老年病人的术后认知功能障碍

术后认知功能障碍（POCD）定义为术后通过反复多次神经心理测试,患者的基本认知功能出现不同程度的损害。而早期术后认知功能及精神障碍更多见于老年患者。虽然POCD多见于心脏手术术后，但非心脏手术后发生POCD亦不少见，老年患者（年龄大于65岁）行心脏手术或非心脏手术，术后1周POCD的发生率分别为50%及26%。POCD的高危因素包括：高龄、术前认知受损以及酗酒等。POCD影响生活质量，加重社会负担并干扰药物治疗效果，延长患者住院周期。有必要深入的研究POCD的病因和神经功能保护的策略。     

Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy

The cognitive behaviour therapy (CBT) emphasis on treatment relevance in assessment, and on evidence‐based intervention, has led to an increasing focus on problem maintenance factors (vs. precipitants) in both its models of psychopathology and in its individual case formulations. This article describes the reasons for this growing focus, and presents a generic CBT model based on the functional analysis of “problem‐maintaining circles” (PMCs) of causes. Some samples of the profuse literature implicating PMCs in many psychological disorders are presented, and the utility of PMC‐based functional analysis, case formulation, or modelling of psychopathology is advanced, not only as a guide to selection of therapeutic interventions, but as an alternative to standard psychiatric diagnosis. A sampling of a taxonomy of such PMCs is presented. And finally, the clinical application of PMC‐based functional analysis, case formulation, and treatment selection is illustrated in five case illustrations drawn from a recent clinical caseload.     

Children''s perceptions of chronic illness: the roles of disease symptoms, cognitive development, and information

This experiment considered the acceptance of chronically illchildren by their peers as a result of the peer's level of cognitivedevelopment, the type of disease, and the amount of informationprovided. The results of multivariate and univariate analysesof variance indicate that (a) children's comprehension of illnessescan be improved significantly with the provision of explanatoryinformation, although preoperational children are less ableto retain specifics, (b) preoperational children as well asuninformed children perceived themselves as significantly morevulnerable to contagion, (c) the more observable illness wasseen as significantly less attractive, and (d) provision ofinformation about the nature of a highly observable illnesstended to decrease rather than increase attraction.     

缺铁性贫血对学龄儿童某些认知能力影响的研究

本文采用双盲法对 IDA 和 NIDA学龄儿童各61名进行了认知能力测验及铁治疗前后的动态比较。结果表明:IDA 儿童识记再认、字母匹配反应时、数字扫描记忆和一般推理能力测验成绩较 NIDA 儿童差。经铁治疗的IDA 儿童,注意、短时记忆和心理动作反应速度均有明显提高。但对较高级认知能力的改善不明显。     

Sleep apnea-related cognitive deficits and intelligence: an implication of cognitive reserve theory

Cognitive deficits in patients with obstructive sleep apnea syndrome (OSAS) are well demonstrated, but the pathophysiology of these deficits is still controversial, as the relationship between OSA severity and cognitive deficits is usually weak. Our study considers the possible relationship between OSA-related cognitive deficits and the overall intellectual function of OSA patients. Forty-seven OSA patients and 36 normal individuals underwent a neuropsychological battery test assessing attention and alertness. According to the resulting IQ score, patients and controls were divided into a high-intelligence group (IQ > or = 90th percentile) and a normal-intelligence group (50 < or = IQ < 90%ile). Between the two patient groups there were no significant differences noticed, regarding OSA severity or sleepiness. High-intelligence patients showed the same attention/alertness performance compared with the high-intelligence controls. On the contrary, patients with normal-intelligence showed attention/alertness decline compared with the normal-intelligence control group. The two patient groups were re-examined with the same battery test after at least 1 year of CPAP treatment. At re-examination neither patient group showed any differences regarding attention and alertness compared with the control groups. We assume that high-intelligence may have a protective effect against OSA-related cognitive decline, perhaps due to increased cognitive reserve.     

Predicting Home and Work Blood Pressure Measurements from Resting Baselines and Laboratory Reactivity in Black and White Americans

The relationship between blood pressure in the laboratory (both at rest and in response to laboratory tasks) and ambulatory blood pressure at home and at work was evaluated. One hundred nineteen normotensive and unmedicated mild-moderate hypertensive black and white females and males participated in laboratory blood pressure monitoring at rest and during four challenging tasks (structured interview, video game, bicycle exercise, and cold pressor test) as well as ambulatory blood pressure monitoring while at home and at work. Baseline blood pressure taken while subjects were at rest was the strongest predictor of ambulatory systolic blood pressure (r = .64) and diastolic blood pressure (r = .77) at work. Among reactivity tasks the strongest predictors of ambulatory blood pressure in the total population were the structured interview and the video game (both psychological tasks) followed by the cold pressor test. Racial comparisons, however, determined that the cold pressor test predicted diastolic blood pressure significantly better for blacks (r = .73) than for whites (r = .40), suggesting a possible difference in blood pressure regulation.     

Language processing from the perspective of electrical stimulation mapping

ABSTRACT

Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.     

Genetic Structure of Spatial and Verbal Working Memory

Working memory (WM) encompasses both short-term memory (storage) and executive functions that play an essential role in all forms of cognition. In this study, the genetic structure of storage and executive functions engaged in both a spatial and verbal WM span task is investigated using a twin sample. The sample consists of 143 monozygotic (MZ) and 93 dizygotic (DZ) Japanese twin pairs, ages 16 to 29 years. In 155 (87 MZ, 62 DZ) of these pairs, cognitive ability scores from the Kyodai Japanese IQ test are also obtained. The phenotypic relationship between WM and cognitive ability is confirmed (r = 0.26–0.44). Individual differences in WM storage and executive functions are found to be significantly influenced by genes, with heritability estimates all moderately high (43%–49%), and estimates for cognitive ability comparable to previous studies (65%). A large part of the genetic variance in storage and executive functions in both spatial and verbal modalities is due to a common genetic factor that accounts for 11% to 43% of the variance. In the reduced sample, this common genetic factor accounts for 64% and 26% of the variance in spatial and verbal cognitive ability, respectively. Additional genetic variance in WM (7%–30%) is due to modality specific factors (spatial and verbal) and a storage specific factor that may be particularly important for the verbal modality. None of the variance in cognitive ability is accounted for by the modality and storage genetic factors, suggesting these may be specific to WM.     

盐酸多奈哌齐对轻、中型脑外伤患者认知障碍的治疗作用

目的 探讨盐酸多奈哌齐对轻、中型脑外伤患者认知障碍及临床预后的影响。方法 78例轻、中型脑外伤并认知障碍患者被随机分成治疗组和对照组，治疗组应用盐酸多奈哌齐10mg／d，对照组应用吡拉西坦8mg，一日3次服用，两组的治疗周期为12周。治疗前及治疗后12周，分别应用简明精神状态检测量表（MMSE）、国人修订成人韦氏智利量表（WAIS-RC）和格拉斯哥预后评分（GOS）评价疗效。结果 两组在治疗后12周，MMSE和WAIS-RC评分均较治疗前提高（P〈0．05）。治疗后12周，治疗组MMSE和WAIS-RC评分较对照组高（P〈0．05），治疗组GOS预后优良率明显优于对照组（P〈0．05）。结论 盐酸多奈哌齐对轻、中型脑外伤后认知障碍有积极治疗作用，并能改善临床预后。     

Family and Illness Predictors of Outcome in Pediatric Brain Tumors

Investigated the prediction of cognitive and behavioral outcomesin 63 children with heterogenous brain tumors. Hierarchicalmultiple regression analyses were used to determine how family-relatedvariables added to the prediction of children's outcome overand above illness measures. The best predictors of children'sbehavior problems and adaptive behavior were family and demographicvariables, whereas the best predictors of achievement were illnessand demographic variables. A combination of family and illnessvariables, however, was the best predictor of intellectual functioning.In addition to identifying specific predictors of cognitiveand behavioral outcome in children with brain tumors, theseresults lend initial support for the inclusion of contextualfactors such as family stress, maternal coping, number of parentsin the home, and family SES measures in studies of how diseasefactors affect outcomes in pediatric brain tumor patients.