Lower Function Research Articles

Cognitive decline in high-functioning older adults: Reserve or ascertainment bias?

The detection of mild cognitive impairment and dementia in high-functioning older adults can be difficult. It has also been observed that high-functioning persons show a lower prevalence of dementia than low-functioning persons. Three alternative explanations for this observation have been proposed in the literature: brain reserve capacity (BRC), cognitive reserve, and ascertainment bias. With data from a prospective, population-based study of incident dementia, the Canadian Study of Health and Aging (CSHA), we classified participants as being high- (HF) or low-functioning (LF) in three ways: educational and occupational attainment, and estimated premorbid IQ. We observed that fewer HF older adults were diagnosed with dementia after five years, which is in accordance with both the BRC and cognitive reserve models. Contrary to expectations, no difference on rate of memory deterioration was observed between those HF and LF persons who exhibited mild cognitive impairment at CSHA-1. However, HF persons who subsequently were diagnosed with dementia (CSHA-2) showed more rapid decline on five of the six memory measures over time than did LF persons diagnosed with dementia at CSHA-2. When performance on measures of memory functioning at CSHA-1 was examined for highly educated older adults, significantly more of those with dementia at CSHA-2 (n = 59) had scores falling within or below the average range in comparison to normative standards than those who continued to show no cognitive impairment (n = 145). Our findings suggest that the lower incidence of dementia for HF persons may be primarily the result of ascertainment bias, not underlying differences in brain or cognitive reserve.

Description Model of Designers' Intention in CAD System and Application for Redesign Process.

The designer's intention is the essence of design. But the geometric information is the only one that we handle in the conventional CAD system. In this paper, we propose the description model of designers' intention that might be helpful to reduce the troubllesome communications among the designers. The designers' intention is described as the correlation using the required funtions, the binding conditions, the technical information, the connotational assignments and the geometric information. The required functions are represented by a tree structure to show the sequence of designers' consideration. The lowest function is assigned to the functional elements that are selected from the geometric information according to the connotational assignments. Additionally, the binding conditions and the technical information are related to the functional elements. The effective usage of designers' intention model is verified under the redesign process. It shows that the redesign is processed successfully using the designers' intention.

Description Model of Designers' Intention in CAD System and Application for Redesign Process.

The designers' intention is the essence of design, but only geometric information is handled in the conventional CAD systems. It is the reason why the powerful communication tools among the designers are required to realize the concurrent engineering. In this paper, the description model of designers' intention which might be helpful to reduce the troublesome communications among the designers is proposed. The designers' intention is described as the correlation between the required functions, the binding conditions, the technical information, the functional elements, the con-notational assignments and the geometric information. The required functions are represented by a tree structure to show the sequence of designers' consideration. The lowest function is assigned to the functional elements which are selected from the geometric information according to the con-notatfonal assignments. Additionally, the binding conditions and the technical information are related to the functional eleents. The effective usage of designers' intention model is verified under the redesign process. It shows that the redesign is processed successfully using the designers' intention.

Vestibular and Sensory Interaction Deficits Assessed by Dynamic Platform Posturography in Patients with Multiple Sclerosis

Vestibular impairments have not been routinely identified in patients with multiple sclerosis (MS), because of the confounding effects of deficits in other neural systems. In this study, 35 patients with MS were evaluated by means of a systematic alteration of the sensory environment (dynamic posturography) in order to identify those patients who became unstable when vestibular inputs were needed to maintain stance. Subjects were assigned to either a high-function (HF) or a low-function (LF) group on the basis of a functional status assessment score obtained prior to the posturography test. For the HF group, 30% (7/23) had abnormal posturography scores. Of those subjects, 3 had a vestibular dysfunction pattern or a somatosensory-vestibular impairment. In contrast, 58% of the LF group (7/12) had abnormal posturography scores. Nearly all of these LF patients (6/7) had a vestibular dysfunction pattern or a combined visual-vestibular or somatosensory-vestibular impairment. Posturography might serve as one method to evaluate the functional consequences of a vestibular deficit in patients with MS.

Functional screening of lower-limb amputees: a role in predicting rehabilitation outcome?

The Functional Independence Measure (FIM), a single-score instrument used to measure independent functioning in six areas of basic self-care skills, was used to evaluate 68 patients following lower-limb amputation. Patients in a rehabilitation hospital were assessed with the FIM upon admission and discharge. Admission scores averaged 52.7, ranging from 25.2 to 70.0. Patients scoring in the lowest and highest quartiles were compared: no remarkable gender, ethnic, or age differences were evident. Persons with the lowest scores (ie, lowest functioning) had a higher prevalence of hypertension, coronary artery disease, and noninsulin-dependent diabetes mellitus. The success of rehabilitation in patients in the lower two quartiles upon admission was variable and not predicted well by the FIM. In contrast, predictability of rehabilitation success was high in patients functioning higher at admission, the majority achieving near-perfect scores by discharge. Length of hospitalization appeared to be largely unrelated to the net difference in FIM scores over the course of hospitalization.

Carkhuff, Maslow, and Interpersonal Perception in Small Groups

With consideration of Carkhuff's and Maslow's models of effective functioning, two studies examine contrasts between high functioning (HF) and low functioning (LF) persons in small groups. HF persons show closer association for a set of relevant variables than do LFpersans, suggesting the presence of a general effectiveness factor. HF persons tend to perceive interpersonal effectiveness as a gestalt, while LF persons perceive interpersonal dimensions as operating independently.