Characteristics of Language Comprehension in Normal Elderly and the Mild Cognitive Impaired

BACKGROUND: Healthy aging is characterized by declines in language function and it is important to differentiate language comprehension difficulties due to pathological aging (i.e., mild cognitive impairment) from those due to normal aging. The purposes of this study were to review the literature on characteristics of language comprehension in normal elderly and the mild cognitive impaired, and to compare their performances on different language domains. METHODS: A comprehensive literature search identified numerous studies on language comprehension in both groups, and we analyzed them according to each language domain. RESULTS: The results indicated that the normal elderly show more difficulties in the comprehension of grammatically or lexically complex sentences and in text/discourse comprehension than words or simple sentences. Compared to normal elderly, MCI shows significantly lower performance on text/discourse comprehension and other tasks demanding higher cognitive function. In both groups, there are many different factors affecting language comprehension, such as hearing sensitivity, speech rate, literacy, and cognition. CONCLUSIONS: The results may provide insight into useful language comprehension tasks for differential diagnosis between normal aging and MCI. Further research on various compensatory strategies in daily life to facilitate language comprehension for both groups is warranted.

The generation of visualinferences in normal elderly - Influence of schooling and visual complexity / A geração de inferências visuais em idosos normais - influência da escolaridade e complexidade visual

The generation of inferences makes the construction and comprehension of discourse easier, and integrates representations which add coherence to the arguments. Visuoperceptual and inferential deficits merge in the attempt to explain the difficulties that some individuals have in the comprehension of certain kinds of visual stimuli. Objectives: a) To examine the performance of cognitively healthy elderly subjects in the execution of visual inferences using pictures of different levels of complexity; b) To compare the performance of subjects according to schooling level. Methods: A total of 45 normal elderly aged from 61 to 82yrs (M=68; SD=0.57) were examined. The subjects were divided into three groups according to schooling level: Group 1 (1 to 4 years); Group 2 (5 to 8 years) and Group 3 (9 or more years). Each subject had to create a narrative based on four figures with controlled visual complexity. The narratives were transcribed, analysed and scored. Results: For the essential inferences, the high educated group (3) had a better performance in both visually simple and complex conditions. On the visually complex figures, the medium educated group (2) was statistically equivalent to the high educated group for one figure and equivalent to the less educated group (1) for the other. There was no difference among the groups for the accessory propositions. Conclusions: Visual complexity interferes with the subject?s ability to make inferences in low and medium educated individuals. High educated subjects maintain the same performance in making inferences, regardless of the visual complexity level.

A geração de inferências facilita a construção e a compreensão do discurso, e integra representações que dão maior coerência aos argumentos. Os déficits visuoperceptuais e inferenciais confundem-se na tentativa de explicar as dificuldades de alguns indivíduos em compreender alguns tipos de estímulos visuais. Objetivos:a) Investigar o desempenho de indivíduos idosos normais, na realização de inferências visuais, a partir de figuras de diferentes graus de complexidade visual; b) Comparar o desempenho dos sujeitos de acordo com os níveis de escolaridade. Métodos: Foram examinados 45 idosos normais com idades entre 61 e 82 anos (M=68; DP=0.57). Constituiu-se 3 grupos segundo nível de escolaridade: grupo 1 (de 1 a 4 anos); grupo 2 (de 5 a 8 anos) e grupo 3 (9 ou mais anos). A cada indivíduo foram apresentadas 4 figuras, com graus de complexidade visuoespacial controlados para elaboração de discurso. Os itens colhidos foram transcritos, analisados e pontuados. Resultados: No que diz respeito às proposições essenciais, o grupo de maior escolaridade (3) apresentou melhor desempenho na descrição de ambas as figuras (simples e complexas). Nas figuras visualmente complexas, o grupo com escolaridade média (2) apresentou resultados estatisticamente equivalente ao grupo de alta escolaridade para uma figura e resultado estatisticamente equivalente ao grupo de menor escolaridade (1) para outra figura. Em relação às informações acessórias, não houve diferenças entre os grupos. Conclusões: A complexidade visual interfere na capacidade de realizar inferências nos indivíduos com baixa e média escolaridade. Indivíduos com alta escolaridade mantêm o mesmo desempenho na realização de inferências, independentemente do grau de complexidade das figuras.

Síndrome de Charles Bonnet: a propósito de um caso / Charles Bonnet syndrome: regarding a case

Idosos com déficit visual por vezes apresentam alucinações visuais relacionadas à síndrome de Charles Bonnet. O surgimento destas alucinoses frequentemente causa ansiedade ao paciente e gera dificuldade diagnóstica e de conduta. Neste artigo descrevemos o caso de uma senhora de 82 anos de idade que se queixou de alucinações visuais complexas e revimos a literatura a respeito da síndrome de Charles Bonnet; condição que promove alucinação visual em pessoas mentalmente saudáveis.

Visually handicapped elderly people sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinosis often causes anxiety to the sufferer and can be difficult for the diagnosis and management. In this article, we report an 82-year-old woman that suddenly complained of complex visual hallucinations, and review the literature on the Charles Bonnet syndrome, a condition involving visual hallucinations in a mentally normal person.

Relationship of Sleep Factors with Neurocognitive Function in Normal Elderly Subjects and Mild Cognitive Impairment (MCI) Patients / 신경정신의학

OBJECTIVES: We aimed to compare sleep factors including daytime sleepiness, sleep apnea and insomnia between mild cognitive impairment (MCI) patients and normal control (NC) subjects and to illustrate their relationship with neuropsychological function in the preclinical stage of dementia. METHODS: Epworth Sleepiness Scale (ESS), sleep apnea subscale of Sleep Disorders Questionnaire (SA) and questionnaire on insomnia were administered to community-dwelling elderly subjects above the age of 60. Both clinical and neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) assessment packet and Stroop Color and Word Test (SCWT) were done for each subject. Seventy seven NC subjects and 47 MCI patients were selected. RESULTS: In the NC group, ESS scores negatively correlated with Stroop interference (SI) scores. SA scores were negatively correlated with Stroop Color Word (SCW) and SI scores. In the MCI group, ESS scores negatively correlated with SCW scores, and SA scores had no correlation with each neurocognitive function test. CONCLUSION: Daytime sleepiness was associated with impaired executive function in community-dwelling normal elderly subjects and MCI patients. But the higher risk of SA was associated with decreased executive function only in normal elderly subjects.

Attitudes toward Disclosing Dementia Diagnosis in Korean Elderly and Family with Dementia Patients

OBJECTIVES: The aims of this study were to know whether Korean healthy elderly and family with dementia patients were wishing to disclose the diagnosis of dementia, to identify reasons of their wishing and unwishing to disclose, and to analyze influencing factors on the disclosing of dementia. METHODS: We obtained data from 78 healthy elderly with age over 60 and 73 family with dementia patients by interviewing with questionnaire about attitudes toward disclosing dementia. RESULTS: 1) 51.3% of healthy elderly and 58.9% of family with dementia patients were wishing to disclose dementia. Other relatives whom they wanted to tell were spouse or adult children. Most family with dementia patients wanted to have predictive tests in preparation for their future. 2) The main reasons for wishing to disclose were to make advance planning in healthy elderly, and to be careful and cooperate well to treat if they aware their illness in family with dementia patients (p<0.005, respectively). The main reasons for unwishing to disclose were whether they might be frightened or upset in healthy elderly (p<0.025), and to worry about being depressed in family with dementia patients (p<0.005). The main reasons why family wanted to be told were family's right to know and to explore treatment options. 3) The influencing factors on disclosing dementia seemed to be sex (p<0.01) and marital status (p<0.005) in healthy elderly, and education (p<0.005), marital status (p<0.005), religion (p<0.025) and socioeconomic status (p<0.01). CONCLUSION: The attitude toward disclosing diagnosis of dementia in Korean healthy elderly and family with dementia patients seemed to be more active. Therefore, doctors should prepare in mental attitude and knowledge to satisfy their need by active provision of information and education.

The Frequency of Serum Autoantibodies to the Epidermal Antigens among Normal Elderly People / 대한피부과학회지

BACKGROUND: One of the age-associated changes in immunity is the increase of autoantibodies due to dysregulation of the immune function. Anti-basement membrane zone antibodies were also reported to be found in the sera taken from normal elderly people. OBJECTIVE: The purpose of this study is to examine the frequency of autoantibodies to the epidermal antigens in the sera among normal elderly people. METHODS:Indirect immunofluorescence using salt-split human skin and immunoblotting with extracts from epidermoid carcinoma cell line(A431) were performed using sera from forty elderly persons without any systemic disease. RESULTS: Among 40 elderly individuals, 3 cases(7.5%) were positive for anti-basement membrane zone IgG antibodies in indirect immunofluorescence, and the titers were 1:10 to 1:40 dilution factor. In immunoblottings, 4 cases(10%) were positive with epidermal antigens; 2 were positive against the 180kD protein with IgG and IgA autoantibodies, 1 showed positive bands at 230kD and 180kD antigens with IgG, and remaining one showed positive at 130kD antigen who had negative result in indirect immunofluorescence. CONCLUSION: Autoantibodies against epidermal antigens(bullous pemphigoid angigen[230/180kD] or pemphigus vulgaris antigen[130kD]) can be detected without any bullous cutaneous diseases among elderly people; possibly as an epiphenomenon of immunosenescence.

The Frequency of Serum Autoantibodies to the Epidermal Antigens among Normal Elderly People / 대한피부과학회지

BACKGROUND: One of the age-associated changes in immunity is the increase of autoantibodies due to dysregulation of the immune function. Anti-basement membrane zone antibodies were also reported to be found in the sera taken from normal elderly people. OBJECTIVE: The purpose of this study is to examine the frequency of autoantibodies to the epidermal antigens in the sera among normal elderly people. METHODS:Indirect immunofluorescence using salt-split human skin and immunoblotting with extracts from epidermoid carcinoma cell line(A431) were performed using sera from forty elderly persons without any systemic disease. RESULTS: Among 40 elderly individuals, 3 cases(7.5%) were positive for anti-basement membrane zone IgG antibodies in indirect immunofluorescence, and the titers were 1:10 to 1:40 dilution factor. In immunoblottings, 4 cases(10%) were positive with epidermal antigens; 2 were positive against the 180kD protein with IgG and IgA autoantibodies, 1 showed positive bands at 230kD and 180kD antigens with IgG, and remaining one showed positive at 130kD antigen who had negative result in indirect immunofluorescence. CONCLUSION: Autoantibodies against epidermal antigens(bullous pemphigoid angigen[230/180kD] or pemphigus vulgaris antigen[130kD]) can be detected without any bullous cutaneous diseases among elderly people; possibly as an epiphenomenon of immunosenescence.