Support in everyday activities with a home-based electronic memory aid for persons with memory impairments.

PURPOSE: The purposes of this study was to examine the possibilities of a home-based electronic memory aid with sensors for persons with memory impairments, as support to carry out everyday activities in their own home environments. METHOD: The method involved a single-subject study with a multiple baseline AB design. Five participants identified three activities each that they usually forget to carry out. An electronic memory aid with individually spoken reminders was installed in the participant's home. There were automatic computer registrations of completed activities during the study phase of 12 weeks. Assessments of functioning and quality of life (QoL) were conducted before and after the intervention and at follow-up after 2 months. RESULTS: Four participants improved in completing most of the self-chosen activities when the electronic memory aid was used. Performance and satisfaction with performance and QoL improved, but there was no memory function improvement. There were technical problems with the aid, which had a negative effect for users. CONCLUSIONS: Electronic memory aids have a large potential for supporting persons with cognitive impairments. It is important to conduct follow-up afterwards, because the use of an aid and the need of support change over time and put high demands on technical reliability of the electronic memory aid.

Computerized working memory training after stroke--a pilot study.

AIM: To examine the effects of working memory (WM) training in adult patients with stroke. METHODS: A randomized pilot study with a treatment group and a passive control group; 18 participants (12 males) in a vocational age group (mean age 54 years) were randomized to either the treatment or the control condition. The intervention consisted of computerized training on various WM tasks for five weeks. A neuropsychological test battery and self-rating on cognitive functioning in daily life (the CFQ) were administered both before and after the treatment. RESULTS: Statistically significant training effects were found on the non-trained tests for WM and attention, i.e., tests that measure related cognitive functions but are not identical to tasks in the training programme (Span board p < 0.05; PASAT p < 0.001; Ruff 2&7 p < 0.005). There was a significant decrease in symptoms of cognitive problems as measured by the CFQ (p < 0.005). CONCLUSION: More than one year after a stroke, systematic WM training can significantly improve WM and attention.

Using electronic aids to daily living after acquired brain injury: a study of the learning process and the usability.

PURPOSE: The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life. METHOD: Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires. RESULTS: Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved. CONCLUSION: The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the user's needs and calls for more consideration for human-technology interaction factors.

Beneficial effect from a cognitive training programme on children with acquired brain injuries demonstrated in a controlled study.

PRIMARY OBJECTIVE: To test the effectiveness of a cognitive training programme in children and adolescents with attention and memory deficits after acquired brain injury (ABI). RESEARCH DESIGN: Randomized controlled study. PARTICIPANTS: Thirty-eight children with ABI, 9-16 years of age. METHODS AND PROCEDURES: The treatment group trained with the cognitive programme for 30 minutes per day interactively with a teacher or parent for a period of 17 weeks. Children in the control group had a freely chosen interactive activity 30 minutes daily for 17 weeks. Pre- and post-training assessments were made using a neuropsychological test battery. MAIN OUTCOME AND RESULTS: Significant improvements in the majority of neuropsychological tests of sustained and selective attention as well as in memory performance were shown in the treatment group as compared to controls. CONCLUSIONS: The immediate effect of the training programme improved complex attention and memory functions, indicating that this method may be a valuable treatment option for improving cognitive efficiency in children after ABI. On the basis of these results, the next step will be to evaluate long-term effects and further ecological validity.

Cognitive training in home environment.

PRIMARY OBJECTIVE: To examine the efficacy of cognitive rehabilitation in the patient's home or vocational environment. RESEARCH DESIGN: Pre-post-follow-up design. METHODS AND PROCEDURES: Ten outpatients with acquired attention and memory problems received cognitive training three times weekly, for 3 weeks. They received individual attention training with Attention Process Training, training for generalization for everyday activities and education in compensatory strategies for self-selected cognitive problems. Treatment effects were evaluated with neuropsychological and occupational therapy instruments before and after the training and after 3 months on impairment, activity and participation levels. MAIN OUTCOMES AND RESULTS: The results indicated a positive effect on some measures on impairment level, but no differences on activity or participation levels at follow-up. CONCLUSIONS: The study indicates that home-based cognitive training improves some attentional and memory functions and facilitates learning of strategies. Future controlled studies are needed to confirm the results and analyse the efficacy of different aspects of home-based training.

Attention and memory training in children with acquired brain injuries.

AIM: To test the feasibility of the Amsterdam memory and attention training for children (Amat-c) in Swedish children with acquired brain damage. METHODS: Amat-c consists of structured exercises in specific attention and memory techniques. Three Swedish children aged 9-16 y with acquired brain injuries and related memory and attention deficits trained with the Amat-c method for half an hour a day in school or at home interactively with a teacher or parent for a period of 20 wk. RESULTS: All children and their coaches completed the training without interruption. The results showed an improvement in several neuropsychological tests of sustained and selective attention as well as in memory performance. Questionnaires filled in by parents and teachers indicate that, using the Amat-c method, the children learned strategies that improved their school achievement and self-image. CONCLUSIONS: The Amat-c is a valuable treatment option for improving cognitive efficiency in children with acquired brain injuries. The results indicate improved performance in several psychometric measurements. On the basis of these results, the second step will be to modify the complexity and duration of the method, as well as to integrate a reward system before further evaluating the efficacy in a larger controlled study.

Central D2 receptor occupancy and effects of zuclopenthixol acetate in humans.

Repeated positron emission tomography (PET) measurements of D2 receptor occupancy, plasma concentrations of zuclopenthixol and reaction time were performed in three healthy subjects after injection of 12.5 mg zuclopenthixol acetate (ZPTA) in an open study design. Five control subjects were examined for reaction time only. D2 receptor occupancy was 51%, 71% and 75% after 7 h and 75%, 83% and 87% after 31 h in the three subjects. The subjects reported sedation, but reaction time was not prolonged. After the low dose of 12.5 mg ZPTA, D2 receptor occupancy exceeded the 70% assumed to be required to induce antipsychotic effect. Extrapolation of data to a clinical dose interval indicates that 50-150 mg ZPTA should induce very high D2 receptor occupancy lasting several days after injection. Such high doses may be required to induce sedation and to avoid frequent intramuscular injections in acutely psychotic patients. However, the simultaneously induced very high D2 receptor occupancy calls for careful assessment of acute extrapyramidal symptoms.

A comparison of propofol and methohexital as anesthetic agents for ECT: effects on seizure duration, therapeutic outcome, and memory.

The effects of the anesthetic agents propofol and methohexital on seizure duration, clinical outcome, recovery, and memory in electroconvulsive therapy (ECT) were studied in a double-blind trial. The study comprised 53 patients, 47 patients with major depression and six patients with other diagnoses according to DSM-III. Several recent clinical studies with a crossover design have shown a reduced seizure duration for anesthesia with propofol in comparison with both methohexital and thiopental. Propofol significantly reduced the seizure duration in this study without reducing the therapeutic outcome as measured by the Montgomery-Asberg Depression Rating Scale. Propofol did not significantly alter the length of the course of ECT; however, a slightly prolonged course for women cannot be completely ruled out. There were no significant differences between the two agents in effects on recovery times after anesthesia and on anterograde memory. In general, it seems that propofol is as effective as methohexital as an induction agent for ECT.

General intelligence and cognitive profile in women with congenital adrenal hyperplasia (CAH).

To investigate possible effects of prenatal androgen exposure on cognitive functions, general intelligence and cognitive profile were studied in 22 women, 17-34 years old, with prenatal virilization due to congenital adrenal hyperplasia (CAH) (21-hydroxylase deficiency) and 22 healthy controls matched for region and date of birth. The tests were selected to measure abilities where gender differences repeatedly had been observed or that had earlier shown differences between CAH subjects and controls. The following cognitive functions were tested: Verbal, Visuo-Spatial, Visuo-Motor, Arithmetical, Logical Inductive abilities, and Field Dependence. Contrary to earlier reports, the mean general intelligence level of the CAH (22) group was significantly lower than the controls' and the earlier observed inferiority for calculation abilities in female CAH subjects was not supported by the results of the present study. A possible verbal disadvantage with significantly inferior results was noted for the two verbal tests for the CAH (22) group. For the 13 CAH/control pairs with equal general intelligence levels, the discrepancy between the inferior verbal vs. visual, arithmetic, and logical category scores was significantly larger for the CAH group than the controls. These results may suggest that CAH women develop a more masculine cognitive pattern under the influence of increased prenatal androgen exposure.

Memory effects of clomipramine treatment: relationship to CSF monoamine metabolites and drug concentrations in plasma.

Performance on tasks tapping automatic and voluntary aspects of memory, attention, and motor speed was examined in 14 patients with major depressive disorder, before and after 3 weeks of treatment with clomipramine (150 mg/day), a potent serotonin and noradrenaline uptake blocker with anticholinergic side effects. Performance on tasks requiring frontal functions improved or did not change, whereas verbal learning and retention, where hippocampal functioning is critical, were impaired. The latter tasks were negatively related to cerebrospinal fluid (CSF) 5-HIAA levels and plasma concentration of clomipramine. The results provide further support for the regulatory role of monoaminergic systems in cognition. Furthermore, we found the automatic-voluntary capacity distinction less heuristically useful. Physiological mechanisms regulating different aspects of cognition and memory appeared to be more closely related to the type of task used than to its capacity-demanding properties.

Genetic factors for the span of apprehension test: a study of normal twins.

The Partial Report Span of Apprehension test has been found to detect cognitive deficits in some first degree relatives of schizophrenic patients. To assess the relative contribution of genetic vs. environmental factors on this measure, 19 monozygotic and 14 dizygotic female twin pairs, selected from a normal population, were tested on the Span of Apprehension test and an IQ test. Both Span of Apprehension test performance and IQ score had high heritabilities: 0.65 and 0.71, respectively. The mode of transmission for performance on the Span of Apprehension test appears to operate in a nonadditive manner. A multivariate behavioral-genetic model applied to the Span of Apprehension and IQ measures indicated that slightly less than half of the genetic effects important for the Span of Apprehension test are found in common with the genetic factors important for IQ. The phenotypic correlation between the Span of Apprehension and IQ measures can be attributed entirely to genetic factors. The influence of unique genetic components in the performance of the Span of Apprehension test in the general population heightens the promise of this measure as a genetic marker for schizophrenia.

Suicidal behavior and cognitive flexibility: design and verbal fluency after attempted suicide.

Aspects of problem solving were measured in nine male psychiatric patients, hospitalized after attempted suicide. Testing took place within 3 weeks (except for one patient) of the suicide attempt. Controls were patients with chronic idiopathic pain and healthy volunteers. Suicidal patients had significantly lower scores on general intellectual tests and in verbal and design fluency. No differences in problem solving (the Perceptual Maze Test and the Wisconsin Card-Sorting Test) and flexibility (the Uses of Objects Test and the Stroop Test) were found. The results are interpreted as indicating a decreased ability of suicidal patients to generate new ideas, when no alternatives are provided.

Smooth pursuit eye tracking and neuro-psychological performance in healthy volunteers. Exploring a possible genetic marker for vulnerability to schizophrenia.

Eye movement dysfunction (EMD) has been repeatedly found in schizophrenics and their first-degree relatives. In the present study, smooth pursuit eye tracking was measured in healthy subjects and related to performance on computerized neuropsychological tasks assumed to involve frontal or frontoparietal functions: monitoring perspective fluctuations (Necker cube), finger tapping, trail making, reaction time (RT) and a perceptual maze test. Poor trackers performed worse on tasks requiring parallel processing (trail making with letters and digits and RT with random auditory signals for response inhibition) and made more errors and cancellations on the mazes. Results are in line with our earlier EMD results on schizophrenics, showing poor performance on frontal tasks. However, their deficiency was more pervasive, whereas the present healthy EMD subjects only had difficulties with more complex tasks. The results are of interest in view of the recent evidence that EMD may be a genetic marker for vulnerability to schizophrenia.

Skin conductance nonresponding and nonhabituation in schizophrenic patients.

Bilateral skin conductance (SC) and heart rate (HR) were measured for 18 RDC diagnosed schizophrenic patients during rest and during presentation of identical tones. Computed tomography scans were evaluated. All but two patients were on neuroleptic medication. Six patients were nonresponders, seven habituated to the tones and five were nonhabituators. Nonresponders had lower SC level, fewer SC spontaneous fluctuations and higher HR level than the other subgroups. On neuropsychological tests the performance of the habituator group was closest to that of healthy subjects. Nonresponders did not differ in clinical symptoms, anamnestic data or in the prevalence of psychiatric morbidity in their families. Seventeen percent of the nonresponders had poor premorbidity adjustment vs 80% of the nonhabituators. Nonhabituators had higher ranks in the following symptoms: Presence of commenting voices, and inability to feel. They also tended to have wider third ventricles than the other two subgroups. The results support earlier findings in our laboratory suggesting nonhabituators as an important subgroup among schizophrenic patients.

Effect of sulpiride on vigilance in healthy subjects.

The effects of the antipsychotic drug sulpiride on vigilance, as measured by choice reaction time and critical flicker fusion, and on heart-rate and skin conductance, were studied in healthy volunteers (n = 6). The measurements were carried out 4 and 28 h after oral and i.v. administration of 100 mg sulpiride and during placebo condition. None of the tests or measurements showed statistically significant differences between the placebo and the active drug condition. The results were related to corresponding serum concentrations of sulpiride, the half-life elimination and the total amount of sulpiride found in the blood. No consistent trends in effects were observed. The results were interpreted as indicating minimal or no effects of sulpiride on the above measures of vigilance and autonomic activation.

Regional cortical dysfunction in schizophrenic patients studied by computerized neuropsychological methods.

18 RDC-diagnosed schizophrenic patients (11 men, 7 women) were compared to 84 normal men with three computerized neuropsychological methods, assumed to reflect lateralized and frontal cortical functions: (1) Bilateral Finger Tapping and Finger Alternation, (2) Bilateral Trail Making, and (3) passively perceived Necker cube reversals. Schizophrenics differed from normals by (1) inferior Tapping/Alternation but only in the right hand, (2) inferior Trail Making, most pronounced for Form B, and (3) lower frequency of Necker cube reversals. Patients with previous neuroleptic medication and prior psychiatric hospitalizations were inferior in Trail Making and had fewer Necker cube reversals. The findings were interpreted in line with recent models of schizophrenia involving a left-hemisphere dysfunction/over-activation and a frontal dysfunction.

Smooth pursuit eye tracking, neuropsychological test performance, and computed tomography in schizophrenia.

Smooth pursuit eye movements (SPEM) were measured in 18 patients who met Research Diagnostic Criteria for schizophrenia. Some degree of SPEM impairment was present in most patients. Deviant eye tracking was not related to ratings of severity of illness, but was related to recurrent episodes of hospitalization, antipsychotic medication, and lower ratings in anxiety and delusions. Worse SPEM tended to be associated with larger lateral ventricles as assessed on computed tomography. Three patients with reversed occipital asymmetry had more deviant eye tracking than the remaining patients. Eye movement impairment was related to worse performance in Finger Tapping and in the Trail-Making Test, and to fewer perceived alternations of a Necker cube, suggesting that frontoparietal disturbances are related to poor pursuit eye tracking in schizophrenia.

Bilateral skin conductance activity, clinical symptoms and CSF monoamine metabolite levels in unmedicated schizophrenics, differing in rate of habituation.

Bilateral skin conductance (SC) and heart rate (HR) were recorded for 18 RDC-diagnosed unmedicated recently admitted psychotic patients (13 schizophrenic and 5 paranoid) and for age- and sex-matched controls, during rest and tone stimulation (85 dBA, 1000 Hz, 1 sec duration and 0.25 msec rise time). Schizophrenics had more SC spontaneous fluctuations and faster HR, indicating higher arousal. SC spontaneous fluctuations were more frequent in left hand and showed an increasing trend over the session. Several SC measures indicated higher responsivity and a more irregular responding pattern in schizophrenics. These patients had higher levels of the noradrenaline metabolite (MHPG). Paranoid psychotic patients had a more stable SC habituation course than controls, and higher levels of the dopamine (HVA) and serotonin metabolites (5-HIAA). Schizophrenic nonhabituators had fewer positive psychotic symptoms than habituators, suggesting that poor habituation is not due to interference by symptoms. It may be related to higher arousal, or to deficient information processing.