Boston Naming Test automatic credits inflate scores of nonaphasic mild dementia patients

Introduction: The Boston Naming Test (BNT), a 60-item test of confrontation naming, may be administered either from Item 1 or Item 30, depending on assumptions of performance. If the BNT is administered from Item 30, 29 automatic credits are given for preceding items, allowing identical norms for either administration. We aimed to compare effects of automatic credits. Method: We compared effects of automatic credits in the Gothenburg Mild Cognitive Impairment Study, first between normal controls (n = 23) and patients (n = 259), and then between the same patients grouped by stage of impairment: subjective cognitive impairment (SCI, n = 75), mild cognitive impairment (MCI, n = 117), or mild dementia (n = 67). Results: Automatic credits added to all groups. Both administrations from Item 1 and those from Item 30 discriminated between controls (n = 23) and all patients (n = 259), as well as between the above stages of impairment. However, neither administration discriminated between normal controls and SCI patients. When earned scores were compared, with scores counted from Item 30 plus 29 automatic credits, mild dementia patients on average received a 3.4-credit boost. This equals 82% of the standard deviation of Tallberg’s Swedish norms [Brain and Language, 94(1), 19–31 (2005)] or 117% of our normal controls’ standard deviation. Conclusions: In our homogenous material, administration of BNT from Item 30 distinguished between stages of deterioration as well as administration from Item 1. In line with recent literature, we also find BNT results skewed. Thus, for clinical accuracy, we recommend use of cumulative percentages, careful consideration of education and demographic factors, and, most importantly, never to mix forms of administrations with and without automatic credits. While BNT automatic credits diminish accuracy on all levels, they inflate scores significantly for nonaphasic mild dementia patients.     

The rate of conversion of mild cognitive impairment to dementia: predictive role of depression

BACKGROUND: Mild cognitive impairment (MCI) is a condition referring to the persons with cognitive deficits measurable in some form or another, but not meeting criteria for dementia, and who have an increased risk of becoming demented. OBJECTIVE: To establish the rate of progression to dementia in MCI, to investigate the risk of conversion for amnestic vs multiple-domains subtypes, and to identify the predictors of progression. METHODS: MCI (n = 105) individuals enrolled in a longitudinal study received annual clinical and psychometric examinations for up to a mean of 3 years. The diagnosis of MCI according to Mayo Clinic Petersen's Criteria was conducted by a panel of specialists. RESULTS: After 3 years of follow-up, 23 of 105 subjects with MCI were diagnosed with dementia. 40 showed cognitive decline not dementia, 34 were stable and showed no cognitive decline or improvement, while eight showed cognitive improvement. CONCLUSIONS: We conclude that conversion rate from MCI to DSM-IIIR dementia was 21.9% over a period of 3 years. The occurrence of depressive symptoms may constitute a predictor for those who are more likely to progress to dementia. The risk of conversion to dementia was higher among the subjects with an evidence of impairment extending beyond memory than with those who suffered only from memory deficits, and the subjects who converted to dementia in this subtype had significantly higher baseline plasma total homocysteine levels than non-converters.     

The catatonic syndrome in dementia praecox

Psychiatric Quarterly -     

The pre-psychotic personality in dementia praecox

Summary A hundred consecutive navy admissions diagnosed dementia præcox have been studied. Only 28 per cent had pre-psycchotic personalities characterized by introversion; 35 per cent showed distinct extroversion; and 37 per cent were ambivert, or showed a mixture of the two traits. No particular diagnostic subtypes seem to be related to either personality trait. It appeared that from six to nine months after admission 61 per cent of the total had been discharged, 9 per cent as recovered, 23 per cent as socially recovered, and 27 per cent as improved. Extroverts showed, approximately, a 10 per cent better recovery rate than introverts, while catatonics showed only about 25 per cent of failure to recover compared to 39 per cent of the total. However, all figures presented need to be considered with great caution as to their significance in view of the relatively small number. Most significantly,the results of the study are not consistent with the conventional idea that a majority of schizophrenics have introvert pre-psychotic personalities.The authors believe that conditions diagnosed as dementia præcox are of widely differing nature and that those exhibiting atypical (extrovert) pre-psychotic personalities should be designated differently, possibly as schizophrenoid psychosis, the term dementia præcox being reserved for those with typical introvert pre-psychotic characters.     

Treatment of dementia praecox

Summary and Conclusions Modern psychiatry has demonstrated that these cases can be adjusted by psychoanalytic procedures, but the technique is by no means an easy one. It requires a superabundance of patience together with a vast knowledge of the unconscious mind in normal and abnormal psychology.Jung was the first to show that this work is a creative effort, and that the treatment of dementia præcox is based entirely upon the empirical knowledge gained from a study of the neuroses. There are two essentials necessary for the successful treatment of dementia præcox: First, we must get the patients in what Jung calls a liquid condition, that is, not yet congealed; second, to be able to diagnose them requires years of experience and an intuitive process that can only be attained by psychiatrists who study the early dementia præcox.The restoration to an adjustment then consists in a reintegration of the dissociated psychic entities (readjustment of the libido). The libido if injured by amoral shock will seek its gratification in other channels. Making known the raging unconscious forces to consciousness is not sufficient to effect an adjustment. The morals of these unfortunate beings must be altered.     

Psychology of dementia praecox

Conclusion Hellaane G. started to give evidence, in infancy, of schizoid traits and tendencies which became increasingly established under the influence of her upbringing. While undoubtedly she can be said to have manifested dementia præcox reactions, at least from the time of puberty, she was nevertheless able, with the exception of periods during times of great stress, to get along fairly well until shortly before her commitment. Despite her obvious inability to meet reality squarely, she, nevertheless, continued, probably chiefly because of her children, to maintain contact with it; and, as long as she was able to feel herself to be of importance to her children, she was on safe ground.For some time preceding her commitment, H. G. had been debating the problem, very important to her, of remarriage. Her aunts objected to this, but the important objection came from her children. Though desirous of going on with the marriage, she sought every possible road of escape from the associated possibility of losing her children's love.When her dog kennel business went badly and debts mounted, she tried desperately to go on by accepting a position in a field foreign to her. Her failure in this was catastrophic in its effect. There was now no outlet left her but to marry. The threat of loss of her children's affections became acute, and the psychosis, with attempt to dissolve the inimical situation, quickly developed. Hellaane could defy her aunts but not her children; and, so because of the unsurmountable obstacle that they represented, she tortured them and killed them off, not however without having herself to suffer for her sadism.     

Psychology of dementia praecox

Psychiatric Quarterly - Hellaane G. started to give evidence, in infancy, of schizoid traits and tendencies which became increasingly established under the influence of her upbringing. While...     

非痴呆型血管性认知障碍的磁共振波谱成像研究进展

血管性认知障碍（VCI）目前已成为老年人认知障碍的主要病因,其中,非痴呆型血管性认知障碍（VCIND）是VCI的初期阶段,具有可逆性。近年来,磁共振波谱（MRS）以其高分辨率、无创的特点,越来越广泛地应用于临床,成为了研究的热点。目前研究表明,VCIND患者的认知损害包括执行功能、视空间、感知功能、记忆力等几乎所有的主要认知域。MRS与认知量表的联合应用可提高VCIND的临床诊断的准确率。VCIND患者额叶、颞叶NAA/Cr降低较为明确,而丘脑仍需进一步研究。Cho在VCIND患者脑组织中的变化研究结果不甚一致。另外,MRS在M-aMCI与VCIND的鉴别中可起到重要的作用。关于VCIND的研究尚存在诸多问题,且结果差异较大,尚需进一步研究。     

从血管性痴呆到血管性认知功能损害

本文通过回顾血管性痴呆的提出及争议，引出血管性认知功能损害提出的背景及其必要性，阐述了其诊断标准目前存在的问题及新近的研究进展，旨在通过比较血管性痴呆到血管性认知功能损害定义的演变说明血管性认知功能损害这一定义的重要性，指出寻找血管性认知功能损害特异性的神经心理学表现、影像学特点、生物学标记以及病理学特点将是今后。     

The neuropathology and cerebrovascular mechanisms of dementia

The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease neuropathology, dementia classifications remain controversial. Recently, the National Plan to address Alzheimer’s Disease prioritized Alzheimer’s disease-related dementias to include: Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, and mixed dementias. While each of these dementing conditions has their unique pathologic signature, one common etiology shared among all these conditions is cerebrovascular dysfunction at some point during the disease process. The goal of this comprehensive review is to summarize the current findings in the field and address the important contributions of cerebrovascular, physiologic, and cellular alterations to cognitive impairment in these human dementias. Specifically, evidence will be presented in support of small-vessel disease as an underlying neuropathologic hallmark of various dementias, while controversial findings will also be highlighted. Finally, the molecular mechanisms shared among all dementia types including hypoxia, oxidative stress, mitochondrial bioenergetics, neuroinflammation, neurodegeneration, and blood–brain barrier permeability responsible for disease etiology and progression will be discussed.     

Neuropsychiatric predictors of conversion to dementia both in patients with amnestic mild cognitive impairment and those with subcortical vascular MCI

Objective

The aim of this study was to investigate whether specific neuropsychiatric domains could predict a conversion to dementia in those patients either with amnestic subtype of mild MCI (aMCI) or subcortical vascular MCI (svMCI).

Methods

At baseline, all subjects underwent neuropsychological tests, Neuropsychiatric Inventory (NPI), and MRI. We compared the baseline NPI scores between converters (CV) and non-converters (NCV) both in the aMCI and svMCI groups.

Results

The mean follow-up duration was 16.74 ± 8.02 months (range: 4.2–43.9). At the second time point, about 30% of aMCI and svMCI patients converted to dementia with 7.5% of aMCI patients exhibiting improvement to normal cognitive state. In female aMCI patients, those who later improved to normal cognition exhibited higher baseline depression scores than the CV group. However, baseline depression scores were higher in the CV group than the NCV group in svMCI patients, and this difference was significant only in males.

Conclusion

Our results suggest that depression might serve as a predictive marker of conversion to dementia in patients with svMCI, albeit only in males. On the other hand, patients who later improved to normal cognition showed higher scores of depression at baseline in female aMCI patients, suggesting that longer follow-ups are warranted in female patients with aMCI and depression.