Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment,clinical aspects and recovery

BackgroundImpaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI).ObjectivesThe present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery.MethodsFollowing the PRISMA guidelines, 95 articles meeting the inclusion criteria were included.ResultsISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness.ConclusionISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.     

我国科研人员和期刊编辑对学术期刊开放科学数据的认知调查分析

【目的】 从各个角度呈现我国科研人员和期刊编辑关于期刊开放科学数据的认知现状,为期刊科学数据开放政策的制订提供数据支持。【方法】 基于文献调研和现场调研确定调查内容,利用问卷星平台对我国期刊编辑和自然科学与工程技术领域的科研人员关于学术期刊开放科学数据的发展前景、担忧的问题,以及所需保障等问题进行调查,共获得950份自然科学与工程技术领域科研人员有效问卷和205份期刊编辑有效问卷。【结果】 我国科研人员在向国内外期刊投稿时遇到期刊要求提供原始数据的情况并不是非常普遍,很多期刊编辑对于期刊开放科学数据并不是非常了解;期刊编辑和科研人员基本都认为期刊开放科学数据有利于科研发展,双方均认为中文期刊开放科学数据是必然之势,但是需要一定的保障措施;国家的鼓励性措施、强制性措施均是促使期刊实施开放科学数据政策的可行方式。【结论】 科技期刊需加强开放科学数据的宣传,加深期刊编辑和科研人员对开放科学数据的认识;加强对原始数据的重视,提升期刊编辑对于文章原始数据的理解,并有意识地加强与作者关于原始数据的沟通,为原始数据全面开放提供参考。     

Prenatal opioid exposure: The next neonatal neuroinflammatory disease

The rates of opioid use disorder during pregnancy have more than quadrupled in the last decade, resulting in numerous infants suffering exposure to opioids during the perinatal period, a critical period of central nervous system (CNS) development. Despite increasing use, the characterization and definition of the molecular and cellular mechanisms of the long-term neurodevelopmental impacts of opioid exposure commencing in utero remains incomplete. Thus, in consideration of the looming public health crisis stemming from the multitude of infants with prenatal opioid exposure entering school age, we undertook an investigation of the effects of perinatal methadone exposure in a novel preclinical model. Specifically, we examined the effects of opioids on the developing brain to elucidate mechanisms of putative neural cell injury, to identify diagnostic biomarkers and to guide clinical studies of outcome and follow-up. We hypothesized that methadone would induce a pronounced inflammatory profile in both dams and their pups, and be associated with immune system dysfunction, sustained CNS injury, and altered cognition and executive function into adulthood. This investigation was conducted using a combination of cellular, molecular, biochemical, and clinically translatable biomarker, imaging and cognitive assessment platforms. Data reveal that perinatal methadone exposure increases inflammatory cytokines in the neonatal peripheral circulation, and reprograms and primes the immune system through sustained peripheral immune hyperreactivity. In the brain, perinatal methadone exposure not only increases chemokines and cytokines throughout a crucial developmental period, but also alters microglia morphology consistent with activation, and upregulates TLR4 and MyD88 mRNA. This increase in neuroinflammation coincides with reduced myelin basic protein and altered neurofilament expression, as well as reduced structural coherence and significantly decreased fractional anisotropy on diffusion tensor imaging. In addition to this microstructural brain injury, adult rats exposed to methadone in the perinatal period have significant impairment in associative learning and executive control as assessed using touchscreen technology. Collectively, these data reveal a distinct systemic and neuroinflammatory signature associated with prenatal methadone exposure, suggestive of an altered CNS microenvironment, dysregulated developmental homeostasis, complex concurrent neural injury, and imaging and cognitive findings consistent with clinical literature. Further investigation is required to define appropriate therapies targeted at the neural injury and improve the long-term outcomes for this exceedingly vulnerable patient population.     

Effects of dance therapy on cognitive and mood symptoms in people with Parkinson's disease: A systematic review and meta-analysis

ObjectiveTo investigate whether the dance therapy was more beneficial than non-dance therapy on cognitive and mood symptoms in patients with Parkinson's disease (PD).MethodsMEDLINE, CINAHL, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to December 11, 2018. Risk of bias for the included trials was assessed using criteria in the Cochrane Handbook for Systematic Reviews of Interventions.ResultsSeven randomized controlled trials were identified on cognitive and mood symptoms in patients with PD. There were significant differences in favor of dance in executive function (WMD = 1.17, 95% CI:0.39 to 1.95, P = 0.003; I² = 0%, P = 0.45), but not in outcomes of global cognitive function, depression and apathy.ConclusionsDance therapy is beneficial in improving executive function for adults with PD. However, there are no positive effects were founded on global cognitive function, depression and apathy for PD.     

Éléments de validation du Protocole d’Évaluation de la Cognition Sociale de Bordeaux (PECS-B) en population générale et dans la schizophrénie

ObjectivesIn recent years, social cognition has received growing interest in the international psychiatric and neurologic literature. Social cognition impairments are described in many different conditions and are associated with a poor functional outcome. Consequently, an accurate and valid assessment of social cognition abilities is necessary in clinical practice, so as to better understand individual functioning and define corresponding therapeutic interventions. The aim of the present study was to provide further elements of validation to the Bordeaux Social Cognition Assessment Protocol (Protocole d’Evaluation de la Cognition Sociale de Bordeaux: PECS-B) in the general population and in one with schizophrenia.MethodsA total of 131 healthy controls and 101 participants with schizophrenia or schizoaffective disorders between 18 and 60 years old were included. Sociodemographic variables (i.e., age, education level, sex), social cognition (i.e., emotional fluency, facial emotion recognition, theory of mind, emotional awareness and alexithymia with the PECS-B), neurocognition (i.e., processing speed, episodic verbal memory, short-term memory, working memory, selective and sustained attention, spontaneous and reactive flexibility), anxiety and depressive mood were assessed in both samples.ResultsResults show a good discriminative power for the PECS-B within the same population. Only “Attribution of Intention” and “Faux-Pas” tasks show ceiling effects in both samples. Structural validity is satisfactory in the general population sample and suggests that the social cognition structure consists of four factors: facial emotion recognition (1), emotional lexicon (2), explicit processing of sophisticated emotional information (3) and theory of mind (4). Structure validity is also satisfactory in the schizophrenia sample, after removal of the variable “Emotional fluency-Percentage of sophisticated words”. In this case, the social cognition structure consists of two factors: general social cognition (1) and explicit processing of sophisticated emotional information (2). Results show a good divergent validity in both populations, between close constructs such as neurocognition and anxiety/depression. Nevertheless, correlations between social cognition and neurocognition are more frequent in the schizophrenia sample. Internal consistency is satisfying in both samples. Finally, results reveal some effects of sociodemographic variables (i.e., age, education level and sex) both in the general population and schizophrenia samples. Norms are also presented for adults aged between 18 and 60.ConclusionStructural validity, divergent validity and internal consistency of the PECS-B are satisfactory in the general population and the schizophrenia one. The PECS-B presents with good psychometric qualities that permit its use for the assessment of adults’ social cognition in clinical practice as much as research.     

康复护理干预在改善脑梗死后患者日常生活能力和认知功能中的应用效果

目的 探讨康复护理对脑梗死后认知功能障碍及日常生活能力的影响及意义。方法 将90 例脑梗死后发生认知功能障碍的患者依随机数字表法分为观察组(45例)与对照组(45例)。对照组和观察组均 实施常规的护理治疗措施,此外,对观察组实施早期的康复护理措施。 疗程为1个月,比较两组患者的认知功能障碍及日常生活能力的情况。结果 试验1个月后,观察组有效率为78%,对照组有效率为31%,两组的临床疗效差异有统计学意义(χ²=19.929,P＜0.001)。观察组的简易智能精神状态检查量表(MMSE)、韦氏成人记忆量表(WMS)和日常生活功能量表(ADL)评分明显增高,两组MMSE(t=3.226,P=0.002)、WMS(t=3.394,P=0.001)、ADL(t=7.221,P<0.001)得分均差异有统计学意义。结论 早期康复护理干预对脑梗死患者具有良好的临床疗效,可以显著改善患者认知功能及日常生活能力。     

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

Background: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments.

Method: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR?=?36%)

Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%).

Conclusion: The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.