Neuropsychological Problems Research Articles

Treating a College-Aged Patient with Neuropsychological Problems and ADHD: Discussion of Dr. Whitman’s Analysis of Mark

ABSTRACTThe central thesis of this discussion is that an adolescent psychoanalyst—someone who understands development, developmental interference, unconscious conflict, and neuropsychiatric impairment—is especially well-suited to treat patients with attention deficit hyperactivity disorder, learning disabilities, and behavior problems. Candidates in such training programs are provided with the didactic instruction and supervision necessary to grasp the kind of multimodal treatment approach that is necessary for these patients. A focus on enhancing inner processing and reflectiveness, building the tools for strengthening executive functioning, and clearing away maladaptive defenses all help to stimulate feelings of becoming an active agent on one’s own behalf. Furthermore, facilitating integration and activating the questioning and evaluating parts of one’s mind to reshape inner standards and values is a principal component of the therapeutic work. This also includes separating from primitive parental introjects, which creates more stable autonomy and the ability to face one’s limitations in small doses, thus leading to amelioration through new experience and the transforming of emotions into modulated, helpful signals.

Programa neuropsicológico de aprendizaje del inglés para alumnos con dislexia

Durante las últimas décadas ha existido un gran interés en el estudio de la dislexia y de las dificultades que los alumnos con dislexia presentaban en la lectura. Fruto de los distintos estudios, se ha constatado la dislexia como un trastorno complejo con una génesis multifactorial en la que predominan dificultades a nivel fonológico, neuropsicológico y en otros aprendizajes, entre los que se encuentra la adquisición de un segundo idioma. En la actualidad, en la sociedad globalizada en la cual vivimos, el dominio de idiomas resulta fundamental, especialmente el inglés, dado que es la lengua internacional por excelencia, y tiene diversas utilidades tanto dentro como fuera de España. Por todo ello, la importancia y novedad del presente trabajo, radica en el desarrollo de un programa neuropsicológico preventivo para atender de forma general los procesos cognitivos y neuropsicológicos comprometidos en el alumnado con dislexia, y de forma específica, en la propuesta de un programa para favorecer el aprendizaje del inglés como segundo idioma, que proporcione al profesorado de inglés orientaciones, métodos, actividades y materiales con el objetivo de contribuir a la mejora de los procesos de enseñanza y aprendizaje del alumnado con dislexia.

Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: a case report and review of the literature

BackgroundHerpes simplex encephalitis is the most common type of sporadic encephalitis worldwide. Frank intracerebral hemorrhage complicating the disease course in herpes simplex encephalitis patients is rare, especially cases where surgical decompression is necessary. Here, we report a previously healthy female with herpes simplex encephalitis who underwent surgical decompression due to temporal lobe hemorrhage.Case presentationA previously healthy 34-year-old Korean female presented with fever, myalgia and severe headache. Brain MRI showed a high T2 signal intensity change and diffuse swelling of the right temporal lobe. Polymerase chain reaction testing of the cerebrospinal fluid confirmed the presence of herpes simplex virus 1. The patient was admitted for close observation and intravenous acyclovir. On hospital day 3, she had a sudden onset of vomiting and severe headache. Brain CT showed frank temporal lobe hemorrhage. Despite aggressive medical treatment, she became increasingly drowsy. Ultimately, she underwent emergency right decompressive craniectomy, expansile duraplasty and intracranial pressure monitor insertion. The patient recovered fully without any neurological deficits or neuropsychological problems. She was discharged after completion of 2 weeks of acyclovir and returned 2 months later for cranioplasty.ConclusionsPatients with severe herpes simplex encephalitis complicated by intracerebral hemorrhage or malignant cerebral edema should undergo aggressive medical treatment. Surgical decompression should also be actively considered in these severe cases to prevent further neurological deterioration.

A - 58Mild Traumatic Brain Injury Not Related to More Neuropsychological Problems in a Clinical Sample

A - 58Mild Traumatic Brain Injury Not Related to More Neuropsychological Problems in a Clinical Sample

Netherton syndrome; neuropsychological and psychosocial functioning of child and adult patients and their parents

Background:Netherton syndrome is a rare severe skin disease. Clinical experience showed considerable psychosocial burdens among Netherton syndrome patients/families. Their (neuro)psychological functioning has never been investigated.Objective:To investigate neuropsychological/psychosocial functioning of Netherton syndrome patients and parents.Methods:A total of 12 Netherton syndrome patients and/or parents completed neuropsychological tests, semi-structured-interviews, and psychological-questionnaires.Results:Intelligence results showed disharmonic profiles, with below-average scores on processing speed. Neuropsychological problems and unfavorable outcomes on health-related quality of life, illness-appearance-related problems, and negative social consequences among patients/parents were found. Psychopathological (emotional) problems were reported; stigmatization, bullying was common among Netherton syndrome patients.Conclusion:Compared with normative data, Netherton syndrome patients showed neuropsychological and psychosocial problems. Standard follow-up is necessary to identify problems at early stage.

Neuropsychological Impairment among Juvenile Delinquents


 
 
 The aim of the present study was to investigate the role of neuropsychological impairment among delinquents and non- delinquents. The total sample comprised of two hundred participants consisting of one hundred juvenile and non-juvenile with age range of 10-17 years (M=15.76, SD= 1.93). Data was collected from the incarcerated subjects from three main jails of Khyber Pakhtunkhwa they include, Central Prisons of Kohat, Peshawar Swabi and Haripur with the help of Psychologists serving in the prison. It was hypothesized that delinquents will score higher on neuropsychological impairment scale as compared to non-delinquents. Neuropsychological impairment will be significantly correlated with the scores of delinquency. The results revealed significant impairment in the neurological functioning of the delinquents as compared to non-delinquents. In the present study six neuropsychological deficits were measured, they included neuropsychological emotional, learning, sensory motor, concentration, and neuropsychological depression in association with delinquency. Hence the results produced three key findings, first the sub-scales of neuropsychological impairment were significantly positively associated with delinquency. Second, sub-scales of neuropsychological impairment predicted variation in the magnitude of association with delinquency. Third, of all the six sub-scales neuropsychological emotional problems, neuropsychological motor problems and neuropsychological depression were slightly strongly associated with delinquency as compared to learning, sensory motor and concentration problem.
 
 

Intervention Approaches for Children with Autism Spectrum Disorder (ASD) and Attention Hyperactivity Disorder (ADHD): Review of Research between 2013 and 2017

This review focusing on studies on autism spectrum disorder (ASD) and attention disorder hyperactivity disorder (ADHD), which consists of assessment and intervention on three main domains; neuropsychological (cognitive), social interaction and behavioral problems. Majority of the studies reviewed used non-randomized control studies which involves mostly children, some adolescence and few adults, who are diagnosed as either ASD, ADHD or ASD +ADHD. The outcome of these studies mostly shows positive results in improving autism symptom such as cognitive skills impairment, social interaction dysfunctions between child and parents and behavioral problem. Children with ASD that undergone occupational therapy using sensory integration needed less caregiver assistance during selfcare and social activities. Pivotal Response Treatment (PRT) challenges the child to improve communication and increased parental self-efficacy. Social skills training (SST) promote social competence and friendship and decreasing feelings of loneliness. Animal companionship increases alertness and attention in human, which might promote enhance concentration and task persistence and promote calming effect in children suffering from ADHD. Mind-Body Therapies showed positive results in mental and emotional health and decreased in behavioral problems in children with ASD. In parent -mediated early intervention for children with ASD, children’s language, adaptive skills and parents stress showed no significance change. Despite of small to medium improvement, there were little scientific evidence of effectiveness of each type of intervention that could be suggested as best suited therapy for children with ASD and ADHD. Therefore, it was suggested to have standardized training technique as a promising area for future research along with continuous monitoring is needed in the long term to see the results in these children.

Risk Factors of Impaired Neuropsychologic Outcome in School-Aged Survivors of Neonatal Critical Illness.

Until now, long-term outcome studies have focused on general cognitive functioning and its risk factors following neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. However, it is currently unknown which neuropsychological domains are most affected in these patients and which clinical variables can be used to predict specific neuropsychological problems. This study aimed to identify affected neuropsychological domains and its clinical determinants in survivors of neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. Prospective follow-up study. Tertiary university hospital. Sixty-five 8-year-old survivors of neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. None. Intelligence, attention, memory, executive functioning and visuospatial processing were evaluated using validated tests and compared with Dutch reference data. Assessed risk factors of outcome were illness severity indicators, number of anesthetic procedures in the first year of life, and growth at 1 year. Patients had average intelligence (mean intelligence quotient ± SD, 95 ± 16), but significantly poorer sustained attention (mean z score ± SD, -2.73 ± 2.57), verbal (immediate, -1.09 ± 1.27; delayed, -1.14 ± 1.86), and visuospatial memory (immediate, -1.48 ± 1.02; delayed, -1.57 ± 1.01; recognition, -1.07 ± 3.10) than the norm. Extracorporeal membrane oxygenation-treated congenital diaphragmatic hernia patients had significantly lower mean intelligence quotient (84 ± 12) than other neonatal extracorporeal membrane oxygenation patients (94 ± 10) and congenital diaphragmatic hernia patients not treated with extracorporeal membrane oxygenation (100 ± 20). Maximum vasoactive-inotropic score was negatively associated with delayed verbal (B = -0.02; 95% CI, -0.03 to -0.002; p = 0.026) and visuospatial memory (B = -0.01; 95% CI, -0.02 to -0.001; p = 0.024). We found memory and attention deficits in 8-year-old neonatal extracorporeal membrane oxygenation and congenital diaphragmatic hernia survivors. The maximum dose of vasoactive medication was negatively associated with verbal and visuospatial memory, which may suggest an effect of early cerebral hypoperfusion in determining these abnormalities.

COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation.

In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III–IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions (P=0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P=0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P=0.05, odds ratio =2.361, 95% CI =0.995, 5.627 respectively). In COPD patients, focusing on pharmacological and nonpharmacological adherence enhance the possibility of tailored pulmonary rehabilitation programs.

A ROLE OF MNA-SF AS A PREDICTOR FOR 30-MONTH MORTALITY IN A NURSING HOME IN JAPAN

Background: Japan is a super-aged society. Along with the aging, the number of dependent elderly has increased. The Mini Nutritional Assessment-Short Form (MNA-SF) has been reported to be one of the useful questionnaires to assess nutritional status in older people. However, studies reporting with MNA-SF for the dependent elderly are lacking. Therefore, we observed residents in nursing homes in Japan for 30 months to examine whether MNA-SF is useful for assessment of nutritional status. Methods: A total of 423 residents (333 women; 84.2 ± 8.6 years) in nursing homes in Japan participated in this investigation. We investigated the following characteristics of the participants: age, sex, height, weight, medical history, Barthel index, clinical dementia rating, and MNA-SF. MNA-SF consists of 6 items: food intake decline, weight loss, mobility, suffering from psychological stress or acute disease, Neuropsychological problems, and BMI. We performed Cox proportional regression analysis to examine the association of MNA-SF score with 30-month mortality. Results: Mean MNA-SF score was 8.9 ± 2.2. Among the participants, 104 (24.6%) were malnourished, 250 (59.1%) were at a risk of malnutrition, and 49 (11.6%) were in a normal nutritional status. After 30-month follow-up, 166 (39.2%) of the participants died. After adjustment for confounders, MNA-SF score was significantly associated with 30-month mortality (HR: 0.843, 95% CI: 0.770–0.922). Conclusion: MNA-SF score was significantly associated with 30-month mortality in Japanese nursing homes, even after adjustment for mortality-associated confounders. Therefore, the approach based on MNA-SF can be effective for nutritional assessment of dependent elderly.

Cerebellar lesions associated to Tuberous Sclerosis: New insights from an Italian paediatric series

Objectives: To evaluate: a) the cerebellar involvement in a pediatric population with tuberous sclerosis; b) the possible clinical and neuroradiological differences comparing patients with cerebellar lesions and those without; c) whether the cerebellar involvement may be considered a prognostic factor for neurological and neuropsychiatric outcomes in patients with tuberous sclerosis. Methods: Retrospective analysis of a pediatric population of 51 patients (21 males, 30 females) affected by tuberous sclerosis. For each patient we evaluated the clinical characteristics and in particular the neurological and neuropsychiatric phenotypes and all the available brain MRI. Results: 25.5% (13/51) of patients had cerebellar lesions (unilateral in 9/13 cases and bilateral in 4/13 cases). 91% of patients with cerebellar lesions had a TSC2 gene mutation (p=0.11) and in all cases mutations were de novo (p=0.02). Patients with cerebellar involvement compared to those without had a more severe phenotype (drug-resistant epilepsy: 46.2% vs 28.9%; intellectual disability: 61.5% vs 39.5%; neuropsychiatric disorders: 61.5% vs 50%; pervasive developmental disorder: 23.1% vs 10.5%; a higher brain tuber load tuberous, a higher frequency of subependymal nodules and subependymal giant cell astrocytomas). All cerebellar lesions involved the posterior lobe. Conclusions: A quarter of our patients with tuberous sclerosis have cerebellar lesions. Cases with cerebellar lesions, compared to those without, have more severe clinical phenotypes and neuroradiologic findings. The cerebellar lesions have a constant and peculiar localization in the posterior lobe of cerebellum, that is considered the seat of the cognitive functions of the cerebellum. Our data support the hypothesis that cerebellar lesions could represent a negative prognostic biomarker in patients with tuberous sclerosis. Their early detection could suggest to screen more carefully for neuropsychiatric disorders and neuropsychological problems and they could facilitate the selection of patients amenable to early treatment with mTOR inhibitors.

Neurological and Neuropsychological Problems in Tyrosinemia Type I Patients.

Clinically, Hereditary Tyrosinemia type I (HTI) is especially characterized by severe liver dysfunction in early life. However, recurrent neurological crises are another main finding in these patients when they are treated with a tyrosine and phenylalanine restricted diet only. This is caused by the accumulation of δ-aminolevulinic acid due to the inhibitory effect of succinylacetone on the enzyme that metabolizes δ-aminolevulinic acid. Due to the biochemical and clinical resemblance of these neurological crises and acute intermittent porphyria, this group of symptoms in HTI patients is mostly called porphyria-like-syndrome. The neurological crises in HTI patients disappeared after the introduction of treatment with 2-(2 nitro-4-3 trifluoro-methylbenzoyl)-1, 3-cyclohexanedione (NTBC). However, if NTBC treatment is stopped for a while, severe neurological dysfunction will reappear.If NTBC treatment is started early and given continuously, all clinical problems seem to be solved. However, recent research findings indicate that HTI patients have a non-optimal neurocognitive outcome, showing (among others) a lower IQ and impaired executive functioning and social cognition. Unfortunately the exact neuropsychological profile of these HTI patients is not known yet, neither are the exact pathophysiological mechanisms underlying these impairments. It may be hypothesized that the biochemical changes such as high blood tyrosine or low blood phenylalanine concentrations are important in this respect, but an direct toxic effect of NTBC or production of toxic metabolites (that previously characterized the disease before introduction of NTBC) cannot be excluded either. This chapter discusses the neurological and neuropsychological symptoms associated with HTI in detail. An extended section on possible underlying pathophysiological mechanisms of such symptoms is also included.

Épilepsie absence de l’enfant : actualités diagnostiques et thérapeutiques

Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome accounting for 10% of all pediatric epilepsies. The aim of this review is to provide an updated overview of this epilepsy syndrome to pediatricians. Most of the patients can be initially managed in private practice or in general pediatric settings. Absence seizures are the only seizure type observed at the time of diagnosis in these patients. An electroencephalogram recording and a clinical evaluation lead to the diagnosis. The underlying mechanisms are not yet fully understood. CAE is considered a self-limited epilepsy syndrome since most of the patients will become seizure free. Only a few patients (5-10%) have resistant CAE. However, CAE, as well as any pediatric epilepsy syndrome, should not be considered a "benign" epilepsy. Attention deficit is observed in about one third of the patients. There is also an increased risk of academic difficulties related to specific cognitive disorders. Therefore, the early detection of children at risk of developing neuropsychological problems can be helpful for preventing school underachievement and poor psychosocial outcome. Recently, several studies including a large randomized controlled trial indicated that ethosuximide should be considered as a first-line treatment and valproate as a second-line treatment. Cognitive side effects should be an important factor in the selection of the antiepileptic drug and should be specifically assessed during the follow-up. This review concludes by discussing the criteria that might lead to referring the patient to a specialist.

Nutritional status of patients with phenylketonuria in Japan

Accumulating evidence suggests that hyperphenylalaninemia in phenylketonuria (PKU) can cause neuropsychological and psychosocial problems in diet-off adult patients, and that such symptoms improve after resumption of phenylalanine-restricted diet, indicating the need for lifetime low-phenylalanine diet. While limiting protein intake, dietary therapy should provide adequate daily intake of energy, carbohydrates, fat, vitamins, and microelements. We evaluated nutrient balance in 14 patients with classical PKU aged 4–38years. Approximately 80–85% of the recommended dietary allowance (RDA) of protein in Japanese was supplied through phenylalanine-free (Phe-free) milk and Phe-free amino acid substitutes. Nutritional evaluation showed that the calorie and protein intakes were equivalent to the RDA. Phenylalanine intake was 9.8±2.2mg/kg of body weight/day, which maintained normal blood phenylalanine concentration by the 80% Phe-free protein rule. The protein, fat, and carbohydrate ratio was 9.5:23.9:66.6% with relative carbohydrate excess. Phe-free milk and amino acid substitutes provided 33.7% of carbohydrate, 82.1% of protein, and 66.7% of fat intake in all. Selenium and biotin intakes were 25.0% and 18.1% of the RDA and adequate intake (AI) for Japanese, respectively; both were not included in Phe-free milk. PKU patients showed low serum selenium, low urinary biotin, and high urinary 3-hydroxyisovaleric acid in this study. The intakes of magnesium, zinc, and iodine were low (71.5%, 79.5%, and 71.0% of the RDA, respectively) and that of phosphorus was 79.7% of the AI, although they were supplemented in Phe-free milk. PKU patients depend on Phe-free milk and substitutes for daily requirement of microelements and vitamins as well as protein and fat. Development of low-protein food makes it possible to achieve the aimed phenylalanine blood level, but this lowers the intake of microelements and vitamins from natural foods. The dietary habits vary continuously with age and environment in PKU patients. We recommend the addition of selenium and biotin to Phe-free milk in Japan and the need to review the composition of microelements and vitamins in A-1 and MP-11 preparations.

Surgical management of pain

Severe and intractable pain is one of the most difficult and challenging neurological conditions to deal with and to treat. The entity is not entirely well understood, and the afflicted patients often have significant concomitant neuropsychological problems that obscure the physical issue at hand. Physicians also do not fully understand what pain is. In a sense all pain is neural in origin. From a therapeutic perspective, pain is divided into visceral (dull and poorly localised owing to enteric sensory receptors) and somatosensory (more discreet and localised – often owing to nociceptors being stimulated) pain. It is detected by nociceptors, i.e. sensory reseptors with the ability to interpret and transmit noxious stimuli. Treatment options include medication, physical therapy and psychotherapy. The availability of sophisticated new medication, such as pregabalin, augments the medical arm of therapy. If these therapies fail, and with a thorough multidisciplinary approach involving carefully screened cases, surgery may form part of the management. Generally, surgical pain management is divided into neuromodulative (enhancing physiological control of the pain system) and neurodestructive (lesioning and destroying the defined pain generator in the central nervous system) surgery. Complex pain management should not focus on cure as the only outcome. Patients often experience pain for years before considering surgery; it would therefore be unwise to expect an immediate cure. Careful psychological support and evaluation is of the utmost importance. This article gives an overview of the neurosurgical management of pain.

The customer is always right? Subjective target symptoms and treatment preferences in patients with psychosis.

Clinicians and patients differ concerning the goals of treatment. Eighty individuals with schizophrenia were assessed online about which symptoms they consider the most important for treatment, as well as their experience with different interventions. Treatment of affective and neuropsychological problems was judged as more important than treatment of positive symptoms (p<0.005). While most individuals had experience with Occupational and Sports Therapy, only a minority had received Cognitive-Behavioral Therapy, Family Therapy, and Psychoeducation with family members before. Patients appraised Talk, Psychoanalytic, and Art Therapy as well as Metacognitive Training as the most helpful treatments. Clinicians should carefully take into consideration patients' preferences, as neglect of consumers' views may compromise outcome and adherence to treatment.

Nutritional Improvement Correlates with Recovery of Activities of Daily Living among Malnourished Elderly Stroke Patients in the Convalescent Stage: A Cross-Sectional Study

BackgroundWhether nutritional improvement correlates with functional recovery in convalescent stroke patients is unclear. ObjectiveThis study was conducted to examine the relationship between nutritional improvement and recovery of activities of daily living among malnourished elderly stroke patients in the convalescent stage. DesignThis study used a cross-sectional study design. Participants/settingOne hundred seventy-eight malnourished stroke patients aged 65 years and older from convalescent rehabilitation wards in Japan between April 2012 and December 2014 were included in the analyses. Main outcome measuresThe participants were classified into three groups according to the Mini Nutritional Assessment Short-Form (MNA-SF) score at discharge (0 to 7 as no improvement, 8 to 11 as lesser improvement, and 12 to 14 as greater improvement). The primary outcome was functional independence measure (FIM) efficiency (FIM gain/length of hospital stay). The secondary outcomes were FIM gain and discharge outcome. Statistical analysisOne-way analysis of variance, χ2 test, and Kruskal-Wallis test were performed for univariate analysis. Linear regression analysis was used to adjust for covariates such as age, sex, length of hospital stay, FIM (motor and cognitive) on admission, and lower-order items of MNA-SF. Binomial logistic analysis for discharge outcome (home/others) was performed to adjust for covariates such as age, sex, and FIM. ResultsStudy participants included 85 men and 93 women with a mean age of 77 years. Based on MNA-SF, 16 were classified as no improvement, 113 as lesser improvement, and 49 as greater improvement. The median FIM efficiency and length of hospital stay were 0.27 points/day and 151.5 days, respectively. The greater improvement group had significantly higher FIM efficiency than the other groups (P<0.001). Home discharge rate was also higher in the GI group (P=0.014). Linear regression analysis for FIM efficiency indicated that mobility, neuropsychological problems, and weight loss, which were lower-order items of MNA-SF at discharge, were independent explanatory variables (R2=0.373; P<0.001). ConclusionsThese findings suggest that nutritional improvement such as maintenance of body weight is associated with the efficient recovery of activities of daily living among malnourished elderly convalescent stroke patients.

Detection of frailty in elderly cancer patients: Improvement of the G8 screening test

The G8 is a screening test to identify frail elderly patients with cancer. Objectives were to design and evaluate the performance of alternative tests taking into account other predictive domains for frailty. We conducted a literature review to identify predictive factors of frailty. Using a Delphi consensus, we collected 24 European experts' opinions to validate the most relevant items to improve the G8. Alternative tests were created and performance assessed on a development population (ONCODAGE cohort). The highest performing test was compared to the G8, and validated through both an internal and an external population validation (Aquitaine Geriatric Oncology cohort). The study population consisted of 1435 patients (ONCODAGE cohort) and 364 patients (Aquitaine Geriatric Oncology cohort). Twenty-three experts validated two items with a strong consensus (>75%): modification of the threshold for the G8 polypharmacy item to six drugs per day and replacement of the G8 item on neuropsychological problems by four Instrumental Activities of Daily Living (IADL) items predictive of incident dementia, creating three modified G8 tests (addition of either item, or both). Only the G8 IADL-modified test had better performance than the G8 when tested on the ONCODAGE cohort: sensitivity=77%, specificity=67%. This test was validated on the internal (sensitivity=78%, specificity=71%) and external (sensitivity=88%, specificity=69%) validation populations. Adding the four IADL items improves the performance of the G8. We have developed and validated a G8-modified test that is more specific than the G8 to detect frail elderly, while still sensitive and feasible in less than 10 min.

Нейропсихологический потенциал метода «фиксированной установки» Д.Н. Узнадзе

We present a neuropsychological study using the technique of the fixed set in the field of haptic sensation developed by D.N. Uznadze, demonstrating the flexibility of the experimental procedure and the possibility of the method of «fixed set» in dealing with neuropsychological problems. It was shown that the modification of the experimental procedure fixed set techniques in the field of haptic allows you to use it in the analysis of at least two components of human mental activity - mnestic and regulatory. We describe the general results of experiments showing the possibilities of the method in the study of the problem of asymmetry and interhemispheric interaction in normal individuals and patients with disorders of the brain. It stresses the great potential of the method of «fixed set» in the study of neuropsychological syndromes disease of the white matter of the brain.

Diagnosis and Treatment of Obstructive Sleep Apnea Syndrome in Children.

Sleep is important for children pertaining to their physical and mental growth. Obstructive sleep apnea syndrome (OSAS) in children has been shown to have different effects as compared to OSAS in adults, including deficits in cognition and neuropsychological functions, hyperactivity, ADHD, behavior problems, aggressive behavior, learning problems and nocturnal enuresis. Hypertrophy of the adenoids and tonsils is a major cause of OSAS in children; therefore, adenotonsillectomy may decrease the effects of OSAS pertaining to physical and mental growth. It is important to accurately diagnose and appropriately treat OSAS in children to prevent OSAS in their adulthood.