Cognitive and memory training in adults at risk of dementia: A Systematic Review

<p>Abstract</p> <p>Background</p> <p>Effective non-pharmacological cognitive interventions to prevent Alzheimer's dementia or slow its progression are an urgent international priority. The aim of this review was to evaluate cognitive training trials in individuals with mild cognitive impairment (MCI), and evaluate the efficacy of training in memory strategies or cognitive exercises to determine if cognitive training could benefit individuals at risk of developing dementia.</p> <p>Methods</p> <p>A systematic review of eligible trials was undertaken, followed by effect size analysis. Cognitive training was differentiated from other cognitive interventions not meeting generally accepted definitions, and included both cognitive exercises and memory strategies.</p> <p>Results</p> <p>Ten studies enrolling a total of 305 subjects met criteria for cognitive training in MCI. Only five of the studies were randomized controlled trials. Meta-analysis was not considered appropriate due to the heterogeneity of interventions. Moderate effects on memory outcomes were identified in seven trials. Cognitive exercises (relative effect sizes ranged from .10 to 1.21) may lead to greater benefits than memory strategies (.88 to -1.18) on memory.</p> <p>Conclusions</p> <p>Previous conclusions of a lack of efficacy for cognitive training in MCI may have been influenced by not clearly defining the intervention. Our systematic review found that cognitive exercises can produce moderate-to-large beneficial effects on memory-related outcomes. However, the number of high quality RCTs remains low, and so further trials must be a priority. Several suggestions for the better design of cognitive training trials are provided.</p

Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review

Background Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults. Methods A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these. Results 28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures. Conclusions The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.ISSN:1471-231

LA TOSSICODIPENDENZA COME REFERENTE SIMBOLICO DI CRISI. PROIBIZIONISMO E FUNZIONE STRATEGICA DELLA COMUNICAZIONE ATTRAVERSO LA LEGGE

L'articolo approfonidesce la discussione relativa al proibizionismo e alla punibilit\ue0 delle condotte tossicofiliche e delle tossicodipendenze. In particolare, viene messo in rapporto il nesso tra punizione e marginalizzazione sociale

L'INASPERIMENTO DELLA PUNIBILITA' DELLA TOSSICODIPENDENZA E L'INVALIDAZIONE DEL LAVORO PSICOTERAPEUTICO

Il presente lavoro , che rispetta l’approccio socio-costruzionista elaborato in Salvini, Testoni, Zamperini (2002), affronta il problema relativo alla revisione in senso proibizionista del DPR 390/90 in discussione in Parlamento con la bozza di disegno di legge secondo la versione del 13.11.2003 . L’articolo intende mostrare come il problema della tossicodipendenza nella società occidentale contemporanea sia un referente simbolico di crisi, ossia si accede ad esso nel dibattito politico per costruire rappresentazioni di una paura – quella provata verso tossicodipendente e il suo mondo – che, per quanto profonda, risulta sostenibile. Ricordando quanto indicato da Galimberti (2002), secondo cui la differenza tra paura e angoscia si gioca all’interno del credere di poter o non poter dominare il pericolo e che per gestire la prima la si riduce all’ambito della seconda, viene ipotizzato che siffatta operazione abbia una funzione difensiva perché permette di creare rappresentazioni ritenute gestibili per proteggersi dall’angoscia più radicale evocata da quanto di realmente pericoloso viene percepito come incontrollabile. Ma questa operazione giocata a livello di rappresentazione ha un costo elevato sulla realtà sociale, che viene pagato dai tossicodipendenti ai quali è dunque attribuita la funzione di capro espiatorio. Lasciando sullo sfondo le modalità con cui il potere dominante facilita e asseconda la costruzione della rappresentazione del “tossicodipendente da punire” per produrre effetti rassicuranti sulla popolazione, si considerano i problemi che derivano per il lavoro terapeutico allorquando tali posizioni politiche invalidino l’intervento di solidarietà sociale. In particolare si considera la vanificazione dell’intervento in Comunità Terapeutica [CT], passando attraverso le considerazioni relative alla fiducia messa in gioco nella relazione di cura, ove – nel rispetto della prospettiva della riduzione del danno – è invece lasciato al tossicodipendente il tempo per attribuire “in prima persona” il senso della propria astinenza per un progetto di vita diverso da quello prodotto dalla coazione all’identità deviante

ERYTHROBLASTIC ISLANDS IN THE BONE-MARROW OF RHEUMATOID-ARTHRITIS WITH ANEMIA

An increase of erythroblastic islands with recognizable central macrophages was observed in bone marrow of 6 RA patients suffering from anaemia. It is possible that this morphological finding might be an expression of the ineffective erythropoiesis observed in RA patients with anaemia

Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): A case control study

Data support the evidence that neuropsychological rehabilitation is effective in Alzheimer disease (AD), to strengthen the pharmacological treatment to delay the progression of dementia. At moment, a few studies have examined the efficacy of non-pharmacological treatment in MCI. This is a controlled study that assesses the effectiveness of neuropsychological rehabilitation on cognitive and behavioral symptoms and functional status in a group of community-dwelling subjects with MCI and MD. Our results demonstrate that a systematic rehabilitation, that provides a computerized cognitive program training, produces an improvement in cognitive and affective status of patients with MCI and MD, while a rehabilitation program not providing a punctual stimulation of cognitive functions, does not have significant effects