Cognitive plasticity as a moderator of functional dependency in elderly patients hospitalized for bone fractures.

INTRODUCTION: Bone fractures in older adults involve hospitalization and surgical intervention, aspects that have been related to loss of autonomy and independence. Several variables have been studied as moderators of how these patients recover. However, the implications of cognitive plasticity for functional recovery have not been studied to date. OBJECTIVE: The present study analyzes the relationship between cognitive plasticity--defined as the capacity for learning or improved performance under conditions of training or performance optimization--and functional recovery in older adults hospitalized following a bone fracture. PATIENTS AND METHODS: The study comprised 165 older adults who underwent surgery for bone fractures at a hospital in southern Spain. Participants were evaluated at different time points thereafter, with instruments that measure activities of daily life (ADL), namely the Barthel Index (BI) and the Lawton Index, as well as with a learning potential (cognitive plasticity) assessment test (Auditory Verbal Learning Test of Learning Potential, AVLT-LP). RESULTS: Results show that most of the participants have improved their level of independence 3 months after the intervention. However, some patients continue to have medium to high levels of dependency and this dependency is related to cognitive plasticity. CONCLUSION: The results of this study reveal the importance of the cognitive plasticity variable for evaluating older adults hospitalized for a fracture. They indicate a possible benefit to be obtained by implementing programs that reduce the degree of long-term dependency or decrease the likelihood of it arising.

[Efectividad de un programa manualizado de intervención en habilidades de resolución de problemas para niños con trastorno del espectro autista (TEA)].

BACKGROUND: Children with Autism spectrum disorders (ASD) frequently present a deficit in interpersonal and social problem solving skills. The Interpersonal Problem-Solving Skills Programme for Children (SCI-Children) comprises 10 weekly, one hour sessions working on interpersonal abilities from a mediation strategy for training purposes. METHOD: The first study explores the effectiveness of training through pre- and post-treatment evaluations of a sample of 22 children with ASD (7-13 years of age). The second study replicates the programme with 15 children who were assessed three times (three months before the programme starts, at the beginning of the training and at the end of it). RESULTS: In the first study, significant differences were found in outcome measures (a parent-report subscale of a socialisation measure and child performance on one subscale and total scores of an interpersonal problem-solving skills task). Results in the second study showed no significant changes in absence of the treatment during the waiting period and significant changes after the treatment in the socialisation measure. CONCLUSIONS: These findings suggest that the SCI-Children program causes positive impact on the participants. Further evaluation is warranted.

Training effects on intelligence of older persons.

In the present study, we tried to answer two main questions: (1) do the elderly of low educational level improve their performance in ability tests when they are trained in inductive reasoning, spatial orientation, or everyday problem solving? (2) If such training were effective, what will the level of training transfer be? Ninety elderly participated in this study (36 women, 54 men; mean age = 67.87); 93.2% of them had less than 4 years of education. The study was based on an experimental-control group design with three main parts: pre-test, cognitive training (three training conditions - Inductive Reasoning, Spatial Orientation and Everyday Problem Solving vs. placebo control) and two post-tests with 3 months of interval. The results indicate that the elderly of low educational level improve their performance both in the domain and transfer test in two of the three training conditions: inductive reasoning and spatial orientation. Results are discussed in relation to other topics related to research studies.

A self-training program in inductive reasoning for low-education elderly: tutor-guided training vs. self-training.

The main aim of this study was to compare the effectiveness of a self-training program in inductive reasoning run for elderly with low levels of education. Two different training settings were considered, i.e. tutor-guided training and self-training, to ascertain whether results obtained in both settings would be similar. A total of 25 subjects took part in this study (average age = 68.266, range = 60-85 years), all volunteers and residents of the city of Granada. A quasi-experimental design was used with random assignment to either training setting. The design was applied in four stages: pre-test, cognitive training (tutor-guided vs. self-trained inductive reasoning), post-test immediately after training and follow-up at 3 months. Results show considerable gains in inductive reasoning training both in tutor-guided and self-trained groups.

[Position test: an instrument for measuring the cognitive plasticity in the elderly with mild cognitive impairment]. / Test de posiciones: un instrumento de medida de la plasticidad cognitiva en el anciano con deterioro cognitivo leve.

INTRODUCTION: The search for variables that mediate in the shift from mild cognitive impairment (MCI) to dementia is currently a very active field of research. In this area, the term cognitive plasticity or modifiability can be of great interest. Proof of the existence of plasticity in the elderly with MCI and its possible value as an indicator of the shift from this condition to dementia have aroused an interest in investigating evaluation tools that enable the evaluation of plasticity in old age. AIMS. In this study we assess the validity of the position test (PT) as a measure of cognitive plasticity in the elderly and we examine its existence in people with MCI. PATIENTS AND METHODS: A total of 117 elderly subjects were evaluated with the Spanish version of the MMSE (Minimental State Examination) as a screening test for cognitive impairment, the AVLT LP (Auditory Verbal Learning Test Learning Potential), a test that is frequently used to evaluate plasticity, and the PT. RESULTS: Findings show that the PT evaluates cognitive plasticity in the elderly suffering from MCI, that it is possible to shorten the test without losing its evaluative properties and that performance in the test is not affected by educational level. Furthermore, it also reveals the fact that some elderly people with MCI show plasticity. CONCLUSION: The data obtained allow us to state that the PT is ideal for evaluating plasticity in the elderly, and we also recommend further research into plasticity and its possible relation with the cognitive progress of people with MCI.

[Validity of the Cognitive Mini-Exam of Lobo et al. for the detection of dementia-associated cognitive deterioration] . / Estudio de validez del Mini-Examen Cognoscitivo de Lobo et al para la detección del deterioro cognitivo asociado a demencias.

BACKGROUND AND OBJECTIVES: The Mini-Examination Cognitive (MEC) of Lobo et al is widely used as a screening tool for dementia in epidemiological studies and in clinical context for the rapid evaluation of cases in whom there is a suspicion of cognitive deterioriation due to dementia. Nevertheless, the validity analysis in old people have not been accomplished. The objective of this study has been to validate the use of this instrument to detect cognitive deterioration associated with dementia in elderly people. PATIENTS AND METHODS: Ninety-five old people have participated, one group of patients of a Neurology Service and another group of healthy old people. All of them have been evaluated through a neuropsychological exploration protocol and the MEC. RESULTS: The results show a high validity of this test for the evaluation of the cognitive deterioration in this population, as in the correlation with the neurological tests used as in the ANOVA intergroups (with and without deterioration) executed; they also reflect the influence on the puntuations of variables such as the age and the educational level. CONCLUSIONS: The utility of this procedure for the Spanish population with a low cultural level and the necessity of working with different criteria depending on the age and the educational level of the patients evaluated is shown here.

Estudio de validez del mini-examen cognoscitivo de lobo et al para la detección del deterioro cognitivo asociado a demencias / The Mini-Examination Cognitive of Lobo et al to detect mental deterioration associated with dementia: a validative study

Fundamento y objetivos: El Mini-Examen Cognoscitivo (MEC) de Lobo et al constituye uno de los procedimientos de cribado neuropsicológico más utilizados en nuestro país para la evaluación rápida en los casos en los que se sospecha la presencia de deterioro cognitivo debido a demencia. No obstante, todavía no se han realizado los pertinentes análisis de validez en población anciana. Por ello, el objetivo de esta investigación ha sido validar el uso de este instrumento para detectar el deterioro asociado a demencias en personas mayores. Material y métodos: Han participado 95 ancianos, un grupo de ellos pacientes de una consulta de neurología y otro grupo de ancianos sanos, residentes en un Centro del IASS, que han sido evaluados mediante un protocolo de exploración neuropsicológica y el MEC. Resultados: Los resultados demuestran una alta validez de esta prueba para la evaluación del deterioro cognitivo en esta población, tanto por las altas correlaciones con la batería de evaluación neuropsicológica utilizada como en los ANOVA integrupos (con y sin deterioro) utilizados; también reflejan la influencia en las puntuaciones de variables como la edad y el nivel educativo. Conclusiones: Se demuestra la utilidad de este procedimiento para población española de bajo nivel cultural y la necesidad de trabajar con diferentes criterios normativos en función de la edad y/o el nivel educativo de los pacientes evaluados (AU)