Cardiovascular Disease in Elders: Is It Inevitable?

Cardiovascular disease is the major cause of death and disability in America. The burden of cardiovascular disease is higher in elders than in younger populations, presumably because of life-long exposure to risk factors such as hypertension, smoking, abnormal blood lipids, lack of exercise, and/or obesity. Many assume that it is too late to attempt to modify risk factors in elders because behavior is so difficult to change. The purpose of this article is to argue that cardiovascular risk factor modification is effective in elders and should be vigorously pursued for the good of individuals, families, communities, and societies.     

现代医学模式形成与疾病治疗

现代生物心理社会医学模式已经成为卫生界领导及广大医务人员的共识 ,并以此指导临床医疗实践。临床诊断正在增添新的内容 ,疾病治疗这个概念也拓宽了她的外延 ,人文科学在医学中越来越显示出她独特的不可替代的地位和作用 ,生物治疗、心理治疗、哲学治疗是未来的三大块治疗模式     

Testing the age related differentiation hypothesis through the Wechsler’s scales

According to the age differentiation hypothesis (ADH), g becomes increasingly invested in specific abilities with age: with increasing age, g should account for a decreasing proportion of the variance in any particular cognitive test. However, there is no conclusive evidence concerning this important topic. Data from the Italian, Spanish, and American standardisation samples of the WPPSI and the WISC-R were analysed in the present study for testing the ADH. No changes in the proportion of variance associated with g in the 4–16 age range were found. This pattern does not change depending on the country. Therefore, the ADH is rejected: g seems to be very stable across age, and, thus, it seems to be an equally important component of intelligence test performance from early childhood to late adolescence.     

Rhythmic priming across effector systems: A randomized controlled trial with Parkinson’s disease patients

This study investigated the immediate effects of auditory-motor entrainment across effector systems by examining whether Rhythmic Auditory Stimulation training of arm or finger movements would modulate gait speed. Forty-one participants with idiopathic Parkinson’s Disease were randomly assigned to 3 groups. Participants in the finger-tapping group tapped in synchrony with a metronome set to 20% faster pace than the pre-training walking cadence, whereas participants in the other group were asked to swing both arms in an alternating motion in synchrony with the metronome. Participants in the control condition did not receive training. To assess gait parameters pre- and post-training, participants walked on a 14-meter flat walkway at his/her preferred walking cadence with no auditory cueing. Results indicated that there was a significant increase in gait velocity after the finger tapping training (p < .005), whereas no differences were observed in the arm swing (p = .802) and in the control conditions (p = .525). Similarly, there were significant changes in gait cadence post-training in the finger tapping group (p < .005), but not after arm swing training (p = .879) or control (p = .759). There were no significant changes in stride length post-training in none of the groups. These findings suggest that auditory-motor entrainment in one effector system may prime a second effector system. Interestingly, however, the priming effect on gait was only observed in the finger tapping condition and not with synchronized arm swing movements. These findings have significant implications for motor rehabilitation and open new avenues for further investigation of the mechanisms underlying cross-effector coupling.     

Digitalized spiral drawing in Parkinson’s disease: A tool for evaluating beyond the written trace

One of the current scientific challenges is to propose novel tools and tasks designed to identify new motor biomarkers in Parkinson’s disease (PD). Among these, a focus has placed on drawing tasks. Independently from clinical ratings, this study aimed to evaluate the pen movement and holding in digitalized spiral drawing in individuals with PD without and with medical treatment and in healthy controls. A three-step data-driven analysis was conducted. First, the effects of spatial and temporal constraints on several variables were determined. Second, the relationship between handedness and dominance of PD symptoms was investigated for the most relevant variables. Finally, a third analysis was conducted to assess the occurrence of changes associated with PD. The first analysis revealed that the number of velocity peaks and pen altitude variations were the most relevant variables in spiral drawing for evaluating the effect of the disease and medication. The second analysis revealed that the effect of medication was present for the movement fluency only, when spirals with spatial constraints were produced at a spontaneous speed by the hand on the side of dominant PD signs. Finally, the third analysis showed that the effect of medication was greater at the beginning of drawing than at the end. Digitalized spiral drawing makes it possible to observe precisely when the kinematic changes related to the disease occur during the task. Such a simple and quick task might be of great relevance to contribute to the diagnosis and follow-up of PD.     

Postural control,falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers?

Postural control asymmetry is an important aspect of Parkinson’s disease (PD) that may be associated with falls. The aim of this study was to compare the postural control asymmetry during postural tasks between fallers and non-fallers in people with PD and neurological healthy age-matched controls (CG). Individuals with idiopathic PD (n = 24) and CG (n = 24) were sub-divided into groups of fallers and non-fallers based on their fall history over the past year. Participants performed blocks of three 30-s trials of quiet standing with feet in a side-by-side and semi-tandem stance position. The center of pressure parameters for each limb were measured and used to calculate the symmetry index. Fallers compared to non-fallers had decreased asymmetry of vertical force in the side-by-side condition. During the tandem-front leg condition, PD non-fallers increased asymmetry of the medial-lateral velocity of sway compared to CG non-fallers. In addition, for the tandem–back leg condition, PD non-fallers increased asymmetry of total displacement and medial-lateral root mean square and mean velocity of sway compared to PD fallers. The results of the study did not support the hypothesis that PD fallers are more asymmetric than PD non-fallers. On the contrary, our results indicated that PD non-fallers had higher postural control asymmetry, especially during the more challenging (semi-tandem standing) postural task.     

Emotion differentiation dissected: between-category,within-category,and integral emotion differentiation,and their relation to well-being

Emotion differentiation, the ability to describe and label our own emotions in a differentiated and specific manner, has been repeatedly associated with well-being. However, it is unclear exactly what type of differentiation is most strongly related to well-being: the ability to make fine-grained distinctions between emotions that are relatively closely related (e.g. anger and irritation), the ability to make larger distinctions between very distinct emotions (e.g. anger and sadness), or the combination of both. To determine which type of differentiation is most predictive of well-being, we performed a comprehensive meta-analysis across six datasets. We examined the correlations between these three types of differentiation and several indicators of well-being (depression, emotional clarity, and self-esteem). Results showed that individuals differentiated most between very distinct emotions and least between more related emotions, and that an index computed across emotions from both the same and different emotion categories was most strongly associated with well-being indicators.     

Positive and negative affect and well-being in cardiac patients and their spouses: the mediating role of illness representations

Objective: The aim of this study was to examine whether illness representations of control and consequences mediate the relation of cardiac patients’ affect to well-being. A further aim was to examine this indirect relationship at a dyadic level (i.e. patient and spouse). Design and main outcome measures: One hundred and four patients with a cardiovascular disease and their spouses participated in the study. Positive and negative affect was assessed at baseline; illness representations were assessed 2 months later, and physical and psychological well-being 4 months later. Results: Illness representations generally mediated the impact of patients’ and spouses’ affect on well-being, while several actor and partner effects were found. However, it was only positive affect that was indirectly related to well-being, while the representations of personal and treatment control chiefly acted as mediators. The effects were stronger for patients than spouses, as well as for physical well-being. Conclusion: The results underline the strong connection between illness-related self-regulation and the overall person/environment interaction as depicted by affect. They also indicate the need to integrate theories on adaptation to illness, with models describing adaptation of couples to stressful conditions, and specific theories about the role of emotion in adaptation to illness.     

Examining multiple feature evaluation and classification methods for improving the diagnosis of Parkinson’s disease

An accurate diagnosis of Parkinson’s disease by specialists involves many neurological, psychological and physical examinations. The specialists investigate a number of symptoms and signs when examining the nervous system conditions of a person. The diagnosis involves reviewing the medical history and genetic factor of the person. The recent diagnosis methodology to Parkinson’s disease relies on voice disorders analysis. This methodology entails extracting feature sets of a recorded person’s voice then utilizing a machine learning technique to identify the healthy and Parkinson’s cases from the voice. This paper attempts to improve the diagnoses of Parkinson’s disease by testing multiple feature evaluation and classification machine learning methods based on the voice disorders analysis. The aim of this paper is to find the optimal solution to the problem by (i) proposing a new Multiple Feature Evaluation Approach (MFEA) of a multi-agent system (ii) implementing five independent classification schemas which are Decision Tree, Naïve Bayes, Neural Network, Random Forests, and Support Vector Machine on the Parkinson’s diagnosis before and after applying the MFEA, and (iii) evaluating the diagnosis accuracy of the results. The methodology of the tests encompasses 10-fold cross-validation to evaluate the learning of methods and track variation in their performance. The test results show that the MFEA of the multi-agent system finds the best set of features and improves the performance of the classifiers. The average rate of improvement in the diagnostic accuracy of the classifiers are Decision Tree 10.51%, Naïve Bayes 15.22%, Neural Network 9.19%, Random Forests 12.75%, and Support Vector Machine 9.13%. These results show that the MFEA makes a significant improvement to the classifiers’ diagnosis results.