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Neuropsychologia jesieni życia

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Psychologia Rozwojowa
|
2012
|
vol. 17
|
issue 1
85-98
EN
Contemporary debate on human aging is intensive and multifaceted in nature because of agerelated transformation in many contemporary societies, i.e. a rapid increase of mean life expectancy (increasing numbers of healthy old people). The aim of this article is to discuss changes in brain and behavior that occur in later life. Life-span developmental neuropsychology emphasizes a close relationship between cognitive problems in later life and age-related loss of large neurons in some parts of the brain. Large neurons shrink into smaller neuron classes. The most pronounced atrophic changes have been reported in the prefrontal area, hippocampus, ubstantianigra and locus cinereus. This article presents also common clinical conditions of later life, such as differential diagnosis of age-associated behavioral changes and dementias. There may be multiple causes of neurogeriatric disorders, such as Alzheimer’s disease. There has been considerable interest in the possible causative role of cognitive and brain reserve which differs among individuals. Therefore between-individual heterogeneity related to normal cognitive aging is signifi cant. Namely, if cerebral pathology occurs (e.g., neurodegeneration with dementia), persons with a greater reserve may not demonstrate the same cognitive impact as others with the same pathology (e.g. lesion size) but less reserve. It is also widely believed that mental difficulties in lder adults cannot be easily attributed to psychomotor slowness which may reflect a loss of white matter tissue, i.e. dysmielinisation of nerve fibers. This article emphasizes an importance of ecologically valid assessment of older adults, whose everyday activities and real--world abilities cannot be predicted by the traditional tests and sophisticated procedures emerging from purely experimental investigations.
PL
Assessment of executive function in an aging populationThe aim of this article is to review the literature about changes in brain and behavior that occur in later life, with particular implications for age changes in executive function, which comprises those capacities that enable a person to engage successfully in organized, goal-directed, flexible behaviour. Neuropsychological evaluation is emphasized because brain changes play a prominent role in the behavioural disturbances in an aging population, i.e. over 65-year old. The article provides an overview of selected aging processes, i.e. executive control, efforful inhibition of motor or cognitive response, and set shifting. There is wide agreement that the neural systems of the prefrontal cortex underlie age differences in cognitive decline, both general and specific to planning and control processes. It has also been argued that the volume of the frontal lobes decrease more than other cerebral areas with age. Some distinguishing features of both normal aging and cerebral pathology (e.g., Parkinson’s disease) are descibed in order to present a neuropsychological picture of these conditions, which is essential for the process of differential diagnosis. Moreover, the importance of “ecologically” valid evaluating of executive function in older patients was underscored, since it may be valid indicators of outcome and behaviour in everyday life. A fundamental thesis is that the complexity of demands imposed by everyday life can lead to significant dysfunction even when fairly good performance is observed during formal neuropsychological testing.
EN
The aim of this article is to discuss the nature of working memory impairment in Alzheimer’s disease (AD). We summarize the progress that has been made in the research on dementia-related deficits of selected components of working memory: central executive system, phonological loop and visuospatial sketchpad. It is concluded that impairments in working memory (on span tests) are a common problem in course of AD. Specifically, patients with mild AD have an abnormality in attentional rather than linguistic aspect of memory processing. Nevertheless, much more disturbances of phonological processes at later stages of the disease may underlie comprehension deficits. It is also possible that impairments in AD patients’ long-term semantic memory is the primary deficit underpinning the reduced contribution of language to remembering. Memory problems can be treated as reliable indicator or contributor to the severity of dementia. Finally, we emphasize the need to differentiate AD into “sub-types” based on the presentation of short-term forgetting and its neuroanatomical correlates.
PL
Stosunkowo mało poznanym zagadnieniem są mózgowe substraty poszczególnych procesów emocjonalnych oraz ich zaburzeń. Ogólnym celem prezentowanych badań była ocena wybranych problemów emocjonalnych po udarze niedokrwiennym prawej półkuli mózgu. Scharakteryzowano stan afektywny oraz zdolność słuchowego i wzrokowego rozpoznawania emocji. W badaniach wzięło udział 30 pacjentów po prawostronnym udarze mózgu oraz 31 osób zdrowych. Posłużono się Skalą HAD (Hospital Anxiety and Depression Scale – Zigmond i Snaith, 1983), Skalą Manii według Pużyńskiego (1979), Testem Prozodii Emocjonalnej z baterii neuropsychologicznej do oceny zaburzeń językowych po uszkodzeniach prawej półkuli mózgu (The Right Hemisphere Language Battery – Bryan, 1995; Łojek Skotnicka, Bryan, 2000) oraz Testem Rozpoznawania Wyrazu Emocjonalnego Twarzy (Facial Affect Recognition Test – Ekman i Friesen, 1976). U chorych z uszkodzeniem prawej półkuli mózgu zaobserwowano nasilone w różnym stopniu zaburzenia afektywne o charakterze depresyjnym lub maniakalnym. Jednocześnie wystąpił związek między prozodią recepcyjną i zdolnością rozpoznawania emocjonalnego wyrazu twarzy. Stwierdzono dysocjację zaburzeń różnicowania emocjonalnego w zakresie badanych modalności: najmniej problemów sprawiała wzrokowa identyfikacja „radości” oraz słuchowa identyfikacja „smutku”. Przeprowadzone badania ukazują związek zaburzeń emocjonalnych z uszkodzeniem prawej półkuli mózgu. Wyniki sugerują również ponadmodalny mechanizm percepcji emocjonalnej, której przebieg zależy od treściowej specyfiki bodźca.
EN
The brain substrates of individual emotional processes and of their disorders are relatively poorly known. The objective of this study was evaluation of selected emotional disturbances following ischaemic stroke of the right hemisphere. The state of affect as well as the capability of visual and auditory recognition of emotion were characterised. 30 patients after the right hemispheric stroke and 31 healthy subjects took part in the study. The following instruments were utilised in the study: Hospital Anxiety and Depression Scale (Zigmond, Snaith, 1983), Mania Scale (Pużyński, 1979), Emotional Prosody Test from The Right Hemisphere Language Battery (Bryant, 1995; Łojek et al., 2000) and Facial Affect Recognition Test (Ekman, Friesen, 1976). In patients with damage to the right hemisphere of the brain, emotional disorders of depressive and manic nature of varying severity were observed. A strong association was found between receptive prosody and the ability to recognice facial affect. The dissociation of emotional differentiation disorders was found with respect to the analysed modalities: visual recognition of joy and auditory recognition of sadness caused the least problems. This study demonstrates the association between affective disturbances with right hemisphere damage. The results suggest an non-specific common machanism of emocional perception whose course is dependent on the content specification of a stimulus.
PL
Dysfunkcje wykonawcze stanowią stosunkowo nową kategorę diagnostyczną, która obejmuje róźnorakie objawy dezorganizacji zachowania, takie jak utrata umiejętności planowania, inicjowania i kontrolowania podjętych działań. Jedną z najczęstszych przyczyn dysfunkcji wykonawczych jest udar mózgu. W badaniach wzięło udział 43 pacjentów, którzy rozwiązywali pięć zadań przeznaczonych do oceny ogólnej sprawności myślenia problemowego (Test Sortowania Kart z Wisconsin), przełączania uwagi (Test Łączenia Punktów, Test Kontrolowanego Kojarzenia Wyrazów – Fluencji Słownej), samokontroli hamującej reakcje konfliktowe (Test Interferencji Nazw i Kolorów – Stroopa, wystandaryzowane zadanie kontroli motorycznej). Pacjentów przydzielono do trzech podgrup różniących się lokalizację ogniska uszkodzenia mózgu. U wszystkich osób zawał ograniczał się jedynie do przednich, jedynie tylnych bądź jedynie podkorowych części mózgu (głównie prążkowia, wzgórza i / lub torebki wewnętrznej) według oceny topografii uszkodzeń wykrytych za pomocą TK i / lub MR. Zbadano również 25 osób zdrowych. Uzyskane wyniki wykazały, że: (a) zaburzenia wykonawcze po udarze mózgu były zróżnicowane pod względem nasilenia, jak i rodzaju; (b) zaburzona w stopniu najgłębszym okazała się zdolność hamowania automatycznych reakcji ruchowych; (c) pacjenci z uszkodzeniem płatów czołowych lub uszkodzeniem struktur podkorowych mózgu mieli więcej problemów z kontrolowaniem reakcji słownych i ruchowych niż pacjenci z uszkodzeniem części tylnej mózgu; (d) analiza profilowa (czyli analiza wzorca wyników całego badania) jest bardzo przydatna w diagnostyce intraindywidualnie heterogenicznych funkcji wykonawczych. Na przykład stwierdzono silny związek między stopniem dysharmonii wyników testowych a ogólnym nasileniem zaburzeń wykonawczych.
EN
Executive dysfunction (ExD) is a relatively common new diagnostic entity, which includes variety of symptoms of disorganized behavior, such as loss of ability to programming, initiating, and con-trolling ongoing actions. One of the most common origin of ExD is ischaemic stroke. Forty-three patients following unilateral hemispheric stroke were submitted to five tasks of executive functions, which is believed to measure an overall flexibility of problem solving (Wisconsin Card-Sorting Test), ability to switch of attention (Trail Making Test, Controlled Oral Word Association Test), and inhibitory control processes (Stroop Color-Word Test, go/no-go task). Subjects were divided into three anatomically-defined groups. The area of structural damage was limited entirely to the respec-tive frontal lobe, subcortical region (mostly striatum, thalamus, and/or internal capsule) or posterior (non-frontal) cortices. All brain lesions were verified by CT or MR scan. Also, 25 healthy subjects took part in the study. Results showed: (a) patients’ group manifested variety of ExD which were heterogeneous with respect to severity and character, (b) the most severe deficit was disinhibition of automatic response in go/no-go task, (c) the patients with frontal or subcortical lesions had more difficulties controlling (inhibiting) ongoing verbal and motor responses than the patients with posterior cerebral lesions, (d) utility of profile-based analysis (pattern analysis of test scores) was emphasized in diagnosis of intraindividual heterogeneity in executive functioning after stroke. For instance, a strong association was found between extent of intraindividual differences of test scores and the overall severity of ExD.
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