Alfred W. Kaszniak

Clinical trial of indomethacin in Alzheimer's disease

In a 6-month, double-blind, placebo-controlled study, 1100 to 150 mg/d indomethacin appeared to protect mild to moderately impaired Alzheimers disease patients from the degree of cognitive decline exhibited by a well-matched, placebo-treated group. Over a battery of cognitive tests, indomethacin patients improved 1.3% (±1.8%), whereas placebo patients declined 8.4% (±2.3%)—a significant difference (p < 0.003). Caveats include adverse reactions to indomethacin and the limited scale of the trial.

Impaired verbal and nonverbal emotion recognition in alexithymia.

Although clinical observations suggest that alexithymic individuals have a deficit in their ability to recognize emotional stimuli and that this deficit is not simply due to a problem in verbal labeling, these two hypotheses have not been empirically confirmed.Three hundred eighty participants in a community survey without current or past histories of psychiatric disorder completed two independent measures of alexithymia [the Levels of Emotional Awareness Scale (LEAS) and the Toronto Alexithymia Scale (TAS-20)] and the Perception of Affect Task (PAT), a 140-item measure of the ability to match emotion stimuli. The PAT includes four subtasks that require the subject to match verbal or nonverbal emotion stimuli with verbal or nonverbal emotion responses. The subtasks include matching sentences and words (verbal-verbal), faces and words (nonverbal-verbal), sentences and faces (verbal-nonverbal), and faces and photographs of scenes (nonverbal-nonverbal). Across the entire sample, higher (alexithymic) TAS-20 and lower LEAS scores were both correlated with lower accuracy rates on each of the subtasks of the PAT (p <.001), accounting for 10.5% and 18.4% of the variance, respectively. Fifty-one subjects met TAS-20 criteria for alexithymia. Alexithymic individuals scored lower than other subjects on purely nonverbal matching, purely verbal matching, and mixed verbal-nonverbal matching (all p <.001). These results suggest that alexithymia is associated with impaired verbal and nonverbal recognition of emotion stimuli and that the hallmark of alexithymia, a difficulty in putting emotion into words, may be a marker of a more general impairment in the capacity for emotion information processing.

Is alexithymia the emotional equivalent of blindsight

A fundamental tenet of psychosomatic medicine is that interference with the experience and expression of emotions can have an adverse affect on health (Taylor 1987). Early in this century it was observed that the onset and course of certain physical diseases were adversely affected by the repression of certain conflictual ideas and their accompanying affects (Alexander 1950). A later alternative view was that a deficit or developmental arrest in the capacity for symbolic mental representation of emotion was the core problem in patients with psychosomatic disorders, typified by a diminished ability to identify and describe feelings (Ruesch 1948). This latter view has evolved into the concept of alexithymia, a term coined by Sifneos in 1972 meaning “absence of words for emotion” (Sifneos 1972). Sifneos and Nemiah posited that the deficit in the capacity for symbolization of emotion (in verbal behavior, fantasy, and dreams) resulted in a variety of manifestations, including abnormal physiology resulting in disease, a propensity for impulsive behavior, discomfort with and avoidance of social relationships, and an impaired capacity for self-care and self-regulation (Nemiah and Sifneos 1970). Subsequent research has revealed that alexithymia is associated with a variety of other psychiatric disorders, including posttraumatic stress disorder (PTSD), substance abuse and dependence, somatization, eating disorders, and panic disorder (Taylor et al 1991; Jimerson et al 1994; Parker et al 1993). It is not known whether the manifestations of alexithymia are similar or different in these various clinical contexts. Recent research has also demonstrated that alexithymia is associated with deficits in the recognition of both verbal and nonverbal emotional stimuli (Lane et al, in press). To obtain a current consensus about the essential features of alexithymia, Haviland and Reise (1996) recently generated a prototypical description of alexithymic individuals derived from 13 experts using the Q-sort method. The results of this survey are presented in Table 1. Alexithymic individuals manifest bland or flattened affect, tend to be somatically preoccupied, express themselves through action and nonverbal behavior, are interpersonally distant, become disorganized under stress, lack imagination and insight, and tend to be socially conforming. Early descriptions of alexithymic individuals included diminished facial expressions, which have been confirmed in recent empirical work (McDonald and Prkachin 1990), but also noted occasional brief, intense, dramatic outbursts of emotion such as tearfulness that end as abruptly as they From the Department of Psychiatry (RDL, GLA, GES, AWK) and Department of Neurology (GLA, GES, AWK), University of Arizona College of Medicine, and Department of Psychology, University of Arizona (RDL, GLA, GES, AWK), Tucson, Arizona. Address reprint request to Richard D. Lane, MD, Department of Psychiatry, Arizona Health Sciences Center, 1501 N. Campbell Avenue, Tucson, AZ 85724. Received January 18, 1996.

Pervasive Emotion Recognition Deficit Common to Alexithymia and the Repressive Coping Style

Objective Previous research has demonstrated a deficit in the ability to recognize emotions in alexithymic individuals. The repressive coping style is thought to preferentially impair the detection of unpleasant compared with pleasant emotions, and the degree of deficit is typically thought to be less severe than in alexithymia. We compared emotion recognition ability in both individuals with alexithymia and those with the repressive coping style. Methods Three hundred seventy-nine subjects completed the 20-item Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Marlowe-Crowne Scale (a measure of repressive defensiveness), the Bendig Short Form of the Taylor Manifest Anxiety Scale, and the Perception of Affect Task. The Perception of Affect Task consists of four 35-item emotion recognition subtasks: matching sentences and words, faces and words, sentences and faces, and faces and photographs of scenes. The stimuli in each subtask consist of seven emotions (happiness, sadness, anger, fear, disgust, surprise, and neutral) depicted five times each. Recognition accuracy results were collapsed across subtasks within each emotion category. Results Highly alexithymic subjects (for all, p < .01) and those with low emotional awareness (for all, p < .001) were consistently less accurate in emotion recognition in all seven categories. Highly defensive subjects (including repressors) were less accurate in the detection of anger, sadness, fear, and happiness (for all, p < .05). Furthermore, scores on the Levels of Emotional Awareness Scale accounted for significantly more variance in performance on the Perception of Affect Task than scores on the Marlowe-Crowne Scale (p < .01). Conclusions The results indicate that alexithymia and the repressive coping style are each associated with impairments in the recognition of both pleasant and unpleasant emotions and that the two styles of emotional self-regulation differ more in the magnitude than in the quality of these impairments.

Implicit and explicit memory in Alzheimer's disease and Parkinson's disease

Several tasks examined implicit and explicit memory in demographically matched samples of Alzheimers (AD) and Parkinsons disease (PD) patients, and healthy elderly subjects. A fragmented pictures test, word stem-completion repetition priming, and a pursuit-rotor tracking task, followed by explicit memory tests, were given. AD patients were impaired on all explicit tests and on word stem-completion priming, but were intact on pursuit-rotor tracking and the skill learning (SL) component of the fragmented pictures test. PD patients were significantly better than AD patients on all explicit memory tests, but were selectively impaired on the SL component of the fragmented pictures test. Finally, a mirror-reading test was given to the PD patients and control subjects, with no significant differences found in performances between the two groups. Results are discussed in terms of hypothetical cognitive processes and brain circuits underlying different implicit and explicit memory domains.

Handbook for clinical memory assessment of older adults

handbook on the neuropsychology of aging and dementia this book offers practitioners a hands on guide to bedrock clinical tasks the first half of the volume addresses special considerations for conducting neuropsychological assessments of older adults such as disease management issues sleep concerns and ethical matters, american geriatrics society 2015 updated beers criteria the 2015 american geriatrics society ags beers criteria are presented like the 2012 ags beers criteria they include lists of potentially inappropriate medications to be avoided in older adults, pharmacologic treatment of hypertension in adults annals appropriate management of hypertension reduces the risk for cardiovascular disease renal disease cerebrovascular disease and death however determining the most appropriate bp targets particularly for adults aged 60 years or older has been controversial, home occupational outlook handbook u s bureau of the occupational outlook handbook is the government s premier source of career guidance featuring hundreds of occupations such as carpenters teachers and veterinarians revised every 2 years the latest version contains employment projections for the 2016 26 decade, psychological assessment and testing resources resources on psychological assessment and testing for psychologists mental health professionals educators students and patients, activities of daily living wikipedia activities of daily living adls or adl is a term used in healthcare to refer to people s daily self care activities the concept of adls was originally proposed in the 1950s by sidney katz and his team at the benjamin rose hospital in cleveland oh and has been added to and refined by a variety of researchers since that time health professionals often use a person s ability or inability to, major depressive disorder wikipedia major depressive disorder mdd also known simply as depression is a mental disorder characterized by at least two weeks of low mood that is present across most situations it is often accompanied by low self esteem loss of interest in normally enjoyable activities low energy and pain without a clear cause people may also occasionally have false beliefs or see or hear things that others, the lawton instrumental activities of daily living iadl from the hartford institute for geriatric nursing new york university rory meyers college of nursing best practices in nursing care to older adults, executive functioning and adhd nature and assessment the term executive functioning generally refers to the mechanisms by which performance is optimized in situations requiring the operation of a number of cognitive processes baddeley 1986, intensive blood pressure treatment in adults aged 60 years hypertension is a very common modifiable risk factor for cardiovascular morbidity and mortality affecting up to two thirds of adults older than 60 years older adults might also be more susceptible to adverse effects from blood pressure bp lowering including falls fractures and cognitive impairment, domestic violence counseling and professional training for the assessment of court mandated perpetrators of domestic violence sonkin daniel and liebert douglas 2003 the assessment of court mandated perpetrators of domestic violence, aging mental health and long term care by william although most adults live independently in their home many are living in long term care facilities the majority of these people up to 90 percent in this setting will be suffering from mental emotional or behavioral problems, main psychopathy reference list this reference list was compiled by robert hare for personal use most but not all of the articles listed on these pages discuss or evaluate the pcl r the pcl sv the pcl yv and other hare scales links to available abstracts and when available links to the full text on the journal web sites are provided search for full text on the page below, traumatic brain injury rehabilitation educational traumatic brain injury rehabilitation educational resources traumatic brain injury testing treatment neuropharmacology medications in survivors of traumatic brain injuries tbi should be used sparingly with the focus being on ameliorating or decreasing psychiatric symptoms behavioral manifestations and maladaptive behaviors that can interfere or impede the rehabilitative process, art therapy program for children and adults with visual creating a safe therapy space a safe emotional space one of the most important aspects of helping a child who has low or no vision feel safe in the art therapy studio is the establishment of a positive therapeutic alliance that will create and support a safe emotional space for that child

Metamemory Experiments in Neurological Populations: A Review

Metamemory refers to knowledge about ones memory capabilities and strategies that can aid memory, as well as the processes involved in memory self-monitoring. Although metamemory has been studied in cognitive psychology for several decades, there have been fewer studies investigating the neuropsychology of metamemory. In recent years, a growing number of studies of neurological patient groups have been conducted in order to investigate the neural correlates of metamemory. In this review, we examine the neuropsychological evidence that the frontal lobes are critically involved in monitoring and control processes, which are the central components of metamemory. The following conclusions are drawn from this literature: (1) There is a strong correlation between indices of frontal lobe function or structural integrity and metamemory accuracy (2) The combination of frontal lobe dysfunction and poor memory severely impairs metamemorial processes (3) Metamemory tasks vary in subject performance levels, and quite likely, in the underlying processes these different tasks measure, and (4) Metamemory, as measured by experimental tasks, may dissociate from basic memory retrieval processes and from global judgments of memory.

A role for right medial prefrontal cortex in accurate feeling-of-knowing judgments: evidence from patients with lesions to frontal cortex

The hypothesis that prefrontal cortex plays a critical role in accurate predictions of episodic memory performance was tested using the feeling-of-knowing (FOK) paradigm. Fourteen patients with a broad spectrum of damage to the frontal cortex and matched controls read sentences and later were tested for recall memory, confidence judgments, and FOK accuracy using as cues the sentences with the final word missing. While frontal patients were impaired at recall and recognition memory, they were able to make accurate confidence judgments about their recall attempts. By contrast, as a group, the patients were markedly impaired in the accuracy of their prospective FOK judgments. Lesion analysis of frontal patients with clear FOK impairment revealed an overlapping region of damage in right medial prefrontal cortex. These findings provide functional and anatomical evidence for a dissociation between recall confidence and prospective memory monitoring and are discussed in terms of familiarity and access theories of FOK predictions.

Fear recognition deficits after focal brain damage A cautionary note

Objective: To test the hypothesis that fear recognition deficits in neurologic patients reflect damage to an emotion-specific neural network. Background: Previous studies have suggested that the perception of fear in facial expressions is mediated by a specialized neural system that includes the amygdala and certain posterior right-hemisphere cortical regions. However, the neuropsychological findings in patients with amygdala damage are inconclusive, and the contribution of distinct cortical regions to fear perception has only been examined in one study. Methods: We studied the recognition of six basic facial expressions by asking subjects to match these emotions with the appropriate verbal labels. Results: Both normal control subjects (n = 80) and patients with focal brain damage (n = 63) performed significantly worse in recognizing fear than in recognizing any other facial emotion, with errors consisting primarily of mistaking fear for surprise. Although patients were impaired relative to control subjects in recognizing fear, we could not obtain convincing evidence that left, right, or bilateral lesions were associated with disproportionate impairments of fear perception once we adjusted for differences in overall recognition performance for the other five facial emotion categories. The proposed special role of the amygdala and posterior right-hemisphere cortical regions in fear perception was also not supported. Conclusions: Fear recognition deficits in neurologic patients may be attributable to task difficulty factors rather than damage to putative neural systems dedicated to fear perception.

Executive control functions in degenerative dementias: A comparative review

This paper reviews the literature concerning executive control impairments in degenerative dementias. The construct of executive control functioning is examined, as is the neuroanatomy of frontal–subcortical networks, believed to underlie executive function (EF) impairments. The pattern of EF impairments in Alzheimers disease (AD) which affects temporal and parietal brain regions most severely is contrasted with observed executive dysfunctions in patients with dementias involving degeneration of primarily frontal and frontal–subcortical brain areas. EF impairments are present in each of these types of dementing illnesses. Although EF impairments are present in AD, they are less prominent than the memory disorder in the neuropsychological profile of the disease and tend to become more pronounced later in the course of the illness. In contrast, patients with frontal or frontal–subcortical dementia may demonstrate executive dysfunction, which occurs earlier in the disease progression and may be initially more severe.