Cumulative illness and neuropsychological decline in hospitalized geriatric patients

A substantial portion of elderly patients admitted for inpatient rehabilitation treatment evidence cognitive dysfunction. Frequently, such patients also present with considerable medical comorbidity, that is, multiple concurrent illnesses. Identifying the potential role of cumulative illness in the etiology of cognitive decline in this group of frail elderly is limited by a lack of empirical information as little is known about this relationship. The goal of the present research was thus to investigate the relationship between cumulative illness and cognitive dysfunction while controlling for age and neurological and psychiatric symptomatology as these are previously known to affect cognitive function. Results indicate that cumulative illness predicts neuropsychological decline beyond the effects attributable to advanced age, mood, neurological pathology and psychiatric impairments. Even mild illness, if cumulative across several physical systems, can be predictive of cognitive deficits in this frail population. Of 11 organ systems studied, impairment of the vascular system was associated with the most diffuse profile of declined neuropsychological performance. Performances on measures of reasoning and judgment showed the strongest associations with cumulative illness. Implications of findings for neuropsychological diagnosis and prognosis are reviewed.

The folly of effort: ironic effects in the mental control of pain

During exposure to pain, participants who were engaged in hypnotic analgesia or stress inoculation provided pain reports every 5 s and 45 s, respectively. It was found that the frequency of pain reporting had a significant effect on participants' level of experienced pain. This finding is discussed in the context of important methodological implications for laboratory investigations of analgesia. Furthermore, preliminary evidence was obtained suggesting that high hypnotizables in hypnotic analgesia remained relatively undisrupted by frequent pain reporting. Based on Wegner's (1994) ironic process theory, it is argued that this pattern of results is inconsistent with theories of hypnosis that propose that hypnotized individuals intentionally engender responses while remaining unaware of their sustained, deliberate effort. The obtained pattern of results was, however, predicted from the dissociated control model of hypnosis (Bowers, 1990, 1992).

The effects of Dynavision rehabilitation on behind-the-wheel driving ability and selected psychomotor abilities of persons after stroke

OBJECTIVE

Many conventional rehabilitation exercises, such as pencil-and-paper and computer tasks, may not train perceptual and motor skills as applied to a complex, multiskill activity such as driving. The present study examined the usefulness of the Dynavision apparatus for driving-related rehabilitation. The Dynavision was designed to train visual scanning, peripheral visual awareness, visual attention, and visual-motor reaction time across a broad, active visual field.

METHOD

Ten persons with a cerebrovascular accident participated in the study. All had failed behind-the-wheel driving assessments. Subjects participated in a 6-week Dynavision training program using exercises designed to impose various motor, perceptual, and cognitive demands.

RESULTS

Dynavision training resulted in significantly improved behind-the-wheel driving assessments as compared to expected outcomes. Comparisons between pretests, posttests, and follow-up tests on a number of Dynavision, response, and reaction time variables showed significant improvements and maintenance effects. Dynavision performance, and, to a lesser extent, choice visual reaction and response times, were found to differentiate between persons assessed as safe and unsafe to drive, and between older and younger drivers. Subject self-reports suggested that a variety of training-related improvements had occurred in everyday functioning.

CONCLUSION

Dynavision training shows some rehabilitative promise for improving driving and basic psychomotor skills. Future research on the benefits and limitations of this apparatus should use finer laboratory skill measures and more comprehensive tests of driving and daily functioning to assess more thoroughly skill improvements in persons after stroke.

Test-retest reliability of three Dynavision tasks

The test-retest reliability of three Dynavision tasks of graded difficulty was estimated as high, with intraclass R correlation coefficients ranging from .88 to .97, and paired correlation coefficients ranging from .74 to .92. Recommendations are made for reliable testing procedures.

Test-retest reliability of the Dynavision apparatus

The test-retest reliability of two tasks on the Dynavision apparatus was estimated as moderate, with intraclass R correlation coefficients ranging from .71 (for .76 subjects) to .73 (for 41 subjects) and paired correlation coefficients ranging from 75 to 93.