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Biomedical subjects

J L Mack

Publications and source records attributed to J L Mack.

7 recordsLinked to original sources

Assessment of functional ability in Alzheimer disease: a review and a preliminary report on the Cleveland Scale for Activities of Daily Living.

Assessment of activities of daily living (ADL) in Alzheimer disease (AD) is critical in establishing the diagnosis, monitoring disease progression, evaluating the efficacy of treatment interventions, and determining the need for health and social services. The proper method to measure ADL depends on the purposes to which the scale is to be put. Existing ADL scales differ as to the type of behaviors assessed, the nature of the observations made, and the manner in which the observations are quantified. These scales were not specifically designed to evaluate changes in the nature and extent of the broad spectrum of functional difficulties seen in individuals with AD. We describe the Cleveland Scale for Activities of Daily Living (CSADL), an informant-based instrument designed to expand upon the capacity of existing physical and instrumental ADL scales by assessing both premorbid and current component acts (e.g., initiation versus implementation) of daily living functions.

Activities of Daily Living

Sign language aphasia in a non-deaf-mute.

A 19-year-old left-handed man, who was raised by deaf-mute parents and learned sign language concurrently with normal speech, sustained a traumatic cerebral contusion. He subsequently had no evidence of apraxic, visual-spatial, or sensorimotor deficits of the left limbs with which he was accustomed to use signs. Globally aphasic with a dense right hemiparesis, he initially recovered sign language to a greater degree than spoken language with a reversal on follow-up observations. Receptive skills improved to a greater degree than expressive skills with no marked difference between verbal and sign language, but with natural signs better preserved than finger spelling.

Adult

Delayed auditory feedback and aphasia.

The effect of Delayed Auditory Feedback (DAF) was evaluated in three groups of subjects: 10 normal controls, 10 non-fluent aphasics, and 10 fluent aphasics. Speec production tasks consisted of (1) repeating sound and words; (2) naming objects; (3) producing sentences from given stimulus words; (4) answering questions; (5) reciting nursery rhymes; and (6) reading. Two delays were used, 180 and 360 msec. Two independent judges rated patients' responses for changes in intensity, duration, and quality of speech. Inter-judge reliability was considered satisfactory. Contrary to some previous reports, all subjects, including all the fluent aphasics, showed some DAF effect. Fluent aphasics, however, showed a significantly smaller DAF effect than non-fluent aphasics. Patient with conduction aphasia appeared to be the least impaired. Overall DAF effect was greater with 180 msec. than with 360 msec. The largest DAF effect occurred during answering question, followed by repeating, reading, nursery rhymes, sentence production, and naming, in that order. Repetition of a complex word produced a greater DAF effect than repetition of a simple sound. Finally, we found a differential effect of DAF on the three measures used in the study. We hypothesize that DAF effects result from changes in two separate monitoring systems. One systems is related to changes in the intensity of speech and does not appear to be affected by aphasia. The other is responsible for duration and qualitative changes in speech and is differentially affected in relation to pathology producing aphasia.

Adult

Neuropsychological correlates of hypertension.

Twenty newly diagnosed, untreated hypertensive men (diastolic blood pressure greater than 105 mm Hg) and 20 normotensive controls were given a neuropsychological battery, including tests of generalized, more global functions (eg, reaction time and full-scale IQ) and of specific functions (eg, language and visual-spatial abilities) sensitive to focal damage. Tests of specific abilities yielded no differences between the two groups. In contrast, tests of general neuropsychological functioning revealed a deficit among hypertensives, who were significantly slower on the reaction time test and had a shorter span for digits in forward order. Results suggest that arterial hypertension is associated with impairment of vigilance and attention span. Future research will determine whether this impairment is associated with the diffuse pathological changes seen in the brain of hypertensive subjects, or with a more "functional" change (eg, reduced cerebral blood flow).

Attention

Response to delayed auditory feedback in patients with hemispheric lesions.

The effect of delayed auditory feedback (DAF) on the performance of verbal and nonverbal tasks at two levels of difficulty by patients with left or right hemispheric lesions and non brain-damaged controls was compared. All subjects showed DAF effects, as measured by increases in response duration and intensity. While controls showed an increase in DAF effects as a function of increased task difficulty, the brain-damaged patients failed to show such an increase on tasks on which they were presumably impaired (verbal tasks for lefts, nonverbal for rights). Findings suggest a clear dissociation between DAF effects in unilateraly lesioned patients due to the nature of the stimulus material and its difficulty level.

Aphasia

Optic ataxia: clinical-radiological correlations with the EMIscan.

After coronary by-pass surgery, a 47 year old, right-handed man developed Gerstmann's syndrome, a visual-spatial perceptual deficit, and a gross impairment of movememt under visual guidance ("optic ataxia"). Visual fields and extraocular movements were intact; he had a left hemiparesis. The EMIscan showed three lesions: a left parietal-occipital lesion; a posterior callosal lesion, and a right frontal lesion. It is hypothesized that optic ataxia in both visual fields requires bilateral lesions which, in the present case, were strategically placed so as to effectively disconnect motor cortex from visual input.

Ataxia