Cognitive rehabilitation in the elderly: overview and future directions.

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed.     

A survey of anxiety disorders clinics in Canadian hospitals.

A questionnaire on anxiety disorder services was sent to 240 Canadian hospitals, of which 117 responded. Eighteen of the responding hospitals had anxiety disorder clinics and saw an average of 208 patients a year. These clinics appear to be scarce although, according to epidemiological studies, there is a high prevalence of anxiety disorders in the community. The specific diagnoses of the patients seen in the specialty clinics and the treatments offered generally followed international patterns.     

Bilingualism and naming: implications for cognitive assessment.

The article by Gollan, Fennema-Notestine, Montoya, and Jernigan (2007, this issue) raises important issues about the, effects of bilingualism on naming test performance in older adults. In particular, proficiency in their two languages determines the ability with which older bilingual adults can name pictures in each of those languages. This observation is important if cognitive status is inferred from naming performance. In this commentary we largely endorse the arguments made by Gollan and colleagues, although we point to some limitations in their experimental design.     

Combining clinical judgement and statistical data in expert systems: Over-the-telephone management decisions for critical congenital heart disease in the first month of life

When a new-born baby with congenital heart disease is referred to a regional specialist centre, the transportation management is crucial but must be decided on the basis of clinical information obtained over the telephone. We consider algorithmic and naive statistical approaches to helping in this decision, and on the basis of preliminary results the relative strengths and weaknesses are discussed. A synthesised logical and probabilistic approach appears to have the best potential and could be implemented on hand-held computers.Paper presented at symposium on Computer-assisted Decision Support and Database Management in Anaesthesia, Intensive Care and Cardio-pulmonary Medicine, Rotterdam, 1988.     

Novelty and Familiarity Activations in PET Studies of Memory Encoding and Retrieval

Nine young right-handed men viewed colored pictures of people,scenes, and landscapes. Then, 24 hr later while undergoing PETscanning, they viewed previously studied (OLD) pictures in onetype of scan, and previously not seen (NEW) pictures in another.The OLD-NEW subtraction of PET images indicates familiarity,and the NEW-OLD indicates novelty. Familiarity activations,signalling aspects of retrieval, were observed in the left andright frontal areas, and posterior regions bilaterally. Noveltyactivations were in the right limbic regions, and bilaterallyin temporal and parietal regions, including area 37. These latteractivations were located similarly to novelty activations inprevious PET studies using visual words and auditory sentences,suggesting the existence of brain regions specializing in transmodalnovelty assessment The effects of novelty are seen both be haviorallyand in replicable patterns of cortical and subcortical activation.We propose a "novelty/encoding hypothesis": (1) novelty assessmentrepresents an early stage of long-term memory encoding; (2)elaborate, meaning-based encoding processes operate on the incoming information to the extent of its novelty, and therefore(3) the probability of long-term storage of information vanesdirectly with the novelty of the information.     

Acute changes in urine protein excretion may predict chronic ifosfamide nephrotoxicity: a preliminary observation

Purpose: To evaluate proteinuria occurring early after ifosfamide therapy and to assess the use of changes in proteinuria in the prediction of severe chronic nephrotoxicity. Methods: One-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis was used to characterize urine protein excretion in 12 children with solid tumours before and after the first course of ifosfamide treatment, and in 24 healthy children. Chronic nephrotoxicity was evaluated at 6 months after ifosfamide treatment and graded as none, mild, moderate or severe. Results: Urine from healthy children and from 10 of 12 patients before ifosfamide therapy showed a protein band with a molecular weight (95.4 kDa) corresponding to that of Tamm-Horsfall protein but no lower molecular weight proteins. After the first course of ifosfamide this 95.4-kDa protein was lost in six of ten patients with a concomitant appearance of a low molecular weight proteinuria (<70 kDa) in eight. Tamm-Horsfall protein was lost in two of five patients who subsequently developed no or mild nephrotoxicity and in four of five patients who subsequently developed moderate or severe nephrotoxicity. Conclusions: Early subclinical changes in urine protein excretion after ifosfamide, manifested by a loss of Tamm-Horsfall protein excretion, may be predictive of subsequent chronic nephrotoxicity. Received: 27 August 1996 / Accepted: 25 July 1997