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PubMed2006

Rethinking speed theories of cognitive development. Increasing the rate of recall without affecting accuracy.

Researchers have suggested that developmental improvements in immediate recall stem from increases in the speed of mental processes. However, that inference has depended on evidence from correlation, regression, and structural equation modeling. We provide counter-examples in two experiments in which the speed of spoken recall was manipulated. In one experiment, second-grade children and adults recalled lists of digits more quickly than usual when the lists were presented at a rapid rate of two items per second. In a second experiment, children received lists at a rate of one item per second; half the children were trained (successfully) to speak their responses more quickly than usual, at a rate similar to adults' usual rate. Recall accuracy was completely unaffected by either of these response-speed manipulations. Thus, although response rate is a strong marker of an individual's maturational level, it does not appear to determine the accuracy of immediate recall. These results have important methodological and theoretical implications for human development.

Adolescent↗

PubMedDate not supplied

Can cancer be cured by meditation and "natural therapy"? A critical review of the book You can conquer cancer by Ian Gawler.

There is a widespread belief that cancer is caused, at least in part, by aberrant mental processes. A corollary of this belief is that cancer may be cured by the application of the mind. These ideas are fostered in Australia by a popular book You can conquer cancer by Ian Gawler, a veterinary surgeon who attributes, at least in part, the development and subsequent cure of his own cancer to such processes. Critical examination of these beliefs finds evidence in their support to be lacking. None the less, many patients with cancer in this country follow the book's advice, often on the basis that it "at least can do no harm". While some patients may be aided to come to terms with their disease and to lead more fulfilling lives by taking up meditation and the positive approach to living that is described in the book, it also contains recommendations about orthodox treatments, life-style and diet which, if adopted uncritically, could be quite detrimental. The potentially harmful effects of accepting such unproved ideas about cancer need to be known more widely. Furthermore, because his ideas are making such an impact on the day-to-day treatment of cancer in this country, Gawler owes it to the community to justify, with evidence, his claims that by meditation patients with cancer may be enabled to achieve a cure of their disease in a way that is unattainable with orthodox medical treatment alone.

Attitude of Health Personnel↗

PubMed1997

P3 latency change in aging and Parkinson disease.

OBJECTIVE: To evaluate whether age-related slowing of mental processing assessed by event-related potentials is more prominent in patients with Parkinson disease (PD) than in age-matched control subjects. DESIGN: Consecutive case series of patients with PD and an age-matched control group. SETTING: A university hospital in Nishinomiya, Japan. STUDY PARTICIPANTS: Twenty-eight nondemented patients with PD and 28 age-matched control subjects. MAIN OUTCOME MEASURES: The P3 component of the event-related potentials was elicited during a visual semantic discrimination task. The relation of the P3 latency and the reaction time (RT) to age within each group was evaluated using correlation and regression analysis. The relationship among the P3 latency, the RT, and age was also assessed by dividing both groups into younger (age < 60 years) and older (age > or = 60 years) subgroups. RESULTS: The P3 latency and the RT of patients with PD were significantly longer than those of the control subjects (P < .01 and P < .02, respectively). There was a significant correlation between the P3 latency and age in both the parkinsonian and control groups (P < .01 and P < .05, respectively). The slope (b = 3.54 ms/y) of the P3 latency vs age was steeper among the patients with PD than among the control subjects (b = 1.66 ms/y) at the Pz site. The P3 latency in the older parkinsonian group (n = 16) was significantly prolonged compared with that in the older control group (n = 16) (P < .01), while no difference was found between the younger patients (n = 12) and the younger control group (n = 12). Similar trends were found for the RTs (P < .05). Neither the P3 latency nor the RT was correlated with any variable (eg, medication, mental status, illness duration, or motor disability). CONCLUSION: The results provide evidence that patients with PD experience excessive cognitive slowing with advancing age.

Adult↗

PubMed1994

PKU in adolescents: rationale and psychosocial factors in diet continuation.

Follow-up of early-treated children with PKU has shown that diet discontinuation in childhood presents risks of cognitive and emotional dysfunction in a substantial number of adolescents and young adults. This dysfunction includes IQ loss, mental processing abnormalities, learning difficulties, anxiety and personality disorders. In addition, neurologic deterioration has been reported in several such individuals. As a consequence of this current understanding of PKU, diet continuation, at least through adolescence and in the young adult years, is now recommended. Many centers are extending this to a policy of "diet for life". This represents a major challenge to adolescents and their families. Metabolic control using the criteria applied during childhood is virtually impossible to achieve past 12 years of age. Time constraints, social pressures, financial limitations and growing independence from the family combine to interfere with dietary control. Added to these difficulties are the biological changes during teenage years which reduce phenylalanine tolerance. To meet these challenges, we have identified a number of psychosocial factors that interfere with adherence to medical recommendations. The factors most highly related to metabolic control were social support for the diet and positive perceptions of treatment. This information has led to the development of support programs for adolescents and young adults with PKU.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1976

Amino acid precursors of monoamine neurotransmitters and some factors influencing their supply to the brain.

There is evidence that changes in the concentrations of the monoamine neurotransmitters within the brain are associated with changes in mental processes, with disorders of control of movement and with certain neuropsychiatric diseases. These neurotransmitters are synthesized in the brain from aromatic amino acid precursors that have to be obtained from the circulating blood. In this study some factors which alter the rates of entry of four amino acids (the important neurotransmitter precursors L-tyrosine and L-tryptophan, as well as L-phenylalanine and L-histidine) into the brain have been studied and the findings considered in relation to conditions in which the quantities of one or more of the monoamine neurotransmitters formed within the cerebral cells may be either too large or too small. Thus too little neurotransmitter will be formed if competition between amino acids for the carriers transporting them into the cerebral cells causes the exclusion of a large proportion of any of the aromatic amino acid precursors from the brain. ,or example, L-tryptophan is partially excluded from the brain if a raised level of any one of several other amino acids is maintained in the circulation. Of these, L-phenylalanine inhibits the transport of L-tryptophan into the brain most effectively, while aromatic amino acids in general exclude L-tryptophan more effectively than do other neutral amino acids. Over-production of one or more of the monoamine neurotransmitters is likely to occur when there is too much of one of the aromatic amino acid precursors in the brain cells as a result of abnormally high uptake from the blood, or as a result of their release by an excessive breakdown of the protein within these cells. Underproduction of neurotransmitters may occur in certain disease states, such as some aminoacidurias or Parkinsonism. We have listed some conditions associated with altered mental states or motor disability in which over- or under-production of monoamine neurotransmitters may occur and have tried to relate the findings in human disease with our experimental results.

Amino Acids, Essential↗

PubMed1975

The basal ganglia. A brief review and interpretation.

The data reviewed suggest that: 1. The BG are not only concerned with motor functions. 2. The BG are not directly involved in the control of neurophysiological, behavioral or homeostatic functions at a primary, elementary level. Thus, the effects of total ablation of the main component of the system, i,e. the caudate nuclei, demonstrates that the BG are not indispensable for life consciousness or the basic elementary integration of movements or sensory processes. 3. The BG operate at a high level of CNS integration and appears to be involved in two main types of, generally speaking, sensorimotor functions: a) The control of some of the organism-environment inter-relationships, both at a behavioral and neurological levels, a context of regulating the balance between approach and avoidance reactions. Some of the features of the acaudate cats suggest that this regulation might also include affective type reactions. b) The preparation or "setting up" of the organism for performance of both complex motor responses (response set), and of task requiring a high level of cognition (cognitive set). 26 High level of integration means here that, in the above functions, the BG control most probably operates upon performances not triggered reflexy, directly or indirectly, from the periphery but originated internally either "volitionally" or generated by symbolic, e.g. verbal, instructions. 4. The above functions appears to be accomplished by means of a modulatory action upon afferent signals arriving into the telencephalon and triggering efferent activities through forebrain output structures, particularly the neocortex. In normal conditions such modulation is seemingly carried on by means of a selective, flexible play of the intrinsic inhibitory mechanisms of the BG. When such control is disturbed either by pathology or by experimental manipulations, abnormal functional manifestations occur. These can be understood along the general concepts of (a) "release" from the BG inhibitory control ("compulsory approaching", hyperactivity, hyper reactivity, involuntary movements, abnormal postures, rigidity) or (b) "deficit" of the "setting up" for action postulated as a positive effect of striatal modulation (akinesia). The latter is viewed, therefore, as a permissive effect of the modulation, i.e., by selective removal of the inhibition, action is allowed to go through and to be expressed in actual performance. 5. Since lesions to individual BG structures, produced either neurosurgically in man or experimentally in animals, appear not to be capable of reproducing the complete clinical manifestations of any of the BG diseases, it follows that most of the BG syndromes in man must result from involvement of several BG components and often of other brain areas as well. More experimental work using the multiple lesions approach is needed to further ascertain this statement. 6. The literature on the effect of lesions and stimulation experiments, in particular, suggest that the BG are also involved in mental processes...

Acetylcholine↗

PubMed1995

Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change.

Implementation of practice guidelines remains problematic in spite of enormous efforts to develop and disseminate them, to establish their credibility, and to create incentives for physicians to adopt them. These strategies have failed to systematically change physician behavior because they do not address the involuntary time and mental processing constraints that have been clearly demonstrated to hamper physicians' ability to comply with guidelines. Computerized patient record systems directly address these constraints, and evidence is mounting that they are effective tools for changing physician behavior. A properly configured computerized patient record system provides decision support, facilitates work flow, and enables the routine collection of data for performance feedback. A synthesis of relevant research from the domains of practice guidelines and medical informatics strongly suggests that the operational support provided by computerized patient record systems will have a major impact on physician compliance with practice guidelines.

Ambulatory Care Information Systems↗

PubMed1984

Subcortical dementia. Review of an emerging concept.

Subcortical dementia is a clinical syndrome characterized by slowness of mental processing, forgetfulness, impaired cognition, apathy, and depression. First recognized in progressive supranuclear palsy and Huntington's disease, the concept has been extended to account for the intellectual impairment of Parkinson's disease, Wilson's disease, spinocerebellar degenerations, idiopathic basal ganglia calcification, the lacunar state, and the dementia syndrome of depression. Disorders manifesting subcortical dementia have pathologic changes that involve primarily the thalamus, basal ganglia, and related brain-stem nuclei with relative sparing of the cerebral cortex. Recent studies of neuropsychologic deficits following focal subcortical lesions also support a role for these structures in arousal, attention, mood, motivation, language, memory, abstraction, and visuospatial skills. The clinical characteristics of subcortical dementia differ from those of dementia of Alzheimer's type where prominent cerebral cortical involvement produces aphasia, amnesia, agnosia, and apraxia.

Alzheimer Disease↗

PubMed1992

Event-related potentials in human immunodeficiency virus infection. A prospective study.

P3 event-related evoked potentials (ERP) were recorded from 47 human immunodeficiency virus (HIV)-positive subjects examined twice and 29 HIV-positive subjects examined three times at 6-month intervals. The P3 latency significantly increased over time for asymptomatic subjects and subjects with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. N2 latency was prolonged relative to control values in both HIV-positive groups but did not increase with time. The P3 latency correlated with neuropsychologic measures of motor control and speed of mental processing. Confounding factors (active or previous substance abuse, developmental disabilities, and history of closed head injury or epilepsy) did not significantly affect ERP latencies. Endogenous ERP components are frequently abnormal in HIV-positive subjects and the P3 latency progressively increases over time. Continued follow-up is required to determine the clinical utility of ERP studies in the HIV-positive population.

Adult↗

PubMed1995

Vigabatrin vs carbamazepine monotherapy in patients with newly diagnosed epilepsy. A randomized, controlled study.

OBJECTIVE: To evaluate the efficacy, safety, and cognitive effects of initial vigabatrin monotherapy compared with initial carbamazepine monotherapy in patients with newly diagnosed epilepsy. DESIGN: Open, randomized, controlled design. Follow-up period of 12 months. SETTING: University hospital with an epilepsy center. PATIENTS: A total of 100 patients, aged 15 to 64 years, classified as suffering from partial seizures and/or generalized tonic-clonic seizures were randomized to either vigabatrin or carbamazepine monotherapy. Fifty-nine patients with a single epileptic seizure and no antiepileptic drug treatment served as a control population for objective safety measures. OUTCOME MEASURES: To evaluate the comparative efficacy and toxicity of vigabatrin and carbamazepine, the drug success rate (ie, the proportion of patients continuing successful treatment with the randomly assigned drug) after 12 months of steady-state treatment was used. To evaluate the safety of the drugs in addition to reported side effects, visual evoked potential recordings and neuropsychological evaluation were performed during follow-up. RESULTS: During the 12-month follow-up period, 60% of patients receiving vigabatrin and carbamazepine were treated successfully. Vigabatrin caused fewer side effects that required discontinuation of therapy. However, vigabatrin had to be discontinuated more often owing to lack of efficacy, and fewer of the successfully treated patients receiving vigabatrin achieved total freedom from seizures. Vigabatrin had no detrimental effects on cognitive functions. Retrieval from both episodic and semantic memory and flexibility of mental processing improved significantly in patients successfully treated with vigabatrin. CONCLUSION: Vigabatrin seems to be an effective and safe antiepileptic drug as primary monotherapy for epilepsy with fewer cognitive side effects than carbamazepine.

Adult↗

PubMed1998

Subclinical cerebral complications after coronary artery bypass grafting: prospective analysis with magnetic resonance imaging, quantitative electroencephalography, and neuropsychological assessment.

OBJECTIVE: To analyze the frequency and severity of subclinical cerebral complications associated with coronary artery bypass grafting (CABG). DESIGN: A prospective controlled study using preoperative and postoperative magnetic resonance imaging (MRI) of the brain, quantitative electroencephalography (QEEG), and detailed neuropsychological and neurologic examinations as potentially sensitive indicators of subclinical cerebral injury associated with CABG. SETTING: Multimodality evaluation in a tertiary care unit (Kuopio University Hospital, Kuopio, Finland). PATIENTS: Thirty-eight patients undergoing elective CABG and 20 control patients undergoing other major vascular surgery, mostly operations on the abdominal aorta. MAIN OUTCOME MEASURES: Coronary artery bypass grafting-associated cerebral complications assessed preoperatively and postoperatively by brain MRI, QEEG, detailed neurologic examination, and a neuropsychological test battery that evaluates cognitive functions in major areas known to be vulnerable to organic impairment (learning and memory, attention, flexible mental processing, and psychomotor speed). RESULTS: There were no major neurologic complications. A mild hemisyndrome developed in 1 patient who underwent CABG and in 1 control patient. Overall, there was no decline in mean cognitive performance 3 months after surgery. Electroencephalographic slowing of 0.5 Hz or more in at least 2 channels occurred in 11 patients who underwent CABG and in 1 control patient (P=.03). The postoperative brain MRI scan revealed new small ischemic lesions in 8 patients (21%) in the CABG group but in none of the control group (P=.03). These new cerebral MRI lesions did not explain deterioration in neuropsychological test performance or the QEEG slowing. CONCLUSIONS: Coronary artery bypass grafting causes more QEEG alterations and small ischemic cerebral lesions that are detectable by MRI than does other major vascular surgery. The effect is mainly subclinical, because no statistically significant deterioration in mean neuropsychological test performance was detected.

Aged↗

PubMed2001

Recognition memory and verbal fluency differentiate probable Alzheimer disease from subcortical ischemic vascular dementia.

BACKGROUND: Alzheimer disease (AD) and vascular dementia are among the most frequently occurring causes of dementia in the world, and their accurate differentiation is important because different pharmaceutical strategies may modify the course of each disease. OBJECTIVE: To determine which of 10 neuropsychological test scores can accurately differentiate patients with probable AD from those with subcortical ischemic vascular dementia (SIVD) for use in evidence-based clinical practice. DESIGN: Patients with suspected dementia were referred to the study by family physicians, geriatricians, and neurologists. All participants received a thorough assessment according to standard diagnostic guidelines. Diagnoses of probable AD (n = 31) and probable SIVD (n = 31) were made according to consensus criteria. The diagnosticians were blind to the results of the 10 neuropsychological test scores. RESULTS: There were no significant differences between the groups in age or Mini-Mental State Examination scores. Logistic regression analyses identified 2 neuropsychological tests that best distinguished the groups (sensitivity = 81%; specificity = 84%; positive likelihood ratio = 5.1). These were the recognition memory subtest of the Rey Auditory Verbal Learning Test and the Controlled Oral Word Association Test. The AD group performed better on the oral association test, whereas the SIVD group did better on the recognition memory test. CONCLUSION: Patients with probable AD and probable SIVD can be distinguished with a high degree of accuracy using these 2 neuropsychological tests.

Aged↗

PubMed1990

Valine, isoleucine, and leucine. A new treatment for phenylketonuria.

Early treatment of phenylketonuria by dietary phenylalanine restriction prevents brain damage. Behavioral and cognitive deficits occur when serum phenylalanine levels increase. Administration of valine, isoleucine, and leucine to patients with phenylketonuria may inhibit entry of phenylalanine into the brain and reduce its toxic effects on the central nervous system. Sixteen adolescents and young adults with phenylketonuria participated in double-blind trials in which a valine, isoleucine, and leucine mixture or a control mixture was given for four 3-month periods. Biochemical and neuropsychologic tests were carried out before and at the end of each period. Time to completion of a test that required substantial attention with mental processing (Attention Diagnostic Method) was faster during the valine, isoleucine, and leucine periods than during the control mixture periods. Improvement with valine, isoleucine, and leucine on a less demanding task (Continuous Performance Test) approached significance. These data lent support to the hypothesis that a regimen of valine, isoleucine, and leucine may help individuals unable to maintain low serum phenylalanine levels.

Adolescent↗

PubMed1999

Mindful practice.

Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary, everyday tasks. This critical self-reflection enables physicians to listen attentively to patients' distress, recognize their own errors, refine their technical skills, make evidence-based decisions, and clarify their values so that they can act with compassion, technical competence, presence, and insight. Mindfulness informs all types of professionally relevant knowledge, including propositional facts, personal experiences, processes, and know-how, each of which may be tacit or explicit. Explicit knowledge is readily taught, accessible to awareness, quantifiable and easily translated into evidence-based guidelines. Tacit knowledge is usually learned during observation and practice, includes prior experiences, theories-in-action, and deeply held values, and is usually applied more inductively. Mindful practitioners use a variety of means to enhance their ability to engage in moment-to-moment self-monitoring, bring to consciousness their tacit personal knowledge and deeply held values, use peripheral vision and subsidiary awareness to become aware of new information and perspectives, and adopt curiosity in both ordinary and novel situations. In contrast, mindlessness may account for some deviations from professionalism and errors in judgment and technique. Although mindfulness cannot be taught explicitly, it can be modeled by mentors and cultivated in learners. As a link between relationship-centered care and evidence-based medicine, mindfulness should be considered a characteristic of good clinical practice.

Clinical Competence↗

PubMed2000

Williams syndrome: from genotype through to the cognitive phenotype.

Williams syndrome, due to a contiguous gene deletion at 7q11.23, is associated with a distinctive facial appearance, cardiac abnormalities, infantile hypercalcemia, and growth and developmental retardation. The deletion is approximately 1.5Mb and includes approximately 17 genes. Large repeats containing genes and pseudogenes flank the deletion breakpoints, and the mutation mechanism commonly appears to be unequal meiotic recombination. Elastin hemizygosity is associated with supravalvular aortic stenosis and other vascular stenoses. LIM Kinase 1 hemizygosity may contribute to the characteristic cognitive profile. The relationship of the other deleted genes to phenotypic features is not known. People with Williams syndrome tend to be over friendly-though anxious-and lack social judgement skills. They exhibit an uneven cognitive-linguistic profile together with mild to severe mental retardation. Analysis of the cognitive phenotype based on analyses of the mental processes underlying overt behavior demonstrates major differences between normal and WS subjects although for some areas, such as face processing, WS subjects can achieve near normal scores. Cognitive analysis of patients with small deletions in 7q11.23 which include elastin and LIM Kinase 1 have revealed varying results and it is premature to draw genotype-phenotype correlations.

Animals↗

PubMed2001

The role of tests of frontal executive function in the detection of mild dementia.

OBJECTIVE: To compare the performance of patients with mild dementia (Mini Mental State Examination (MMSE) >23), depression (Montgomery-Asberg depression rating scale (MADRS) >12) and controls on tests of frontal executive function (FEF), to see if simple tools could be an adjunct to early recognition of dementia in primary care. DESIGN: Subjects were required to score above 23 on the MMSE, and to be non-depressed unless in the depression group. Tests of FEF used were a letter based verbal fluency test, a cognitive estimates test, trail marking parts A and B, and a Stroop colour word test. Subjects were followed up at one year to assess long-term outcomes. SETTING: The Thornhill Unit, an old age psychiatry unit, Moorgreen Hospital, Southampton, UK. PATIENTS: Sixteen patients with a clinical diagnosis of dementia but with normal or borderline MMSE scores, 16 subjects with depression and 19 healthy control subjects. RESULTS: Subjects with mild dementia scored significantly worse than control subjects on all FEF tests used other than verbal fluency. Subjects with mild dementia were only found to score worse than depressed subjects on the cognitive estimates test and Stroop test, with the Stroop test providing better discrimination between these groups. At follow-up, MMSE scores of both dementia and depression groups were worse. CONCLUSIONS: Many simple tests of FEF can distinguish subjects with mild dementia from controls, although caution must be taken in the presence of depression. Of these tests, the cognitive estimates test may provide a simple test which can be used in conjunction with screening tests for dementia, such as the MMSE. The Stroop colour test was the most successful at distinguishing subjects with mild dementia from those with depression, but was more difficult to use. The depression group remained cognitively impaired at follow-up, despite improvements in depressive symptoms.

Aged↗

PubMed1976

The concept of suggestion in the early history of advertising psychology.

As early as 1896, experimental psychologists began studying the mental processes involved in advertising. The first psychological theory of advertising maintained, in effect, that the consumer was a nonrational, suggestible creature under the hypnotic influence of the advertising copywriter. Walter Dill Scott was the major proponent of this theory, and it was largely through his writings that advertising men learned about the psychology of suggestion. Scott's theory was consistent with a growing trend in the advertising profession toward viewing consumer behavior as irrational. Scott's efforts might also be viewed as part of the trend in the advertising profession toward seeking a scientific basis for copywriting theory and practice.

Advertising↗

PubMed1979

The tasks of consciousness: how could the brain do them?

According to Darwin's theory of evolution by natural selection, the existence of mental operations proves their usefulness. Darwin called himself a mental materialist. This is one scientific theory of consciousness. Human consciousness has three useful aspects: awareness, intentionality and sharing with others. All have simple equivalents in animals. The latter two are neglected in neurophysiology and experimental psychology. Developmental, neuroanatomical and neuropsychological evidence shows that the human brain has innate structures of awareness, intentionality and interpersonal sharing. Human life depends on interpersonal cooperation. We may have a conscious self, but consciousness of others is essential in us. Studies of commissurotomy patients demonstrate the elaborate interconnected neural organization of consciousness and provide evidence of underlying and necessary levels of motivation, perception and motor integration below consciousness. Additionally, they show that awareness may be split into two different modes. These regulate one another during development and are complementary in culturally sophisticated adult life. One hemisphere, usually the left, has responsibility for expressing ideas and purposes in language. The other responds to the phenomenal context and the subjective situation. Both have human experiences and purposes. Both still collaborate in a unified intentional system after commissurotomy. Infant studies reveal that language develops out of an interpersonal mental process. This seems to control development of thinking. Thus notions of the newborn as an isolated amoral id, and of the infant as an egocentric discoverer of the object concept, must be rejected. Cultivation of moral awareness and a sense of purpose guided by meanings and values depends on innate organization of the human brain for interpersonal consciousness.

Awareness↗