Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Review of Robust Cooperative Spectrum Sensing Techniques for Cognitive Radio Networks

Cognitive radio networks sense spectrum occupancy and manage themselvesto operate in unused bands without disturbing licensed users. The detection capability of aradio system can be enhanced if the sensing process is performed jointly by a group of nodesso that the effects of wireless fading and shadowing can be minimized. However, taking acollaborative approach poses new security threats to the system as nodes can report falsesensing data to reach a wrong decision. This paper makes a review of secure cooperativespectrum sensing in cognitive radio networks. The main objective of these protocols is toprovide an accurate resolution about the availability of some spectrum channels, ensuring thecontribution from incapable users as well as malicious ones is discarded. Issues, advantagesand disadvantages of such protocols are investigated and summarized.

De los contenidos a las competencias numéricas en la enseñanza obligatoria = From contents to numerical competence in Compulsory Secondary Education

Mathematics has formed part of all our daily lives since the most remote origins of our civilization, although on too many occasions schools have done little for this functional view of mathematics reclaiming the formal role of this discipline in detriment of its more practical and applied element. From this perspective the curriculum organized by competence arises due to the need to fill this vacuum and allow our students to function better in the constant elements of real situations which they are going to have to resolve throughout their lives. The specifying of this general view of mathematic competence in the numeric competence should allow all our students to progressively acquire numeric sense, that is, that they have the capacity to apply good quantitative ideas in real situations

'Situaciones problema' y desarrollo de la competencia motriz en educación física escolar: cuestiones didácticas = Problem situations and developing motor competence in Physical Education at school: didactic questions

From the areas of motor learning and the teaching of Physical Education we promote coherent methodological orientationswith the present curricular guide that are focused in such a way so that the student is able to act independently. In thissense we may consider the problem situations as a good example for methodological proposals. So as to determine its useand adequateness for Physical Education it is conveniente to analyse the characteristics of the motor tasks that areproposed as well as the features of the teaching intervention in such a way as to ease the adquisition and development ofthe motor competence of the students

Social competence and loneliness during the school years - Issues in assessment, interrelations and intergenerational transmission

Väitöskirjassa tarkastellaan kouluikäisten lasten ja nuorten sosiaalisen kompetenssin ja yksinäisyyden mittaamista, yhteyksiä ja periytyvyyttä vanhemmilta heidän lapsilleen. Alakouluikäisten lasten tutkimusaineisto (n=985) koostuu lapsilta itseltään, heidän luokkatovereiltaan, opettajiltaan ja vanhemmiltaan vuosina 2000 - 2004 osana Merkitystä etsimässä – tutkimusprojektia (M. Vauras) kerätystä aineistosta. Mukana on itse-, toveri-, opettaja- ja vanhempien arviot lasten sosiaalisesta kompetenssista, seuranta-aineisto lasten yksinäisyydestä, opettajien arviot lasten motivationaalisesta orientaatiosta, standardoiduin testisarjoin arvioidut akateemiset taidot sekä lasten äitien ja isien arviot omasta yksinäisyydestään ja koetusta kyvykkyydestään toimia vanhempana. Yläkouluikäisten nuorten (n=386) aineisto koostuu vuosina 2006 – 2007 osana Sosioemotionaalinen oppiminen ja hyvinvointi yläkouluyhteisössä (P. M. Niemi) kerätystä nuorten yksinäisyyden, sosiaalisen ahdistuneisuuden ja sosiaalisen fobian seuranta-aineistosta. Mitattavuutta (päätavoite 1) tutkittiin erityisesti monitahoarviointien rakenteiden yhtenäisyyksiä, subjektiivisten arvioiden ajallista pysyvyyttä sekä mittareiden validiteettia ja reliabiliteettia testaamalla. Sosiaalisen kompetenssin ja yksinäisyyden keskinäisten yhteyksien lisäksi tarkasteltiin näiden yhteyttä alakoululaisten oppimiseen sekä yläkou¬lulaisten psykososiaaliseen hyvinvointiin (päätavoite 2). Kolmantena päätavoitteena oli selvittää yksinäisyyden mahdollista periytymistä vanhemmilta lapsille. Osana ensimmäistä päätavoitetta kehitettiin Monitahoarviointi sosiaalisesta kompetenssista (MASK) -arviointimenetelmä (artikkeli 1). Konfirmatorisen faktorianalyysin tulosten perusteella nelifaktorinen rakenne (prososiaalisuus sisältäen yhteistyötaidot ja empatiakyvyn sekä antisosiaalisuus sisältäen impulsiivisuuden ja häiritsevyyden) sopi sekä lasten itsensä, heidän luokkatovereidensa, opettajiensa että vanhempiensa tekemiin arviointeihin. Eri tahojen arviointien väliset korrelaatiot olivat tilastollisesti merkitseviä, joskin suhteellisen matalia, ts. eri tahojen näkökulmat lapsen sosiaalisesta kompetenssista ovat toisistaan eriäviä. Täten eri arvioitsijatahojen käyttäminen on kokonaisuuden tutkimisen kannalta tärkeää. Toisena mittaamiseen liittyvänä tavoitteena oli validoida Hozan, Bukowskin ja Beeryn (2000) sosiaalisen ja emotionaalisen yksinäisyyden mittari suomalaisille lapsille (artikkeli 3) ja nuorille (artikkeli 4) soveltuvaksi sekä tutkia, ovatko lasten ja nuorten arviot omasta yksinäisyydestään ajallisesti pysyviä. Alakoululaisten lasten osalta yksinäisyys, erityisesti sosiaalinen yksinäisyys osoittautui suhteellisen pysyväksi, mutta vahvistui entisestään yläkouluikäisten nuorten aineistoa tarkasteltaessa. Huomionarvoista sekä ala- että yläkoululaisten aineistoissa oli poikien kokema vahva emotionaalinen yksinäisyys. Molempien mittareiden osalta sekä validiteetti että reliabiliteetti todettiin hyväksyttäväksi ja niitä voidaan suositella lasten ja nuorten sosiaalisen kompetenssin ja yksinäisyyden arviointimenetelmiksi. Toisena päätavoitteena oli rakenneyhtälömallinnuksen keinoin tarkastella sosiaalisen kompetenssin ja yksinäisyyden yhteyksiä sekä keskenään (artikkelit 2 ja 3) että suhteessa lasten oppimiseen (artikkeli 2) ja nuorten psykososiaaliseen hyvinvointiin (artikkeli 4). Alakouluikäisten lasten osalta sosiaalinen kompetenssi oli yhteydessä pait¬si yksinäisyyteen myös opettajien oppilaistaan tekemiin motivationaalisen orientaation arvioihin sekä standardoiduin testien arvioituihin akateemisiin taitoihin. Yläkouluikäisten nuorten osalta yksinäisyys oli yhteydessä sosiaaliseen ahdistuneisuuteen ja sosiaaliseen fobiaan. Täten sosiaalisen kompetenssin voidaan katsoa olevan koululaisten hyvinvointia ja oppimista vahvistava, ja toisaalta yksinäisyyden nuorten psykososiaalista hyvinvointia heikentävä tekijä. Viimeisenä päätavoitteena mallinnettiin yksinäisyyden mahdollista periytyvyyttä. Ensimmäisessä vaiheessa periytyvyyttä tarkasteltiin koko perheen sisällä, vanhempien tai lasten sukupuolta erottelematta (artikkeli 2). Tässä rakenneyhtälömallissa vanhempien kokema yksinäisyys ennusti heikompaa kyvykkyydentunnetta vanhemmuudesta, joka edelleen ennusti lapsen heikompaa toveriarvioitua sosiaalista kompetenssia koulussa ja tätä kautta vahvempaa yksinäisyyden kokemusta. Toisessa mallissa eroteltiin äitien ja isien sekä tyttöjen ja poikien aineistot, jotta periytyvyyttä voitiin tarkastella äiti-tytär, äiti-poika, isä-tytär ja isä-poika dyadisuhteissa. Rakenneyhtälömallinnuksen tulosten perusteella sekä äitien että isien kokema yksinäisyys ennusti

AU COMMENCEMENT ÉTAIT LA MÉTAPHORE: UNE INTUITION PRÉCOCE DE NIETZSCHE SUR LA PRIMAUTÉ DE LA MÉTAPHORE COMME MATRICE COGNITIVE

RÉSUMÉ Cette étude met en perspective le précédent constitué par les travaux précoces du jeune Nietzsche où ce dernier fait valoir la force structurante de la métaphore comme matrice des facultés cognitives. Nous offrons d’abord une brève esquisse des postulats et des acquis des grammaires cognitives associées aux travaux d’Eleanor Rosch, ensuite de George Lakoff et Mark Johnson, ainsi qu’à la notion d’inscription corporelle de l’esprit développée par Francesco Varela. Cet exercice sert de propédeutique à une série de lectures tangentes mobilisant divers angles d’approche appelés à faciliter noter évaluation des contributions de Nietzsche au domaine de la cognition. Les travaux examinés nous situent dans la période contemporaine de la publication de son premier grand ouvrage, La naissance de la tragédie (1872) : les notes pour le cours intitulé Présentation de la rhétorique ancienne (Darstellung der antiken Rhetorik), prononcé au semestre d’hiver 1872-1873 à l’Université de Bâle, ensuite ses Theoretische Studien, datant de l’été 1873, avec un renvoi aux développements plus tardifs dans le Gai Savoir (1882). La thèse de Nietzsche peut être résumée comme suit : tous les éléments de l’appareil catégorial et du régime conceptuel à l’aide desquels nous appréhendons la réalité, a fortiori la notion de vérité qui en est le garant, sont le « précipité » ou le résidu d’un faisceau de métaphores qui constituent la force structurante des facultés cognitives. Si chez Kant nous n’avons accès qu’aux phénomènes et non au noumène, chez Nietzsche nous n’avons affaire qu’à des perspectives ou des points de vues alors que la réalité nous est monnayée sous forme de vérités qui sont des fictions ou des métaphores usées. Il ressort de cet examen que le tropisme endogène de la langue constitue une force majeure dans l’implémentation d’une conceptualité qui a la vertu d’oblitérer sa préhistoire et de se ménager un statut qui est incessamment implosé par le reflux de l’imagination créatrice nourrie par la force métaphorique qui répond à une impulsion foncière que Nietzsche associe à une « force artiste » (Kunstkraft) qui tend à démultiplier les perspectives dont la généalogie se conjugue à l’exponentiel.

Verbal learning in mild cognitive impairment and alzheimer's disease : behavioural and neural approaches

The main focus of the present thesis was at verbal episodic memory processes that are particularly vulnerable to preclinical and clinical Alzheimer’s disease (AD). Here these processes were studied by a word learning paradigm, cutting across the domains of memory and language learning studies. Moreover, the differentiation between normal aging, mild cognitive impairment (MCI) and AD was studied by the cognitive screening test CERAD. In study I, the aim was to examine how patients with amnestic MCI differ from healthy controls in the different CERAD subtests. Also, the sensitivity and specificity of the CERAD screening test to MCI and AD was examined, as previous studies on the sensitivity and specificity of the CERAD have not included MCI patients. The results indicated that MCI is characterized by an encoding deficit, as shown by the overall worse performance on the CERAD Wordlist learning test compared with controls. As a screening test, CERAD was not very sensitive to MCI. In study II, verbal learning and forgetting in amnestic MCI, AD and healthy elderly controls was investigated with an experimental word learning paradigm, where names of 40 unfamiliar objects (mainly archaic tools) were trained with or without semantic support. The object names were trained during a 4-day long period and a follow-up was conducted one week, 4 weeks and 8 weeks after the training period. Manipulation of semantic support was included in the paradigm because it was hypothesized that semantic support might have some beneficial effects in the present learning task especially for the MCI group, as semantic memory is quite well preserved in MCI in contrast to episodic memory. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, indicating that the MCI patients’ preserved semantic memory abilities compensated for their impaired episodic memory. The MCI group performed equally well as the controls in the tasks tapping incidental learning and recognition memory, whereas the AD group showed impairment. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that acquisition is compromised in both MCI and AD, whereas long13 term retention is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI. In studies III and IV, the neural correlates of naming newly learned objects were examined in healthy elderly subjects and in amnestic MCI patients by means of positron emission tomography (PET) right after the training period. The naming of newly learned objects by healthy elderly subjects recruited a left-lateralized network, including frontotemporal regions and the cerebellum, which was more extensive than the one related to the naming of familiar objects (study III). Semantic support showed no effects on the PET results for the healthy subjects. The observed activation increases may reflect lexicalsemantic and lexical-phonological retrieval, as well as more general associative memory mechanisms. In study IV, compared to the controls, the MCI patients showed increased anterior cingulate activation when naming newly learned objects that had been learned without semantic support. This suggests a recruitment of additional executive and attentional resources in the MCI group.

The cultural dimension in focus : promoting awareness of diversity and respect for difference in a Finland-Swedish EFL classroom

This study addresses the role of EFL education, its potential and shortcomings, and the challenges the future of EFL education will bring. It is argued that new societal demands and the limited time we have at our disposal in the classroom make it necessary to rethink goals and content and move away from the transmissionof limited sets of facts and information to helping students develop awareness and competences that can be applied in many different situations, also in a perspective of lifelong learning. The overall aim of the current study is to problematize and increase understanding of the implementation of cultural aspects in the language classroom by addressing the interrelated what, why and how of the cultural dimension within EFL education. This has been conducted by means of theoretical explorations into the area, alongside an attempt at promoting intercultural competence (IC) in a more systematic and insightful manner within my own educational praxis. The focus of the intercultural work in the classroom was on the promotion of awareness of difference and diversity, as well as respect for such difference through the ability to decenter from cultural norms and behavior that previously have been taken for granted. These are two elements that have been suggested as fundamental for other work with IC in the classroom and for the realization of important aspects of the underlying values of basic education. In the context of this study, IC comprises several interconnected components supportingeach other in a variety of ways, with the further aim being interaction with and respect for difference in general, not only concerning e.g. representatives ofcertain English-speaking communities. The methodology was informed by action research, with myself in the role of the teacher-researcher or the reflective practitioner. For the purpose of the project I was authorized to take on the EFL education for the three years of upper comprehensive school of one random class of students originally assigned to one of the language teachers of the selected Finland-Swedish school. Thus, the class of 17 students was not specifically chosen for the project, and the aims and contents chosen for the development project were placed within the framework of the ordinary curriculum. By exploring the students¿ insights concerning different English-speaking cultural groups, mainly through a set of questionnaires, it was possible to outline the work with the cultural dimension in the classroom for the following three years. Work progress was evaluated at specific stages, and the final project evaluations were conducted through individual student interviews in grade 9. The interviews were focused on possible development of students¿ insights concerning different aspects of the cultural dimension. In particular this concerned awareness of difference and diversity, including modification of stereotypes, as well as the ability to decenterin order to be better able to respect such difference. I also explored students¿ awareness and views of the activities and approaches used in class, as well asaffordances both inside and outside the EFL classroom in relation to these intended insights. A further focus area was the perceived relevance to students of different aspects of the cultural dimension. The frameworks and approaches adopted for the work in the classroom all have in common that they are based on a constructivist framework, where knowledge is constructed and reconstructed through interaction with one¿s social and cultural environment, including interaction with others. Reflective processes precede or are simultaneous with the learning of basic factual knowledge. This entails a view of learning as a progression from simple to more complex models rather than as a progression from facts to understanding and analysis. Here, the development of intercultural competence is seen asa cyclical process, or along a spiral curriculum, from simple to more complex levels through a combination of cognitive, affective and behavioral elements within a framework of experiential learning. This project has shown one possible wayforward concerning the development of intercultural competence within EFL education through a more systematic and comprehensive approach regarding linguistic and cultural aspects. The evaluation of the educational process explored in the study suggests the possibilities for work with the promotion of awareness of difference and diversity concerning some specific context that, based on students¿ prior knowledge and preconceptions, would benefit from further work. In this case, the specific context primarily concerned different aspects of both cultural and linguistic conditions in the UK. It is also suggested that many students developed the ability to decenter, described in the study as integral to being able to respect otherness. What still remains to be explored are more individualized approaches considering students¿ different levels of departure. Further work alsoneeds to be put into how to apply insights gained in these specific situations to more general contexts. It is also necessary to explore the use of the suggested approaches in a wider range of different contexts.

In pursuit of an intercultural dimension in EFL-teaching : exploring cognitions among Finland-Swedish comprehensive school teachers

This thesis is about the educational purpose of foreign language teaching (FLT) in an increasingly internationalised world.The past 20-30 years have witnessed a fundamental rethinking of the aims of FLT, entailing a shift in emphasis from linguistic competence over communicative competence to intercultural competence. The growing emphasis on cultural issues, called for by research and international curricular documents, places new demandson language teachers. The overall aim of this study is to deepen the knowledge about the attitudes of teachers at the upper level of the Finland-Swedish comprehensive school towards the treatment of culture in English foreign language (EFL) teaching. The questions in focus are: 1) How do teachers interpret the concept"culture" in EFL-teaching?, 2) How do they specify the cultural objectives of their teaching? and 3) What do they do to attain these objectives? The thesis strives to reveal whether or not language teaching today can be describedas intercultural, in the sense that culture is taught with the aim of promotingintercultural understanding, tolerance and empathy. This abductive and largely exploratory study is placed within a constructivist and sociocultural framework,and is inspired by both phenomenography and hermeneutics. It takes its starting-point in language didactics, and can also be regarded as a contribution to teacher cognition research. The empirical data consists of verbatim transcribed interviews with 13 Finland-Swedish teachers of English at grades 7-9. The findings are presented according to three orientations and reviewed with reference to the 2004 Finnish National Framework Curriculum. Within the cognitive orientation, "culture" is perceived as factual knowledge, and the teaching of cultureis defined in terms of the transmission of knowledge, especially about Britain and the USA (Pedagogy of Information). Within the action-related orientation, "culture" is seen as skills of a social and socio-linguistic nature, andthe teaching aims at preparing the students for contacts with people from the target language areas (Pedagogy of Preparation). Within the affective orientation, which takes a more holistic approach, "culture" is seen as a bi-directional perspective. Students are encouraged to look at their own familiar culture from another perspective, and learn to empathise with and show respect for otherness in general, not just concerning representatives of English-speaking countries (Pedagogy of Encounter). Very few of the interviewed teachers represent the third approach, which is the one that can be characterised as truly intercultural. The study indicates that many teachers feel unsure about how to teach culture in an appropriate and up-to-date manner. This is attributed to, among other things, lack of teacher insights as well as lack of time and adequate material. The thesis ends with a set of recommendations as to how EFL could be developed ina more intercultural direction.

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Mild Cognitive Impairment and Early Detection of Alzheimer`s Disease. A Positron Emission Tomography Study

Alzheimer`s disease (AD) is characterised neuropathologically by the presence of extracellular amyloid plaques, intraneuronal neurofibrillary tangles, and cerebral neuronal loss. The pathological changes in AD are believed to start even decades before clinical symptoms are detectable. AD gradually affects episodic memory, cognition, behaviour and the ability to perform everyday activities. Mild cognitive impairment (MCI) represents a transitional state between normal aging and dementia disorders, especially AD. The predictive accuracy of the current and commonly used MCI criteria devide this disorder into amnestic (aMCI) and non-amnestic (naMCI) MCI. It seems that many individuals with aMCI tend to convert to AD. However many MCI individuals will remain stable and some may even recover. At present, the principal drugs for the treatment of AD provide only symptomatic and palliative benefits. Safe and effective mechanism-based therapies are needed for this devastating neurodegenerative disease of later life. In conjunction with the development of new therapeutic drugs, tools for early detection of AD would be important. In future one of the challenges will be to detect at an early stage these MCI individuals who will convert to AD. Methods which can predict which MCI subjects will convert to AD will be much more important if the new drug candidates prove to have disease-arresting or even disease–slowing effects. These types of drugs are likely to have the best efficacy if administered in the early or even in the presymptomatic phase of the disease when the synaptic and neuronal loss has not become too widespread. There is no clinical method to determine with certainly which MCI individuals will progress to AD. However there are several methods which have been suggested as predictors of conversion to AD, e.g. increased [11C] PIB uptake, hippocampal atrophy in MRI, low CSF A beta 42 level, high CSF tau-protein level, apolipoprotein E (APOE) ε4 allele and impairment in episodic memory and executive functions. In the present study subjects with MCI appear to have significantly higher [¹¹C] PIB uptake vs healthy elderly in several brain areas including frontal cortex, the posterior cingulate, the parietal and lateral temporal cortices, putamen and caudate. Also results from this PET study indicate that over time, MCI subjects who display increased [¹¹C] PIB uptake appear to be significantly more likely to convert to AD than MCI subjects with negative [¹¹C] PIB retention. Also hippocampal atrophy seems to increase in MCI individuals clearly during the conversion to AD. In this study [¹¹C] PIB uptake increases early and changes relatively little during the AD process whereas there is progressive hippocampal atrophy during the disease. In addition to increased [¹¹C] PIB retention and hippocampal atrophy, the status of APOE ε4 allele might contribute to the conversion from MCI to AD.

Vaccination Competence - The Concept and Evaluation

The purpose of this two-phase study was to define the concept of vaccination competence and assess the vaccination competence of graduating public health nurse students (PHN students) and public health nurses (PHNs) in Finland, with the goal of promoting and maintaining vaccination competence and developing vaccination education. The first phase of the study included semi-structured interviews with vaccination professionals, graduating PHN students and clients (a total of n=40), asking them to describe vaccination competence as well as the factors strengthening and weakening it. The data were analyzed through content analysis. In the second phase of the study, structured instruments were developed, and vaccination competence of PHN students (n=129) in Finland and PHNs (n=405) was assessed using a self-assessment scale (VAS) and taking a knowledge test. PHNs were used as a reference group, enabling us to determine whether a satisfactory level of vaccination competence was achieved by the end of studies, or whether it was gained through work experience vaccinating clients. The data were collected from five polytechnic institutions and seven health centers located in various parts of the country. The data were collected using instruments developed for this study, and were analyzed statistically. In the first phase, based on the results of the interviews, vaccination competence was defined as a large multi-faceted entity, including the concepts of competent vaccinator, competent implementation of the vaccination, and the outcome of the implementation. Semi-structured interviews revealed that factors strengthening and weakening vaccination competence were connected to the vaccinator, the client being vaccinated, the vaccination environment and vaccinator education. On the whole, factors strengthening and weakening vaccination were the opposite of each other. In the second phase, on the self-assessment of vaccination competence, students rated themselves as significantly lower than working professionals. On the knowledge test, the percentage of correct answers was lower for students than PHNs. When all background variables were taken into account in multivariate analysis, there was no longer a significant difference between the students and PHNs on the self-assessment. However, in multivariate analysis, the PHNs still performed better than students on the knowledge test. For this study, a satisfactory level of vaccination competence was defined as a mean of 8.0 on the self-assessment and 80% correct answers on the knowledge test. Based on these criteria, students almost reached the level of satisfactory in their overall self-assessment, and PHNs did. Both groups, however, did rank themselves as satisfactory in some sum variables. On the knowledge test the students did not achieve a level of satisfactory (80%) in their total score, though PHNs did. As before, both groups did achieve a level of satisfactory in several sum variables. Further research and development should focus on vaccination education, the testing of vaccination competence and vaccination practices in clinical practice, as well as on developing the measurement tools.

PET and MR imaging in Parkinson’s disease patients with cognitive impairment. A study of dopaminergic dysfunction, amyloid deposition, cortical hypometabolism and brain atrophy

Parkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterized by a severe loss of substantia nigra dopaminergic neurons leading to dopamine depletion in the striatum. PD affects movement, producing motor symptoms such as rigidity, tremor and bradykinesia. Non-motor symptoms include autonomic dysfunction, neurobehavioral problems and cognitive impairment, which may lead to dementia. The pathophysiological basis of cognitive impairment and dementia in PD is unclear. The aim of this thesis was to study the pathophysiological basis of cognitive impairment and dementia in PD. We evaluated the relation between frontostriatal dopaminergic dysfunction and the cognitive symptoms in PD patients with [18F]Fdopa PET. We also combined [C]PIB and [¹⁸F]FDG PET and magnetic resonance imaging in PD patients with and without dementia. In addition, we analysed subregional striatal [¹⁸F]Fdopa PET data to find out whether a simple ratio approach would reliably separate PD patients from healthy controls. The impaired dopaminergic function of the frontostriatal regions was related to the impairment in cognitive functions, such as memory and cognitive processing in PD patients. PD patients with dementia showed an impaired glucose metabolism but not amyloid deposition in the cortical brain regions, and the hypometabolism was associated with the degree of cognitive impairment. PD patients had atrophy, both in the prefrontal cortex and in the hippocampus, and the hippocampal atrophy was related to impaired memory. A single 15-min scan 75 min after a tracer injection seemed to be sufficient for separating patients with PD from healthy controls in a clinical research environment. In conclusion, the occurrence of cognitive impairment and dementia in PD seems to be multifactorial and relates to changes, such as reduced dopaminergic activity, hypometabolism, brain atrophy and rarely to amyloid accumulation.