The effectiveness of diverse technology-based instructions in assisting people with Alzheimer's disease with medication management.

Purpose: In patients with mild cognitive impairment and Alzheimer's disease (AD), faculties associated with instrumental activities of daily living (IADL) decline owing to reduced cognitive function. One type of IADL is medication behaviour. Medication management is critical for patients with AD. Previous studies have reported that presentations using speech and images are effective for facilitating IADL autonomy but there are few examinations of effective presentation methods. Therefore, we examined what kind of display methods are effective in helping patients with AD with medication management.Materials and methods: Ten healthy elderly and 9 patients with mild AD were asked to perform the task of taking out medicine bags from a case at a designated time. We gave 3 kinds of instructions and examined the differences in participants' reaction times. Task 1 included verbal instructions alone, Task 2 included verbal instructions and pictorial and written instructions, and Task 3 used a video conference system (presenting pictorial, written, and verbal instructions) at a designated time. Task 3 could be conducted remotely over the internet. The relationship between these results and neuropsychological tests was also explored.Results: Task 3 was an effective method for patients with mild AD. In addition, we found correlations between the methods of Tasks 1-3 and the Japanese version of the Mini-Mental State Examination (MMSE-J).Conclusions: The method of Task 3 may lead to home support for patients with AD. The MMSE-J could be used to identify changes in the adaptive functioning of patients exposed to distinct presentation methods.Implications for rehabilitationAppropriate transmission methods will increase the IADL autonomy of patients with mild AD who have memory impairment. While still images alone are not effective for patients with mild AD, when combined with verbal instructions, they prove effective for this group.The results of this study are useful for providing patients with mild AD with support in their IADLs, especially when methods that use images plus speech are employed. As participants were instructed via the internet, this study shows a way to help patients with mild AD even from a remote location.Until now, no studies have examined the adaptation criteria for instructive methods for patients with mild AD. This study shows that the MMSE could be used to determine the applicability of these instructive methods. The identification of cut-off values in future research could lead to more effective IADL support.

Transformative learning experience for physical therapy students through a community health promotion project for mothers of hearing-challenged children.

[Purpose] The purpose of this project was to expose physical therapy students to transformative learning through a community health promotion project for mothers of hearing-challenged children. [Subjects and Methods] The participants were three mothers with their respective hearing-challenged child and twenty physical therapy students. The project consisted of seven sessions supervised throughout by a physical therapy instructor. The students participated in seven sessions, while the mothers were required to attend only two sessions of a health checkup and exercise program. [Results] Through the interaction between the mothers and students, the former felt physically and mentally refreshed, and the latter experienced transformative learning. The mother's physical status showed that all parameters for health variables were within normal range. However, it was found that mothers had little time for their personal mental or physical well-being because their focus was on planning and executing daily assignments for development of the child's verbal skills. [Conclusion] This project contributed to the students' learning experience and provided them with tools for possible future interest and involvement in community activity. The exercise session appeared to stimulate in the mothers an awareness and importance of their own personal and mental well-being.

Analysis of causal relationships by structural equation modeling to determine the factors influencing cognitive function in elderly people in Japan.

The purpose of this study is to identify a potentiality factor that is a preventive factor for decline in cognitive function. Additionally, this study pursues to clarify the causal relationship between the each potential factor and its influence on cognitive function. Subjects were 366 elderly community residents (mean age 73.7 ± 6.4, male 51, female 315) who participated in the Taketoyo Project from 2007 to 2011. Factor analysis was conducted to identify groupings within mental, social, life, physical and cognitive functions. In order to detect clusters of 14 variables, the item scores were subjected to confirmatory factor analysis. We performed Structural Equation Modeling analysis to calculate the standardization coefficient and correlation coefficient for every factor. The cause and effect hypothesis model was used to gather two intervention theory hypotheses for dementia prevention (direct effect, indirect effect) in one system. Finally, we performed another Structural Equation Modeling analysis to calculate the standardization of the cause and effect hypothesis model. Social participation was found to be activated by the improvement of four factors, and in turn, activated "Social participation" acted on cognitive function.

Agraphia of Kanji (Chinese characters): an early symptom of sporadic Creutzfeldt-Jakob disease in a Japanese patient: a case report.

INTRODUCTION: Slowly progressive cognitive decline is the most frequent initial manifestation in MM2-cortical-type sporadic Creutzfeldt-Jakob disease. Agraphia has never been noted in patients with this type of sporadic Creutzfeldt-Jakob disease, however, we report the case of a Japanese patient with sporadic Creutzfeldt-Jakob disease in whom agraphia of Kanji was an initial cardinal symptom. CASE PRESENTATION: A 59-year-old right-handed Japanese woman complained of agraphia of Kanji (Chinese characters) as an initial symptom. A neurological examination revealed mild word-finding difficulty, constructive disturbance, hyperreflexia in her jaw and lower limbs, and bilateral extensor plantar reflexes. An examination of her cerebrospinal fluid revealed increased levels of 14-3-3 and total tau proteins, and abnormal conformation of the proteinase K-resistant prion protein. Diffusion-weighted magnetic resonance imaging showed diffuse hyperintensity in bilateral cerebral cortices. Single-photon emission computed tomography scans revealed hypoperfusion in the left temporal lobe, bilateral parietal and occipital lobes. An analysis of the prion protein gene demonstrated no mutation with homozygous for methionine at the codon 129. We diagnosed our patient with sporadic Creutzfeldt-Jakob disease. Although a histological examination was not performed, it was assumed that our patient could be the MM2-cortical type according to the clinical findings and the elevated levels of 14-3-3 protein in her cerebrospinal fluid. The left posterior inferior temporal area, which was affected in our patient as a hypoperfusion area, is associated with selecting and recalling Kanji characters. CONCLUSIONS: Focal signs as an early symptom and hypoperfusion areas in sporadic Creutzfeldt-Jakob disease are critical to recognize initial brain lesions damaged by the proteinase K-resistant prion protein accumulation.

Horizontal visual search in a large field by patients with unilateral spatial neglect.

In this study, we investigated the horizontal visual search ability and pattern of horizontal visual search in a large space performed by patients with unilateral spatial neglect (USN). Subjects included nine patients with right hemisphere damage caused by cerebrovascular disease showing left USN, nine patients with right hemisphere damage but no USN, and six healthy individuals with no history of brain damage who were age-matched to the groups with brain right hemisphere damage. The number of visual search tasks accomplished was recorded in the first experiment. Neck rotation angle was continuously measured during the task and quantitative data of the measurements were collected. There was a strong correlation between the number of visual search tasks accomplished and the total Behavioral Inattention Test Conventional Subtest (BITC) score in subjects with right hemisphere damage. In both USN and control groups, the head position during the visual search task showed a balanced bell-shaped distribution from the central point on the field to the left and right sides. Our results indicate that compensatory strategies, including cervical rotation, may improve visual search capability and achieve balance on the neglected side.

Parkinson's disease showing progressive conduction aphasia.

Patients with Parkinson's disease (PD) may develop progressive dementia late in their clinical course. Dementia in PD is mostly related to neuropathological findings of extensive Lewy bodies (LBs), with or without the coexistence of Alzheimer's disease (AD) pathology. Aphasia has been reported in patients with LB diseases with AD pathology; however, there have been no reports of typical PD patients developing progressive aphasia during their clinical course. We describe a female PD patient who later developed progressive conduction aphasia characterized by phonemic paraphasia and disturbance in repetition of short sentences without disturbance in writing or auditory comprehension. No episodes of fluctuations of attention, memory complaints, or planning errors were observed. She experienced episodes of visual hallucination. Her low scores on the Mini-Mental State Examination suggested impairment of orientation and attention, and her scores on Raven's Coloured Progressive Matrices test indicated impaired visuospatial functions. However, her cognitive deficits were not sufficiently severe to impair her daily life. Brain magnetic resonance images revealed atrophy of the left superior temporal gyrus and widening of the left sylvian fissure. [(18)F]-fluorodeoxyglucose positron emission tomography revealed glucose hypometabolism in the left cerebral hemisphere. These findings may be related to conduction aphasia. During the progression of PD lesions, the brainstem LB is assumed to take an upward course, extend to the limbic system, and then extend to the neocortex. Conduction aphasia observed in our patient may be associated with an unusual progression of the LB pathology from the brainstem to the left temporoparietal lobe.

Identification of three factors influencing trail making test performance using multichannel near-infrared spectroscopy.

Recent advances in medical care have facilitated the survival of patients with stroke or traffic-related injuries. However, such patients may suffer from higher brain dysfunction; i.e., an impaired ability to plan and perform behaviors based on prior knowledge. The Trail Making Test (TMT) is a cognitive task that is used to evaluate higher brain dysfunction caused by frontal lobe injury. TMT consists of two tasks; TMT-A involves connecting consecutive numbers, and TMT-B involves connecting numbers and letters alternately. In this study, using near-infrared spectroscopy (NIRS) and the achievement value (TMT score), we investigated the effects of three factors on TMT performance: knowledge of the TMT, the order of TMT-A and TMT-B performance, and gender. The subjects were 48 healthy adults, consisting of college graduates and undergraduates (age: 22.8 ± 2.5 years, education: 16.0 ± 1.2 years, 24 males and 24 females). We measured the changes in oxygenated hemoglobin (oxy-Hb) levels using NIRS, showing that the increase in oxy-Hb was higher in subjects who had no knowledge of the TMT than those who had prior knowledge. In both TMT-A and TMT-B, the subjects who performed their first task displayed higher oxy-Hb levels. Moreover, the oxy-Hb level in males was higher than that in females. In contrast, only the order of TMT performance showed noticeable effect on the TMT score. In the present study, using NIRS we have shown that either knowledge of the TMT, the order of the TMT, or gender affects TMT performance, providing invaluable information for interpreting TMT results.

[Acquired stuttering as an early symptom in a patient with progressive supranuclear palsy].

We report a 57-year-old man with progressive supranuclear palsy (PSP) showing acquired stuttering (AS) as an early symptom. He had noticed micrographia at age 48, and thereafter he began to suffer from progressive speech disturbance at age 49. Neurological examination at age 57 revealed prominent acquired stuttering, supranuclear vertical gaze palsy, axial rigidity, disturbance of postural reflex, motor perseveration, and catalepsy, but no aphasia. A brain MRI study demonstrated atrophy of the midbrain tegmentum and dilatation of the third ventricle with a few lacunar infarcts in the basal ganglia. Anti-parkinsonian drugs were ineffective. We diagnosed his illness as PSP. His speech was characterized by repetition of sounds and syllables. It was more dominant at repetition of sentences than at that of words, and was improved with rhythmic stimulation. Although pathophysiology underlying AS remains unknown, the AS in this patient seems to be closely related to his motor perseveration and catalepsy. These symptoms may be caused by the disturbance of dopaminergic system from midbrain to limbic system and frontal cortex as reported in PSP. In conclusion, As can be an early and prominent symptom which may be related to characteristic impairment of the dopaminergic system.