Peter Böhm

Clinical Validity and Utility of the Interview for Deterioration of Daily Living in Dementia for Spanish-Speaking Communities

The assessment of activities of daily living is a central procedure in the diagnosis of dementia. Few instruments in the field allow for early detection of functional decline because the items they use refer mainly to basic activities of daily living (BADL), which do not become compromised until later in the disease process. The Interview for Deterioration of Daily Living in Dementia (IDDD) may be a valuable tool for early detection of functional decline because it includes, apart from a BADL subscale, another subscale containing a variety of instrumental activities of daily living (LADL), which are the first to be affected in dementing processes. We present an adaptation and validation of the IDDD for Spanish-speaking communities (S-IDDD). A total of 254 control subjects (CONT), 86 patients with mild memory/cognitive impairment with no dementia (CIND), and 111 patients diagnosed with probable dementia of the Alzheimer type (DAT) participated in this project. IDDD total scores (mean and SD) were as follow: CONT: 33.1 (0.4); CIND: 35.2 (3.4); DAT: 54.3 (18.6). The present validation showed no sociodemographic effects on the IDDD total scores. The IDDD demonstrated great internal consistency (alpha = .985) and reproducibility (intraclass correlation coefficient = .94). Correlations were high (r = .81; p < .1) when they took into account the whole sample, but decreased significantly when the groups were separated by pathologic condition. The scale showed significant differences between DAT versus CIND and CONT. The IADL subscale differentiated all three groups, which makes it extremely valuable for early detection of functional decline. The present study shows that the S-IDDD is a reliable adaptation of the original IDDD scale and may be used successfully in Spanish populations for staging and follow-up of subjects with dementia.

A Preliminary Study of the Mini-Mental State Examination in a Spanish Child Population:

The Mini-Mental State Examination is one of the most widely used screening tests for the adult population in daily neurologic practice. The aim of this study was to describe and to analyze the results of the Mini-Mental State Examination administered to Spanish children and to assess the relationship between Mini-Mental State Examination scores and the childs mental age/intelligence quotient. The study population included 181 children whose ages ranged between 4 and 12 years. The neuropsychologic battery consisted of the Mini-Mental State Examination and Kaufman Brief Intelligence Test. Percentiles were obtained for the Mini-Mental State Examination total score according to age ranges. Performance gradually increased from 4 to 10 years of age when a plateau in the total Mini-Mental State Examination score was reached. At the age of 6 years, results exceeded 24 on average. Pairwise mean comparisons showed statistically significant differences between the age groups (P < .05). Data distribution could be classified in 4 independent groups for the following chronologic ages: 4, 5, and 6 years and from 7 to 12 years of age. The total Mini-Mental State Examination score correlated significantly with the childs chronologic (r = 0.80, P < .001) and mental (r = 0.76, P < .001) ages. This is a preliminary study of the application of the Mini-Mental State Examination in a Spanish child population as well as a first step for the assessment of the usefulness of this instrument as a cognitive screening tool for childrens development.

Acquired dyslexias and dysgraphias (I): A cognitive model for the analysis of disturbances of reading and writing in Spanish

Abstract This paper, following the standards of cognitive neurosciences, presents a functional architecture (a model). The aim of this functional architecture is to try to explain, in the most explicit way possible, the underlying cognitive structure of reading aloud and writing of single words to dictation. The model, developed to describe the mentioned behavior in normal subjects, will serve as a basis for the description of the various pathologies described in the specialized aphasiologic literature on acquired dyslexias and dysgraphias. Following this line of thought, a protocol for the exploration of these behaviors has been developed for the Spanish language, based on the the model outlined in this paper, cf. ‘Acquired dyslexias and dysgraphias (II)’. This protocol is intended to serve as a basis for the assessment of brain-damaged patients with reading and/or writing disturbances.

Semantic memory as assessed by the Pyramids and Palm Trees Test: The impact of sociodemographic factors in a Spanish-speaking population

The objective of this study is to obtain preliminary normative data on the performance the Pyramids and Palm Trees Test (PPT) for a Spanish-speaking population. The effects of age, gender, and educational level on the PPT test were also analyzed. A total of 234 healthy participants, with a broad range of age (18-80 years) and education (1-20 years) performed the three-picture version of the PPT. The mean performance was 51.1 out of 52 possible points (SD=1.3). PPT performance did not vary with age or gender. However, subjects with less than 6 years of formal education scored significantly lower than those with more than 6 years of education though this effect was confounded with age because the group with lower education was also older. Given the ceiling effects of the PPT, further investigation is needed to determine if the visual PPT is sensitive to mild semantic memory impairment.

The Comparison of Cognitive and Functional Performance in Children and Alzheimer's Disease Supports the Retrogenesis Model

The retrogenesis model states that the progression of brain aging and Alzheimers disease (AD) deterioration proceeds inversely to human ontogenic acquisition patterns. Our aim was to assess if the progressive decline of cognitive abilities and functional capacity in AD follows an inverse sequence of acquisition compared to normal developmental patterns. One hundred eighty one children ranging in age from 4 to 12 years and 148 adults (cognitively normal, subjects with mild cognitive impairment, and mild-moderately severe AD) were assessed with the same cognitive and functional tools. The statistical analyses showed a progressive and inverse distribution on cognitive, functional, and mental age scores when comparing results of children classified by chronological age and patients by dementia staging. The pattern of cognitive acquisition in children showed a progressive development of overall cognitive function along all age ranges, in addition to a simultaneous acquisition of instrumental and basic daily living activities in the functional domain. AD patients showed a progressive decline in cognitive and functional domains, which concurs with the sequence of impairment reported in this dementia. Our findings provide support to the inverse and progressive pattern of functional and cognitive decline observed in AD patients compared to the developmental acquisition of these capacities in children, as stated by the retrogenesis model. Nonetheless, certain differences should be considered when comparing the sequence of acquisition during ontogenic development with that of progressive loss during the course of AD. Retrogenesis may account for the progressive loss of neocortical-related functions in AD.

On manifestations of aphasia in Catalan: a case study of Broca's aphasia

Abstract This paper discusses a case of Brocas aphasia in light of the impact of the structure of the patients mother tongue, Catalan, on the types of errors he makes. What seems to be most affected in the present case, in terms of Kolks (1995) theory of “structural simplification” —proposed originally for sentence production and comprehension—are those linguistic levels that are most complex in Catalan: closed class word morphology and verb morphology as well as production and comprehension of sentences with non-canonical word order. The types of errors presented always occur in structurally obligatory contexts where the semantic or propositional content of the omitted or misused elements is rather small. Another important fact to bear in mind when studying Catalan aphasics is that, due to the bilingualism of all speakers, some of the signs and symptoms of aphasic speech have to be interpreted in light of the rival language, Spanish.

Una forma de anotación (lingüística) para las paralexias y las paragrafias1

Resumen Este articulo presenta, de manera detallada, una descripcion de las paralexias y las paragrafias mas importantes que se observan en cualquier enfermo con alteraciones de la lectoescritura. Ademas de la descripcion de estos dos sintomas semiologicos, el articulo introduce una forma de anotacion, desde el campo de la linguistica, para las paralexias y las paragrafias. Esta anotacion tiene como objetivo la estandarizacion de esta semiologia en el ambito de la neuropsicologia.

Acquired dyslexias and dysgraphias (II): Clinical protocol for the assessment and analysis of reading and writing disorders in Spanish

This paper is presented in continuation of (and association with) ‘Acquired dyslexias and dysgraphias (I)’, where a functional architecture outlining the cognitive substrates of reading aloud and writing single words to dictation in an alphabetic writing system, like Spanish, is presented. Based on this theoretical approach, the present paper describes a Protocol designed to evaluate the alterations that may be observed in brain damaged patients suffering from acquired dyslexia/dysgraphia. Divided into two parts, one for the analysis of reading and the other one for the analysis of writing, each section is subdivided into four separate subsections. The first two of these subsections, for both reading and writing, serves as evaluation of the mentioned behaviors. Cases involving an elevated numbers of errors will necessitate the use of subsections three and four (supplementary and psycholinguistic tasks). As for reading tasks, the reaction time of the subjects when exposed to the stimuli will be taken into account. The proposed protocol, based on the model described in the preceding paper, will thus be capable of the accurate investigation of the clinical disorders observed in reading and writing.