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The majority of the world’s population is believed to speak more than one language. Moreover, given current demographic trends, older adults make up a significant portion of our population. In this chapter, we review what is known about the intersection between cognitive aging and language processing in one’s first and second language. We review current research findings concerning speech and language processing in older bilinguals at the level of words, sentences, and discourse. We review the implications of being bilingual for nonlinguistic cognitive functions and cognitive reserve. We close by highlighting the need for models of auditory and visual language processing to accommodate age-related changes in sensation, perception and cognition, and to account for important individual differences in language history and use.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.
The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.
Findings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.
Significance of results
Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
Water samples taken from extracorporeal membrane oxygenator (ECMO) devices used at University Hospitals Birmingham yielded high total viable counts (TVCs) containing a variety of microorganisms, including M. chimaera. Disinfection resulted in the reduction of TVCs and eradication of Mycobacterium chimaera. Weekly disinfection and water sampling are required to manage the water quality in these devices.
When speakers engage in conversation, acoustic features of their utterances sometimes converge. We examined how the speech rate of participants changed when a confederate spoke at fast or slow rates during readings of scripted dialogues. A beat-tracking algorithm extracted the periodic relations between stressed syllables (beats) from acoustic recordings. The mean interbeat interval (IBI) between successive stressed syllables was compared across speech rates. Participants’ IBIs were smaller in the fast condition than in the slow condition; the difference between participants’ and the confederate's IBIs decreased across utterances. Cross-correlational analyses demonstrated mutual influences between speakers, with greater impact of the confederate on participants’ beat rates than vice versa. Beat rates converged in scripted conversations, suggesting speakers mutually entrain to one another's beat.
Relational elements of language (e.g. spatial prepositions) act to direct attention to aspects of an incoming message. The listener or reader must be able to use these elements to focus and refocus attention on the mental representation being constructed. Research has shown that this type of attention control is specific to language and can be distinguished from attention control for non-relational (semantic or content) elements. Twenty-two monolinguals (18–30 years) and nineteen bilinguals (18–30 years) completed two conditions of an alternating-runs task-switching paradigm in their first language. The relational condition involved processing spatial prepositions, and the non-relational condition involved processing concrete nouns and adjectives. Overall, monolinguals had significantly larger shift costs (i.e. greater attention control burden) in the relational condition than the non-relational condition, whereas bilinguals performed similarly in both conditions. This suggests that proficiency in a second language has a positive impact on linguistic attention control in one's native language.
Un grand merci à Shari Baum and Debra Titone for their review paper, “Moving Toward a Neuroplasticity View of Bilingualism, Executive Control and Aging.” (Please note the code switch in that previous sentence is part of my effort to build my cognitive reserve.) The authors are to be congratulated for providing a timely and constructive review of the current state of our understanding of the potential impact of bilingualism on executive control processes and cognitive aging. In this short commentary, I will comment on one of their key contributions to the discussion, namely, that researchers should embrace and address the individual variability among bilinguals.
Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue.
The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS).
We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS.
Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.
Amnestic mild cognitive impairment (aMCI) represents a group of individuals who are highly likely to develop Alzheimer's disease (AD). Although aMCI is typically conceptualized as involving predominantly deficits in episodic memory, recent studies have demonstrated that deficits in executive functioning may also be present, and thorough categorization of cognitive functioning in MCI may improve early diagnosis and treatment of AD. We first provide an extensive review of neuropsychology studies that examined executive functioning in MCI. We then present data on executive functioning across multiple sub-domains (divided attention, working memory, inhibitory control, verbal fluency, and planning) in 40 aMCI patients (single or multiple domain) and 32 normal elderly controls (NECs). MCI patients performed significantly worse than NECs in all 5 sub-domains, and there was impairment (>1.0 SD below the mean of NECs) in all sub-domains. Impairment on each test was frequent, with 100% of MCI patients exhibiting a deficit in at least one sub-domain of executive functioning. Inhibitory control was the most frequently and severely impaired. These results indicate that executive dysfunction in multiple sub-domains is common in aMCI and highlights the importance of a comprehensive neuropsychological evaluation for fully characterizing the nature and extent of cognitive deficits in MCI. (JINS, 2012, 18, 541–555)
Depression and specific health problems
Dominique L. Musselman, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,
Angela Bowling, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,
Natalie Gilles, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,
Hannah Larsen, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,
Ephi Betan, Georgia School of Professional Psychology, Atlanta, GA, USA,
Lawrence S. Phillips, Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
The World Health Organization (WHO) highlights that approximately 150 million people worldwide have diabetes mellitus. This chapter reviews the pathophysiological alterations related to glucose intolerance in depressed patients and the beneficial effects of depression treatment upon glycaemic control. Antidepressant agents have been recognised to affect glucose concentration. Understanding the bidirectional relationship between depression and diabetes, including the sociocultural, biological and psychological pathways of influence, is ultimately critical to the treatment and prevention of diabetes. Education, functional impact of diabetes and financial stress may contribute the most to depression and anxiety in patients with diabetes early in their disease. Gender differences also exist, which may interact with socioeconomic factors. Psychological distress often can be reduced through the use of cognitive-behavioural therapy (CBT). Effective treatment of depression in patients with type 1 or type 2 diabetes may normalise neuroendocrine and immuno-inflammatory hyperactivation, facilitate adherence to diet and exercise, and improve glycaemic control.
We investigated the sensitivity of the P300 event-related brain
potential (ERP) recorded during a memory-demanding task to memory
function in subjects with dementia of the Alzheimer's type (DAT),
those with mild cognitive impairment (MCI), and normal elderly
controls. We also explored the ability of neuropsychological (delayed
verbal memory), neuroanatomical (MRI-based hippocampal volume), and
electrophysiological (memory search P300 amplitude) memory measures to
distinguish between the three subject groups using discriminant
function analyses. Fourteen patients with DAT, 16 with MCI, and 15 age-
and education-matched controls were tested. P300 amplitude was reduced
in DAT subjects at all levels of memory load; however, it did not
differ between MCI and control subjects. Delayed verbal memory
performance best discriminated DAT from MCI and control subjects, while
delayed verbal memory and hippocampal volume best discriminated MCI
subjects from controls. These results support the utility of
neuropsychological and neuroanatomical measures in diagnosing dementia
and do not support the notion that P300 amplitude is sensitive to
mild memory dysfunction when measured using the current task.
(JINS, 2004, 10, 200–210.)
The results of a systematic investigation by transmission electron microscopy (TEM), cathodoluminescence (CL), Rutherford backscattering (RBS), X-ray diffraction and topography and scanning force microscopy (SFM) techniques on several InGaAs/InP compressive and tensile strained layers covering the misfit range from −2.3 to 1.5×10−2 and grown by the metal organic vapor phase epitaxy (MOVPE) technique are reported. In compressively strained films the same dependence for the residual strain vs the film thickness as for the InGaAs/GaAs is found whereas a different strain release rate and different extended defects are found in tensile stressed InGaAs alloy. In particular in tensile stressed samples, grooves, planar defects and cracks are present in addition to the interfacial network of misfit dislocations. The correlation between the observed planar defects and the mechanisms of strain relaxation in the case of tensile strained layers is discussed.
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