Objective: Cognitive reserve influences age of onset, speed of progression, and clinical manifestations of Alzheimer’s disease. We investigated whether cognitive reserve interacts with clinical and neuropsychological parameters in mild cognitive impairment (MCI). Methods: In this cross-sectional study, we recruited 273 people (70.6 ± 10.1 years, 54.6% women) suffering from subjective memory complaints (n = 65), MCI (n = 121), or dementia (n = 87). Patients underwent neuropsychological evaluation, laboratory testing, and brain imaging. Additionally, we obtained information on years of education and help-seeking motivation. Results: MCI patients with a university degree were significantly older than those without (71.6 ± 9.6 vs. 66.9 ± 10.3, p = 0.02). University-educated MCI patients demonstrated superior performance in verbal fluency. Intrinsic help-seeking motivation (self-referral) was associated with higher cognitive reserve. Female MCI patients presented with greater intrinsic motivation. Conclusion: Cognitive reserve modulates clinical and neuropsychological measures in patients with MCI.

La mastocytose se définit par une accumulation excessive de mastocytes dans un ou plusieurs organes ou tissus. Si dans la plupart des cas la maladie ne diminue pas l’espérance de vie, elle reste néanmoins associée à un handicap souvent mal connu et mal compris. Malgré l’importance des manifestations neuropsychiatriques accompagnant la mastocytose, les efforts concentrés sur leur compréhenson et celle de leurs liens avec la maladie ont été longtemps mis au second plan. L’objectif de cette thèse était de mieux connaître ces troubles neuropsychologiques, notamment la dépression et les troubles de l’attention/ mémoire, d’investiguer les liens entre ces troubles et des aspects biologiques et émotionnels comme l’effet d’un inhibiteur de tyrosine kinase bloquant les mastocytes sur la dépression ; les liens entre le stress perçu, la dépression et la longueur des télomères ; et les liens entre dépression et compétences de régulation émotionnelle. Nos résultats montrent que la dépression est un symptôme fréquent dans la mastocytose, ainsi que les troubles de la mémoire. Ces derniers ne semblent pas liés à la dépression. Par ailleurs, la dépression est améliorée par un traitement visant les mastocytes ; le stress perçu chez ces patients est lié à la longueur des télomères et le métaolisme du tryptophane, en particulier l’activité de l’IDO est associée aux troubles neuropsychologiques chez ces patiens. Ces résultats ouvrent des nouvelles perspectives dans la compréhension des symptômes psychologiques associés à la mastocytose. / Mastocytosis is defined as an excessive accumulation of mast cells in one or more organs or tissues. While in most cases the disease does not reduce life expectancy, it is associated with a disability often poorly known and poorly understood relate to the symptoms due to the release of mast cell mediators. Despite the importance of these neuropsychiatric manifestations, efforts focused on their understanding and their relationship to the disease has been put into the background. The aim of this thesis was to better know these neuropsychological disorders present in mastocytosis, including depression and attention deficit disorder and to investigate the relationship between these disorders and biological and emotional aspects as effect of an inhibitor of tyrosine kinase locking mast cells, the relationship between perceived stress, depression, and telomere length, and the links between depression and emotional regulation skills. Our results show that depression and memory disorders are common symptoms in mastocytosis. Attention impairment do not seem related to depression. Furthermore, depression is improved by masitinib treatment. Perceived stress in these patients is related to telomere length and tryptophan metabolism; in particular the activity of IDO is associated with neuropsychological disorders. These results open new perspectives in understanding the psychological symptoms associated with mastocytosis.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Persons with Mild Cognitive Impairment (PwMCI) battle progressive disengagement from personally meaningful activities that results in functional decline. Little is known about PwMCI experience of engaging in meaningful activities and relationships among MCI stage, confidence, depressive symptoms, and function. Daily Engagement of Meaningful Activity (DEMA) is a multicomponent, family-focused, tailored intervention designed to benefit PwMCI and their caregivers by facilitating goal identification, preserve engagement, and support adjustments to cognitive and functional changes. Objectives: The aims of this secondary analysis were to: (i) describe PwMCI experience of engagement in DEMA, (ii) evaluate for potential relationship among MCI stage, confidence, depressive symptoms, activity type, activity performance, physical function and (iii) evaluate ability of select outcomes to predict change in depressive symptoms and physical function, (iv) determine difference between participants when sub-grouped by ICF level. Methods: Mixed methodology was used to conduct a secondary analysis from the parent study. The parent study used a two-group randomized trial involving PwMCI and informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N=20, Information Support N = 20) examined outcomes at baseline, posttest and follow-up. Analysis employed: (i) Colaizzi's Method of empirical phenomenology to describe PwMCI experience of engagement in activity intervention related to perceptions of changes in confidence, activity performance, and physical function; (ii) Pearson's and Spearman's correlation to ascertain relationship; (iii) Linear regression to model the relationship between explanatory and dependent variables; (iv) Independent t-test to determine significant difference in activities and physical function. Results: Qualitative themes confirm improved awareness, adjustment, problem-solving, confidence and optimized function. Significant correlations were found at baseline and posttest for MCI stage, depressive symptoms, activity type and physical function. At posttest, change in self-rated performance predicted change in depressive symptoms. Additionally, those who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Conclusion: Qualitative themes and quantitative results clearly indicate the positive impact of DEMA. Future research should employ a larger, randomized controlled longitudinal trial to ascertain DEMA impact on physical function, reduction of participation restriction and improved QOL.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21669号 / 医博第4475号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 古川 壽亮, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This thesis aims to highlight the relevance of patients engaging with their patient narratives as a tool in recovery from illness and in regaining their sense of agency. / This thesis aims to rename the term ‘illness narrative’ to a more disclosive writing called the ‘patient narrative’ as a means to focus on the patient as a person who experiences illness, instead of the illness label. Exploring patient narratives, such as Susannah Cahalan’s Brain on Fire: My Month of Madness, as a form of disclosive writing will highlight the need for this tool to act as a more personal and effective communication between patients, healthcare professionals, and caregivers. The thesis is presented in two parts: a critical essay and my patient narrative. Part One is a critical essay that explores how engaging with patient narratives contributes to the patient reclaiming their agency and sense of identity. In three subsections, the essay highlights the difficulties patients go through with illnesses or rare medical events, as well as the emotional and physical impacts that they experience, going beyond medical symptoms. The essay focuses on three points separated into three sections. The sections are: Recognizing Pathologies and Injuries, Communication and Language in the Patient Experience, and Reclaiming Agency. Part Two is my autopathography centring on the complications encountered while seeking a common surgery. After general anaesthesia, I develop Postoperative Cognitive Changes of unknown aetiology. This greatly complicates the situation when surgery is needed, and the ensuing cognitive impairments have lasting impacts on me academically, personally, emotionally, and socially. While both parts are distinct, together they mirror how patient narratives have the iv potential to bridge the communication gap between medicine and humanities. As such, patient narratives can communicate connections between patients, medical communities, and a broader audience which acts to underscore the need of a deeper awareness for the importance of compassion and empathy for those experiencing any form of health challenge. / Thesis / Master of Arts (MA) / Patient narratives are a form of expressive writing that enables the patient to regain their sense of identity and agency following a health illness. When a person first becomes a patient, they leave their known world of familiarity and comfort and enter into a new one on their health journey. Their language and ways of communicating are required to adapt to the world of medicine. The patient loses their sense of identity and agency as a result of their illness. This thesis is presented in two parts, a critical essay and my brief patient memoir, and will explore how the patient, when engaging with patient narratives such as Susannah Cahalan’s Brain on Fire: My Month of Madness, can reclaim their agency and sense of identity. The first part is an essay exploring the contributions of patient narratives. The second part is my memoir, exemplifying a patient narrative.

The aim of this study was to examine and increase the understanding for how the nursing staff and unit managers in the municipality “Emmaboda” experience language barriers impact on their work and their opportunity to give equal care to the elder who do not master the Swedish language. Through the choice of qualitative method eight semi structured interviews have been held, two of these interviews were held with unit managers and six of these were held with nursing staff. The result has been analyzed on the basis of the qualitative analysis method, previous research and the concepts of inclusion and exclusion. The results show that the majority of the respondents experience that they can not give equal care to the elders regardless of which language the elders speak. The nursing staff experience also shows that the resources the municipality has in place is not enough to manage language barriers in elderly care. The result also shows that elders who do not manage the Swedish language are at risk of being affected by exclusion. Through Emmabodamodellen’s unique work, the municipality can in some ways promote the needs of the individual at the center and also promote inclusion. Our conclusion is that the right to equal care remains but it will take further more research to investigate which resources is needed to make it possible for the nursing staff to offer equal care, contribute to inclusion and counteract exclusion.

No description available.

Stressrelaterad ohälsa är en av de vanligaste sjukskrivningsorsakerna i västvärlden. I Sverige diagnostiseras vanligen långvarig stressrelaterad ohälsa som utmattningssyndrom. Vid utmattningssyndrom är kognitiva besvär ett framträdande symptom som kan vara långvarigt.  Kognitiv nedsättning vid utmattningssyndrom har tidigare fastställts utifrån en normativ ansats, vilket innebär att jämförelse görs med en icke-klinisk normgrupp. En annan metod är att använda en ideografisk ansats, vilket innebär att jämförelse görs med personens premorbida kognitiva nivå. Syftet med denna studie var att undersöka hur stor andel av patienter med utmattningssyndrom som uppvisar kognitiv nedsättning, utifrån en normativ respektive ideografisk ansats, samt hur kognitiv funktion relaterar till arbetsförmåga i patientgruppen. Data i denna studie utgörs av pretestmätningen från RECO-studien i Västerbotten. Patientgruppen bestod av 127 deltagare med utmattningssyndrom och normgruppen av 60 friska deltagare. Samtliga genomförde ett kognitivt testbatteri. Data analyserades med hjälp av olika gränsvärden för att undersöka frekvensen och andelen procent kognitivt nedsatta. Resultatet visade att andelen som uppvisade kognitiv nedsättning ökade då ideografisk ansats användes, men att majoriteten, oavsett ansats, var kognitivt intakta. Vidare sågs signifikanta samband mellan självskattad arbetsförmåga och kognitiv funktion utifrån ideografisk ansats, men inte utifrån normativ ansats. Dessa resultat tyder på att premorbid kognitiv nivå kan vara viktigt att ta hänsyn till vid bedömning av kognitiv funktion vid utmattningssyndrom. Vidare forskning inom området behövs, exempelvis där en större normgrupp används. / Stress-related illness is one of the most common sick leave causes in the Western world. In Sweden long term stress-related illness is usually diagnosed as exhaustion disorder. In exhaustion disorder, cognitive deficits are a prominent symptom that can be long-lasting. Cognitive impairment in exhaustion disorder has previously been determined based on a normative approach, which means that comparison is made with a non-clinical norm group. Another method is to use an idiographic approach, which means that comparison is made with the person's premorbid cognitive level. The aim of this study was to investigate the proportion of patients with exhaustion disorder who display cognitive impairment, based on both normative and idiographic approaches, and how cognitive function relates to work ability in the patient group. The data in this study consists of the pretest measurement from the RECO study in Västerbotten. The patient group consisted of 127 participants with exhaustion disorder and the norm group of 60 healthy participants. All participants completed a cognitive test battery. The data were analysed using different cut-offs ​​to examine the frequency and percentage of cognitively impaired. The results showed that the proportion who showed cognitive impairment increased when the idiographic approach was used, but that the majority, regardless of the approach, were cognitively intact. Furthermore, significant relationships were seen between self-estimated work ability and cognitive function based on an idiographic approach, but not based on a normative approach. These results suggest that premorbid cognitive level may be important to consider when assessing cognitive function in exhaustion disorder. Further research in the area is needed, for example where a larger norm group is used.

[pt] Esse trabalho se voltou para o desenvolvimento de um teste de avaliação do processamento sintático na compreensão da linguagem no envelhecimento. Esse teste tem como objetivo oferecer um auxílio no diagnóstico de Comprometimento Cognitivo Leve (CCL). Este é um quadro que pode evoluir para a Doença de Alzheimer (DA). Por isso, o diagnóstico o mais cedo possível de um comprometimento cognitivo no envelhecimento pode oferecer um melhor prognóstico para o paciente, a partir de acompanhamento médico e reabilitação neuropsicológica. Sabe-se que a idade avançada é um dos principais fatores de risco para o desenvolvimento da DA. Esta pesquisa se justifica na medida em que a população mundial vem envelhecendo em ritmo acelerado e também pela enorme carência de um instrumento de avaliação voltado para o processamento sintático no envelhecimento e, principalmente, pela carência de um instrumento em português brasileiro. Uma revisão sistemática feita nas plataformas PubMed, LILACS e SciELO revelou que por volta dos últimos 5 anos pouquíssimos estudos avaliaram o processamento sintático de pacientes com CCL. E o número de estudos que consideraram o processamento sintático de sentenças com estrutura mais complexa é mais reduzido ainda. Apresentamos, portanto, neste trabalho, um protótipo de um teste de compreensão de sentenças que variam em nível de complexidade sintática, construído com base em pesquisas na área de Psicolinguística e de Neuropsicologia Clínica. Trata-se de um teste de identificação de figura a partir de uma tarefa de verificação de correspondência entre sentença e imagem. Esse teste explora a compreensão de sentenças com oração relativa de sujeito e de objeto; interrogativas de sujeito e de objeto; clivadas de sujeito e de objeto; passivas reversíveis (implausíveis e neutras) e irreversíveis; estruturas com verbo de perspectiva; e ativas simples reversíveis e irreversíveis. Como a literatura reporta, até mesmo no envelhecimento saudável, espera-se um declínio no processamento dessas estruturas sintáticas mais complexas, que acarretam maior demanda cognitiva. Em um quadro de envelhecimento não saudável, esse declínio estaria mais acentuado e evidente. Por isso, esse teste pode ser uma medida promissora na detecção de um CCL que afete o domínio da linguagem. Foi realizado um estudo piloto com um grupo de 43 adultos mais jovens e um grupo de 10 idosos sem comprometimento cognitivo, para avaliar a funcionalidade do teste desenvolvido. Os dois grupos realizaram a tarefa de identificação de imagens sem dificuldades, com média de tempo similar e baixo percentual de erros, tendo estes ocorrido com as estruturas mais complexas do conjunto de sentenças examinadas. Os resultados do piloto sugerem, portanto, que o teste pode ser um instrumento sensível na avaliação do processamento sintático na compreensão de sentenças por parte de adultos e idosos. / [en] This work focused on the development of a test to assess syntactic processing in language comprehension in aging. This test aims to help in the diagnosis of Mild Cognitive Impairment (MCI), a condition that can progress to Alzheimer s Disease (AD). Thus, the early diagnosis of cognitive impairment in aging can offer a better prognosis for the patient, based on medical follow-up and neuropsychological rehabilitation. It is known that one that greatest risk factor for AD is advancing age. This research is very relevant because the world population has been aging at an accelerated pace and because there is a huge lack of an assessment instrument aimed at syntactic processing in aging, mainly due to the lack of a test in Brazilian Portuguese. A systematic review carried out on the PubMed, LILACS and SciELO platforms revealed that over the last 5 years very few studies have evaluated the syntactic processing of patients with MCI. And the number of studies that considered the processing of syntactically complex sentences is even smaller. Therefore, in this work, we present a prototype of a test of comprehension of sentences that vary in level of syntactic complexity, developed on the basis of research in the fields of Psycholinguistics and Clinical Neuropsychology. It is a sentence-picture matching task, in which participants must evaluate the correspondence between the sentence and the correct illustration. This test explores the comprehension of sentences with subject and object relative clause; subject and object interrogatives; sentences with subject and object topicalization; reversible (implausible and neutral) and irreversible passive sentences; structures with perspective verb; and reversible and irreversible active sentences. As the literature reports, even in healthy aging, a decline in the processing of more complex syntactic structures is expected, which entail greater cognitive demand. In a context of unhealthy aging, this decline would be more accentuated and evident. Therefore, this test can be a promising measure in the detection of a MCI that affects the language domain. A pilot study was conducted with a group of 43 younger adults and a group of 10 elderly people without cognitive impairment, to evaluate the functionality of the developed test. Both groups performed the image identification task without difficulties, with a similar average time and a low percentage of errors, which occurred with the most complex structures of the set of the examined sentences. Therefore, the pilot study results suggest that the test can be a sensitive measure in the evaluation of syntactic processing in sentence comprehension by adults and the elderly.

Our lives become longer with new advancements in medicine and technology. As a result, cognition and memory impairments will become a growing concern[23]. To be able to treat cognitive decline, dementia and related diseases, the need for early detection of memory deficiencies increases. This study aimed to validate the use of a new digital interaction version of a common memory test, the Rey Auditory Verbal Learning Test (RAVLT), compared with norm from the traditional human-to-human interaction version of the same test. This was performed through userstudies with both test versions in a counterbalanced order. The results consisted of quantitative results from the tests together with qualitative data from interviews with the participants in connection to each test occasion. The results showed a slight difference in some aspects of the quantitative test results, but at the same time, no significant difference for most of the measured results. Further, the interviews demonstrated that the differences in interaction and experience between the versions of the tests could be the reason for some of the differences in the quantitative result. The conclusion from this study was that there are many difficult problems to solve for speech interfaces in neurocognitive tests like the RAVLT. In line with previous research [22], the results highlight the importance of a natural speech interaction that conforms with the basic principles of human conversation, to create a stress-free experience and test results that can be reliable and comparable.