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Takasaki A, Hashimoto M, Fukuhara R, Sakuta S, Koyama A, Ishikawa T, Boku S, Ikeda M, Takebayashi M. Gesture imitation performance in community-dwelling older people: assessment of a gesture imitation task in the screening and diagnosis of mild cognitive impairment and dementia. Psychogeriatrics 2024; 24:404-414. [PMID: 38290836 DOI: 10.1111/psyg.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Gesture imitation, a simple tool for assessing visuospatial/visuoconstructive functions, is reportedly useful for screening and diagnosing dementia. However, gesture imitation performance in healthy older adults is largely unknown, as are the factors associated with lower performance. To address these unknowns, we examined the gesture imitation performance of a large number of community-dwelling older adults aged ≥65 years in Arao City, Kumamoto Prefecture (southern Japan). METHODS The examiner presented the participants with eight gesture patterns and considered it a success if they could imitate them within 10 s. The success rate of each gesture imitation was calculated for three diagnostic groups: cognitively normal (CN) (n = 1184), mild cognitive impairment (MCI) (n = 237), and dementia (n = 47). Next, we reorganised the original gesture imitation battery by combining six selected gestures with the following scoring method: if the participants successfully imitated the gestures, immediately or within 5 s, two points were assigned. If they succeeded within 5-10 s, one point was assigned. The sensitivity and specificity of the battery were investigated to detect the dementia and MCI groups. Factors associated with gesture imitation battery scores were examined. RESULTS Except one complex gesture, the success rate of imitation in the CN group was high, approximately 90%. The sensitivity and specificity of the gesture imitation battery for discriminating between the dementia and CN groups and between the MCI and CN groups were 70%/88%, and 45%/75%, respectively. Ageing, male sex, and a diagnosis of dementia or MCI were associated with lower scores on the gesture imitation battery. CONCLUSION Gesture imitation tasks alone may not be sufficient to detect MCI. However, by combining gestures with set time limits, gesture imitation tasks can be a low-burden and effective method for detecting dementia, even in community medicine, such as during health check-ups.
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Affiliation(s)
- Akihiro Takasaki
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Ryuji Fukuhara
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shizuka Sakuta
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Asuka Koyama
- Faculty of Social Welfare, Kumamoto Gakuen University, Kumamoto, Japan
| | | | - Shuken Boku
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Abstract
BACKGROUND Functional cognitive disorders (FCD) are an important differential diagnosis of neurodegenerative disease. The utility of suggested diagnostic features has not been prospectively explored in "real world" clinical populations. This study aimed to identify positive clinical markers of FCD. METHODS Adults with cognitive complaints but not dementia were recruited from memory, neurology, and neuropsychiatry clinics. Participants underwent structured interview, Mini International Neuropsychiatric Interview, Montreal Cognitive Assessment, Luria 3-step, interlocking fingers, digit span and Medical Symptom Validity Test, Patient Health Questionnaire 15, Hospital Anxiety and Depression Scale, Multifactorial Memory Questionnaire, and Pittsburgh Sleep Quality Inventory. Potential diagnostic variables were tested against expert consensus diagnosis using logistic regression. RESULTS FCD were identified in 31/49 participants. Participants with FCD were younger, spoke for longer when prompted "Tell me about the problems you've been having," and had more anxiety and depression symptoms and psychiatric diagnoses than those without FCD. There were no significant differences in sex, education, or cognitive scores. Younger age and longer spoken response predicted FCD diagnosis in a model which explained 74% of diagnostic variability and had an area under the curve (AUC) of 94%. CONCLUSIONS A detailed description of cognitive failure is a sensitive and specific positive feature of FCD, demonstrating internal inconsistency between experienced and observed function. Cognitive and performance validity tests appear less helpful in FCD diagnosis. People with FCD are not "worried well" but often perform poorly on tests, and have more anxiety, depression, and physical symptoms than people with other cognitive disorders. Identifying diagnostic profiles is an important step toward parity of esteem for FCDs, as differential diagnoses of neurodegenerative disease and an independent target for clinical trials.
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Staios M, Nielsen TR, Kosmidis MH, Papadopoulos A, Kokkinias A, Velakoulis D, Tsiaras Y, March E, Stolwyk RJ. Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis. Arch Clin Neuropsychol 2022; 38:598-607. [DOI: 10.1093/arclin/acac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Aims
Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad).
Method
We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.
Results
While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.
Conclusion
Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.
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Affiliation(s)
- Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - T Rune Nielsen
- Danish Dementia Research Centre, Neuroscience Centre, Copenhagen University Hospital Department of Neurology, , Rigshospitalet, Copenhagen, Denmark
| | - Mary H Kosmidis
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Alexandra Papadopoulos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Arthur Kokkinias
- The Royal Melbourne Hospital, Inner West Area Mental Health Service , Parkville, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health Department of Psychiatry, , Melbourne, Australia
- The Royal Melbourne Hospital Neuropsychiatry, , Melbourne, Australia
| | - Yiannis Tsiaras
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre , Melbourne, Australia
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Khalili N, Mazhari S, Mortazavi N. Neurocognitive Functions Related to Parietal Lobe in Patients with Schizophrenia and Methamphetamine Induced Psychotic Disorder and Healthy Individuals: A Comparative Study. Addict Health 2022; 14:244-249. [PMID: 37559788 PMCID: PMC10408750 DOI: 10.34172/ahj.2022.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/18/2021] [Indexed: 08/11/2023]
Abstract
BACKGROUND There are some inconsistent findings about neurocognitive functions in schizophrenia and methamphetamine induced psychosis (MIP). This study aimed to compare these two disorders in terms of neurocognitive functions related to parietal lobe. METHODS This was a cross-sectional study in which 30 patients with schizophrenia, 30 patients with MIP, and 32 healthy individuals were compared. The two groups of patients were selected through convenience sampling from among patients hospitalized in Shahid Beheshti hospital in Kerman, Iran and healthy individuals were selected via convenience sampling from among the employees of Kerman University of Medical Sciences. The three groups were administered clock-drawing test (CDT), Rey-Osterrieth complex figure (ROCF) copying test, and interlocking finger test (IFT) and their demographic and clinical data were collected. The one-way analysis of variance (ANOVA) was used to investigate the differences between the groups. Multivariate analysis of covariance was also used to examine the effects of confounding factors. Besides, follow-up pairwise comparisons were performed after adjustment for multiple testing. FINDINGS The group with schizophrenia had significantly more impairment than the group with MIP with reference to the results of IFT and the ROCF test. However, the scores of patients with MIP on these two tests were not different from those of the normal controls. With regard to the CDT, the only significant difference was observed between the group with schizophrenia and controls. CONCLUSION On the condition that the results are replicated in other studies, some parietal lobe neurocognitive tests might be used when it is difficult to differentially diagnose schizophrenia and MIP.
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Affiliation(s)
- Navid Khalili
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrzad Mazhari
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Mortazavi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Schmidt N, Strohmaier T, Witt K. A modified version of the interlocking finger test as a bedside screening test for visuospatial deficits and dementia in Parkinson's disease. Brain Behav 2022; 12:e2516. [PMID: 35257517 PMCID: PMC9015001 DOI: 10.1002/brb3.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 01/22/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Objective of this study was to examine if the Interlocking Finger Test (ILFT) is a suitable bedside screening test for visuospatial functions and/or dementia in Parkinson's disease (PD) patients aiming to facilitate the diagnosis of a dementia syndrome associated with posterior cortical and temporal lobe dysfunction according to the dual syndrome hypothesis (frontostriatal vs. posterior cortical cognitive impairment). METHODS Forty-seven PD patients were assessed with the ILFT and an extensive cognitive test battery. The ILFT was carried out in the original version as well as in three modified versions of the test including a fifth figure and/or a more complex rating system, leading to four different ILFT scores (named after the maximum achievable scoring result: ILFT 4, ILFT 5, ILFT 12, and ILFT 15). We conducted a correlation analysis to reveal associations between the ILFT scores and cognitive as well as motor impairments. Receiver operating curve (ROC) analyses were calculated to evaluate the ability of the ILFT scores to predict visuospatial impairments and dementia. RESULTS ILFT scores correlated significantly with global cognition, visuospatial functions, memory, attention, and age (p < .0125) but not with executive functions, language, education, depression, and motor impairment. The ROC analyses revealed ILFT 15 as best predictor for visuospatial deficits and dementia with an area under the curve of .82 and .88, respectively. CONCLUSION The ILFT is suitable for detecting symptoms of the posterior cortical degeneration syndrome according to the dual syndrome hypothesis. We recommend the use of the modified test version ILFT 15.
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Affiliation(s)
- Nele Schmidt
- Department of Neurology, University Oldenburg, Oldenburg, Germany
| | | | - Karsten Witt
- Department of Neurology, University Oldenburg, Oldenburg, Germany.,Research Center of Neurosensory Sciences, University Oldenburg, Oldenburg, Germany
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Nagahama Y, Okina T, Suzuki N. Neuropsychological basis of impaired gesture imitations in patients with Alzheimer's disease and dementia with Lewy bodies. Int J Geriatr Psychiatry 2022; 37. [PMID: 34505307 DOI: 10.1002/gps.5622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/06/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of this study was to examine the neuropsychological factors that may be related to the impaired gesture imitations in patients with dementia. METHODS The imitation of unilateral finger and bimanual gestures was evaluated in 162 patients with Alzheimer's disease (AD) and 103 patients with dementia with Lewy bodies (DLB). The relationships of gesture imitation performance to global cognition, semantic fluency, phonemic fluency, figure copying, clock drawing, and trail-making test part A (TMT-A) scores were examined. RESULTS Mean scores for unilateral finger imitation were significantly lower in DLB patients than in AD patients, and significantly more DLB patients showed impaired performance in unilateral finger imitation than AD patients. In contrast, the percentage of patients with impaired bimanual gesture imitation was not significantly different between AD and DLB patients. Unilateral finger imitation performance was predicted by pentagon copying in the AD patients, and was predicted by cube copying in the DLB patients. Bimanual gesture imitation performance was predicted by TMT-A scores and phonemic fluency in the AD patients but was predicted by TMT-A scores, cube copying, and parkinsonism severity in the DLB patients. DISCUSSION Our study suggested that bimanual gesture imitation is a complex task that is supported by a wide range of neuropsychological processes, such as visuospatial attention, executive function, and visuomotor control, and therefore, it was easily impaired in early dementia. Unilateral finger imitation was more similar to constructional tasks, such as figure drawing, and was impaired more often in DLB patients than in AD patients.
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Affiliation(s)
- Yasuhiro Nagahama
- Department of Psychiatry and Neurology, Kawasaki Memorial Hospital, Kawasaki, Kanagawa, Japan
| | - Tomoko Okina
- Department of Geriatric Neurology, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Norio Suzuki
- Department of Geriatric Neurology, Shiga General Hospital, Moriyama, Shiga, Japan
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McWhirter L, Sargent B, Ritchie C, Stone J, Carson A. I think, therefore I forget - using experimental simulation of dementia to understand functional cognitive disorders. CNS Spectr 2020; 25:511-8. [PMID: 31566154 DOI: 10.1017/S1092852919001329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Symptoms of functional neurological disorder have traditionally been thought to depend, in part, on patients' ideas about symptoms rather than on the rules of pathophysiology. The possibility that functional cognitive symptoms might similarly reflect ideas of dementia has not been explored. We aimed to assess beliefs, through performance, about symptoms of dementia in healthy non-medical adults with the intention of identifying potential markers of functional cognitive disorders. METHODS Healthy volunteers were asked to simulate symptoms of mild dementia during testing with the Montreal Cognitive Assessment (MoCA), coin-in-hand forced-choice test, short digit span trials, Luria 3-step test and interlocking finger test. Family history of dementia was recorded. RESULTS In 50 participants aged 18-27, simulating dementia, mean MoCA score was 16 (SD 5.5, range 5-26). Delayed recall was the most frequently failed item (100%) and cube drawing least frequently failed (42%). Twenty-six percent failed forward three-digit span and 36% failed reverse two-digit span. On the coin-in-hand test, 32% scored at or below chance level. Inconsistent response patterns were common. CONCLUSIONS Cognitively healthy young adults simulating mild dementia perform similarly to older adults with mild dementia, demonstrating beliefs that dementia is associated with significant global impairment, including attention, motor function, and letter vigilance, but preservation of cube drawing. Inconsistent response patterns were common. Contrary to expectation, family history of dementia did not influence performance. Two and three digit span showed particular promise as a bedside test for simulation. Further investigation will establish whether similar patterns of results are produced in individuals with functional cognitive symptoms.
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Souza CP, Oliveira GN, Foss MP, Tumas V. The interlocking finger test in patients with Parkinson’s disease and healthy subjects. J Clin Neurosci 2016; 29:145-8. [DOI: 10.1016/j.jocn.2015.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 09/14/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
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Nagahama Y, Okina T, Suzuki N. Impaired imitation of gestures in mild dementia: comparison of dementia with Lewy bodies, Alzheimer's disease and vascular dementia. J Neurol Neurosurg Psychiatry 2015; 86:1248-52. [PMID: 25515503 DOI: 10.1136/jnnp-2014-309436] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/26/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To examine whether imitation of gestures provided useful information to diagnose early dementia in elderly patients. METHODS Imitation of finger and hand gestures was evaluated in patients with mild dementia; 74 patients had dementia with Lewy bodies (DLB), 100 with Alzheimer's disease (AD) and 52 with subcortical vascular dementia (SVaD). RESULTS Significantly, more patients with DLB (32.4%) compared with patients with AD (5%) or SVaD (11.5%) had an impaired ability to imitate finger gestures bilaterally. Also, significantly, more patients with DLB (36.5%) compared with patients with AD (5%) or SVaD (15.4%) had lower mean scores of both hands. In contrast, impairment of the imitation of bimanual gestures was comparable among the three patient groups (DLB 50%, AD 42%, SVaD 42.3%). DISCUSSION Our study revealed that imitation of bimanual gestures was impaired non-specifically in about half of the patients with mild dementia, whereas imitation of finger gestures was significantly more impaired in patients with early DLB than in those with AD or SVaD. Although the sensitivity was not high, the imitation tasks may provide additional information for diagnosis of mild dementia, especially for DLB.
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Affiliation(s)
- Yasuhiro Nagahama
- Department of Geriatric Neurology, Shiga Medical Center, Moriyama, Shiga, Japan
| | - Tomoko Okina
- Department of Geriatric Neurology, Shiga Medical Center, Moriyama, Shiga, Japan
| | - Norio Suzuki
- Department of Geriatric Neurology, Shiga Medical Center, Moriyama, Shiga, Japan
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Lökk J, Fereshtehnejad SM. Managing palliative care in Parkinson’s disease from diagnosis to end-stage disease: what the clinician should know. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
SUMMARY Progression of Parkinson’s disease (PD) is followed by aggravation of both motor and non-motor symptoms, which calls for more prominent palliative care towards the end stage of the disease. These palliative services should include multidisciplinary teamwork, in addition to taking into account treatment side effects, dose readjustment, and add-on nonpharmaceutical and pharmaceutical approaches. The treatment protocols in the advanced stage of PD are quite different from the ones in the early stages. The focus is shifted from symptom relief strategies to providing the patient with comfort and support during the palliative stage. In this review, some specific palliative approaches for dealing with motor and non-motor complications of end-stage PD are provided, as well as some general knowledge on palliation.
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Affiliation(s)
- Johan Lökk
- Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Blickagången 1, 141 86 Stockholm, Sweden.
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Blickagången 1, 141 86 Stockholm, Sweden
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Nielsen TR, Jørgensen K. Visuoconstructional abilities in cognitively healthy illiterate Turkish immigrants: a quantitative and qualitative investigation. Clin Neuropsychol 2013; 27:681-92. [PMID: 23379740 DOI: 10.1080/13854046.2013.767379] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assessment of visuospatial function is an integral part of most neuropsychological assessments and is frequently assessed by visuoconstructional tests. A significant impact of limited schooling and illiteracy has been found on numerous neuropsychological tests and it can be difficult to interpret test results from illiterate individuals. In this study, quantitative and qualitative aspects of performance of elderly cognitively healthy illiterate and literate Turkish immigrants were compared on five commonly used visuoconstructional tests. Significantly poorer performances of illiterate compared to literate subjects were found in copying of two- and three-dimensional geometric designs, and in Clock Drawing Test performance. A systematic qualitative analysis found lacking three-dimensionality, "curved angles", omissions, distorted relation between elements, and spatial disorganization to be common error types in illiterate subjects. Performances were not found to be influenced by duration of residence in Denmark or level of acculturation. The results warrant caution in the interpretation of visuoconstructional test performances in illiterate subjects, as they can easily be misinterpreted as signs of cognitive dysfunction.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Cohen H, McCabe C, Harris N, Hall J, Lewis J, Blake DR. Clinical evidence of parietal cortex dysfunction and correlation with extent of allodynia in CRPS type 1. Eur J Pain 2012; 17:527-38. [PMID: 23132624 DOI: 10.1002/j.1532-2149.2012.00213.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unusual symptoms such as digit misidentification and neglect-like phenomena have been reported in complex regional pain syndrome (CRPS), which we hypothesized could be explained by parietal lobe dysfunction. METHODS Twenty-two patients with chronic CRPS attending an in-patient rehabilitation programme underwent standard neurological examination followed by clinical assessment of parietal lobe function and detailed sensory testing. RESULTS Fifteen (68%) patients had evidence of parietal lobe dysfunction. Six (27%) subjects failed six or more test categories and demonstrated new clinical signs consistent with their parietal testing impairments, which were impacting significantly on activities of daily living. A higher incidence was noted in subjects with >1 limb involvement, CRPS affecting the dominant side and in left-handed subjects. Eighteen patients (82%) had mechanical allodynia covering 3-57.5% of the body surface area. Allochiria (unilateral tactile stimulation perceived only in the analogous location on the opposite limb), sensory extinction (concurrent bilateral tactile stimulation perceived only in one limb), referred sensations (unilateral tactile stimulation perceived concurrently in another discrete body area) and dysynchiria (unilateral non-noxious tactile stimulation perceived bilaterally as noxious) were present in some patients. Greater extent of body surface allodynia was correlated with worse parietal function (Spearman's rho = -0.674, p = 0.001). CONCLUSION In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia.
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Affiliation(s)
- H Cohen
- Royal National Orthopaedic Hospital, Stanmore, UK.
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Duffin JT, Collins DR, Coughlan T, O'Neill D, Roche RAP, Commins S. Subtle memory and attentional deficits revealed in an Irish stroke patient sample using domain-specific cognitive tasks. J Clin Exp Neuropsychol 2012; 34:864-75. [PMID: 22643030 DOI: 10.1080/13803395.2012.690368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Stroke disrupts motor, sensory, and cognitive systems in survivors. Unlike in physical impairments, assessment of cognitive function is often inadequate, as no standardized procedure to monitor cognitive recovery post stroke exists. We evaluated a number of novel task-orientated tools designed to assess subtle cognitive deficits (including memory, attention, and executive functioning) in a sample of stroke patients. Although unimpaired on MMSE (Mini-Mental State Examination)-based indices of cognition, memory, and intelligence, stroke survivors were significantly impaired on tasks testing visual attention, spatial/relational processing, and associative memory. We recommend a standardized multidomain cognitive assessment and propose that cognitive deficits post stroke require in-depth assessment to inform patient-orientated rehabilitation.
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Affiliation(s)
- Joseph T Duffin
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
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Delazer M, Karner E, Zamarian L, Donnemiller E, Benke T. Number processing in posterior cortical atrophy--a neuropsycholgical case study. Neuropsychologia 2005; 44:36-51. [PMID: 15936044 DOI: 10.1016/j.neuropsychologia.2005.04.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Revised: 03/21/2005] [Accepted: 04/21/2005] [Indexed: 12/23/2022]
Abstract
Posterior cortical atrophy (PCA) is an uncommon syndrome of dementia with early onset, characterised by disorders of higher visual function, variable symptoms of Balint's syndrome, visual agnosia, alexia, agraphia, finger agnosia, right-left disorientation and dyscalculia [Benson D. F., Davis R. J., & Snyder B. D. (1988). Posterior cortical atrophy. Archives of Neurology, 45, 789-793]. In a single case study specific numerical deficits were observed which may be predicted by parietal neurodegeneration (more pronounced on the right side; verified by SPECT). Besides impairments in all tasks involving visuo-spatial abilities (e.g., dot counting, analog number scale task), deficits appeared in tasks requiring access to an internal representation of numbers such as mental number bisection, approximation, estimation and semantic facts. In number comparison an increased distance effect was found. In simple arithmetic, a striking dissociation between operations was found-multiplication and addition facts being preserved at a superficial level, subtraction and division being severely impaired. The study confirms the close relation between spatial and numerical processing and highlights the modular organisation of the semantic system (number semantics impaired). Moreover, the study adds evidence about the clinical manifestation of the particular degenerative syndrome.
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Affiliation(s)
- M Delazer
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Kim E, Lee Y, Lee J, Han SH. A case with cholinesterase inhibitor responsive asymmetric posterior cortical atrophy. Clin Neurol Neurosurg 2005; 108:97-101. [PMID: 16311158 DOI: 10.1016/j.clineuro.2004.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 10/18/2004] [Accepted: 11/26/2004] [Indexed: 11/26/2022]
Abstract
A 55-year-old right-handed woman presented initially with mild amnestic and depressive episodes but slowly developed progressive neurobehavioral symptoms, indicative of posterior cortical atrophy in ensuing years. A more detailed neurobehavioral test suggested predominant right temporo-parietal dysfunction with executive functional deficits. SPECT and MRI findings revealed right unilateral temporo-parietal involvement. Cholinesterase inhibitor administration led to amelioration of symptoms. We suggest that cases of posterior cortical atrophy or visual variant of Alzheimer's disease may be responsive to cholinesterase inhibitor therapy; however, the observation in a single case should be confirmed on larger populations in a clinical trial design with placebo control.
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Affiliation(s)
- Eunhee Kim
- Department of Neurology, Chungbuk National University Hospital, Republic of Korea
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