ALZHEIMER'S DISEASE AND SOCIALLY EXTENDED MENTATION

Abstract: The leading accounts of the ethics of proxy decision making implicitly draw on internalist conceptions of the philosophy of mind, or so this essay tries to demonstrate. Using the views of Ronald Dworkin as its jumping-off point, the essay argues that accepting the sort of externalism associated with writers such as Putnam and Burge would alter Dworkin's conclusions concerning how we should respond to the current or precedent decisions of people suffering from dementia. Building on the views of Agnieszka Jawarska, it argues that accepting "active" externalism à la Clark and Chambers would provide currently competent people with new resources for establishing the authority of their present values over inconsistent values they might come to entertain should they become demented.     

A computational model of Parkinsonian handwriting that highlights the role of the indirect pathway in the basal ganglia

Parkinsonian handwriting is typically characterized by micrographia, jagged line contour, and unusual fluctuations in pen velocity. In this paper we present a computational model of handwriting generation that highlights the role of the basal ganglia, particularly the indirect pathway. Whereas reduced dopamine levels resulted in reduced letter size, transition of STN–GPe dynamics from desynchronized (normal) to synchronized (PD) condition resulted in increased fluctuations in velocity in the model. We also present handwriting data from PD patients (n = 34) who are at various stages of disease and had taken medication various lengths of time before the handwriting sessions. The patient data are compared with those of age-matched controls. PD handwriting statistically exhibited smaller size and larger velocity fluctuation compared to normal handwriting.     

Musical and verbal memory in Alzheimer’s disease: A study of long-term and short-term memory

Musical memory was tested in Alzheimer patients and in healthy older adults using long-term and short-term memory tasks. Long-term memory (LTM) was tested with a recognition procedure using unfamiliar melodies. Short-term memory (STM) was evaluated with same/different judgment tasks on short series of notes. Musical memory was compared to verbal memory using a task that used pseudowords (LTM) or syllables (STM). Results indicated impaired musical memory in AD patients relative to healthy controls. The deficit was found for both long-term and short-term memory. Furthermore, it was of the same magnitude for both musical and verbal domains whether tested with short-term or long-term memory tasks. No correlation was found between musical and verbal LTM. However, there was a significant correlation between verbal and musical STM in AD participants and healthy older adults, which suggests that the two domains may share common mechanisms.     

The assessment of recognition memory using the Remember/Know procedure in amnestic mild cognitive impairment and probable Alzheimer’s disease

This study used the Remember/Know (R/K) procedure combined with signal detection analyses to assess recognition memory in 20 elders with amnestic mild cognitive impairment (aMCI), 10 patients with probable Alzheimer’s disease (AD) as well as matched healthy older adults. Signal detection analyses first indicated that aMCI and control participants were comparable on general recognition performance. As regards AD patients, they were impaired relative to both aMCI and healthy elders. When assessing Remember and Know responses the aMCI group showed diminished sensitivity for Remember responses but intact Know responses compared to healthy elders. In contrast, AD patients showed decreased sensitivity for both Remember and Know responses compared to control and aMCI participants. The response bias index revealed that AD patients were more liberal than aMCI and control participants when providing Know responses. On the other measures, response bias was comparable between the groups. Overall, this study indicates that the R/K procedure can characterize different aspects of recognition memory performance in persons with aMCI or AD.     

Parkinsonian Patients Reduce Their Stroke Size with Increased Processing Demands

Parkinson's disease (PD) patients often show reductions in writing size (micrographia) as the length of the text they produce increases. The cause for these reductions in stroke size are not well understood. Reductions in stroke size could be associated with either concurrent processing demands that result from the coordination and control of fingers, wrist, and arm during writing and the processing of future words or increased extension of the wrist joint as the execution of the writing progresses to the right across the page, resulting in increased stiffness in the pen-limb system. Parkinson's patients and elderly controls wrote phrases of different lengths with target patterns in various serial positions. When the number of words to be written increased, PD patients reduced their stroke size of the initial target pattern, while the elderly controls did not reduce their stroke size. There was no systematic change in stroke size of the second pattern as function of serial position. This result suggests that PD patients reduce the size of their handwriting strokes when concurrent processing load increases.     

循证医学及其在心血管疾病中的应用

循证医学作为一门新兴的学科,对医学的研究和实践将产生越来越大的影响。在循证医学的操作过程中,如何正确评价和应用所获得的证据极为重要。在短短的十几年间,循证医学给心血管疾病的临床实践带来了根本的变化。     

Evidence of Impaired Glucose Tolerance and Insulin Resistance in Patients With Alzheimer’s Disease

Alzheimer’s disease (AD) and diabetes rarely occur together, a finding that provides a possible clue as to the development of AD. Abnormal glucose metabolism is not limited to diabetes, but also can include impaired glucose tolerance, insulin resistance, and hyperinsulinemia. AD patients have significantly varying insulin levels after drinking sugared sodas and thus may be classified as insulin resistant. After reviewing the literature on impaired glucose tolerance and insulin production in AD, we present several hypotheses as possible explanations for the relationship between insulin resistance and AD. Finally, we suggest future studies, including studies on use of thiazolidinediones (currently used in the treatment of diabetes) in AD.     

浅谈恙虫病的几点认识

恙虫病是自然疫源性急性传染病。通过恙虫病医疗实践，谈几点个人认识：恙虫病流行与该疫源地区鼠类活动有关；恙虫病疫源地会因气候变化而变更；重视恙虫病准确而及时诊断，尽量减少病人疾苦；恙虫病立克次体对人单核-吞噬细胞系统有特别的亲嗜性与专性细胞内寄生，是其临床病理基础；用氯霉素联合双黄连治疗恙虫病可获满意效果。     

Resilience in siblings of children with sickle cell disease

This pilot study was conducted to identify factors responsible for promoting resilience in siblings of children with sickle cell disease. Twenty siblings (10–17 years of age) of children (5–13 years) with sickle cell disease were selected from the Pediatric Clinic of Howard University Center for Sickle Cell Disease. The siblings responded to questionnaires, and the data obtained was analyzed by chi-square for association. The results indicated that age, birth order, and gender had no effect on resilience in the siblings. However, family size, number of parents in the home, sibling's knowledge of the illness, degree of morbidity of the illness, socioeconomic status of the family, and parents' attitudes and childrearing practices were all found to affect resilience. These findings provide additional insight into the psychosocial aspects of, and genetic counseling for sickle cell disease, as well as for other chronic genetic disorders.