an intellectual disability are often ignored, which increases the burden on individual caregivers. A more comprehensive strategy, which extends Gibson's theory of affordances, allows us to consider how higher level social systems influence the immediate environment and provides the context for understanding why successful change occurs when a multifaceted, holistic approach that works on several levels is adopted. Examining these systems within an ecological framework fundamentally redefines our thinking by shifting the focus from a person's disability to a more nuanced understanding of a person's abilities within the context of appropriate environmental supports in which the person's disability becomes less salient.     

Frequent Versus Non-frequent Prompts and Task Performance in Persons with Severe Intellectual Disability

Abstract

This study extended the evaluation of frequent vs non-frequent prompts to support task performance with people with severe intellectual disability. Three participants were involved in the study. The data indicated that the frequent prompts strategy promoted higher levels of on-task behaviour and correct responding for 2 participants and on-task behaviour for 1 participant. The relation of these data with previous findings and their implications for daily occupation programmes for persons with severe developmental disabilities are discussed     

Impact of Neurologic Deficits on Motor Imagery: A Systematic Review of Clinical Evaluations

Motor imagery (MI, the mental representation of an action without engaging in its actual execution) is a therapeutically relevant technique to promote motor recovery after neurologic disorders. MI shares common neural and psychological bases with physical practice. Interestingly, both acute and progressive neurologic disorders impact brain motor networks, hence potentially eliciting changes in MI capacities. How experimental neuroscientists and medical practitioners should assess and take into account these changes in order to design fruitful interventions is largely unresolved. Understanding how the psychometric, behavioral and neurophysiological correlates of MI are impacted by neurologic disorders is required. To address this brain-behavior issue, we conducted a systematic review of MI data in stroke, Parkinson’s disease, spinal cord injury, and amputee participants. MI evaluation methods are presented. Redundant MI profiles, primarily based on psychometric and behavioral evaluations, emerged in each clinical population. When present, changes in the psychometric and behavioral correlates of MI were highly congruent with the corresponding motor impairments. Neurophysiological recordings yielded specific changes in cerebral activations during MI, which mirrored structural and functional reorganizations due to neuroplasticity. In this view, MI capacities may not be deteriorated per se by neurologic diseases resulting in chronic motor incapacities, but adjusted to the current state of the motor system. Literature-driven orientations for future clinical research are provided.     

Neuropsychological Measures in the Arab World: A Systematic Review

Although Arabic is one of the most widely used languages in the world, little is known on the availability of standardized neuropsychological tests in Arabic. We review the literature published before 2016, using the keywords Arab*, cogniti*, and neuropsycholo*, as well as keywords for each Arab country. PubMed, PsycINFO, Education Source, Academic Search Complete, Education Resources Information Center, Shamaa, and Arabpsynet databases were searched, in addition to a selected number of Arabic medical and educational journals. After excluding case reports, studies conducted on Arab groups residing outside the Arab world or Israel, and studies that employed intelligence scales or cognitive screens without standardization, 384 studies were eventually reviewed. Tests with most extensive use, adaptation, validation and norming were identified. The Raven Matrices, with its variants, was the most normed cognitive test for Arab individuals (normed in 16 countries). The rate of neuropsychology publications from the Arab countries combined, per year, was less than half of that of each American journal (top 10 journals pertaining to cognition). Nonetheless, the rate in Arab countries has increased after 2010. Publications were mostly from Egypt and Saudi Arabia, but the ratio of test adaptation-to-publication was the largest in Jordan and Lebanon. Approximately half of these publications did not employ cognitive tests that were developed, translated, adapted, or standardized according to international guidelines of psychological measurement. We provide recommendations on improving clinical neuropsychology to better serve Arab patients.     

表面相似性与共享标签知识对智障儿童数量表征的影响

采用给数取物任务和数量比较任务,考察表面相似性与共享标签知识对96名7～16岁智障儿童数量表征的影响。研究结果表明：（1）智障儿童数量表征能力随着年龄增长而提高,11～13岁和14～16岁智障儿童完成数量比较任务的正确率显著高于7～10岁;（2）智障儿童在高表面相似物体下完成数量比较任务的正确率显著高于低表面相似物体下的正确率;（3）擅长使用数字标签的智障儿童,在数量比较任务的表现显著优于不擅长组。