Quality of life one year after epilepsy surgery.

BACKGROUND: The aim of surgery for medically intractable epilepsy was to achieve seizure freedom and improve overall quality of life (QOL) in patients. This investigation looked at changes in QOL one year after epilepsy surgery and the relationship of changes to mood, language, and seizure outcomes. METHOD: Depressive symptoms, QOL, and naming were measured in 25 patients with temporal lobe epilepsy before and one year after dominant temporal lobe resection. The Quality of Life in Epilepsy-89 (QOLIE-89), Beck Depression Inventory II (BDI-II), and Boston Naming Test (BNT) were used, respectively, and seizure outcome was reported according to the Engel classifications. Minimum clinically important differences (MCID) and reliable change indices (RCI) were used to assess the proportion of patients who achieved meaningful improvement or worsening in the respective areas of functioning, and the relationship between outcomes was evaluated. Changes on the 17 individual items of the QOLIE-89 were also assessed. RESULTS: Overall, there was a significant improvement in QOL, reduction in depressive symptoms, and decline in naming one year after surgery. Positive clinically important improvement in QOL was achieved in 76% of patients, meaningful reduction of depressive symptoms was achieved in 20%, and clinically important naming declines were observed in 48% of the cohort. Sixteen patients were seizure-free one year after surgery, but there was no significant correlation between changes in QOL and seizure outcome, depressive symptoms, or naming. CONCLUSION: The results in the reported cohort of patients showed that surgical treatment of temporal lobe epilepsy in the dominant hemisphere resulted in clinically meaningful improvement in overall QOL and declines in naming but no significant reduction of mood disturbance.

Tipos de trastornos anómicos en las afasias / Types of anomic disorders in aphasia

Los trastornos anómicos están presentes en todos los síndromes afásicos, pero son muy heterogéneos ya que las causas que los producen son muy variadas al ser muchos los procesos cognitivos que intervienen en la producción oral. En este estudio se analizó una muestra de 28 pacientes afásicos pertenecientes a diferentes síndromes (afasias de Broca, de Wernicke, etc.), pero todos con trastornos anómicos. El objetivo era comprobar las variedades de anomias existentes y si esas variedades están ligadas a los síndromes clásicos. A esos pacientes se le aplicaron ocho tareas lexicosemánticas, fundamentalmente de denominación de dibujos (objetos y acciones), semánticas (emparejamiento palabra-dibujo, asociación semántica, etc.) y fonológicas (repetición de palabras y seudopalabras). En base a los resultados en esas tareas se clasificó a los pacientes mediante análisis discriminante en cuatro grupos (anomia pura, semántica, fonológica y mixta) y se analizaron las principales disociaciones (p. ej. denominación de objetos frente a denominación de acciones) existentes entre ellos. También se hicieron correlaciones entre los resultados de las tareas para comprobar la capacidad de las pruebas de predecir los distintos tipos de anomias. Los resultados muestran la existencia de una gran variedad de trastornos anómicos, que además son independientes de los síndromes a los que pertenezcan los pacientes (AU)

The anomic disorders are present in all the aphasic syndromes, but they are very heterogeneous because of their multiple causes, as there are many cognitive processes involved in the oral production. A sample of 28 aphasic patients belonging to different syndromes (Broca’s aphasia, Wernicke’s, etc.) but all with anomic disorders was analyzed in this study. The goal was to check the variety of anomias and their connection with the classical syndromes. Eight lexical-semantic tasks were applied to those patients, especially picture naming (objects and actions) and semantic (word-picture matching, semantic association, etc.) and phonological tasks (words and pseudowords repetition). On the basis of their results on those tasks the patients were classified in four groups through a discriminant analysis (pure, semantic, phonological and mixed anomia) and the main dissociations between the groups were analyzed (e.g, objects vs. actions naming). Other analysis were also carried out, specifically the correlations between the results in the tasks to check the capacity of the tasks to predict the different types of anomia. The results show the existence of a great variety of anomic disorders, which are besides independent of the syndromes to which the patients belong (AU)

Language impairment in euthymic, elderly patients with bipolar disorder but no dementia.

BACKGROUND: Neurocognitive impairment is known to occur in euthymic bipolar patients, but language alterations have not been thoroughly investigated. The aim of this study is to examine the performance in language tests of a sample of elderly patients with bipolar disorder. METHODS: We studied 33 euthymic elderly patients with bipolar disorder but no dementia and 33 healthy individuals, matched for age and education, who were compared in terms of their CAMCOG global score and its subitems. RESULTS: The scores obtained in language-related abilities for patients and controls, respectively, were: language (total): 27.3 (1) and 28.5 (1), p < 0.0001; comprehension: 8.6 (0.5) and 8.9 (0.3), p = 0.006; production: 18.7 (1) and 19.6 (0.9), p = <0.0001; abstraction: 6.8 (1.1) and 7.3 (0.7), p = 0.016; verbal fluency: 16.3 (4.3) and 19.6 (4.1), p = 0.003. CONCLUSION: A mild but significant impairment in language-related ability scores was detected when comparing patients and controls.

Naming is associated with left temporal pole metabolite levels in neurodegenerative diseases.

AIM: To investigate the relationship between performance in language tests and levels of brain metabolites in two selected left temporal lobe regions. METHODS: Ninety-five subjects were included: 26 controls, 30 amnestic mild cognitive impairment subjects, 27 Alzheimer's disease and 12 frontotemporal lobar degeneration (FTLD) patients. Language was assessed by a naming test: Boston Naming Test (BNT) and by a semantic verbal fluency test. Other cognitive functions: verbal and visual memory, visual perception, attention and executive function, and praxis were also assessed. Single voxel magnetic resonance spectroscopy was obtained in the left temporal pole (L-TPOLE), and in the left posterior temporoparietal region (L-TPAR). RESULTS: BNT scores were significantly associated with N-acetylaspartate/creatine ratios (r = 0.45; p < 0.001) and choline/creatine ratios (r = 0.33; p < 0.005) in the L-TPOLE. No significant associations were found between BNT and metabolite levels in the L-TPAR. No significant associations were found between the semantic verbal fluency test and other cognitive tests and metabolite levels either in the L-TPOLE or in the L-TPAR. CONCLUSION: Naming performance is related to metabolite levels in the anterior L-TPOLE.

Preserved proper naming following left anterior temporal lobectomy is associated with early age of seizure onset.

PURPOSE: Anterior temporal lobectomy (ATL) is an effective surgical option for managing pharmacoresistant temporal lobe epilepsy. Many patients with left ATL develop postsurgical difficulties with proper name retrieval, although curiously, some patients have entirely intact proper naming following left ATL. Here, we tested the hypothesis that early age of seizure onset would be a reliable factor "protecting" patients from developing proper naming defects following left ATL. METHODS: Proper naming of unique persons (Famous Faces Test, 155 items) and places (Landmark Test, 65 items) was measured in 23 patients who had undergone left ATL for pharmacoresistant epilepsy. Data were collected for a number of variables, including age of seizure onset, age at surgery, handedness, IQ, and seizure outcome. The patients were sorted into two groups based on proper naming performance: (1) Unimpaired: 7 patients performed normally on both the Faces and Landmark tests; (2) Impaired: 16 patients performed abnormally on one or both of the tests. RESULTS: In support of our hypothesis, the Unimpaired group had a significantly earlier age of seizure onset (M = 2.1 years) than the Impaired group (M = 15.1 years). Moreover, a correlation analysis indicated a strong association between age of seizure onset and naming outcome (R =-0.569). The groups were comparable (and statistically indistinguishable) on nearly all other variables. CONCLUSIONS: These findings document the importance of age of seizure onset in predicting proper naming outcome following left ATL (with earlier being better), and extend understanding of brain reorganization and plasticity.

Variabilidad en el acceso al léxico en el envejecimiento normal / Variability in lexical access in normal aging

Se ha estudiado la variabilidad interindividual o diversidad en el acceso al léxico en el proceso de envejecimiento normal. las medidas de variabilidad se basaron en el rendimiento de 141 voluntarios con edades comprendidas entre los 19 y 82 años en una tarea experimental de producción de eventos de la punta de la lengua (PDL) y en dos test de vocabulario, el WAIS y el Peabody. Se realizó un análisis descriptivo basado en la representación gráfica de máximos y mínimos y en un análisis de regresión polinomial sobre la edad. los resultados indicaban que la variabilidad se incrementa con la edad en dos de las medidas utilizadas, TR de los PDL y puntuaciones en el Peabody, pero no en frecuencia de PDL ni en puntuaciones del WAIS. Estos resultados se interpretan, dentro de la teoría de la división de recursos de procesamiento lingüístico, como que la variabilidad aumenta con el incremento de la edad en los procesos on-line pero no en los procesos off-line implicados en el procesamiento léxico. Se discute también la implicación de los hallazgos en relación con la teoría de la inteligencia fluida y cristalizada en la vejez, sugiriendo que la variabilidad aumenta en factores cognitivos fluidos pero no en los cristalizados

Variability between persons (diversity) in lexical access was examined in normal aging. Variability measures were based on performance of 141 volunteers aged from 19 to 92 years in an experimental task for producing tip of the tongue events (TOTs) and in two vocabulary tests (WAIS and Peabody). Data were subjected to a descriptive analysis based on maximum and minimum graphic representation, and to a polynomial regression analysis on age. Results indicated that variability increases with increasing aging in two of the used measures as RT of TOTs and Peabody scores but not in the frequency of TOTs and WAIS scores. These results are interpreted, in the light of the hypothesis of division of linguistic processing resources, as an increase of variability in the online but not in the off-line pracesses in aging. The findings are discussed with respect to the Crystallized and Fluid Intelligence theory in aging suggesting that variability increases for fluid factors but not for crystallized factors

Treating anomia in semantic dementia: improvement, maintenance, or both?

A treatment programme for AK, an anomic patient with semantic dementia is described. The programme was based on home practice and resulted in re-learning the names of some objects AK could not name and/or comprehend prior to the treatment. The effects of treatment were still present one month post-treatment for items that AK could not name but could comprehend prior to treatment. In addition to items that AK could not name, items that she could both understand and name were also included in the programme. This allowed us to evaluate the influence of practice on the retention of words that appeared to be intact at the outset of the investigation. Results indicated that practice delayed the progression of loss. In addition, the programme was designed jointly with AK who made many important decisions related to treatment.

Drawing: its contribution to naming in aphasia.

Drawing in aphasia therapy has been used predominately as a substitution for speech or to augment communication when other modalities are non-functional. The value of drawing as a route for facilitating verbal expression has not been a focus of prior research. We compared the usefulness of drawing and writing as compensatory strategies for improving naming in individuals with aphasia. Activation patterns of writing and drawing in healthy adults were examined using fMRI. Clinical results suggest that drawing facilitated naming whereas writing diminished accurate naming responses, and that drawing quality is not relevant to this facilitatory effect. Functional MRI findings revealed strong bi-hemispheric activation of semantic and phonological networks while drawing that may support our clinical findings.

Predicting cognitive decline in healthy older adults.

OBJECTIVE: Authors performed a neuropsychological determination of which individuals in a group of community-dwelling, healthy elderly volunteers would develop cognitive decline. METHODS: A group of 155 volunteers reporting good memory and thinking participated in a prospective study over 4 years. Authors monitored cognitive functioning and incidence of Mild Cognitive Impairment (MCI)/Alzheimer disease (AD). RESULTS: Baseline assessment revealed a subgroup of participants with deficits in associative learning and naming; subsequent cognitive decline was more precipitous in these individuals, who also showed higher relative risk of MCI/AD. CONCLUSION: Cognitive measures may be useful in community and clinical dementia screening and applicable for identifying enriched samples for trials of anti-dementia treatments.

La salud de los trabajadores en la empresa red / Workers´ Health in the network enterprise

La empresa, en cuanto organización para la producción y en cuanto institución social, está en la actualidad cambiando a un ritmo muy rápido, y estos cambios conceptuales, estructurales y de medios y recursos repercuten sobre la salud de los trabajadores. En el presente trabajo se abordan estas repercusiones en tres aspectos concretos: la anomía, el estrés y los problemas musculares (AU)

The ''enterprise'', considered both as an organization for production and as a social institution, is currently changing at a very rapid pace. These changes, which affect the concepts, the structure, and the means and resources, impinge on the workers´ health. We here address this impingement in three concrete aspects: anomy, stress and musculoskeletal problems (AU)

Efectos del tratamiento de la dependencia a la heroína en la anomia, alienación y autoconcepto / Effects of the treatment heroin dependency on anomie, alienation and self-concept

En este estudio nos planteamos contrastar la efectividad de 3 programas de tratamiento de drogodependientes de heroína (Programa Libre de Drogas, Programa de Mantenimiento con Metadona y Programa de Mantenimiento con Naltrexona) en las medidas de la anomia, alienación y autoconcepto. Tomamos 91 pacientes a tratamiento por heroína: 31 a tratamiento con metadona, 30 a tratamiento con naltrexona y otros 31 en un programa libre de drogas. Los resultados mostraron que los pacientes estaban altamente alienados y no evidenciaron un efecto significativo del factor tratamiento. Los resultados también informan de niveles elevados de anomia entre los pacientes a tratamiento a la vez que un efecto significativo del factor tratamiento. En concreto, los pacientes a tratamiento con metadona perciben mayores niveles de anomia que aquellos a tratamiento con naltrexona. Asimismo, observamos que el autoconcepto era positivo para el conjunto de pacientes a la vez que encontramos que los pacientes a tratamiento con metadona presentaban un autoconcepto más bajo en algunos componentes que aquellos a tratamiento con naltrexona o en un programa libre de drogas. Finalmente, se discuten las Implicaciones para los programas de intervención y prevención (AU)

The aim of this study was to contrast the effectiveness of three different treatment programmes for heroin abusers (drugfree treatment, antagonist treatment, and agonist treatment programmes) in mitigating the alienation, anomie and personal breakdown. 91 subjects were undergoing drug therapy: 30 with methadone treatment, 30 with naltrexone treatment and 31 with drug-free treatment. The results showed high alienation levels among the subjects in treatment and a non-significant effect was found in relation to the treatment factor. The results also indicate high levels of anomie among the subjects in treatment and a significant effect of the treatment factor i.e., higher anomie among patients treated with methadone v. naltrexone. Moreover, in the sample as a whole, self concept was positive at the same time we found that patients being treated with methadone had a lower self-concept in certain components than those being treated with naltrexone or taking part in a drug free programme. Implications for intervention and prevention programs are discussed (AU)

Predicability (ease of predication) as semantic substrate of imageability in reading and retrieval.

It was proposed by Jones (1985) that the apparent influence of a word's imageability upon the probability of the word being read correctly by a deep dyslexic person could be understood in terms of an underlying semantic variable, ease of predication (also termed predicability). In a recent critique, de Mornay Davies and Funnell (2000) claim to have identified a number of problems with the ease of predication proposal. It is shown here, however, that it is the critique itself which is fundamentally flawed. In contrast, the predicability approach continues to identify correctly the semantic substrate of apparent effects of imageability upon reading and memory retrieval.

Influence of age, sex, literacy and pathologic lesion on incidence, severity and type of aphasia.

The influence of sex, age, educational level and pathologic lesion on incidence, severity and clinical form of aphasia was investigated in 390 right-handed, left brain-damaged patients. Sex and educational level were not related to any parameter. Etiology of lesion and age were related to both incidence and type of aphasia. Incidence of aphasia increased with age and was higher in patients with cerebrovascular accidents than in subjects with other types of brain lesions. Non-fluent forms of aphasia were more frequent in young patients suffering from acute cerebrovascular accidents, whereas anomia prevailed in neoplastic subjects and Wernicke's aphasia increased regularly in frequency with age. Some tentative explanations of these findings are discussed.