Characteristics of assessment of motor and process skills and Rivermead Behavioral Memory Test in elderly women with dementia and community-dwelling women.

The purpose of this study was to demonstrate the characteristics of the Instrumental Activities of Daily Living (IADL) ability, evaluated by the Assessment of Motor and Process Skills (AMPS), and everyday memory functions (the memory necessary for daily life), assessed by the Rivermead Behavioral Memory Test (RBMT) in elderly people with dementia compared with a community-dwelling group. We divided the RBMT into three categories: prospective memory (PM), retrospective memory (RM), and PM+RM. The study was performed with 102 women, those with dementia who lived in a healthcare facility or three group homes (n = 52) and those who were cognitively well and lived in their own homes (n = 50). Subjects were over 68 and under 92 years old. We assessed them by Mini-Mental State Examination (MMSE), AMPS and RBMT. The results of the MMSE, AMPS, and RBMT revealed that the community-dwelling group's averages were higher than those of the Dementia group. No associations were found between AMPS motor skills and MMSE or PM, RM, and PM+RM in both groups. There were slight associations between the AMPS process and RM in both groups, but none between AMPS process skills and PM in either group. From that result, we found that IADL performance ability and everyday memory were not simultaneously damaged. Moreover, analyzing a scatter chart revealed some subjects had a PM deficit even though they were at the IADL independent level. In conclusion, occupational therapists need to assess both IADL performance and everyday memory, including PM, in elderly people.

[Characteristics of instrumental activities of daily living and everyday memory in elderly women--method for assessment of abilities in early dementia].

AIM: To demonstrate the characteristics of the Instrumental Activities of Daily Living (IADL), assessed by the Assessment of Motor and Process Skills (AMPS), and everyday memory functions (memory necessary function for daily life) assessed by the Rivermead Behavioral Memory Test (RBMT) in elderly people with dementia. To compare the ability and the function between them and community-dwelling normal subjects. METHODS: We divided the RBMT result into three categories: prospective memory, retrospective memory, and prospective memory+retrospective memory. The study was performed in102 women (68-92 years old) with dementia who lived in a healthcare facility or three group homes (n=52) and cognitively normal subjects who lived in their own homes (n=50). RESULTS: There were no associations between AMPS motor and prospective memory, retrospective memory, and prospective memory+retrospective memory in both groups. There were associations between the AMPS process and retrospective memory in both groups, but no associations between the AMPS process and prospective memory in either groups and a scatter chart revealed some subjects with a prospective memory deficit even though they had a normal IADL performance ability level. From those results, we found that IADL performance ability and everyday memory were not simultaneously damaged. CONCLUSION: When assessing elderly people, it is necessary to assess both IADL performance and everyday memory, including prospective memory. According to these methods, mild cognitive impairment may be screened more accurately.

[Comparison of activities of daily living for a convalescent rehabilitation ward and general ward for stroke patients].

We investigated changes in the Activities of Daily Living (ADL) of stroke patients in a convalescent rehabilitation ward and a general ward using a Functional Independent Measure (FIM). The subjects were 109 patients hospitalized for rehabilitation purposes at the Oyamada Memorial Spa Hospital. The change in FIM at the time of hospitalization and that at 1 week later was investigated in 81 patients in the convalescent rehabilitation group (CRG) and 28 patients in the control group (CG). In addition, the CRG was investigated again after one month. Intensive rehabilitation service based on ADL and worksheets was introduced in the CRG. On the other hand, these were not introduced in the CG. The total score of FIM increased significantly (p<0.01) in the first week after hospitalization in both groups. The FIM-gain after one week in the CRG was high. With regard to each item, a significant improvement was observed in patients' motor skills while eating, grooming, bathing, dressing the upper body, dressing the lower body, toilet, bladder management, transfer bed/chair, toilet and tub, and walking/wheelchair (11/13). Multiple regressions were used to assess the relationships between FIM-gain (one week, one month), age, rehabilitation intensity and other predictive variables. Better rehabilitation outcomes were observed in patients with lower level of dementia and high rehabilitation intensity. It was thought that planned rehabilitation based on ADL was effective in the CRG, and it was suggested that the CRG's system is effective in the rehabilitation of stroke patients.

Acute motor and sensory neuronopathy associated with small-cell lung cancer: a clinicopathological study.

A 48-year-old Chinese woman developed ascending motor paralysis while visiting Japan, leading to tetraplegia and respiratory failure over 2 weeks. The patient's course was complicated by anoxic encephalopathy. Nerve conduction studies revealed a severely decreased amplitude of compound muscle action potentials and a sural nerve biopsy specimen showed findings consistent with axonal-form Guillain-Barr6 syndrome. An autopsy, excluding the brain, demonstrated small-cell lung cancer that was not detected clinically, axonal-dominant degeneration in the nerve roots and distal peripheral nerves, and the loss of both myelin and axons in the dorsal spinal column. The spinal anterior horn cells were severely decreased and were accompanied by astrocytic reaction in all spinal segments with lymphocytic infiltration. A limited examination of the dorsal root ganglia did not show Nageotte nodules, but the infiltration of T cells was observed. Although the clinical course mimicked axonal-form Guillain-Barré syndrome, the autopsy demonstrated both sensory and motor neuronal involvement, as well as small-cell lung cancer. Although anti-Hu and antiganglioside antibodies were negative in the patient's serum, the para-neoplastic mechanism might have damaged the anterior horn and dorsal root ganglia cells, which subsequently led to secondary axonal degeneration. There has been a report on a case of paraneoplastic subacute motor neuronopathy, but the acute course described here has not been reported before.