Gait and risk of falls associated with frontal cognitive functions at different stages of Alzheimer's disease

ABSTRACT

The decline in frontal cognitive functions contributes to alterations of gait and increases the risk of falls in patients with dementia, a category which included Alzheimer's disease (AD). The objective of the present study was to compare the gait parameters and the risk of falls among patients at different stages of AD, and to relate these variables with cognitive functions. This is a cross-sectional study with 23 patients with mild and moderate AD. The Clinical Dementia Rating was used to classify the dementia severity. The kinematic parameters of gait (cadence, stride length, and stride speed) were analyzed under two conditions: (a) single task (free gait) and (b) dual task (walking and counting down). The risk of falls was evaluated using the Timed Up-and-Go test. The frontal cognitive functions were evaluated using the Frontal Assessment Battery (FAB), the Clock Drawing Test (CDT) and the Symbol Search Subtest. The patients who were at the moderate stage suffered reduced performance in their stride length and stride speed in the single task and had made more counting errors in the dual task and still had a higher fall risk. Both the mild and the moderate patients exhibited significant decreases in stride length, stride speed and cadence in the dual task. Was detected a significant correlation between CDT, FAB, and stride speed in the dual task condition. We also found a significant correlation between subtest Similarities, FAB and cadence in the dual task condition. The dual task produced changes in the kinematic parameters of gait for the mild and moderate AD patients and the gait alterations are related to frontal cognitive functions, particularly executive functions.     

One more datum on Rorschach form quality

The central purpose of this work is to examine to what extent Form Quality (FQ) scoring of Rorschach responses, using Exner's (2003) Table A, is the reason for lower FQ to often be found in normative data outside the United States. The Rorschach protocols of 180 Portuguese boys and girls between 6 and 10 years of age were codified with respect to Form Quality in accordance with Exner's table of objects classified as ordinary, unusual, and minus, based on frequencies seen among U.S. adults and on an analogous Portuguese table (Table P) constructed from the protocols of 400 nonpatient children. Mean differences between the various FQ variables of the 2 tables were found to be insignificant. However, use of Janson's (2003) iota coefficient to evaluate agreement between the 2 approaches to scoring on the same protocols revealed that the more striking differences occurred in the FQu variable when agreement was assessed on the basis of each individual response. In view of these results, the authors recognize the possibility of Rorschach normative data to be universally applied, but still consider the possible advantage of each country or culture to build its own FQ table that will permit preservation of its particularities.     

The supervisory field and projective identification1

Taking as their starting point the Baranger and Baranger model of the ‘psychoanalytic field’, the authors extend the notion of intersubjectivity in the analytic relationship to the supervision process. They use a practical example of a supervision to show the development of what they term the ‘supervisory field’, formed from the superimposition of the two fields of analyst‐patient and supervisor‐supervisee. They emphasize the interplay of projective identifications with objects emanating from the inner world of the patient that are relived in the analytic relationship and transposed to the supervisory field. They believe that the concept of the ‘supervisory field’ contributes to a deeper understanding of the unconscious processes occurring in the mind of analysand, supervisee and supervisor during supervision, particularly regarding the identification, comprehension and resolution of persistent disturbances in the supervisory process.     

Association Between Gait and Dual Task With Cognitive Domains in Older People With Cognitive Impairment

The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination–Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.     

Benign and disruptive disturbances of the supervisory field1

Inspired by Baranger, Baranger and Mom’s notion of psychoanalytic bastion, we describe an unconscious collusion between analytic supervisors and supervisees. This collusion’s purpose is to avoid the anxiety inherent in the psychoanalytic field and that enters unprocessed into the supervisory field. The supervisor/supervisee dyad’s emotional experience can be fleeting, with moderate intensity, but can slow down the process. This can happen sometimes in any supervisory situation. Or it can become permanent and with greater intensity and bring the entire process to a standstill and to a disruption of the supervisory field. We call the first situation a ‘benign disturbance of the supervisory field’, the second a ‘disruptive disturbance of the supervisory field’. We illustrate both disturbances using supervisory material. Our purpose is to show how to detect these disturbances, understand them, and manage them.     

Children's expectations about training the approximate number system

Humans possess a developmentally precocious and evolutionarily ancient approximate number system (ANS) whose sensitivity correlates with uniquely human symbolic arithmetic skills. Recent studies suggest that ANS training improves symbolic arithmetic, but such studies may engender performance expectations in their participants that in turn produce the improvement. Here, we assessed 6‐ to 8‐year‐old children's expectations about the effects of numerical and non‐numerical magnitude training, as well as states of satiety and restfulness, in the context of a study linking children's ANS practice to their improved symbolic arithmetic. We found that children did not expect gains in symbolic arithmetic after exercising the ANS, although they did expect gains in ANS acuity after training on any magnitude task. Moreover, children expected gains in symbolic arithmetic after a good night's sleep and their favourite breakfast. Thus, children's improved symbolic arithmetic after ANS training cannot be explained by their expectations about that training.