Attentional ability among survivors of leukaemia.

Attentional ability in 19 survivors of acute lymphoblastic leukaemia and 19 sibling controls was assessed using a neuropsychological model of attention. Analysis revealed that children who had received treatment for leukaemia exhibited significantly poorer performance on measures of the "focus encode" and "focus execute" elements of attention and on measures of the ability to respond to external cues and feedback. No significant differences in performance were found for measures of sustained attention and the ability to shift attention. These results indicate that children who have received treatment for leukaemia may experience highly specific attentional deficits that could have an impact on academic performance, particularly mathematical and reading skills. It is suggested that this underlying attentional deficit might be the source of the neuropsychological sequelae associated with the disease. Future attempts at remediation should incorporate activities specifically designed to ameliorate focusing difficulties.

Structural and functional abnormalities in elderly patients clinically recovered from early- and late-onset depression.

BACKGROUND: Structural and functional brain changes have been described in elderly patients with unipolar affective disorder. Changes appear to be more marked in patients with late-onset depression, but the reversibility of such changes after clinical recovery is not known. METHODS: Magnetic resonance imaging, electroencephalography (EEG), and cognitive tests were performed in 23 elderly patients (mean age 66.5 years) clinically recovered from major depression. Twelve had late-onset depression (first episode over 55 years of age); 11 had early onset (first episode before 50 years). EEG and cognitive testing were also performed on 15 control subjects. RESULTS: Patients with late-onset depression had larger third and lateral ventricles, increased ventricular-brain ratio, and greater frequency and severity of subcortical white matter lesions than those with early onset. There was no difference between early- and late-onset patients in EEG and cognitive measures, but compared with controls patients showed significant changes in EEG evoked potentials and increased slow-wave activity, slowed reaction times, and global impairments in cognitive function. CONCLUSIONS: These results suggest that structural changes are greater in patients with late-onset depression, and that EEG and cognitive impairments persist after recovery, regardless of age of onset of depression, and are independent of structural changes.

Sex differences on an adaptation of the Digit Symbol subtest of the Wechsler Intelligence Scale for Children-III.

To make the Digit Symbol subtest of the Wechsler Intelligence Scale for Children-III more useful in neuropsychological assessment, the measurement and influence of motor speed and incidental learning on subjects' performance was examined. Analysis indicated that motor speed but not incidental learning were significant influences on scores. Statistically significant differences between 150 males (M age 12.3 yr., SD = 2.8) and 150 females (M age 12.1 yr., SD = 2.7) were obtained for both raw and scaled scores on the Digit Symbol subtest. The implications of these gender differences are discussed as a possible example of differences in executive function.

Memory after treatment for acute lymphoblastic leukaemia.

Long term survivors of acute lymphoblastic leukaemia (ALL) often experience cognitive difficulties, which may be related to impairment of memory function. Memory ability has been studied in a group of survivors of ALL along with sibling controls and in children who have received treatment for other forms of cancer. Children in the ALL group were found to have significant deficits in memory function in tasks which required the application of strategic planning behaviour. These deficits are potentially remediable by educational strategies.

An assessment of dental anxiety in children.

The aims of this study were to assess child behaviour in a dental surgery and to isolate the variables most closely associated with lack of cooperation by means of a questionnaire/interview. Sixty-five children aged 6-18 years, who had been referred to one dentist because of poor cooperation, formed the study group. Forty-two children of similar age, treated by the same dentist, but referred for reasons other than lack of cooperation, acted as the control. Assessments of anxiety were made independently by a psychologist who used a number of indices, including the Child Manifest Anxiety Scale (CMAS), Melamed's Child Behaviour Rating Scale and the Venham Picture Scale. Fifty-one children in the study group had experienced a general anaesthetic for dental treatment compared with five in the control group (P less than 0.001). Parents of children in the study group could identify specific instances which contributed to fear of dentistry in 75% of cases. The CMAS found no difference between the groups in general anxiety, but anxiety and cooperation ratings made by parent and dentist in the dental surgery showed significant differences between the two groups, as did the results of the Venham Picture Scale.

Cognitive function after two doses of cranial irradiation for acute lymphoblastic leukaemia.

The cognitive function of 23 children given cranial irradiation in a dose of 24 Gy was compared with that of 41 given 18 Gy. No significant differences were found in intellectual function or in mean number of intelligence quotient points lost between patients in the two treatment groups. A reduction in the dose of cranial irradiation does not seem to alleviate long term neuropsychological deficits.

Coma arousal procedure: a therapeutic intervention in the treatment of head injury.

This study reports on the efficacy of a 'coma arousal procedure'. This procedure involved a programme of vigorous sensory stimulation administered to comatose patients by relatives using Comakits. An experimental group of 12 severely head-injured patients received the coma arousal procedure while a matched control group did not. Total duration of coma and weekly Glasgow Coma Scale Scores were recorded for the two groups. Results indicate that the total duration of coma was significantly shorter and that coma lightened more rapidly for the experimental group.

Cognitive style and perceived control in spouse caregivers of dementia sufferers.

The study investigated the cognitive style and perception of control in co-resident spouse caregivers of dementia sufferers and their association with psychological adjustment. Depression and strain were significantly correlated with the caregivers' perception that the stress they were experiencing would continue and the expectation that it would affect all areas of their lives. However, the correlations between these factors and depression were no longer significant after partialling out the caregivers' rating of the behavioural disabilities and disturbances of the dementia sufferer. Depression and strain were significantly correlated with the caregivers' perceived lack of control over their own emotional reaction and over the dementia suffers' behaviour.

The relationship between marital intimacy, perceived strain and depression in spouse caregivers of dementia sufferers.

This study explored the quality of marital relationship between dementia sufferers and their spouse caregivers. It assessed the quality of the relationship (level of intimacy) prior to the onset of dementia and also at the time of the study. Caregivers who experienced lower levels of marital intimacy, both currently and before the onset of dementia, were found to have higher levels of perceived strain and depression. The decline in intimacy following the onset of dementia was estimated from the difference between the levels of past and present intimacy. Caregivers who experienced a greater loss of intimacy had a higher level of depression, but did not show evidence of increased perceived strain. It is speculated that a poor premorbid relationship makes caregiving more stressful because of a greater difficulty in performing the caregiving role. In addition, it is suggested that a poor premorbid relationship or high loss of intimacy acts as a vulnerability factor, predisposing the caregiver to depression.

Factors affecting the emotional wellbeing of the caregivers of dementia sufferers.

Recent research on the factors that mediate the emotional wellbeing of the caregivers of dementia sufferers is reviewed. The roles of such factors as the caregiver's attributional style and coping strategies, the caregiver's relationship with the dementia sufferer, and levels of formal and informal support are discussed with reference to identifying those caregivers who are particularly vulnerable to emotional disorder or strain.

Cognitive functioning in Parkinson's disease: in relation to prevalence of dementia and psychiatric diagnosis.

Forty-three neurologically and psychiatrically assessed patients with idiopathic Parkinson's disease (PD) underwent detailed cognitive assessment. Cognitive deficits typical of senile dementia of Alzheimer's type (SDAT) were found in 7% but the majority showed definite impairments not typical of SDAT. Cognitive impairment was significantly more likely in those with more severe PD symptoms. There was substantial agreement between psychiatric diagnosis and psychological picture of SDAT and some links were found between other diagnostic categories and nature of cognitive functioning. However, cognitive deficits were also found in two-thirds of patients with no psychiatric diagnosis.

Intellect after malignancy.

A previous study has shown that significant intellectual deficits exist in children treated for leukaemia but not in those with solid tumours. Unexpectedly, the deficits had not increased in the two years since the original study, suggesting that the nadir had already been reached five years after diagnosis.

Intellectual function after treatment for leukaemia or solid tumours.

Twenty three children who had been treated for acute lymphoblastic leukaemia (ALL) were evaluated intellectually using the British Ability Scales. Their treatment included early cranial irradiation, intrathecal chemotherapy, and systemic chemotherapy. Nineteen children who had been treated for various types of solid tumours (ST), had undergone related chemotherapy, and had received irradiation to sites of the body other than the cranium were used as controls. In addition, patients' siblings were assessed and their scores statistically corrected to produce a best estimate of the patients' pre-morbid degree of intellectual functioning. The results showed intellectual deficits after treatment in both patient groups, but these were consistently larger in the ALL group, particularly for the higher functions of intelligence. Intellectual deficit in ALL patients did not show immediately after radiotherapy but became progressively more apparent some time afterwards and particularly in younger children. In contrast, in the ST group, intellectual deficits seemed to diminish over time, and the age at radiotherapy was not a critical factor.

Intellectual impairment in chronic renal failure.

In a dialysis centre with a high tap water aluminium content and a known high incidence of dialysis encephalopathy, 29 patients undertaking regular home dialysis, without clinical evidence of encephalopathy, were studied with a battery of psychological tests that have proved useful in detecting early organic intellectual deterioration in other conditions. Full-scale intelligence quotient, as measured by the Wechsler Adult Intelligence Scale, did not differ significantly from that of the normal population, but the patients showed significant deficiencies in three tests of performance--namely, digit symbol, block design, and picture arrangement. The ability to acquire new information in relation to performance was impaired and the abnormality increased with time on dialysis. Such tests should be useful in early detection of dialysis dementia at a reversible stage.

Cognitive function and length of survival in elderly subjects living at home.

177 people aged 65 or over, chosen at random from larger representative samples of elderly people living at home in Newcastle upon Tyne, were given the Weschler Adult Intelligence Scale (WAIS) or a shortened form of it, and followed up for 7 years or till death. Discriminated function analysis showed that the power of the test score to predict death occurring within 2 years was not explained away by its correlations with age, sex, social class or physical disability. Exclusion of clinically diagnosed chronic brain syndromes reduced but did not abolish the relationship found to exist between test score and outcome. The ascertainment of impaired cognitive functioning has important applications in the assessment of prognosis and in the planning of care of elderly people.

Psychological approaches to the treatment of the elderly.

Various psychological approaches to the treatment of elderly patients (including activity and stimulation programmes, reality orientation, environmental approaches and behabiour modification) are discussed with regard to their efficacy and those features that approaches claiming success have in common. The importance of the attitudes of the care staff is discussed, especially in relation to the consistency and intensity of application of treatment programmes. It is argued that the behavioural model is a useful starting point for future progress, and that much of the present literature is comprehensible in this framework.