Impaired Skills Research Articles

COMPARISON OF MACHINE LEARNING MODELS FOR AUTOMATED AUTISM DIAGNOSIS

Autism Spectrum Disorder (ASD) is characterized by impairment in communication and language skills as well as repetitive and stereotyped behaviors. Early ASD diagnosis helps in developing a meaningful outcome in its treatment. Machine learning (ML) models can provide faster diagnostic capacity to determine patterns not observable by humans through behavioral analysis. We applied the ML classification models, including random forest, logistic regression, K-nearest neighbor intuition, support vector machine, decision tree, kernel support vector machine, and Naive Bayes, for each data set (children, teenagers, and adults). Our results show that ML models are powerful tools that can assist healthcare professionals in diagnosing ASD. Our model predicts non-autism cases with 97.9% accuracy. We believe that performing a logistic regression analysis indicating which factors increase or decrease the probability of diagnosis is a significant contribution. We hope to elucidate alternative ways to objectively diagnose ASD for timely treatment purposes.

Advances in the Study of APOE and Innate Immunity in Alzheimer's Disease.

Alzheimer's disease (AD) is a progressive degenerative disease of the nervous system (CNS) with an insidious onset. Clinically, it is characterized by a full range of dementia manifestations including memory impairment, aphasia, loss of speech, loss of use, loss of recognition, impairment of visuospatial skills, and impairment of executive function, as well as changes in personality and behavior. The exact cause of AD has not yet been identified. Nevertheless, modern research indicates that genetic factors contribute to 70% of human's risk of AD. Apolipoprotein (APOE) accounts for up to 90% of the genetic predisposition. APOE is a crucial gene that cannot be overstated. In addition, innate immunity plays a significant role in the etiology and treatment of AD. Understanding the different subtypes of APOE and their interconnections is of paramount importance. APOE and innate immunity, along with their relationship to AD, are primary research motivators for in-depth research and clinical trials. The exploration of novel technologies has led to an increasing trend in the study of AD at the cellular and molecular levels and continues to make more breakthroughs and progress. As of today, there is no effective treatment available for AD around the world. This paper aims to summarize and analyze the role of APOE and innate immunity, as well as development trends in recent years. It is anticipated that APOE and innate immunity will provide a breakthrough for humans to hinder AD progression in the near future.

Travel Demand Increment Due to the Use of Autonomous Vehicles

Advanced technology available in promising fully autonomous vehicles (AVs) will encourage people to travel more than they have up to now using their regular vehicles. It is believed that the disadvantages of manually driven vehicles, such as driving fatigue, stressful feelings, aging physical skills deterioration, and other unwanted effects, will vanish once AVs are employed. For this purpose, this study presents the results of a large questionnaire performed in Győr, Hungary, about the public perception and acceptance of AVs. In addition, assessing the impact of using such technology on increasing travel demand when people can alter their mode of transport to an AV. The study demonstrates that respondents’ prior knowledge of AVs plays a crucial role in generating a greater number of trips when they are able to use AVs. Furthermore, it has also been found that providing further awareness and education to the population about the meaning of the term autonomous vehicles and widening their insights about the new features provided by these vehicles will result in a higher number of trips. Eventually, this information will act as a considerable indicator to provide a prior understanding of the possible challenges that may impact the sustainability of future transport systems.

Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study.

Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.

Absence of typical images and progressive psychiatric manifestations may suggest the diagnosis of neurodegeneration associated with pantothenate kinase deficiency

Neurodegeneration associated with pantothenate kinase deficiency is a rare disease. To confirm its diagnosis, studies are needed that are often not available in all countries and times (as in this case). Clinical case: In the Child Psychiatry ward of the "Juan Manuel Márquez" Pediatric Hospital, an adolescent was treated with psychiatric disorders of psychotic functioning level with little response to treatment, extrapyramidal manifestations and other progressive neurological dysfunction. The classic image of "tiger eyes" was evidenced by magnetic resonance imaging of the skull, at the beginning unilateral, and at 10 months it was performed again, verifying the bilateral image, in addition to significant cognitive, language, communication and loss of skills deterioration. With regression, affective symptoms and sleep disorder. Conclusions: Although neurodegeneration associated with pantothenate kinase deficiency is a rare disease and in the present case it could only be considered probable, it should be included in the differential diagnosis of children and adolescents with the progression of clinical manifestations, including extrapyramidal dysfunction. dementia, even in the absence of a tiger-eye image at the onset of manifestations or its unilateral presence. Psychiatric manifestations were the cause of admission from the start, and their persistence and poor response to treatment may be a manifestation that alerts to the presence of this disease.

Translation and Validation of Developmental Coordination Disorder Questionnaire in Urdu Language for Developmental Coordination Disorder Population

Aim: To translate developmental coordination disorder questionnaire in Urdu language and validate its psychometric properties for cross cultural adaptation. Methods: This validation study was done at the Lahore College of Physical Therapy. The Developmental Coordination Disorder Questionnaire (DCDQ) was translated into Urdu utilizing Bombardier, Beaton, and Guillemin's cross-cultural adaption principles. The forward and backward translations were completed by two separate translators, one of whom is a medical professional professor and the other an Urdu language professor. The final certified version of DCDQ-Urdu was confirmed by bilingual professionals. The validated version's reliability was then evaluated on 28 children with developmental coordination disorder. Results: After population testing, the Cranach's alpha of the DCDQ-Urdu version was 0.873. The inter item correlation of the DCDQ-Urdu for three domains, control during movement, fine motor/handwriting, and general coordination, with total DCDQ score is 0.386, 0.312, and 0.3002, respectively, and after population testing is 0.273, 0.303, and 0.397. The original English and translated DCDQ-Urdu versions had a significant association (Spearman's rho 0.951 p 0.000).Test retest reliability ranged from 0.504 to 0.721. Conclusion: The Urdu version of the Developmental Coordination Disorder Questionnaire has good internal consistency and fair inter-item correlation, making it suitable for use as a screening tool for parents of children with and without impaired motor coordination. Keywords: Developmental Coordination Disorder, DCDQ-Urdu version, Motor skill impairment

Perceived Self-Competence of Youths with Visual Impairment in the Expanded Core Curriculum Skills

The purpose of this study was to evaluate the perceived self-competence of youths with visual impairment in Turkey in the Expanded Core Curriculum (ECC) areas. To examine how youths with visual impairment perceive their self-competence within the nine ECC areas, an ECC screening tool developed by the Iowa Department of Education was adapted into a five-point Likert-type scale (ranging from 1 = strongly disagree to 5 = strongly agree). Participants were 118 high school students with visual impairment across Turkey. Statistical analysis procedures included descriptive and nonparametric methods. The descriptive statistics were used to determine how participants perceive their competences in the nine ECC areas. The Mann-Whitney U test was used to compare the differences between the mean ranks of self-competence levels within the independent groups. Gender, grade level, and socio-economic level were the variables that evidenced significant differences (p < .05) among the participants’ self-competence levels in the ECC areas of independent living, career education, orientation and mobility (O&M), recreational and leisure skills. The findings demonstrated that some demographic variables may be considered as possible factors contributing to perceived self-competence of youths with visual impairment. As one of the earliest studies relating to ECC skills of youth with vision impairment in Turkey, practitioners may find value in the construct of Likert-type scale to measure the perceived self-competence of youths with visual impairment in the ECC areas.

Motor deficits in autism differ from that of developmental coordination disorder.

A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

What is specific about employment status, workplace experiences and requirements in individuals with autism in Germany?

The challenge of sustainably integrating highly educated individuals with ASD without intellectual disabilities in the first labor market is repeatedly described in literature. In a retrospective study, a group of 197 clinically late-diagnosed adults with ASD without intellectual disabilities was compared to a closely matched group of 501 individuals who did not meet the criteria for the diagnosis of ASD within a utilization population of the Cologne Autism Outpatient Clinic. Results indicated that the pronounced demand for reduction of social and interpersonal requirements at the workplace (including planned or limited contact with colleagues and customers) as well as the experience of difficulties following unexpected changes in the daily routine were specific for ASD. In addition, individuals with ASD reported greater difficulties in finding a suitable job and being able to live on their wages, taking age and educational qualification into account. Supported employment measures were provided significantly more frequently to individuals in the ASD group. In conclusion, impairments in social skills emerged as one of the main obstacles of workplace performance for individuals with ASD emphasizing the necessity to develop and apply ASD-specific support services.

Case report: Co-occurring autism spectrum disorder (Level One) and obsessive-compulsive disorder in a gender-diverse adolescent.

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Developmental Profiles in Children and Young Adults with Alexander Disease

ABSTRACT Purpose The study aims to describe the developmental profile of children and young adults with Alexander disease [AxD] infantile form, analyzing their clinical features, adaptive behavior and neuropsychological skills. Methods Participants were eight children or young adults (Mean age = 11 years; SD = 6.86; range = 5–23) and their parents. A multi-method approach was adopted to assess participant competencies: (1) an online parent survey, (2) a semi-structured interview with parents, and (3) a direct assessment of the participant’s neuropsychological skills. Results Only four parents and their children completed all measures, and a common developmental profile could not be identified. The participants experienced substantial impairment in gross-motor skills, memory and narrative macrostructure. Most parents reported a regressive trend in at least one area. Conclusions The high individual variability and the regressive trend highlight the need for an accurate and periodic assessment of each individual’s developmental profile.

The interplay of ADHD symptoms and exercise in youth

The interplay of ADHD symptoms and exercise in youth

Cannabis and Driving: Developing Guidelines for Safety Policies.

The dynamism in the regulatory frameworks concerning the consumption of cannabinoids has placed their effects on cognitive and psychomotor skills at the center of the scientific debate. In consideration of the potential repercussions on public safety, particular attention has been focused on the impairment of driving skills, opening up the need to specifically regulate driving under the effects of cannabinoids. Both native cannabinoids and metabolites show a long positivity at low concentrations in the biological fluids, especially in the case of chronic consumption. Qualitative positivity to cannabinoids does not itself prove the presence of detrimental effects, which require the presence of active substances at relevant concentrations. Driving Skill Impairment: Multiple studies highlight a tetrahydrocannabinol (THC) concentration- based alteration of driving skills mainly affecting automatisms, whereas skills subjected to cognitive control are preserved up to higher dosages. The evidence relating to associations with other substances, chronic consumption and other cannabinoids, on the other hand, is still burdened by a high degree of uncertainty. Regulation Policies: Different models can be adopted in the regulation of driving under the effects of cannabinoids: sanctions can be applied in case of qualitative positivity, cannabinoids concentration above a defined threshold, or in presence of a demonstrated state of cognitive alteration. "Per se limit" with a quantitative THC cut-off between 3.5 and 5 ng/ml can currently be considered the most balanced choice. Finally, the analysis carried out allowed to identify pitfalls in both scientific and legislative fields for the improvement of safety policies.

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

IntroductionRobot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery.MethodsAn international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated.ResultsA total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery.ConclusionThe crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.

Cognitive, adaptive and behavioral profile in Sotos syndrome children with 5q35 microdeletion or intragenic variants.

Sotos syndrome (SoS) is a congenital overgrowth syndrome with variable degree of intellectual disability caused in the 90% of cases by pathogenetic variants of the Nuclear receptor binding SET Domain protein1 (NSD1) gene. NSD1 gene functions can be abrogated by different genetic alterations (i.e., small intragenic pathogenic variants like deletions/insertions, nonsense/missense pathogenic variants, partial gene deletions and whole deletions or microdeletion of 5q35 chromosomal region). Therefore, correlation of the genotype-phenotype with a possible contribution of more implicated genes to the medical, cognitive and behavioral profile is a topic of great interest. Although a more severe learning disability has been described in individuals with 5q35 microdeletion when compared to individuals with NSD1 intragenic pathogenic variants a fully delineated cognitive and behavioral phenotype has not been described yet. The importance of providing clinical characterization in relation to the genotype comes from the necessity to early identify children more at risk of developing psychopathological disorders. We characterize the cognitive, adaptive and behavioral phenotype of a pediatric sample of 64 individuals affected by SoS, performing a standardized neuropsychological evaluation. Secondly, we compare cognitive-behavioral profiles of SoS individuals carrying and not carrying the 5q35 microdeletion. SoS participants were characterized by a mild cognitive impairment of both Intellectual Quotient and adaptive skills in association to borderline symptoms of attention deficit. Our results suggest that the 5q35 microdeletion is associated with lower scores specifically concerning the cognitive, adaptive functioning and behavioral domains. However, longitudinal studies are necessary to confirm these findings and delineate a developmental trajectory of SoS.

Does more schooling imply improved learning? Evidence from the Kanyashree Prakalpa in India

Studies on Conditional Cash Transfer (CCT) programs have documented positive effects on school enrollment though evidence on learning outcomes is mixed. Using representative data, we evaluate one of the largest CCT programs, Kanyashree Prakalpa (KP), which was implemented in the state of West Bengal, India, in 2013. In particular, we examine the effect on female school enrollment and learning outcomes. Exploiting the timing of the program implementation for identification and applying difference-in-difference regressions, we document a positive effect on enrollment with no discernible impact on secondary and higher secondary school completion. We also observe significant improvements in lower-level learning outcomes but a marked deterioration in higher-level skills like solving simple division problems. Complementary investments like classroom availability and teacher attendance appear to have fallen after the implementation of KP, which explains the decline in learning skills despite higher schooling exposure, thereby underscoring the need for supply-side interventions in school amenities.

Objective measurement of retention of laparoscopic skills, a prospective cohort study.

There has been an overall growth of 462 percent in laparoscopic procedures performed by surgical residents between 2000 to 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after and 4 months after completing the Basic Laparoscopy Course. Force, motion and time were the measured variables. A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force (P=0.004), motion (P≤ 0.001) and time (P≤ 0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force (P≤ 0.001), motion (P=0.005) and time (P≤ 0.001).Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force (P=0.046), max impulse (P=0.12) and time (P=0.002). For the ZigZag loop, skill decay was observed for force (P=0.021) motion (P=0.015) and time (P≤ 0.001) parameters. Acquired laparoscopic technical skills decreased 4 months after the Basic Laparoscopy Course. Compared to baseline performance, subjects showed significant improvement, however deterioration was observed compared to post course measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.

ChatGPT applications in medical, dental, pharmacy, and public health education: A descriptive study highlighting the advantages and limitations.

Since its public release in November 2022, ChatGPT has gained a widespread attention and received mixed responses in the academia. Promising applications of ChatGPT in university education has been suggested; however, several concerns were raised. The aim of this descriptive study was to investigate the pros and cons of ChatGPT use in medical, dental, pharmacy, and public health education. Based on expert panel discussion and review of the existing literature, specific and concise ChatGPT prompts were constructed and the responses were generated on 25 February 2023. Out data suggested that in medical education, ChatGPT benefits included the possibility of improving personalized learning, clinical reasoning and understanding of complex medical concepts. The benefits listed in the context of dental education included improved skills through step- by-step instructions and interactive content, with instant feedback on student techniques. In pharmacy education, the advantages included possible explanations of complex subjects and the deployment of interactive tools aiding to develop skills for patient counselling. In public health education, the listed benefits included providing explanations and case scenarios, besides improved skills in data analysis and literature review. The limitations listed based on ChatGPT-generated content were common across all of the investigated healthcare disciplines and included data privacy issues, risk of generating biased and inaccurate content, and the risk of deterioration of critical thinking and communication skills among healthcare students. The ChatGPT-generated content in the context of healthcare education was deemed partially helpful by the expert panel. However, several important points regarding the pros and cons of ChatGPT use in medical, dental, pharmacy and public health education were missed by ChatGPT- generated content including: the risk of plagiarism, copyright issues, the risk of academic dishonesty, and the lack of personal and emotional interactions necessary for developing proper communication skills in healthcare education. In conclusion, despite the promising prospects of ChatGPT in healthcare education, several drawbacks should be addressed with implementation of guidelines for proper use to ensure exploiting the benefits of this innovative technology.

The Autism Spectrum: Behavioral, Psychiatric and Genetic Associations

Autism spectrum disorder (ASD) consists of a group of heterogeneous genetic neurobehavioral disorders associated with developmental impairments in social communication skills and stereotypic, rigid or repetitive behaviors. We review common behavioral, psychiatric and genetic associations related to ASD. Autism affects about 2% of children with 4:1 male-to-female ratio and a heritability estimate between 70 and 90%. The etiology of ASD involves a complex interplay between inheritance and environmental factors influenced by epigenetics. Over 800 genes and dozens of genetic syndromes are associated with ASD. Novel gene-protein interactions with pathway and molecular function analyses have identified at least three functional pathways including chromatin modeling, Wnt, Notch and other signaling pathways and metabolic disturbances involving neuronal growth and dendritic spine profiles. An estimated 50% of individuals with ASD are diagnosed with chromosome deletions or duplications (e.g., 15q11.2, BP1-BP2, 16p11.2 and 15q13.3), identified syndromes (e.g., Williams, Phelan-McDermid and Shprintzen velocardiofacial) or single gene disorders. Behavioral and psychiatric conditions in autism impacted by genetics influence clinical evaluations, counseling, diagnoses, therapeutic interventions and treatment approaches. Pharmacogenetics testing is now possible to help guide the selection of psychotropic medications to treat challenging behaviors or co-occurring psychiatric conditions commonly seen in ASD. In this review of the autism spectrum disorder, behavioral, psychiatric and genetic observations and associations relevant to the evaluation and treatment of individuals with ASD are discussed.

Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills

Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.