Dementia: Trauma and loss of personhood vs Family as recuperative space

The paper looks at the exploration in three Indian novels in English, of the hitherto glorified Indian family through the paradigm of dementia, examines the strained space called “home” in the shadow of dementia, and its transformation into a recuperative space with the help of support systems other than immediate family members. These three recent texts in Indian writing in English have discussed this crippling condition; which earlier authors shied away from. Anuradha Roy’s The Folded Earth (2012), Ranjit Lal’s Our Nana was a Nutcase (2015), and Pankaj Varma’s Silver Haze (2014), focus on the life-changing effects of the deadly disease dementia. These literary texts opt for a non-medical approach through which the person suffering dementia is depicted, rather than dementia itself. The family becomes a narrative prism through which to view the changing equations in relationships, the erosion of the family structure, instead of the specific medical condition. In conclusion, one could say that families become the recuperative space for patients rather than medical facilities for long term care. These Indian writers in English do not focus much on the medicalisation of dementia or geriatric health issues. They do mention medical treatments, but the spotlight is on the family, not on clinical viewpoints or medical approaches. Key words: Dementia, disorientation, trauma, deterioration, family space, caregivers.

Non-Intrusive, Visual-Less Wearable Haptic Stimuli Navigational Assistance For Elderly With Dementia

@#Age is typically affiliated with the decline of cognitive function and the probability to be diagnosed with neurodegenerative disease, namely dementia. Of all dementia-related deficits, the paper highlights on the decline of wayfinding ability, since it is interrelated with mobility, autonomy, caregiving burden and eventually institutionalization. The sense of directions in elderly is also affected by the sensory changes, while the most obvious sensory declines are both vision and hearing. Hence navigation systems that support mainly on visual and auditory may not be the best option for them. A concept of wearable navigational assistance that is non-intrusive and uses haptic stimuli instead of visual and/or audio signals is presented in this paper. A Usability Test (UT) was performed towards the elderly with dementia at a selected nursing home to investigate how they perceive haptic-feedback as a modality of navigation. The assessments involved three phases: (1) orientation or training, (2) navigation test and (3) further navigation test. Results indicate the potential efficacy of haptic modality as a navigation signal. Improvement on subjects’ navigational performance was shown especially during the further navigation test, signifying the familiarization of the intervention. Employing the haptic modality could be a beneficial substitute for navigational purpose when vision and audio are less appropriate. Nevertheless, as much as the encouraging outcomes from the results and analysis of the assessments are valuable, the constructive reviews attained are indeed important for the future development of the device system.

A Survey of Patients whose Consciousness Levels have been Judged as 1 on the Japan Coma Scale by Emergency Life-saving Technicians / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>We retrospectively examined the grounds for judging the consciousness level as 1 on the Japan Coma Scale (JCS) made by emergency life-saving technicians (ELSTs).</p><p><b>Methods: </b>The survey involved the sick and injured who were transferred to the hospital by ambulance during the 25-month period from July 1st, 2011, and who were able to respond to questions asked by hospital staff to make records after ELSTs had judged their consciousness level as 1 on the JCS.</p><p><b>Result: </b>A survey involving 105 cases was conducted to examine grounds for judgment of consciousness level of the sick and injured as 1 on the JCS. "Vacant or blank expression", "delay in reactions" or "delay in responses" were cited as the grounds by 61.0 and 47.6%, respectively.</p><p><b>Conclusion: </b>When ELSTs judged the consciousness level of the sick and injured as 1 on the JCS, they made the above observations of the patients. Although these factors are useful for evaluating the status of consciousness, they are not certain. In some cases, ELSTs may have judged the consciousness level as 1 when it should have been judged as 2 or 3 on the JCS. Therefore, it is suspected that some ELSTs may not recognize disorientation appropriately.</p>

Herpes Simplex Encephalitis Showing Prominent Spatial Disorientation with Visual Hallucination

A 58-year-old woman was admitted to hospital due to memory impairment and visuospatial dysfunction. Brain MRI revealed high signal lesions on both the temporal and inferior frontal lobes. She was diagnosed as having herpes simplex encephalitis based on her clinical and laboratory findings. Twelve months later she still presented with spatial disorientation, although her amnesia was improved. Neuropsychological testing revealed multiple cognitive impairments, and especially visuospatial dysfunction. This patient represents a case of herpes simplex encephalitis associated with spatial disorientation even when the amnesia had disappeared.

Delirium in general practice.

Delirium is a complex neuropsychiatric syndrome characterized by disturbances in consciousness, orientation, memory, thought, perception, and behaviour due to one or more structural and/or physiological abnormalities directly or indirectly affecting the brain. It is quite prevalent in medical and surgical settings and is associated with high rates of death and healthcare costs. We review its prevalence, clinical features, risk factors, pathogenesis, assessment instruments, differential diagnosis, management, prognosis and prevention. Special emphasis is given on the Indian research, which is quite meagre.

Topographical Disorientation in Mild Cognitive Impairment: A Voxel-Based Morphometry Study

BACKGROUND AND PURPOSE: To assess the neural substrates underlying topographical disorientation (TD) in patients affected by mild cognitive impairment (MCI), forty-one patients diagnosed with MCI and 24 healthy control individuals were recruited. METHODS: TD was assessed clinically in all participants. Neurological and neuropsychological evaluations and a volumetric-head magnetic resonance imaging scan were performed in each participant. Voxel-based morphometry was used to compare patterns of gray-matter atrophy between patients with and without TD, and a group of normal controls. RESULTS: We found TD in 17 out of the 41 MCI patients (41.4%). The functional abilities were significantly impaired in MCI patients with TD compared to in MCI patients without TD. Voxel-based morphometry analyses showed that the presence of TD in MCI patients is associated with loss of gray matter in the medial temporal regions, including the hippocampus and parahippocampal cortex, the fusiform gyrus, the inferior occipital gyrus, the amygdala, and the cerebellum. CONCLUSIONS: The findings found in this study represent the first evidence that the presence of TD in patients with MCI is associated with loss of gray matter in those brain regions that have been documented to be responsible for orientation in both neuropsychological and neuroimaging studies.

Topographical disorientation in Alzheimer's disease / Desorientação topográfica na doença de Alzheimer

Topographical disorientation (TD) has not been as extensively studied as other frequent manifestations of Alzheimer's disease (AD). OBJECTIVE: To verify the occurrence of TD and to identify the neuropsychological dysfunctions associated with TD in AD. METHOD: Thirty patients with probable AD, their caregivers and 30 subjects without dementia (controls) were interviewed with a questionnaire and evaluated with tests related to topographical orientation. RESULTS: AD patients, even those with mild dementia, differ from controls in the questionnaire on topographical orientation and in most neuropsychological tests except for tests of spatial working memory, point localization, three dimension and nonsense figure copy. When the performances in the neuropsychological tests of patients with mild or moderate dementia were compared, only landmark recognition and route description were more impaired in moderate dementia. CONCLUSION: TD occurs even in mild dementia of AD, a finding apparently not explained by the impairments of more elementary spatial functions.

Desorientação topográfica (DT) não tem sido tão exaustivamente estudada quanto outros sintomas frequentes da doença de Alzheimer (DA). OBJETIVO: Verificar a ocorrência de DT e identificar as disfunções neuropsicológicas associadas com a DT na DA. Método: Trinta pacientes com DA provável, seus cuidadores e trinta sujeitos sem demência (controles) foram entrevistados com um questionário e testes relacionados à orientação topográfica. RESULTADOS: Pacientes com DA, mesmo aqueles com demência leve, diferiram dos controles no questionário de orientação topográfica e na maioria dos testes neuropsicológicos, exceto nos testes memória operacional espacial, localização de pontos, cópia de figuras sem sentido e de figura em três dimensões. Quando os desempenhos de pacientes com demência leve ou moderada foram comparados, apenas os testes de reconhecimento de marcos e descrição de rotas foram mais comprometidos na demência moderada. CONCLUSÃO: DT ocorre mesmo na demência leve da DA, um achado aparentemente não explicado pelo comprometimento das funções espaciais mais elementares.

Aeromedical Consideration of Designing Attitude Indicator for Preventing Spatial Disorientation / 항공우주의학회지

To develop an aeromedical strategy to prevent aircraft accidents caused by spatial disorientation or loss of situational awareness, it is no wonder to say the first step may begin with understanding of operating principles of flight displays, especially attitude indicator. Therefore, this review article focused on explaining the unique aeromedical aspects of various types of attitude indicator. Also, the concept of newly developed attitude indicator was introduced to consider pros and cons of current design.

Clinical Features of Elderly Patients Referred to Neuropsychiatric Department

OBJECTIVE: As the geriatric admission and geropsychiatric consultation increase, more study was needed about geropsychiatric consultation. This comparative study investigates the character of geropsychiatric consultation in general hospital. METHOD: We compared 22 young patients (25(age<45) with 55 elderly patients ((65) who are consulted to neuropsychiatry department for the first time for 3 months (2004. 1. 1-2004. 3. 31) in Kang-Dong Sacred Heart Hospital, Hallym University. Data on patterns of consultation, demography, psychiatric and physical illness were collected and analyzed. RESULT: 1) The rate of psychiatric consultations for elderly patients was 6.2%, and this rate was much higher than 1.9% of young patients. 2) There were no significant difference in referral department between the elderly group and the control group, and internal medicine was the most common referral department in both groups. 3) The main reasons of consultations were alcohol related problems and psychiatric follow up in order in control group, but sleep disturbance and disorientation in order in elderly group. 4) In elderly group, the most frequent psychiatric diagnoses made by consultants were organic brain disorder such as dementia and delirium, but in control group, they were functional psychiatric disorder such as alcohol related disorder and psychosis. 5) Psychotropic drug and follow-up consultation were two most frequent recommendations from consultants in both group. But recommendations for psychotherapy and psychosocial management were rare in both groups. 6) There were significant difference only in psychiatric transfer among compliance for psychiatric consultation between the elderly group and the control group. Compliance for recommendations were low in both groups. 7) In both group, only one follow up consultation was done. And OPD follow up after discharge was rare in both groups. CONCLUSION: Elderly patients need more psychiatric consultations than younger patients and has different characteristics in pattern of consultations. Further studies are warranted on geropsychiatric consultation in Korea.

A Clinical Study of Psychiatric Consultation for the Inpatients above 65 in a General Hospital

OBJECTIVE: This clinical study investigates the current status of geropsychiatric consultation in Korea, as the geriatric population and the needs for geropsychiatric consultation increase. METHOD: Hospital records of all geriatiric patients (> or =65) consulted to psychiatric department during hospital stay in a general hospital for 18 months (1998. 9. 1-2000. 2. 1) were reviewed retrospectively. Data on somatic illness, psychiatric illness and patterns of consultation were collected and analyzed. RESULT: Total number of patients was 136 (M 50, F 86) and mean age was 72.5 years old. Psychiatric consultation rate for patients above 65 was 2.5%, it was 29.5% among the whole psychiatric consultations. 65.4% was consulted by the Internal Medicine, Orthopedic surgery was the second most frequent referral department. Nonpsychiatric consultations were frequent, a geriatric patient was consulted to 2.7 other different departments on average, during the same period of hospital stay. Sleep disturbance, depressive mood, anxiety/agitation, somatization with normal laboratory findings were the main reasons of psychiatric consultation. 40% of these cases were tried to manage psychiatric problems by consultee. 50% of patients were suffered from depression, followed by delirium and dementia in frequency. Mean lagtime for consultation was 8.4 days, drug compliance was 90.5%. 54.4% of consultations has been followed up more than twice, 7.4% of consultations has required to be followed up more than 5 times. Compliance for consultation follow up during hospital stay was 78.7% and complicance for OPD follow up after discharge was 52.4%. Mean number of drugs being used on the day of consultation was 7.8, among them, 0.9 were psychiatric drugs. psychiatric drugs were prescribed for 51.5% of patients before psychiatric consultation. 2.2 drugs were prescribed by consultant. Disorientation was shown at 33.8%, visual hallucination was shown at 18.4%, sleep disturbance was prevalent at 64.0% of patients. Disorientation found to be associated with age, sleep disturbance, number of nonpsychiatric consultations, number of psychiatric follow up consultations. CONCLUSION: Clinical Variables on geropsychiatric consultation at a general hospital were investigated. Further studies are warranted on geropsychiatric consultation in Korea.