The scope of using pragmatic language tests for early detection of dementia: A systematic review of investigations using figurative language.

INTRODUCTION: Dementia cases are expected to rise to 81.1 million in 2040. Efforts are underway to develop diagnostic methods to facilitate early detection of the disease. Herein we review research findings focusing on pragmatic dysfunction in patients with dementia and evaluate the usefulness of assessing dementia and its progress with a battery of tests assessing figurative language skills. METHODS: A total of 74,778 article titles were identified from EMBASE, PubMed, and Google Scholar databases. After systematic screening, 51 journal articles were selected for the final review. RESULT: The review suggests that impaired figurative language might be a marker for early cognitive decline. Different forms of figurative language may be impaired at different stages of the disease and in different types of dementia involving different neuropathologies. CONCLUSION: The use of pragmatic tests in combination with the existing diagnostic protocols might increase the probability of early diagnosis. HIGHLIGHTS Pragmatic impairment could be a marker of early cognitive impairment. Figurative language-an important pragmatic aspect-is disrupted in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Figurative language impairment might precede literal language impairment. Pragmatic tests could be more sensitive than standard neuropsychological tests. Inclusion of pragmatic tests in diagnostic guidelines might bolster early detection.

Pragmatic deficits in patients with schizophrenia and right hemisphere damage: A pilot study.

BACKGROUND: While pragmatic deficits are well documented in patients with schizophrenia (SCZ) and right hemisphere damage (RHD), there is a paucity of research comparing the pragmatic deficits of these two groups. Do they experience similar cognitive dysfunction or is there a dissociation between the two patient groups? AIMS: To investigate the nature of pragmatic deficits in these two groups and to gain an understanding of the underlying cognitive mechanisms that might be associated with these deficits to further future investigations. METHODS & PROCEDURES: A total of 60 participants (15 patients with SCZ; 15 with RHD; 30 (15 + 15) healthy controls (HC) were administered the Bengali Audio-Visual Test-Battery for Assessment of Pragmatic Skills. OUTCOMES & RESULTS: Both SCZ and RHD patients were found to have significant pragmatic deficits compared with their matched controls. SCZ patients were found to score significantly better than the RHD group in six out of the 10 pragmatic skills when controlled for age and education. Discriminant function analysis was performed and 86.7% of the cases (HC = 100%, SCZ = 73.3% and RHD = 86.7%) were correctly reclassified into their original categories using the test scores. CONCLUSIONS & IMPLICATIONS: The study suggests that there is heterogeneity in the nature of the pragmatic breakdown within and across patient groups. Therefore, individualized restorative measures targeting the disrupted cognitive mechanism(s) might help elevate pragmatic competence and enhance the social functioning of patients with pragmatic deficits. WHAT THIS PAPER ADDS: What is already known on the subject Pragmatic deficits are common in adults with cognitive impairments of different etiologies. However, few studies have explored pragmatic deficits across clinical populations. Consequently, very little is known about the nature of pragmatic deficits in patients with schizophrenia and right hemisphere damage. What this paper adds to existing knowledge This work offers preliminary data on pragmatic difficulties in patients with schizophrenia and right hemisphere damage. This study overrides the boundaries of traditional classifications and evaluates pragmatic difficulties in these two clinical populations with reference to the underlying cognitive mechanisms, which might be disrupted. What are the potential or actual clinical implications of this work? The study adds a transdiagnostic perspective suggesting that there might be heterogeneity in pragmatic deficits, both within and across patient groups, and stresses the need for individualized therapy.

Validation of revised reading the mind in the eyes test in the Indian (Bengali) population: A preliminary study.

BACKGROUND: Social cognition deficits are common in clinical populations but there is a dearth of standardized social cognition assessment tools in India. Theory of mind (ToM) is an important aspect of social cognition which is often assessed with the revised reading the mind in eyes test (RMET-R). However, we do not have a statistically validated version of the test for the Indian population. AIM: This study aims to assess the acceptability, reliability, and validity of the Bengali version of the RMET-R. MATERIALS AND METHODS: We administered the RMET-R to 23 patients with chronic schizophrenia (SCZ), 22 patients with bipolar disorder, and 104 healthy controls (HCs) to evaluate the reliability and validity of the instrument in the Indian (Bengali) population. RESULTS: We obtained moderate internal consistency (Cronbach's alpha = 0.6) and test-retest reliability (intraclass correlation coefficient = 0.64, P < 0.001). Positive correlations were found between RMET-R and Wechsler picture arrangement (r = 0.60, P < 0.001), picture completion (r = 0.54, P < 0.001), and comprehension subtests (r = 0.48, P < 0.001). Patients with SCZ (M = 49.7, standard deviation [SD] = 16.5) scored significantly lower than HCs (M = 68.9, SD = 13.8) (P = 0.008; Cohen's d = 1.3) on the RMET-R. Thus this tool could discriminate patients who are reported to have Theory of Mind deficits from healthy controls. CONCLUSION: The Bengali version of the RMET-R is a reliable and valid tool for assessing first-order ToM insofar as the original RMET-R measures this construct.

Stress, Sleep and Psychological Impact in Healthcare Workers During the Early Phase of COVID-19 in India: A Factor Analysis.

Background: Risks to healthcare workers have escalated during the pandemic and they are likely to experience a greater level of stress. This cross-sectional study investigated mental distress among healthcare workers during the early phase of Coronavirus disease-2019 (COVID-19) outbreak in India. Method: 140 healthcare workers of a tertiary care hospital in India were assessed for perceived stress and insomnia. A factor analysis with principal component method reduced these questions to four components which were categorized as insomnia, stress-related anxiety, stress-related irritability, and stress-related hopelessness. Further statistical analyses were done on these factor scores to identify the predictors and investigate the differences between the different categories of healthcare workers. Result: Doctors had the highest level of anxiety among the healthcare workers. Both doctors and nurses perceived a greater level of irritability than the other HCWs. Compared to doctors and nurses, other HCWs were more likely to experience insomnia. Lower age, higher education, female gender, and urban habitat were associated with greater perception of anxiety. Older age, being quarantined, and single marital status were the significant predictors of irritability. Female gender, single marital-status, and higher number of medical ailments contributed to perceived hopelessness. Quarantine significantly predicted insomnia. Conclusion: Different categories of healthcare workers are experiencing varied mental health problems owing to their heterogeneous socio-demographic backgrounds. Tailored and personalized care, as well as policies, might help in alleviating their problems. Further research is warranted to explore the psychological distress and remedies among these frontline workers during and after the ongoing pandemic crisis.

Effects of Chronic Brain Injury on Quality of Life: A Study in Patients With Left- or Right-Sided Lesion.

OBJECTIVES: To test the hypothesis that quality of life (QOL) is made up of different components, and each of these has different anatomic and demographic contributors. DESIGN: Questionnaire-based study. SETTING: Center for Cognitive Neuroscience, University of Pennsylvania. PARTICIPANTS: People with chronic brain injury (N=52) volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury (LHI) (9 women and 13 men; mean age ± SD, 60.6±11.2y [range: 36-83]; mean chronicity ± SD, 11.5±4.2y) and 20 patients with right hemisphere injury [RHI] (16 women and 4 men; mean age ± SD [62.7±12.8y] [range: 31-79]; mean chronicity ± SD 10.1±4.3y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (version 3.0), Positive Affect and Negative Affect Scale, and Distress Thermometer to measure QOL in LHI and RHI patients. Exploratory factor analysis with principal component method reduced these measures to 5 factors, roughly categorized as-(1) physical functioning; (2) general health; (3) emotional health; (4) social functioning; and (5) cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures. RESULTS: Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (P<.001). Age also affected emotional health. (P=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (P=.009) and RHI patients with their physical functioning (P=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component. CONCLUSIONS: QOL is composed of 5 components. Clinical and demographic factors appear to differentially affect these aspects of patients' perceived QOL, providing hypotheses for further testing and suggesting potential relations for therapeutic interventions to consider.

Development of Bengali Audio-Visual Test Battery for Assessment of Pragmatic Skills: Preliminary Normative Data Based on Educational Level.

Pragmatic competence may be disrupted due to psychological and neurological causes. For appropriate remedy and rehabilitation, a precise assessment of pragmatic skills is important. However, there is no test battery in the Bengali language, and consequently, there is no published data on pragmatic ability of Bengali speakers. Due to the vast diversity of the population, it becomes increasingly difficult to assess pragmatic ability of an individual without a proper knowledge of the normal variations. To address this problem we have developed a test battery in Bengali, and to begin with, we have administered it to one hundred and five (105) normal healthy persons having different levels of education. The four groups having 17 years and above, 15 to < 17 years, 12 to < 15 years and 10 to < 12 years of education yielded a normative score of 193, 189, 171 and 150, respectively. These normative scores will allow clinicians to make a proper assessment of patients suffering from pragmatic deficits and help avoid interpreting social differences as neurological deficits.