Maria Pąchalska

Aggressive and impulsive behavior in Alzheimer's disease and progression of dementia.

Summary Background The symptoms of Alzheimer’s disease (AD) are numerous, including worsening of mood, psychotic symptoms, aggressive and impulsive behaviours, and many others. It is generally assumed that there exists a relationship between the severity of dementia and aggressive symptoms. The aim of this study was to assess the relationship between aggressive and impulsive behaviours and cognitive function disorders in AD patients. Material/Methods Forty-eight AD patients living in a nursing home were included in the research group on the basis of NINCDS/ADRDA criteria. The subjects underwent two years of naturalistic observation. The intensity of agitation and aggressive behaviours was assessed on the basis of the Cohen-Mansfield Agitation Inventory (CMAI). The Alzheimer’s Disease Assessment Scale Cog (ADAS-cog) was used to assess cognitive function. Pharmacotherapy administered during the observation period was also taken into account. Results Thirty-one patients completed the two year long observation. Individuals with more severe cognitive deficiencies demonstrated a greater intensity of aggressive and impulsive behaviours, as assessed using the CMAI scale. Aggression escalated together with the development of dementia disorders. The intensity of dementia disorders was most significantly connected with physical agitation and verbal aggression. The use of neuroleptics and mood stabilisers decreased the progression of aggressive and impulsive behaviours. Conclusions There is a relationship between cognitive functioning disorders and the intensification of aggressive and impulsive behaviours. More severe forms of dementia are connected with greater intensification of aggressive and impulsive behaviours as the disease progresses. Periodical administration of pharmacotherapy may reduce the development of aggressive behaviours.

The quality of life of persons with TBI in the process of a Comprehensive Rehabilitation Program

Summary Background The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program. Material/Methods The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation. Results The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained. Conclusions A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.

The Effects of Intellectual, Physical, and Social Activity on Further Prognosis in Mild Cognitive Impairment

Background Our goal was to specify the relationship between the level of activity (intellectual, physical, and social) in persons diagnosed with mild cognitive impairment (MCI) and the further progression of cognitive dysfunction. Material/Methods We examined 193 patients diagnosed with MCI (according to the criteria of the Working Group on Mild Cognitive Impairment) and under treatment at our Mental Disorders Clinic. It was assumed that these persons would remain under systematic psychiatric observation until dementia was diagnosed. The present study results from a seven-year observation period. The mini–mental state examination (MMSE), the Activity Scale (with the intellectual, physical, and social subscales), and the Instrumental Activities of Daily Living (IADL) scale were used to evaluate the participants’ status at baseline. The MMSE was re-administered after one year and again at the end of the observation (either upon diagnosis of dementia or after seven years). At each meeting with the participant, the clinical diagnosis was verified to determine if the patient had dementia or not. Of the 193 people initially qualified for the study, 75 were available for the final analysis. Results It was found that there was no statistically significant difference in the baseline MMSE scores between the persons with stable MCI and the persons who had progressed to dementia. However, statistically significant differences in the level of activity at baseline on both the global IADL scale and the Activity Scale between those with stable MCI and those who had progressed to dementia were found. These differences were manifested in the IADL subscales for telephone use, shopping, transportation, and personal finances, and in the physical activity subscale. Conclusions An evaluation of intellectual, physical, and social activity can be useful in determining the prognosis for the future course of MCI.

Characteristics of cognitive deficits and writing skills of Polish adults with developmental dyslexia

The present study was aimed at analysing cognitive deficits of dyslexic adults, and examining their written language skills in comparison with their peers. Our results confirm the presence of a certain profile of symptoms in adult dyslexics. We noticed deficits in: phonological (verbal) short-term memory, phonological awareness, rapid automatised naming (speed, self-corrections), visual perception and control, and visual-motor coordination. Moreover, the dyslexic participants, as compared with their nondyslexic peers, produced more word structure errors whilst writing an essay. However, there were no significant differences between the two groups in the length of the essay, the number of linguistic and punctuation errors, the number of adjectives, and stylistic devices.

Evaluation of a neurotherapy program for a child with ADHD with Benign Partial Epilepsy with Rolandic Spikes (BPERS) using event-related potentials

Summary Background We hypothesized that there would be a good response to relative beta training, applied to regulate the dynamics of brain function in a patient with benign partial epilepsy with Rolandic Spikes (BPERS), associated with neuropsychiatric deficits resembling the symptoms of attention deficit-hyperactivity disorder (ADHD). Case Report The patient, E.Z., age 9.3, was suffering from neuropsychiatric symptoms, cognitive dysfunction, especially attention deficits, and behavioral changes, rendering him unable to function independently in school and in many situations of everyday life. He was treated for epilepsy, but only slight progress was made. The patient took part in 20 sessions of relative beta training combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment and after the completion of the neurotherapy program. Neuropsychological testing at baseline showed multiple cognitive deficits. Over the course of neurotherapy, E.Z.’s verbal and non-verbal IQ increased significantly. His cognitive functions also improved, including immediate and delayed logical and visual recall on the WMS-III, maintaining attention on the WMS-III, and executive functions, but remained below norms. Physiologically, the patient showed substantial changes after neurotherapy, including fewer spikes and an increased P300 NOGO component. Conclusions The cognitive deficits characteristic for ADHD in a child with BPERS may be unresponsive to antiepileptic treatment, but are reversible after a carefully selected neurotherapy program, combined with antiepileptic treatment. Event Related Potentials (ERPs) in the GO/NOGO task can be used to assess functional brain changes induced by neurotherapeutical programs.

Vascular Factors and Cognitive Dysfunction in Alzheimer Disease

Background The purpose of the present study was to assess the influence of vascular factors on the degree of intensity and rate of progression of cognitive disorders in the course of Alzheimer Disease (AD). Material/Methods The research group consisted of 39 persons, all of whom were diagnosed with AD according to the NINCDS/ADRDA criteria. We divided these patients into 2 subgroups, based on the vascular factors measured by the modified Hachinski Ischemic Scale (Ha-mod): group A, without the vascular component (HA-mod score of 0–1 point), and group B, with the vascular component (a score over 1 point). Cognitive functions were evaluated at baseline and again 2 years later, using the Cognitive Part of the Alzheimer Disease Assessment Scale (ADAS-cog). Results We found that the patients from subgroup B, with the stronger vascular component, demonstrated the highest intensity of cognitive disorders at baseline, both in terms of the overall ADAS-cog score, and in the subscores for ideational praxis, orientation, spoken language ability, comprehension of spoken language, and word-finding difficulty in spontaneous speech. Another variable which was connected with the intensity of dementia was age. After 2 years, however, the rate of progression of cognitive disorders was not significantly different between the 2 groups. Conclusions The severity of vascular factors correlates directly with the intensity of cognitive disturbances. At the 2-year follow-up examination, however, no correlation was observed in the research group between greater vascular involvement and more rapid progression of cognitive disorders, as measured by the ADAS-cog scale.

Neurofeedback training for peak performance.

AIM One of the applications of the Neurofeedback methodology is peak performance in sport. The protocols of the neurofeedback are usually based on an assessment of the spectral parameters of spontaneous EEG in resting state conditions. The aim of the paper was to study whether the intensive neurofeedback training of a well-functioning Olympic athlete who has lost his performance confidence after injury in sport, could change the brain functioning reflected in changes in spontaneous EEG and event related potentials (ERPs). CASE STUDY The case is presented of an Olympic athlete who has lost his performance confidence after injury in sport. He wanted to resume his activities by means of neurofeedback training. His QEEG/ERP parameters were assessed before and after 4 intensive sessions of neurotherapy. Dramatic and statistically significant changes that could not be explained by error measurement were observed in the patient. CONCLUSION Neurofeedback training in the subject under study increased the amplitude of the monitoring component of ERPs generated in the anterior cingulate cortex, accompanied by an increase in beta activity over the medial prefrontal cortex. Taking these changes together, it can be concluded that that even a few sessions of neurofeedback in a high performance brain can significantly activate the prefrontal cortical areas associated with increasing confidence in sport performance.

MEMORY IMPAIRMENTS IN ADULTS WITH DYSLEXIA

The aim of our study was to analyze the functioning of various aspects of memory in adults with developmental dys lexia, as compared to adults without developmental dyslexia. Our research involved a total of 180 adults, mostly students and university graduates from the Tri-City metropolitan region in north central Poland. The criterion group consisted of 93 adults with developmental dyslexia, while the control group consisted of 87 adults without developmental dyslexia. The results obtained confirm the assumption of a lower level of functioning of individuals with dyslexia in relation to phonemic analysis and phonemic awareness, phonological awareness and verbal working memory, visual working memory and perception in a task requiring the analysis and synthesis of details of a complex pattern, recalling data from the mental lexicon. The two groups did not differ in terms of working visuospatial memory (spatial span). These results are consistent with a majority of scientific reports on memory function ing in adults with developmental dyslexia. Our findings confirm the phonological deficit hypothesis, as the most profound disturbances were observed in phonological processing and verbal working memory. Moreover, our studies do not provide support for the compensation model of dyslexia, as diverse memory deficits persist into adulthood. However, adults with dyslexia were aware of their cognitive limitations in terms of memory.

ALEXANDER ROMANOVICH LURIA (1902-1977) AND THE MICROGENETIC APPROACH TO THE DIAGNOSIS AND REHABILITATION OF TBI PATIENTS

Alexander Romanovich Luria (1902-1977), Russian psycho logist and neuropsychologist, is recognized throughout the world as one of the most eminent and influential psychologists of the 20th century, who made advances in many areas, including cognitive psychology, the processes of learning and forgetting, mental retarda tion and neuropsychology. Luria’s scientific career was build in “the stages of a journey undertaken” (as the Russian title of Luria’s autobiography says): co-working with Lev S. Vygotsky (1896-1934) and the foundation of the cultural-historical school (the 1920s), cross-cultural research, an expedition to Central Asia, and studies on twins (the 1930s), the war and the first works on brain injured patients (the 1940s), research into mentally retarded children, brain injuries and rehabilitation (1950s), the systematic development of neuropsychological research (the 1960s and 70s). The research on the functioning of the brain, touching on learning and forgetting, attention and perception as psychological constructs, was to engage Luria for forty years. Analysis of functional changes resulting from local brain lesions constituted the area of greatest interest. The single-case approach to neurological studies was to be the focus of his last years. In this paper we attempt to show the impact of Luria’s approach on the foundations of the microgenetic approach to the diagnosis and rehabili tation of patients with traumatic brain injuries, and espe cially the importance of symptom analysis in single-case studies.

Evaluation of differences in health-related quality of life during the treatment of post-burn scars in pre-school and school children

OBJECTIVE The aim of the research was an assessment of the differences in the self-evaluation of health-related quality of life during the treatment of post-burn scars on the upper limbs of pre-school and school children. MATERIALS AND METHOD a group of 120 children were examined--66 boys and 54 girls, divided into a pre-school group of 60 children (average age 4.3±1.7) and a primary school group of 60 children (average age 10.4±1.2). The structured interview and an adopted Visual Analog Anxiety Scale and Visual Analog Unpleasant Events Tolerance Scale were used to evaluate the level of plaster tolerance, and anxiety caused by the removal of dressings during treatment. RESULTS In the first test, In both groups, a low tolerance was noted to the pressure plaster, with the pre-school aged children obtaining worse results (x=18.9±SD 10.16) than those of school age (x=33.65±SD 13,21), regardless of gender. Pre-school children were afraid (x=47.5±SD 24.26), while school-aged children were not afraid of having the plaster removed (x=20.5±SD 9.46). The differences between the groups were statistically significant. In the fourth and final test on pre-school aged children, the tolerance of plasters had improved (x=23.24±SD 15.43) obtaining a value somewhat lower than for school-aged children (32.4±SD 6.45), as well as a noted fall in the anxiety level (30.83±SD 23.38) with an average value insignificantly higher than that recorded for the children of school age (15.83±SD 6.19). CONCLUSIONS The tests confirmed the appearance of differences in the self-evaluation of health-related life quality in pre-school and school-aged children.