Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets–cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes–restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.     

Response Speed and Accuracy During Anticipatory Stress

Response speed and accuracy of 48 general aviation pilots were determined under condition of anticipatory physical threat stress (APTS). Variables included unpleasantness of the event (electrical shock), proximity of the event, and relationship of Ss’ performance to the occurrence of the event. The data support inclusion of these variables in Wherry’s model of APTS. Ss who believed they could avoid the shock by an adequate performance were able to maintain or improve that performance while the performance of Ss who perceived the shock as inevitable was deteriorating. Two possible modifications of the APTS model were discussed: (1) weighting APTS determiners according to their effectiveness in generating anticipatory stress, (2) recognizing the interaction of the APTS variables with S’s personality structure.     

For the new family therapist: A glossary of terms

Abstract

Traditional psychodynamic terms used in describing, diagnosing, and treating individual patients have proven less than helpful in working with families. In an attempt to alleviate this difficulty, and as an aid to the newcomer in the field of family therapy, this glossary of terms is presented. This glossary is not meant to be all-inclusive. Rather, its purpose is to provide the new family therapist with an introduction to the language of the field, an armamentarium from which to work, and to provide a basis of knowledge that is usually not accumulated by the new family therapist until he or she has worked with a number of families over a period of time.     

A Foucauldian Foray into the New Genetics

A Foucauldian assessment of the common presumption that genetic information is potent and thus oppressive demonstrates that the concern may be misplaced. Foucault's concept of “technologies of self” reveals that genetic power originates not only from the potency of genetic information but from the penchant of individuals to victimize themselves in the name of optimal health, enhanced intelligence, perfect babies, or would-be immortality. Rather than seeking liberation from the power of the new genetics, Foucault's reinterpretation of the ancient understanding of concern for the self offers the possibility to avoid control by the scientific discourse. His ethical response calls for resistance rather than opposition and places responsibility for resistance in the hands of the subject. Characteristically, he avoids a generalizable form of morality but clarifies that resistance includes acknowledging the human appetite for perfection and subordinating science to ethical and aesthetic matters.     

The Boundaries of the Analytic Encounter: Clinical and Ethical Dimensions: A Roundtable Discussion: January 15, 1998

The American Journal of Psychoanalysis -     

Idiopathic orthostatic hypotension]

The disease picture of idiopathic orthostatic hypotonia is described from a clinical and histological point of view with reference to a case treated by the present authors. The independent character of this particular ailment may be considered as resulting from the virtually uncontrollable orthostatic decreases in blood pressure in connection with the progressive disorders especially of the motor system. Also, the etiology is not yet fully understood.     

The development of language in genie: a case of language acquisition beyond the “critical period”

The present paper reports on a case of a now-16-year-old girl who for most of her life suffered an extreme degree of social isolation and experiential deprivation. It summarizes her language acquisition which is occurring past the hypothesized “critical period” and the implications of this language development as related to hemispheric maturation and the development of lateralization. The results of a series of dichotic listening tests administered to her are included.     

State work engagement and state affect: Similar yet distinct concepts

State work engagement (SWE), a multidimensional construct of work-related well-being, was originally conceptualized as a trait, but diary studies have revealed substantial within-person fluctuations. Given that SWE is conceptualized as a work-related affective-motivational construct, the question arises as to whether SWE can be differentiated from other affective constructs. Thus, the goal of the present study was to compare SWE and state affect with respect to their degree of within-person variability and to examine their distinct relationships with health and performance variables (i.e., sleep quality and job performance). Fifty-two employees (44% female) participated in the study, which included 3 assessments per day over the course of 2 weeks. Our results revealed that energetic arousal and tense arousal fluctuated more strongly within days than vigor and absorption. Multilevel analyses demonstrated that high sleep quality predicted higher state affect but not higher SWE. In addition, vigor exhibited an inverted U-shaped relation with performance. In sum, SWE as a time-varying construct showed some overlap with state affect but also demonstrated discriminant validity.     

Engineering Ethics: Looking Back, Looking Forward

The eight pieces constituting this Meeting Report are summaries of presentations made during a panel session at the 2011 Association for Practical and Professional Ethics (APPE) annual meeting held between March 3rd and 6th in Cincinnati. Lisa Newton organized the session and served as chair. The panel of eight consisted both of pioneers in the field and more recent arrivals. It covered a range of topics from how the field has developed to where it should be going, from identification of issues needing further study to problems of training the next generation of engineers and engineering-ethics scholars.     

The effects of nature or of nurture on sex differences in intellectual functioning: Israeli findings

Sex Roles - This paper contrasts the results of studies examining sex differences in intellectual functioning in the United States and in Israel. Israeli studies indicate earlier sex differences as...