The Geras Solutions Cognitive Test for Assessing Cognitive Impairment: Normative Data from a Population-Based Cohort.

BACKGROUND: There is a need for the development of accurate, accessible and efficient screening instruments, focused on early-stage detection of neurocognitive disorders. The Geras Solutions cognitive test (GSCT) has showed potential as a digital screening tool for cognitive impairment but normative data are needed. OBJECTIVE: The aim of this study was to obtain normative data for the GSCT in cognitively healthy patients, investigate the effects of gender and education on test scores as well as examine test-retest reliability. METHODS: The population in this study consisted of 144 cognitively healthy subjects (MMSE>26) all at the age of 70 who were earlier included in the Healthy Aging Initiative Study conducted in Umeå, Sweden. All patients conducted the GSCT and a subset of patients (n=32) completed the test twice in order to establish test-retest reliability. RESULTS: The mean GSCT score was 46.0 (±4.5) points. High level of education (>12 years) was associated with a high GSCT score (p = 0.02) while gender was not associated with GSCT outcomes (p = 0.5). GSCT displayed a high correlation between test and retest (r(30) = 0.8, p <0.01). CONCLUSION: This study provides valuable information regarding normative test-scores on the GSCT for cognitively healthy individuals and indicates education level as the most important predictor of test outcome. Additionally, the GSCT appears to display a good test-retest reliability further strengthening the validity of the test.

Multimodal Preventive Trial for Alzheimer's Disease: MIND-ADmini Pilot Trial Study Design and Progress.

BACKGROUND: Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer's disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. OBJECTIVES: To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. METHODS: MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. RESULTS: Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. CONCLUSIONS: For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).

Digital Screening for Cognitive Impairment - A Proof of Concept Study.

BACKGROUND: Due to an ageing demographic and rapid increase of cognitive impairment and dementia, combined with potential disease-modifying drugs and other interventions in the pipeline, there is a need for the development of accurate, accessible and efficient cognitive screening instruments, focused on early-stage detection of neurodegenerative disorders. OBJECTIVE: In this proof of concept report, we examine the validity of a newly developed digital cognitive test, the Geras Solutions Cognitive Test (GCST) and compare its accuracy against the Montreal Cognitive Assessment (MoCA). METHODS: 106 patients, referred to the memory clinic, Karolinska University Hospital, due to memory complaints were included. All patients were assessed for presence of neurodegenerative disorder in accordance with standard investigative procedures. 66% were diagnosed with subjective cognitive impairment (SCI), 25% with mild cognitive impairment (MCI) and 9% fulfilled criteria for dementia. All patients were administered both MoCA and GSCT. Descriptive statistics and specificity, sensitivity and ROC curves were established for both test. RESULTS: Mean score differed significantly between all diagnostic subgroups for both GSCT and MoCA (p<0.05). GSCT total test time differed significantly between all diagnostic subgroups (p<0.05). Overall, MoCA showed a sensitivity of 0.88 and specificity of 0.54 at a cut-off of <=26 while GSCT displayed 0.91 and 0.55 in sensitivity and specificity respectively at a cut-off of <=45. CONCLUSION: This report suggests that GSCT is a viable cognitive screening instrument for both MCI and dementia.

A psychoanalyst in methadonia.

This paper argues that the contemporary psychoanalytic model of addiction is compatible with the biochemical deficit model of Dole and Nyswander, the basis of methadone pharmacotherapy. The author explains the self-object function of methadone in the repair of self-deficits, specifically in the area of affect regulation, and he expands the dynamics of self-repair to the relational and programmatic "context of care" of methadone maintenance. Clinically, the problems of resistance and transference are examined as they arise and are resolved within an intersubjective counseling relationship. The treatment process in methadone maintenance is then reconceptualized as the gradual transformation of the central organizing principles of the addicted person as a result of the experience of psychophysiological stability, complemented by acceptance and empathy within a secure context of care. In closing, the need for an individual, self-focused approach to deciding between maintenance and detoxification is suggested.

Methadone maintenance counseling. Definition, principles, components.

Counseling has been a major service component of methadone maintenance since its inception. Yet, there is no consensus about what methadone counseling is or how it should be practiced. This paper proposes a definition of professional methadone counseling as a specialized modality of addiction therapy and rehabilitation. Five principals of methadone counseling are reviewed: (1) coordination of care, (2) use of the counseling relationship, (3) attention to the stage of recovery, (4) structure and flexibility, and (5) facilitation of patient resourcefulness and social recovery. Fifteen components of methadone counseling are also reviewed. These include interventions focused on (1) the initial phase of treatment, (2) the treatment itself, and (3) the work of rehabilitation. General counseling issues are considered, such as counselor education, the role of the counselor in the program, the methadone controversy, as well as the impact of HIV disease and "crack/cocaine." In closing, the advantages of the proposed model are stressed.

Mourning: a review and reconsideration.

The psychoanalytic model of mourning, while useful in its depiction of a certain type of process, may not be valid as a general model. The author of this paper reviews the development of the standard psychoanalytic model of mourning, and offers a critique from several perspectives. First, the psychoanalytic literature and data from clinical practice fails to confirm basic components of mourning theory. Second, some non-analytic research is at odds with several of the model's key assumptions, and historical studies have shown how individuals in western culture have mourned differently over time. Finally, from a cross-cultural perspective it is also clear that there is infinite variety in people's responses to death, in how they mourn, and in the nature of their internalisation of the lost object. In closing, a perspective on bereavement is proposed that, rather than being process-oriented, understands mourning to be an adaptive response to specific task demands arising from loss which must be dealt with regardless of individual, culture or historical era.

The role of the other in mourning.

Mourning is a highly social process. This paper's thesis is that surviving objects play a crucial role in the accomplishment of a number of the major psychological tasks of mourning. To illustrate the thesis, the psychoanalytic treatment of a man suffering the aftermath of parental loss in adolescence is presented. The failure of the social surround to assist with mourning is identified and explored, and the treatment implications of the role of the other in mourning are discussed.

Bereavement and neurosis.

The psychoanalytic model of mourning is necessary but not sufficient for the analysis of many disorders resulting from bereavement. A set of definitions is offered to differentiate bereavement (a set of traumatic events that are psychologically elaborated) from mourning (the resolution of the psychological attachment to the dead). This article argues that the traditional approach to bereavement, solely in terms of disturbances of mourning, has been too restrictive and has limited our understanding of other factors. After a review of the analytic bereavement literature, a multifactorial approach is suggested, which the author believes better captures the complex nature of these conditions. These factors include: (1) trauma, (2) vulnerability, (3) unconscious significance, (4) object relations, and (5) defense and adaptation. The psychoanalytic treatment of a woman who suffered the loss of her mother and possible incest in adolescence is discussed in detail. The focus of the analysis was on conflicts related to oedipal victory and narcissistic trauma. The analysis is reviewed in light of the multifactorial model.

Rupture of the common femoral artery during hip replacement surgery. A report of two cases.

Two cases are reported where the common femoral artery ruptured during hip replacement surgery. In both cases only the intimal and medial layers of the artery were injured, without profuse bleeding during the operation. The diagnosis of this type of lesion of the arterial wall can be delayed. The use of non-invasive Doppler ultrasound techniques for verifying arterial injury proved to be effective and the presence and degree of arterial insufficiency was easily estimated from distal blood pressure measurements. In both cases the femoral artery was then exposed with no preoperative angiography and the arterial damage was successfully repaired. If the classical signs of acute ischaemic lesion are observed soon after hip replacement operations, the possibility of an acute arterial lesion must be kept in mind.

Replantation service in Helsinki University Central Hospital 1980-1985.

A replantation service is a routine part of medical services. The best results are obtained when the work is centralized. In Finland five university hospitals have a replantation service. In the Helsinki University Central Hospital, 94 severed parts of the upper limb were replanted/revascularized in 1980-85. The amputation injury requiring replantation was most often a thumb avulsed by the driving axle of a tractor. The patients came from all over the country, and the short time span between the initial injury and admission to hospital--2.4 hours an average in 1985--shows that transport of these patients is not a problem in Finland. The mean duration of surgery was 6.9 hours. Most of the operations took place in the late afternoon, evening or at night. 16% of the cases needed immediate reoperation because of vascular problems. Later, over 40% of the cases underwent secondary procedures. Most of the patients returned to their former employment. In long-term follow-up, however, nine out of ten patients reported that the replanted organ was intolerant to cold. Therefore, with the exception of the thumb, single finger replantation should not be a routine procedure in a cold climate such as that encountered in Finland. A replantation service requires a minimum of four surgeons qualified in plastic surgery or hand surgery. The operating theatre will be in use through the night. Nurses, physiotherapists and occupational therapists must be specially trained. The surgeon must be prepared to perform multiple reconstructive procedures, both immediately and later on.

Cellular immunohistopathology of acute, subacute, and chronic synovitis in rheumatoid arthritis.

Cellular inflammation in rheumatoid arthritis (RA) synovial membrane was studied in biopsy specimens taken at different stages of synovitis and disease. Patients were classified into three subgroups: acute RA, subacute RA, and chronic RA. Inflammatory cells were characterised by a histochemical esterase method and immunohistochemical peroxidase-antiperoxidase (PAP) and avidin-biotin-peroxidase (ABC) staining. The amounts and distribution of inflammatory cells were different in various stages of the synovitis. In acute onset RA monocytes and granulocytes predominated, suggesting that the beginning of rheumatoid inflammation is similar to inflammatory reaction in general. The presence of T cells and also of plasma cells in subacute RA suggests underlying subclinical changes also in apparently healthy joints in RA. The most typical feature of prolonged synovitis in chronic RA was its intensity, characterised by the presence of large T cell and plasma cell infiltrates. Our findings suggest that the immunological mechanisms are secondary to the tissue damage caused by the initial inflammatory events of unknown cause. However, the immunological mechanisms may still play a central role in the aetiopathogenesis, because findings in chronic RA suggest a defective down-regulation of the immune response.