Working Memory and Learning in Early Alzheimer’s Disease

Cognitive deficits associated with early Alzheimers disease (AD) have been recently operationalised in terms of an acquisition deficit and the research supporting this view is presented. However, there is still debate concerning the nature of this deficit and how underlying cognitive processes may be detrimentally affecting the ability to acquire new information in early AD. This review argues that the pattern of cognitive deficits contributing to the acquisition impairment in early AD patients may be readily interpreted within the context of a working memory model. Isolating the component processes of working memory that underlie the acquisition deficit in early AD patients will aid in the design of clinical applications that are focussed at enhancing the ability to acquire new information in everyday life.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

Developmental Differences in Metacognition and their Connections with Cognitive Development in Adulthood

This study investigated developmental differences in some metacognitive variables in ill-defined problem solving and their possible connections with cognitive development in adulthood. Participants were 57 individuals of different ages (adolescents, young adults, mature adults and older adults). They solved one well-defined and six ill-defined problems while their thinking-aloud was taped. They then answered a metacognitive statements questionnaire. Differences in performance were statistically significant in all problems: the best results in interpolation and divergent production problems were achieved by the younger adult group and the best performance on most dialectical everyday problems was found in the mature adults' group. We found no significant differences between age groups in the on-line monitoring of the solving process. Accuracy in metacognitive statements was however significantly better in the mature adult and the younger adult groups. Awareness of and reflection on one's own mental processes showed a similar developmental pattern to relativistic/dialectical thought: low expression in adolescence, an increase in early adulthood, a peak in mature adulthood and a minor decline in later years.     

The Role of Temperament in the Etiology of Child Psychopathology

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.     

A call to restructure the drug development process: Government over-regulation and non-innovative late stage (Phase III) clinical trials are major obstacles to advances in health care

The history of drug/vaccine development has included major advances guided primarily by risk/benefit analyses concerning the innovative agent, not by evidence-based clinical trials (Phase I–IV). Because the approval for new drugs is hindered under the present process, the system requires restructuring. The Phase I/II study period should be more flexible, using the “environment of knowledge” about the new agent, plus risk/benefit assessments. Phase III, as presently constructed, does not add new adverse events data, it provides a narrower profile of drug efficacy than properly done Phase II studies, and placebo-controlled trials continue to raise unresolved ethical and social issues. Phase III studies should be abandoned for most drugs, and substituted with properly powered Phase II doseranging studies plus careful post-marketing surveillance. Phase III should be a penalty for poor drug development, not a regulatory requirement. To accomplish efficient drug development, greater cooperation between pharmaceutical companies and governments in developing clinical trials is needed rather than over-regulation. These changes will synchronize the drug development and regulatory process with the current rapid drug discovery process, reduce drug development time and cost, and improve patient care. The author is Adjunct Professor of Medicine, Weill Medical College of Cornell University, New York, New York, USA.     

The growing complexity of international policy in intellectual property

Intellectual property has historically been a self-contained policy at the international level. With the introduction of the TRIPs Agreement in 1994 and developments since the conclusion of the TRIPs Agreement, the relationship between intellectual property policy and other areas of public policy has become much more complex and interactive. This shift reflects the centrality of intellectual property in the knowledge economy, the rapid development of enabling technologies, notably the Internet and biotechnology, and the advent of the networked society. The consequences of this shift are manifold and herald the increased sophistication and complexity that may be expected of intellectual property regimes in the knowledge economy. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

Partial Knowledge of Word Meanings: Thematic and Taxonomic Representations

The type of information (taxonomic or thematic) available at different levels of knowledge was investigated. Following extensive norming to identify taxonomic and thematic associates of low-frequency nouns, participants determined if taxonomic or thematic associates were meaningfully related to target words at three levels of knowledge: target words they correctly defined (known), recognized as familiar (frontier), or mistakenly denied as part of the language (unknown). In another experiment, participants reported which type of relationship (taxonomic or thematic) was preferred. Results indicated that both types of information were available at all levels of knowledge. However, accuracy and preference were greater for taxonomic associates across word levels. A differential increase in available thematic information relative to taxonomic information was found. Implications for the acquisition and representation of word meanings are discussed.