Cognitive impairments of aphasics in picture sorting and matching tasks

On the basis of earlier experiments showing a differential deficit of aphasics in picture sorting and matching tasks, two experiments were conducted to test the conjecture of a specific deficit of aphasics in the analytical appraisal of individual features. Broca's and Wernicke's aphasics-according to clinical diagnoses and the Aachener Aphasie Test-were compared with patients having right-hemisphere lesions or left-hemisphere lesions without aphasia. Both groups of aphasics differed from the control groups in the sorting task, irrespective of the sorting criterion, but the differences were small. The picture matching task did not discriminate between groups. Obviously, the basic assumption has to be modified with respect to specific conditions of task requirements. The experimental literature is reviewed.This research was supported by a Research Grant from the Deutsche Forschungsgemeinschaft.The research was conducted at the following clinics and rehabilitation centers. We are grateful for their support: Abteilung Neurologie der Med. Fak., RWTH, Aachen. Poliklinik für Stimm-und Sprachkranke, Universitätsklinikum Steglitz, Freie Universität Berlin. Neurologisches Rehabilitationszentrum Godeshöhe e. V., Bonn. Rheinische Landesklinik für Sprachgestörte, Bonn. Neurologische Klinik der Universität Ulm, Dietenbronn. Kliniken Schmieder, Gailingen und Allensbach. Max-Planck-Institut für Psychiatrie, München. Neurologiches Krankenhaus, München. Neurologisches und Hirneverletzten-Versorgungskrankenhaus, Tübingen.We are also most grateful for the kind help of K. Willmes, Aachen, in carrying out the discriminant analyses to classify the aphasics on the basis of the Aachener Aphasie Test.     

老年性痴呆患者的听觉损害

目的　确定老年性痴呆患者 (seniledementiaoftheAlzheimer′sdisease ,AD)有无周围性听功能障碍及其与认知障碍的关系。方法　利用纯音测听、言语识别率、声导抗、听觉脑干反应检测AD患者 43例 ,健康老年人 50例 ,评定受试者测听可信度 ,统计测试结果 ,并将上述结果同受试者简易精神状态量表 (mini mentalscaleofequastionnaire ,MMSE)得分进行对照分析 ,寻找二者之间的关系。结果　受试者两耳间周围听力差异无显著性 ,以右耳听力结果 ( x±s)进行统计。AD组纯音听阈为 (2 6 3± 8 5)dBHL和 (2 9 1± 8 7)dBHL ,言语识别率为 (85 5± 5 5) % ;对照组纯音听阈为 (2 3 2± 1 0 6)dBHL和 (2 6 2± 1 1 8)dBHL ,言语识别率为 (87 6± 6 8) %。虽然AD组周围听功能检查结果低于对照组 ,但无统计学意义 (P >0 0 5)。测听可信度、声导抗和ABR阈值两组间差异无显著性 (P >0 0 5)。结论　老年性痴呆患者纯音听阈和言语识别率与老年聋相似 ,其周围听功能障碍与MMSE认知量表得分无关。     

昆山市中小学生安全知识现况调查

目的了解昆山市中小学生安全知识现况,为学校安全教育提供依据。方法随机抽取昆山市小学五、六年级,初中一、二年级,高中一、二年级学生共1 198名,应用自行设计的问卷进行安全知识现况调查。结果学生火灾知识和急救常识的平均得分分别为13.73和10.75分,正确率分别为72.3%和71.7%。不同性别、不同年级学生安全知识得分差异有统计学意义。结论不同性别、不同年级学生安全知识水平不同,应分别采取相应的安全知识教育,以增强学生的安全意识。     

Cognitive disorders in patients with occlusive disease of the carotid artery: a systematic review of the literature

We present a systematic review of the literature on the prevalence, nature, severity, course, and causes of cognitive deficits in patients with occlusive disease of the carotid artery prior to surgery (if surgery was under discussion). Searches were carried out on Medline and Psychlit from 1980 to 1999 using neurovascular and psychological index terms, and papers and books were checked for further references. Studies describing neuropsychological assessment of groups of patients with carotid obstruction were included. Eighteen studies were found. We extracted from the papers data on study design, demographic characteristics of patients, clinical diagnosis, carotid obstruction, cerebral imaging, time interval between ischemic episode and neuropsychological assessment, neuropsychological asessment procedures, integration and interpretation of test performances, and conclusions of authors. Fourteen studies concluded that there are cognitive deficits both in patients with symptomatic and in those with asymptomatic carotid obstruction; four studies denied cognitive impairment. There were no differences in patient characteristics, study design, or neuropsychological assessment procedures between the 14 studies that found deficits and the 4 that did not. There are indications for a mild, diffuse, detrimental effect of carotid occlusive disease on cognitive functioning. However, methodological problems prevent a definitive conclusion. Further research is needed to confirm these findings and to ascertain the neurovascular risk factors for and the natural course of cognitive impairment in patients with carotid occlusive disease. Received: 12 July 1999/Received in revised form: 10 November 1999/Accepted: 26 January 2000     

血管性痴呆患者脑血流变化特点

目的探讨血管性痴呆(VD)患者脑血流灌注显像特点。方法分别对12例血管性痴呆患者,13例血管性轻度认知功能障碍(VaMCI)患者和11名正常对照(NC)组进行单光子发射电子计算机断层扫描(SPECT)局部脑血流灌注显像,定量分析各脑区血流灌注情况。结果D组和VaMCI组与对照组相比;VD组与VaMCI组相比额叶、颞叶、顶叶,基底节局部脑血流灌注减少(P<0.05)。尤以额叶、颞叶血流灌注减低最为显著(P<0.01),额叶、颞叶血流灌注减低与简易智能状态量表(MMSE)评分间呈正相关(r额=0.981,P<0.01,r颞=0.76,P<0.05),尤以额叶更显著。结论SPECT对VD患者有早期辅助诊断价值,即使对VaMCI患者SPECT也同样敏感。其对于VD的预测、早期治疗以及VCI与阿尔茨海默病的高危人群轻度认知障碍(MCI)的鉴别都有重要意义。     

北京市社区老年人群血压水平与认知功能变化的4年纵向研究

目的 探讨北京市社区老年人血压与通过简短精神状态(MMSE)量表检测的认知功能之间的关系。方法 以北京市一个有代表性的60岁及以上老年群体为研究对象,进行大样本的纵向流行病学研究。于1993年进行基线调查,检测血压,以MMSE为工具检查认知功能,并进行问卷调查,内容包括人口学情况、健康状况、生活状况等。1997年进行随访,以相同的工具复测认知功能并进行问卷调查,分析基线认知功能正常者4年后的变化。结果 2079名基线认知得分正常的老年人,平均收缩压为(141.77±24.94)mmHg(1mmHg=0.133kPa),平均舒张压为(81.76±12.08)mmHg。基线平均MMSE得分(25.65±3.59)分,4年后随访平均MMSE得分(23.24±5.63)分。随访得分与基线得分比较下降≥4分为认知功能明显下降。发现随着基线收缩压及舒张压水平增高,认知得分及认知功能明显下降的老年人比例增大。分层分析提示,在低龄(<75岁)、农村、无糖尿病及不用降压药物的老年人中,不同血压水平对认知功能改变有显著影响,血压水平高者认知得分明显下降的比例增大,这种关系在排除脑血管病和心脏病的影响后,在收缩压组依然存在。结论 纵向研究显示,老年人收缩压及舒张压升高可导致认知功能受损,随着血压水平的增高,认知功能下降的幅度增大。     

Wilfred Trotter and the biosociology of peace and war

The distinguished surgeon Wilfred Trotter (1872–1939), in his book Instincts of the Herd in Peace and War, can be regarded as a pioneer of biosociology and its application to the phenomenon of war. In this paper some of Trotter's ideas are discussed and their relevance to the problems of the present day are considered.     

A prospective study on the neurological complications of breast cancer and its treatment: Updated analysis three years after cancer diagnosis

ObjectivesTo quantify the prevalence of neurological complications among breast cancer patients at one and three years after diagnosis, and to identify factors associated with neuropathic pain (NP) and chemotherapy-induced peripheral neuropathy (CIPN).Material and methodsProspective cohort study including 475 patients with newly diagnosed breast cancer, recruited among those proposed for surgical treatment (Portuguese Institute of Oncology, Porto). Patients underwent a neurological evaluation and had their cognitive function assesses with the Montreal Cognitive Assessment, before treatment and at one and three years after enrollment. We estimated the prevalence of each neurological complication, and odds ratios (OR), adjusted for socio-demographic and clinical characteristics, to identify factors associated with NP and CIPN.ResultsMore than half of the patients [54.7%, 95% confidence interval (95%CI): 50.2–59.2] presented at least one neurological complication, at one or at three years after cancer diagnosis. Between the first and the third year of follow-up, there was an increase in the prevalence of NP (from 21.1% to 23.6%), cognitive impairment (from 7.2% to 8.2%), cerebrovascular disease (from 0.6% to 1.5%) and brain metastasis (from 0.0% to 0.6%). The prevalence of CIPN decreased from 14.1% to 12.6%. Axillary lymph node dissection was associated with NP at one year (OR = 2.75, 95%CI: 1.34–5.63) and chemotherapy with NP at three years (OR = 2.10, 95%CI: 1.20–3.67). Taxane-based chemotherapy was strongly associated with prevalence of CIPN at one and three years.ConclusionNeurological complications are frequent even three years after cancer diagnosis and NP remained the major contributor to the burden of these conditions among survivors.     

Cognitive impairment and sedentary behavior predict health-related attrition in a prospective longitudinal Parkinson's disease study

IntroductionIn Parkinson's disease (PD), the high burden of motor and non-motor symptoms, such as cognitive impairment or falls, is associated with rapid disease progression and mortality. This is often reflected by an increased drop-out rate of PD patients in longitudinal studies. Active physical behavior can impact the disease course beneficially and has an overall positive effect on health. Contrarily, sedentary behavior is associated with cognitive impairment in PD. The aim of this study was to investigate whether sedentary physical behavior assessed in the home environment and cognitive impairment can predict health-related study attrition due to sickness and death in PD.MethodsData of 45 PD patients, longitudinally assessed, were analyzed. Of those, 20 patients completed six yearly visits, 16 dropped out due to sickness or death, and nine for other reasons. All patients wore a mobile device to assess physical behavior and completed cognitive testing.ResultsLogistic regression revealed global cognition was the primary predictor for health-related drop-out in varying models (p ≤ .04). In the survival analysis, cognitive impairment (p = .005) and longer sedentary mean bout length (p = .02) were associated with drop-out due to sickness and death. The occurrence of health-related study drop-out or death was highest in patients with both impaired cognition and longer sedentary bouts.ConclusionsCognition was the primary predictor for study drop-out due to sickness and death. However, it seems that sedentary behavior might have a potential negative influence on PD patients’ health, especially those with cognitive impairment.