Laura Hokkanen

DANCE AND MOVEMENT THERAPEUTIC METHODS IN MANAGEMENT OF DEMENTIA: A RANDOMIZED, CONTROLLED STUDY

To the Editor: Behavioral and cognitive problems in dementia can be addressed using various nonpharmacological interventions such as neuropsychological rehabilitation and Reality Orientation therapy, but alternative methods still need to be sought for. Creative activities, stimulation of sensomotor system, and music therapy have been found to be potentially beneficial. We previously demonstrated the applicability of dance and movement therapy (DMT) in dementia, and this letter evaluates whether it would improve patients’ cognitive level or behavior. The DMT intervention consisted of nine sessions with 1-week intervals lasting for 30 to 45 minutes each (see for the description); the control group spent the same amount of time together in regular nursing home activities. The intervention study was conducted in compliance with Declaration of Helsinki ethical standards. The patients and their spouses signed an informed consent, and the municipal board of Health Centre of Nivala, acting as a disciplinary committee, approved the study. Assessments made 1 week before and immediately before the beginning of the DMT (double-baseline, the mean used in statistical comparisons), at Weeks 5 and 9 of the intervention, and at Week 13 (follow-up 4 weeks post-intervention) included the Mini-Mental State Examination (MMSE); the Word List savings score (percentage of the delayed recall compared with the third learning trial) and the Clock Drawing Test (maximum score 6) from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery; the Cookie Theft picture description task from Boston Diagnostic Aphasia Test, along with other pictures used alternatively, scored for the number of Information Units; and the Nurses’ Observation Scale for Geriatric Patients (NOSGER), for which, in each subscale, a higher score indicates greater impairment. Means and standard deviations are given; an independent-samples t-test, a multivariate analysis of variance (MANOVA) for repeated measures, and a paired-samples t-test from SPSS for Windows (Release 13.0.1. 2004. SPSS Inc., Chicago, IL) were used.

The reliability of the MSFC and its components

Background –  The Multiple Sclerosis Functional Composite (MSFC) is a multidimensional measurement tool for multiple sclerosis (MS) including a measure of ambulation (Timed 25‐foot Walk [TWT]), arm function (Nine‐Hole Peg Test [9HPT]) and cognition (Paced Auditory Serial Addition Test [PASAT]).

Cognitive Outcome in Acute Sporadic Encephalitis

Acute encephalitis is an inflammation of the brain parenchyma. In the United States, 20,000 cases occur yearly. A variety of cognitive deficits, often the sole cause of disability, may persist after the acute stage. Still, infectious diseases tend to be covered only briefly in neuropsychological handbooks. Recent literature demonstrates the heterogeneity of both amnestic disorders and the outcome following encephalitides. Herpes Simplex virus (HSV), the most common single etiology of sporadic encephalitis, usually causes the most severe symptoms. Modern antiviral medication, however, seems to improve the cognitive outcome. Much less is known about non-HSV encephalitides, where both mild and severe defects have been observed. This article summarizes the current knowledge and also calls upon a more active neuropsychological research in the area.

Uric acid associates with cognition in Parkinson's disease

Cognitive dysfunction is common in Parkinsons disease (PD). Low plasma uric acid level is a risk factor for PD but its association with cognitive impairment in PD has not been previously studied. In the present study urine uric acid level as well as plasma uric acid- and homocysteine levels were measured in 40 patients with PD. Comprehensive neuropsychological tests including computerized tasks were performed on all. Both low plasma and low urine uric acid levels associated with decreased neuropsychological performance. In multiple linear regression low urine uric acid level predicted worse performance in the Picture completion subtest of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) (p=0.003) and in the Rule shift cards test of the Behavioral Assessment of the Dysexecutive Syndrome (BADS) (p=0.04). Low plasma uric acid level predicted worse performance both in the Picture completion (p=0.02) and Similarities subtest of the WAIS-R (p=0.02). Reaction time and the time spent on cognitive processing in the Statement verification task were inversely correlated with the uric acid levels (p=0.0001). There was no correlation between the homocysteine level and neuropsychological performance. Instead, the plasma uric acid and homocysteine levels correlated significantly and their possible association in PD is discussed.

Neuropsychological sequelae of acute-onset sporadic viral encephalitis

Acute encephalitis is an inflammation of the brain parenchyma. In the USA, by estimation, 20,000 cases occur every year. A variety of cognitive deficits may persist after the acute stage, and they are often the sole cause of disability. Recent literature demonstrates the heterogeneity of both mnestic disorders and the outcome following encephalitis. Herpes simplex virus is the most commonly recognised single aetiology of sporadic encephalitis and it may be the cause of the most severe symptoms. Antiviral medication, however, seems to have improved the cognitive outcome when compared to the historical, untreated cases. The cognitive sequelae following herpes simplex virus encephalitis (HSVE) are best known and most commonly described, e.g., in textbooks, but they do not represent the typical symptomatology of encephalitis in general. Much less is unfortunately known about other types of encephalitis, those that account perhaps up to 80% of all cases, where both mild and severe defects have been observed. This article summarises the current knowledge.

CERAD‐neuropsychological battery in screening mild Alzheimer’s disease

Sotaniemi M, Pulliainen V, Hokkanen L, Pirttilä T, Hallikainen I, Soininen H, Hänninen T. CERAD‐neuropsychological battery in screening mild Alzheimer’s disease. 
Acta Neurol Scand: 2012: 125: 16–23. 
© 2011 John Wiley & Sons A/S.

Cognitive performance in HIV‐1 infection: relationship to severity of disease and brain atrophy

We examined cognitive performance in 72 HIV‐1 infected patients and 34 controls. None of the patients had opportunistic infections or unusual neoplasms of the central nervous system (CNS). Factors other than HIV‐1 known to cause cognitive decline were excluded from both groups. Cognitive functioning analysed with special emphasis on the severity of HIV infection was related to neuroradiological and immunological findings. In patients with AIDS‐related complex (CDC IVa) or AIDS (CDC IVc,d), a deterioration of memory as well as cognitive speed and flexibility was detected. Furthermore, memory deficits were associated with central cerebral and infratentorial atrophy in those patients, while no association was found between cognitive deficits and immunological abnormalities. Patients at CDC stages II or III showed slight association between altered cognitive speed and flexibility and elevated leukocyte count, suggesting a subclinical CNS disease already at early stages of HIV infection.

Cognitive impairment after acute encephalitis: comparison of herpes simplex and other aetiologies.

OBJECTIVE: To compare the cognitive defects after acute acyclovir treated herpes simplex encephalitis with those after other types of acute encephalitis. METHODS: Seventy seven consecutive patients between 1985 and 1995 and 29 normal controls were studied. Of the 77 patients without concomitant neurological conditions, 17 had herpes simplex, one virus encephalitis (HSVE group), 27 had some other identified aetiology (non-HSVE group), and in 33 patients the cause was unknown. Acyclovir treatment was started less than four days after the first mental symptoms in 12 of 17 patients with HSVE. A thorough neuropsychological assessment was carried out about one month after the onset. RESULTS: The HSVE group had deficits in verbal memory, verbal-semantic functions, and visuoperceptual functions more often than the non-HSVE group. The risk for cognitive defects was twofold to four-fold in the patients with HSVE compared with the non-HSVE patients. Two (12%) of the patients with HSVE and 12 (44%) of the non-HSVE patients were cognitively intact. Six patients with HSVE (46%) and 17 (89%) non-HSVE patients later returned to work. The lesions on CT or MRI were bilateral only in one patient with HSVE. The defects in the three patients with adenovirus infection were severe and resembled the amnesia after HSVE. Cognitive impairment, not previously reported, was found in encephalitis after rotavirus infection and epidemic nephropathy. CONCLUSION: The recovery in the HSVE group was better than expected based on the medical literature. On the other hand there were surprisingly severe cognitive defects in encephalitis after other viruses. With early acyclovir treatment patients with the least severe HSVE were equivalent to those with non-HSV encephalitis with good outcome whereas those with the most severe non-HSV encephalitis were equivalent to those with HSVE with poor outcome.

Cognitive recovery instead of decline after acute encephalitis: a prospective follow up study

OBJECTIVE Follow up of cognitive sequelae of acute encephalitis and estimation of the frequency of persisting dementia. METHODS Out of a series of 45 consecutive patients with acute encephalitis prospectively studied in 1990–95, 40 were screened for difficulty in everyday life using the Blessed dementia scale (BDS) 3.7 (1.4), mean (SD), years after onset. Eight patients had had herpes simplex encephalitis (HSVE), 16 some other identified aetiology, and in 21 the aetiology was unknown. All, except two patients with a non-herpetic encephalitis, were treated with acyclovir. All patients with disability in BDS (12/40), were invited to a neuropsychological reassessment, and the results of this assessment were compared with those of a similar assessment done after the acute stage. At follow up one patient could not complete the tests due to intractable epilepsy. RESULTS In six of 11 cases the symptoms causing disability were mainly psychiatric. Five patients (two with HSVE) had a pronounced memory impairment together with other cognitive deficits, indicating dementia (frequency of 12.8%). In eight of the 11 testable cases cognitive performance had improved over the years, in two cases a decline was found and one patient with severe deficits showed no change. Intractable epilepsy was found in four of 12 cases. CONCLUSION Cognitive decline had taken place already at the acute stage, and further deterioration was uncommon. Considerable improvement occurred in most patients during follow up. Also in patients with HSVE treated with acyclovir the cognitive recovery was substantial and of a magnitude not expected based on previous literature. Intractable epilepsy contributed to the cognitive deterioration in some cases. Affective disorders also had a surprisingly important role for the long term outcome.

Having a Male Co-Twin Masculinizes Mental Rotation Performance in Females

Probably the most robust cognitive sex difference is that, on average, males outperform females in tests of mental rotation ability (Voyer, Voyer, & Bryden, 1995). This sex difference is evident across many different cultures (Silverman, Choi, & Peters, 2007), and it appears early in infancy, at 3 to 5 months of age (Moore & Johnson, 2008; Quinn & Liben, 2008). Studies have suggested that elevated levels of fluctuating testosterone are associated with better spatial abilities among females, whereas in males, lower fluctuating testosterone levels relate to better spatial abilities (Gouchie & Kimura, 1991; Moffat & Hampson, 1996). In persons with congenital adrenal hyperplasia, which usually affects the production of sex steroids, the organizational effects of elevated prenatal testosterone may account for improved spatial test performance in females and impaired spatial test performance in males (Puts, McDaniel, Jordan, & Breedlove, 2008). Moreover, a positive relationship between mental rotation test (MRT) performance and prenatal testosterone has been reported in healthy girls (Grimshaw, Sitarenios, & Finegan, 1995). Animal studies have shown that female fetuses located adjacent to male fetuses in the uterus can be masculinized through prenatal exposure to testosterone (Ryan & Vandenbergh, 2002). In humans, prenatal masculinization can be studied by comparing female twins from opposite-sex twin pairs with female twins from same-sex pairs. Sisters of twin brothers have been reported to be masculinized in physiological traits, including maternal fitness (Lummaa, Pettay, & Russell, 2007) and second-to-fourth-finger ratio (van Anders, Vernon, & Wilbur, 2006), but other studies have not demonstrated the same results (Medland, Loehlin, & Martin, 2008; Medland, Loehlin, Willemsen, et al., 2008). One commonly cited study concerns mental rotation ability in female twins from opposite- and same-sex pairs (Cole-Harding, Morstad, & Wilson, 1988); however, this study was published only as a meeting abstract. In the study reported here, we assessed masculinization effects on MRT performance among female twins with male co-twins by comparing their performance with that of female twins with female co-twins. We also investigated whether or not there are differences in MRT performance between males with female co-twins and males with male co-twins.