Considerations for Reliable Digit Span as a performance validity test for long-term survivors of childhood brain tumors

The Reliable Digit Span (RDS) is a performance validity test (PVT) used widely within non-clinical samples, but its utility is in question in clinical groups with cognitive impairment. To investigate, RDS scores were calculated and correlated with the Neurological Predictor Scale, an informant-reported Activities of Daily Living score, and a proxy measure of intelligence (Vocabulary) for 83 adult survivors of childhood brain tumors and 105 healthy controls. Analyses were covaried for age at examination. Participants were divided into passing and failing groups at each RDS cutoff, and ANCOVAs for each of the three variables of interest covaried for age at the examination were run. RDS was correlated with all three variables of interest in survivors but only Vocabulary in controls. At the ≤7 cutoff, passing and failing survivors demonstrated significant differences across all variables of interest, while passing and failing controls differed only on Vocabulary. Differences were also found between passing and failing survivors at lower cutoffs. RDS is related to and likely impacted by various neurological and cognitive challenges faced by brain tumor survivors. Using the standard RDS cutoff of ≤7 may result in inaccurate interpretation of valid performance in this population; therefore, the use of other PVTs is recommended.

Health Professionals’ Experience Using an Azure Voice-Bot to Examine Cognitive Impairment (WAY2AGE)

Virtual Assistants (VA) are a new groundbreaking tool for screening cognitive impairment by healthcare professionals. By providing the volume of data needed in healthcare guidance, better treatment monitoring and optimization of costs are expected. One of the first steps in the development of these items is the experience of the healthcare professionals in their use. The general goal of the current project, WAY2AGE, is to examine healthcare professionals’ experience in using an Azure voice-bot for screening cognitive impairment. In this way, back-end services, such as the ChatBot, Speech Service and databases, are provided by the cloud platform Azure (Paas) for a pilot study. Most of the underlying scripts are implemented in Python, Net, JavaScript and open software. A sample of 30 healthcare workers volunteered to participate by answering a list of question in a survey set-up, following the example provided in the previous literature. Based on the current results, WAY2AGE was evaluated very positively in several categories. The main challenge of WAY2AGE is the articulation problems of some older people, which can lead to errors in the transcription of audio to text that will be addressed in the second phase. Following an analysis of the perception of a group of thirty health professionals on its usability, potential limitations and opportunities for future research are discussed.

Transposition and Normalization of the Mini-Mental State Examination in French Sign Language

OBJECTIVE

Due to the lack of a validated translation, the mini-mental state examination (MMSE) cannot be used to screen for suspected dementia in deaf people who communicate in French Sign Language (FSL). Taking into consideration the cultural and linguistic features of this specific population, we transposed the validated French version of the MMSE into a version adapted to FSL users: mini-mental state-langue des signes (MMS-LS). The objective of our work was to obtain screening norms for the MMS-LS.

METHODS

The MMS-LS was tested on 194 deaf users of FSL with clinical dementia rating as the gold standard. Healthy and demented participants were seen for two or three consecutive testing sessions at 1-year intervals.

RESULTS

The MMS-LS exhibited excellent internal coherence validity (Cronbach's α = .81), unidimensionality (p = .002), and excellent sensitivity (p < .001). The MMS-LS score declined with overt and severe dementia.

CONCLUSION

The percentiles obtained are useful norms for clinical assessment but must be interpreted with precaution due to the small number of participants (related to recruitment constraints) in the present study. In order to facilitate clinical use, the MMS-LS has been made available online, together with an instructions manual and clinical advice useful for improved awareness of the specific nature of this population.

The Impact of Aging on Spatial Abilities in Deaf Users of a Sign Language

Research involving the general population of people who use a spoken language to communicate has demonstrated that older adults experience cognitive and physical changes associated with aging. Notwithstanding the differences in the cognitive processes involved in sign and spoken languages, it is possible that aging can also affect cognitive processing in deaf signers. This research aims to explore the impact of aging on spatial abilities among sign language users. Results showed that younger signers were more accurate than older signers on all spatial tasks. Therefore, the age-related impact on spatial abilities found in the older hearing population can be generalized to the population of signers. Potential implications for sign language production and comprehension are discussed.

Assessing Deaf patients in the neurology clinic

There are over 87 000 Deaf people in the UK with British Sign Language (BSL) as their first language.1 Few healthcare professionals receive training in Deaf awareness or in BSL, and missed diagnoses and inadequate treatment of Deaf patients are estimated to cost the National Health Service £30 million per year.2 Neurologists are likely to encounter Deaf BSL users in their practice, but without prior experience may find consultations challenging, especially within the time constraints and pressure of a standard clinic. In this article, we provide guidance on consulting with Deaf people in a neurology clinic, drawing on experience from our cognitive clinic for Deaf BSL users where effective communication is essential.

Authentic public and patient involvement with Deaf sign language users: It is not just about language access

This article concerns Public and Patient Involvement practice with Deaf people who are sign language users. It draws on the experience of public and patient involvement in a project concerning Deaf people's lived experience of dementia and focusses on: (i) creating the conditions of trust in circumstances of unrecorded knowledge; (ii) being a community insider as a necessary but not sufficient condition without public and patient involvement and (iii) community consultation as influencing positive public and patient involvement practice. It sets out a series of recommendations for authentic public and patient involvement practice with Deaf sign language users linked to each of these themes before considering more generally barriers to Deaf people's involvement in public and patient involvement in health and social care research.

Yoga Education Program for Improving Memory in Older Adults: A Multicity 5-Year Follow-Up Study

This article reports a multicity study on the effect of a yoga education program (YEP) in improving memory and cognitive functions of a nonclinical sample of community-dwelling older adults. Specifically, the intervening personal resources that bolster or hinder YEP effectiveness were examined. Of the original cohort of 918 older adults randomized into intervention and waitlist control groups, 792 remained with the study 5 years later. Results indicated that weekly YEP lessons and self-practice improved participants’ scores on the Mini-Mental State Examination (MMSE) and Rivermead Behavioral Memory Test–Third Edition (RBMT-3). Participants from Asian cities, women, Hindus and Buddhists, middle class, highly educated, retired, ever single or widowed, living alone or with children and kin, were more responsive to the YEP. Regular attendance and self-practice were strong moderators of YEP effectiveness, with self-practice having the strongest predictor effect. Some cultural variations and improvisations would lend the YEP a wider application.

Serum Ceramide Kinase as a Biomarker of Cognitive Functions, and the Effect of Using Two Slimming Dietary Therapies in Obese Middle Aged Females

AIM

Highlighting the impact of obesity on mental and cognitive functions using serum ceramide kinase enzyme concentration as a biomarker for cognitive evaluation in the middle aged females, and also targeting to control the obesity and simultaneously postponing the deterioration of the cognitive functions, by implementing two slimming dietary therapies each incorporating different functional ingredients known to boost cognition.

SUBJECTS AND METHODS

Ninety six obese middle aged females, divided into two groups volunteered to follow a low caloric balanced diet combined with two bread supplements composed essentially of barley flour and wheat germ mixed with either 5% turmeric, group (A); or with 5% ginger, group (B) for 4 weeks, phase (1); to be followed by the hypocaloric diet alone for another 4 weeks, phase (2).

RESULTS

By the end of phase (1), the biochemical analysis showed a positive response of the levels of C-peptide and modified homeostatic model assessment of insulin resistance; also increased levels of the serum ceramide kinase enzyme, coupled with improved cognitive functions tests. Improvement of the relevant metabolic profile, fasting blood glucose, blood pressure and the anthropometric measurements was detected.

CONCLUSION

Using dietary therapy supported by special formulas which contain active ingredients succeeded in reducing weight and improving both the metabolic profile and the cognitive functions.

Effect of reinforcing kidney-essence, removing phlegm, and promoting mental therapy on treating Alzheimer's disease

OBJECTIVE

To explore the mechanism of reinforcing kidney-essence, removing phlegm, and promoting mental therapy in treating Alzheimer's disease (AD).

METHODS

Sixty patients with AD in Wuhan No.1 Hospital of Traditional Chinese Medicine for Geriatrics from May 2009 to April 2011 were randomly divided into two groups, with 30 in each group. Patients in Bushenhuatanyizhi group (BHY group) took BHY instant granules (6 g, twice per day). Patients in the control group took piracetam (0.8 g, 3 times per day). There were twelve weeks in a course. Changes in the mini-mental state examination (MMSE) score and Activity of Daily Living Scale (ADL) score were analyzed before and after treatment.

RESULTS

MMSE scores in the two groups increased and ADL scores decreased after treatment, compared with those before treatment (both P < 0.05). The total effective rate was 86.67% in the BHY group (10 very effective, 13 effective, 7 non-responsive). The control group was 57.69% (5 very effective, 16 effective, 9 non-responsive) (P < 0.05). Superoxide dismutase levels were increased, lipid peroxide and triglyceride levels decreased after treatment in the BHY group as compared with the control group.

CONCLUSION

Reinforcing kidney-essence, removing phlegm, and promoting mental therapy can improve cognitive function and daily life of AD patients. The mechanism of the therapy might be related to improving blood fat, scavenging free radicals, and inhibiting lipid peroxides.

Sign language aphasia from a neurodegenerative disease

While Alois Alzheimer recognized the effects of the disease he described on speech and language in his original description of the disease in 1907, the effects of Alzheimer's disease (AD) on language in deaf signers has not previously been reported. We evaluated a 55-year-old right-handed congenitally deaf woman with a 2-year history of progressive memory loss and a deterioration of her ability to communicate in American Sign Language, which she learned at the age of eight. Examination revealed that she had impaired episodic memory as well as marked impairments in the production and comprehension of fingerspelling and grammatically complex sentences. She also had signs of anomia as well as an ideomotor apraxia and visual-spatial dysfunction. This report illustrates the challenges in evaluation of a patient for the presence of degenerative dementia when the person is deaf from birth, uses sign language, and has a late age of primary language acquisition. Although our patient could neither speak nor hear, in many respects her cognitive disorders mirror those of patients with AD who had normally learned to speak.

Fifty percent reduced-dose cerebral CT perfusion imaging of Alzheimer's disease: regional blood flow abnormalities

To evaluate the value of 50% reduced-dose cerebral computed tomography (CT)perfusion imaging (CTPI) to show the perfusion abnormalities in Alzheimer's disease (AD), as an attempt to develop a new imaging protocol with lower radiation dose to track the correlation of AD with regional blood flow abnormalities. A total of 52 patients with AD were assigned to the AD group and 28 healthy volunteers served as the control group. All participants were given a 50% reduced-dose cerebral CTPI (current was reduced from 160 to 80 mA) test by a multislice spiral CT scanner. Perfusion parameters of the bilateral frontal cortex, temporal cortex, hippocampus, and basal ganglia were measured, including the cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP). Both the CBV and CBF values of the measured regions were significantly higher in the healthy control group than in the AD group (P < .05), while the MTT and TTP values of these cerebral areas were significantly lower in the healthy control group than in the AD group (P < .05). Four perfusion parameters, namely the MTT of the left frontal cortex, right temporal cortex, right basal ganglia, and right hippocampus, had the greatest sensitivity and a striking correlation with the incidence of AD. The blood flow per unit of time in the regions of interest was significantly lower in the AD group, which provides new evidence for the existence of microcirculation disturbance and ischemia in AD. The 50% reduced-dose cerebral CTPI scan is valuable to show the regional perfusion abnormalities in the patients with AD.