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PubMed1988

The Early Neuropsychologic Optimality Rating Scale (ENORS-9): a new developmental follow-up technique.

The development and application of the Early Neuropsychologic Optimality Rating Scale (ENORS-9) is described. This 24-item technique, scored in an optimal/nonoptimal fashion, enables assessment of posture, tone, and movement, as well as developmental delays. The ENORS-9 was compared with the Bayley Mental and Psychomotor Developmental indexes and a neurologic examination administered at 9 months, in terms of sensitivity and specificity of cognitive, motor, and neurologic outcome at 36 months. Using an ENORS-9 cut-off score of 85% for cognitive and motor, and 75% for neurologic outcome, sensitivity values were more than three times greater than more traditional assessment techniques. This instrument meets many needs in developmental follow-up because of straightforward scoring, decreased personnel requirements and cost, and flexibility in regard to missing data and cut-off scores. The implications of these findings are discussed.

Child Development↗
PubMed2005

Neuropsychological tests with lateralizing value in patients with temporal lobe epilepsy: reconsidering material-specific theory.

PURPOSE: To assess the ability of neuropsychological tests to determine the side of seizure onset for preoperative assessment in patients with drug-resistant temporal lobe epilepsy. METHODS: Twenty-nine consecutive patients diagnosed with temporal lobe epilepsy (TLE), in whom the epileptogenic focus was clearly identified and localized to either the right or left hemisphere. Patients underwent a full neuropsychological assessment as part of their pre-surgical investigation, including the Boston Naming Test (BNT) and a variety of Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and Wechsler Memory Scale-Third Edition (WMS-III) subtests. Two multivariate analyses of variance were carried out to assess differences on memory and language measures between groups according to side of epileptogenic focus. Binary logistic regression analysis was performed to find the sets of tests that best predicted the side of seizure onset (determined by EEG and MRI). RESULTS: Memory multivariate analysis of variance failed to show significant differences between the right- and left-sided groups. Among language measures, only the BNT revealed significant differences between the groups. The neuropsychological measures that best predicted the side of seizure onset were the BNT and Visual Reproduction II. CONCLUSIONS: Language measures predict the side of seizure focus better than memory measures. The results of this study in a sample of drug-resistant temporal lobe epilepsy patients challenge the memory material-specific theory for the side of seizure focus.

Adult↗
PubMed2005

Prodromal cognitive signs of dementia in 85-year-olds using four sources of information.

OBJECTIVE: To evaluate the utility of assessing four cognitive domains obtained from four information sources to identify individuals at risk for developing dementia, Alzheimer disease (AD), and vascular dementia (VaD). METHODS: A representative population sample of nondemented 85-year-olds (n = 313) from Gothenburg, Sweden, was examined regarding memory, language, and visuospatial and executive functions, using self- and key informant reports and neuropsychiatric and psychometric examinations. The sample was followed 3 years for incident dementia, AD, or possible VaD. RESULTS: All cases of dementia, AD, and VaD were preceded by low performance in most domains irrespective of information source. Isolated low memory performance or low cognitive performance with unimpaired memory did not predict dementia. Positive predictive values increased with number of domains affected. Self- and key informant reports were less useful for predicting dementia than neuropsychiatric and psychometric examinations. The best positive predictive value (88%) was for low cognitive performance in all domains using neuropsychiatric and psychometric examinations; however, sensitivity was only 18%. CONCLUSIONS: Although memory impairment was necessary to predict dementia, it was not sufficient. Other cognitive domains needed to be affected. Relying on self-reports or key informants for early detection of dementia excluded a large group at risk. In addition, vascular dementia appeared to have a prodromal stage.

Aged, 80 and over↗
PubMed2006

White matter damage of patients with Alzheimer's disease correlated with the decreased cognitive function.

Increasing evidence demonstrates that there is marked damage and dysfunction in the white matter in Alzheimer's disease (AD). The present study investigates the nature of white matter damage of patients with Alzheimer's disease with diffusion tensor magnetic resonance imaging (DTI) and analyses the relationship between the white matter damage and the cognition function. DTI, as well as T1 fluid attenuated inversion recovery (FLAIR) and T2-FLAIR, was performed on probable patients of Alzheimer's disease, and sex and age matched healthy volunteers to measure the fractional anisotropy (FA) and mean diffusivity (MD) in the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, and the white matter of frontal, temporal, parietal, and occipital lobes. FA was lower in the splenium of corpus callosum, as well as in the white matter of the frontal, temporal, and parietal lobes from patients with Alzheimer's disease than in the corresponding region from healthy controls and was strongly positive correlated with MMSE scores, whereas FA appeared no different in the anterior and posterior limbs of internal capsule, occipital lobes white matter, and the genu of corpus callosum between the patients and healthy controls. MD was significantly higher in the splenium of corpus callosum and parietal lobes white matter from patients than in that those from healthy controls and was strongly negative correlated with MMSE scores, whereas MD in the anterior and posterior limbs of internal capsule, as well as in frontal, temporal, occipital lobes white matter and the genu of corpus callosum, was not different between the patients and healthy controls. The most prominent alteration of FA and MD was in the splenium of corpus callosum. Our results suggested that white matter of patients with Alzheimer's disease was selectively impaired and the extent of damage had a strong correlation with the cognitive function, and that selective impairment reflected the cortico-cortical and cortico-subcortical disconnections in the pathomechanism of Alzheimer's disease. The values of FA and MD in white matter, especially in the splenium of corpus callosum in AD patients, might be a more appropriate surrogate marker for monitoring the disease progression.

Aged↗
PubMed2004

The effect of common origin of the carotid arteries in neurologic outcome after neonatal ECMO.

BACKGROUND: Common origin of the carotid arteries (COCA) is a normal anatomic variant reported to occur in approximately 11% of the general population. The objective of this study was to determine whether this variant places venoarterial extracorporeal membrane oxygenation (ECMO) patients at a higher risk for adverse neurologic sequelae owing to potential occlusion of both carotid arteries by the arterial cannula. METHODS: The authors reviewed clinical records and echocardiograms of the initial 220 ECMO patients at their institution. Aortic arch morphology was determined by a pediatric cardiologist blinded to all other data. After exclusion of predetermined patients, 131 patients were divided into 2 groups: those with separate origin of the carotid arteries (n = 111) and those with COCA (n = 20). The neurologic outcome variables studied included the results of magnetic resonance imaging (MRI); computed tomography (CT); electroencephalogram (EEG); brainstem auditory-evoked response (BAER), head ultrasound scan, and Bayley Scales of Infant Development reported as Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI). RESULTS: COCA had no predictive value in determining PDI and MDI outcomes and no significance in predicting an increased risk of adverse neurologic sequelae based on MRI, CT, EEG, BAER, or head ultrasound scan. CONCLUSIONS: This study confirms that COCA is a common aortic arch variant (15%, n = 20 of 131) and that this variant does not appear to increase the risk of neurologic injury in infants undergoing venoarterial ECMO.

Brachiocephalic Trunk↗
PubMed2003

P300 (latency) event-related potential: an accurate predictor of memory impairment.

To determine if P300 latency changes precede and correlate with memory and mental status, patients (N=1506 aged 20-100 years) who received medical and psychiatric diagnoses (from 1997 to 2002), were assessed for P300 (N=1496), WMS-III (N=694), and MMSE (N=456). Patient and control groups included, a) normal WMS-III on all 4 subscales (N=36), b) normal WMS-III and MMSE (N=189) with subjective memory/mental status complaints, and c) medical patients with normal WMS-III and no memory complaints (N=205), and d) P300 control group without medical, psychiatric or memory problems for ROC. Patients with impaired/borderline memory had a prolonged P300 latency (P<0.02) compared to age matched non-impaired controls; in patients with normal WMS-III/MMSE, with subjective mild memory/mental status impairment, P300 latency was prolonged compared to controls (P=0.0004). The P300 latency increased by 0.72ms per year (P=7.9x10(-65)) and voltage decreased by 0.03dV per year (P=6.7x10(-10)), and both parameters were linearly correlated with the age of the subjects. Male subjects had an average voltage of 6.1dV and female 6.8dV (P=0.00009). Statistically, prolonged latency began at age range 41-50 (P=0.0002); reduced P300 voltage began at age range 51-60 (P=0.003). WMS-III memory decline for all measures began in females at age range 61-70 (P value at least=0.02) and for males at age range 61-80 (P=0.02). Prolonged P300 latency (P<0.0001) and memory impairment (at least <0.02) were greater for females than males. MMSE memory decline, male and female, began at age range 81-90 (P value of at least 0.00007). In our logistic regression model P300 latency was more predictive of WMS-III impairment than MMSE > 24. In patients whose WMS-III score is impaired < or = 69, or borderline < or = 79 (P at least=0.004), a P300 latency more prolonged than the norm (> or = 300 + 30 + Age) identifies these patients, whereas a MMSE > 24 failed. With the ROC curve, we confirmed that P300 latency could accurately identify borderline/impaired memory.

Adolescent↗
PubMed1988

[Comparison of three miniaturized Limulus-amoebocyte-lysate methods].

Comparative examinations with three different micro-models for the LAL-test methods,--namely the capillary test, Endotoxin-test "Mini" and Coatest-Endotoxin-method-, tested with 11 Enterobacteriaceae- and 6 Pseudomonas-type-strains and isolates from foods gave only slight differences for the endotoxin content. Out of 250 single measurements per test method the capillary test as well as the Coatest-Endotoxin-method gave count limits between 2.8 X 10(1) and 7.4 X 10(3) CFU/ml. For the endotoxin-test method "Mini" the limits were one log unit higher-namely between 8.6 X 10(2) and 5.0 X 10(4) CFU/ml. The maximum values for count limits of all three methods correspond to approximately 1 ng Endotoxin. For the two gel test methods a relative error of +/- 15% has to be taken into account; for the chromogen method however, the relative error lies within +/- 25%, if the concentration is 0.0125 ng LPS/ml or lower. Between 0.025 and 0.1 ng LPS/ml or 0.075 and 0.1 ng LPS/ml the relative error is reduced to +/- 16% and +/- 5% respectively. The study has shown that the three micro tests in question as tested with pure cultures give comparable and reproducible results; inspite of the high relative error.

Animals↗
PubMed1989

Immunity to diphtheria in a sample of adult population from central Italy.

A sample of 643 healthy subjects from central Italy aged 20 to 80, were screened for diphtheria antitoxin. Serum diphtheria antitoxin was assayed by a new passive haemagglutination technique using turkey red blood cells sensitized with diphtheria toxoid, after having performed a correlation study between this technique and the reference in vivo neutralization test. Of the studied population 26.7% showed a lack of serum antitoxin titres considered to be protective. The rate of susceptible subjects increased with age, showing the highest value (38.9%) in the sixth decade of age. Males proved less protected than females; 53.2% of the male population aged 50-59 were lacking a protective anti-diphtheria immunity. On the basis of present results, a periodical revaccination of the entire adult population with reduced doses of diphtheria toxoid would be advisable.

Adult↗
PubMedDate not supplied

Decreased high-density lipoprotein cholesterol and serum apolipoprotein AI concentrations are highly correlated with the severity of Alzheimer's disease.

Serum apolipoprotein (apo) AI concentration was studied in 98 Alzheimer's disease (AD) patients (77.56+/-8.83 years) and 59 healthy, elderly controls (75.37+/-5.27 years). ApoAI levels were significantly lower (p<10(-7)) in AD patients. An apoAI cutoff value of 1.50 g/L, could distinguish between the two groups with a sensitivity of 71% and a specificity of 69%. ApoAI levels were highly correlated with mini-mental state (MMSE) scores of patients (p<0.0001). These relationships remained significant after adjustment for multiple testing. Our findings raise the question of the potential implication of apoAI in the etiopathology of AD and bring serum apoAI concentration to the fore as an important biochemical marker.

Aged↗
PubMed1989

An improved ELISA and serum neutralisation test for the detection of turkey rhinotracheitis virus antibodies.

The development of a double-well ELISA test for the detection of turkey rhinotracheitis (TRT) virus antibody in turkey and chicken sera, utilising a streptavidin-biotin detection protocol is described. This test was compared with a conventional ELISA, which detects antibody using a peroxidase-labelled anti-turkey IgG. The double-well streptavidin-biotin ELISA was more sensitive than the conventional ELISA, and, due to the consistently low background values obtained, was further modified to a single-well ELISA test. Antibody titres obtained using the single-well streptavidin-biotin ELISA were similar to those obtained using the conventional ELISA. A microtitre serum neutralisation test for TRT virus read using an indirect immunoperoxidase (IIP) detection protocol after 48 h was also developed and compared to the standard neutralisation test employing a 7 day incubation and read by CPE. The specificity of the single-well streptavidin-biotin ELISA was confirmed using the rapid (IIP) serum neutralisation test.

Animals↗
PubMedDate not supplied

Quantitative analysis of platelet function using stagnation point flow aggregometry. First clinical results.

BACKGROUND: The clinical consequences of atherosclerosis result from vascular occlusion. The central role of platelet-vessel wall interaction in the initiation and perpetuation of this process is well established. Individual analysis and quantification of two major platelet functions underlying atherosclerosis and thrombosis, i.e. adhesion (platelet-wall interaction) and aggregation (platelet-platelet interaction), would contribute significantly towards elucidation of the mechanisms involved and therefore towards optimization of prophylaxis and therapy. The Stagnation-Point-Flow-Adhesio-Aggregometer (SPAA), in which such an evaluation of platelet function is possible, was thus standardized and its clinical reproducibility and predictive power assessed. METHODS: Using the SPAA, a morphometric separation of adhesion and aggregation is obtained via dark field micrographs of platelet microthrombi formed during stagnation point flow of platelet rich plasma (PRP). Quantification is achieved via biomathematical evaluation of simultaneously obtained growth curves, whereby the degree of adhesivity and aggregability is reflected in the respective growth rate constants Kpw (%) and Kpp (%). Experiments with the PRP of 36 healthy volunteers were performed and the results compared to those obtained for 32 patients exhibiting angiographically verified peripheral arterial disease (PAD). RESULTS: The control group exhibited values (Kpw) ranging from 0.40% to 1.10% (average Kpw: 0.71 +/- 0.21%). Differences in average Kpw value between the control subgroup over and that under 45 years of age were absent. A spontaneous platelet aggregation was not observed in the controls (Kpp = 0%). The overall intraindividual Kpw variation in 18 volunteers examined 3 times or more ranged from a minimum of 3% to a maximum of 20% of respective Kpw value. The patients were divided into two subgroups: diabetics and nondiabetics. The nondiabetic group demonstrated an average Kpw of 1.56%. In addition, a spontaneous aggregation was observed in 50% of all experiments (average Kpp = 1.42%). The diabetic group exhibited the highest average adhesion value (Kpw = 1.94%) occurrence of spontaneous aggregation in all experiments (Kpp = 2.10%). CONCLUSION: The consistency in adhesion values obtained among the controls as well as the minimal intraindividual variance observed, demonstrates the reproducibility of the method. The statistically significant increase (p < 0.001) in adhesivity of patients as compared to controls, as well as the common occurrence of spontaneous aggregation can therefore be considered a pathologic platelet response reflecting the severity of the disease. Results obtained verify the presence of circulating hyperreactive platelets in PAD patient and indicate the predictive power of the method. Thus the SPAA may be of considerable aid in improving thrombosis prophylaxis and therapy.

Arteriosclerosis↗
PubMed2006

Comparison of VASP-phosphorylation assay to light-transmission aggregometry in assessing inhibition of the platelet ADP P2Y12 receptor.

There is need to improve platelet function testing to monitor the response to antiplatelet drugs. We compared flow-cytometric analysis of intraplatelet vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) to light-transmission aggregometry for the detection of drug-induced in-vitro inhibition of the platelet P2Y12 ADP receptor on 22 healthy subjects (10 males, 12 females, 28.5 +/- 6.6 years). The platelet reactivity index (PRI) of VASP was calculated both from mean fluorescence intensity (MFI) and percent of fluorescence-positive platelets in the presence of PGE1 with or without ADP (10 microM). Platelet aggregation was induced by ADP (1.25, 2.5 and 5 microM). Cangrelor, a competitive inhibitor of the P2Y12 receptor, preincubated 5 minutes, induced a concentration-dependent inhibition of platelet ADP-receptor function in both tests. Indeed PRI (%) based on either MFI or percent platelets gated were highly correlated with each other (r = 0.97, p %lt; 0.0001) and with aggregation induced by ADP. The IC50 of cangrelor against each of the three ADP concentrations used in aggregometry increased from 5.8 +/- 3.4 nM to 23.1 +/- 4.0 nM and to 98 +/- 25 nM, respectively. The IC50 of cangrelor based on VASP-P was within the same range (25.5 +/- 7.7 nM). No correlation was observed between IC50 values of cangrelor and ADP concentrations giving 50% effect (EC50) in the absence of the drug. However, at 10 nM cangrelor seven subjects could be identified by the VASP-P assay as " low responders " to the drug (PRI > 50%), and six of them also had an aggregation response to 5 micro M ADP > 50%. These six subjects showed the lowest ADP EC50 values in the absence of the drug, possibly reflecting high sensitivity of their platelet P2Y12 receptors to ADP. In conclusion, both the VASP-P assay and light-transmission aggregometry detect in a comparable way in-vitro pharmacological inhibition of the platelet P2Y12 ADP receptor and its individual variability.

Adenosine Diphosphate↗
PubMed2004

Functional magnetic resonance imaging before and after aphasia therapy: shifts in hemodynamic time to peak during an overt language task.

BACKGROUND AND PURPOSE: Comparing the temporal characteristics of hemodynamic responses in activated cortical regions of aphasic patients before and after therapy would provide insight into the relationship between improved task performance and changes in blood oxygenation level-dependent (BOLD) functional MRI (fMRI) signal. This study investigated differences in the time to peak (TTP) of hemodynamic responses in activated regions of interest (ROIs), before and after therapy, and related them to changes in task performance. METHODS: Three aphasic patients and 3 controls overtly generated a single exemplar in response to a category. For the patients, TTP of hemodynamic responses in selected ROIs was compared before and after language therapy. The timing differences between auditory cues and verbal responses were compared with TTP differences between auditory and motor cortices. RESULTS: The selected ROIs were significantly activated in both aphasic patients and controls during overt word generation. In the aphasic patients, both the timing difference from auditory cues to verbal responses and the TTP difference between auditory and motor cortices decreased after rehabilitation, becoming similar to the values found in controls. CONCLUSIONS: Findings indicate that (1) rehabilitation increased the speed of word-finding processes; (2) TTP analysis was sensitive to this functional change and can be used to represent improvement in behavior; and (3) it is important to monitor the behavioral performance that might correlate with the temporal pattern of the hemodynamic response.

Acoustic Stimulation↗
PubMed1988

The degradation of platelet-activating factor in serum and its discriminative value in atherosclerotic patients.

Platelet-activating factor (PAF) is transformed in vivo rapidly into the biologically inactive lyso-PAF. This reaction as well as lipid parameters were quantified in serum from 40 survivors of myocardial infarction and 36 healthy controls matched for age and body weight. The PAF-degrading capacity was 23% (p less than 0.001) higher in patients compared with the control group. Using the degradation of PAF as an univariate discriminator more than 70% of subjects were classified correctly. This is comparable with the discriminatory value of the best lipid variables, apolipoprotein B and HDL-cholesterol. Statistically significant differences in the degradation of PAF were found also by comparing subgroups which were matched for plasma levels of total cholesterol, VLDL/LDL-cholesterol or apolipoprotein B. The ratio by 48% (p less than 0.0001) in the case group was identified as an additional good discriminator between both groups. In contrast, platelet aggregation tests which were performed in acetylsalicyclic acid treated platelet-rich plasma discriminated poorly between patients and controls.

Apolipoproteins↗
PubMed1990

Blocking ELISA to distinguish pseudorabies virus-infected pigs from those vaccinated with a glycoprotein gIII deletion mutant.

A blocking enzyme-linked immunosorbent assay (ELISA) test has been developed to distinguish pseudorabies virus (PRV)-infected pigs from those immunized with a glycoprotein g92(gIII) deletion mutant, PRV(dlg92dltk). The blocking ELISA utilizes 96-well microtiter test plates coated with a cloned PRV g92(gIII) antigen, a mouse monoclonal antibody against gIII antigen (moMCAgIII): horseradish peroxidase (HRPO) conjugate, and undiluted test sera. Analyses can be completed in less than 3 hours with results printed out by an automated plate reader. Analyses on over 300 pig sera from PRV-free farms, on sera from other species, and on control sera containing antibodies to microorganisms other than PRV showed that the ratio of the optical density at 405 nm for the test sample to the optical density at 405 nm for the negative control (S/N value) was greater than 0.7 for all sera. No false positives were identified. Likewise, the S/N values were greater than 0.7 for over 400 sera obtained from pigs vaccinated twice with more than 1,000 times the standard PRV (dlg92dltk) dose or 1-4 times with the standard dose (2 x 10(5) TCID50/pig). Following challenge exposure to virulent PRV, the S/N values of the vaccinates were 0.1, showing that g92(gIII) antibodies in the sera of experimentally challenged pigs strongly blocked the binding of the moMCAgIII:HRPO conjugate to the antigen-coated wells. Sera of 233 pigs from PRV-infected herds with virus neutralization (VN) titers of 1:4 or greater were tested. All except 2 of these sera had S/N values less than 0.7 and more than 175 had S/N values less than 0.1. Sixteen sera from fetal pigs with VN titers of 1:4 or greater had S/N values of 0.24 or less, but 2 sera with VN titers of 1:4 when tested 5 years prior to the PRV g92(gIII) blocking ELISA test gave false negative S/N values. Twenty-four of 29 pig sera from PRV-infected herds with VN titers less than 1:4 were positive for g92(gIII) antibodies, illustrating the sensitivity of the PRV g92(gIII) blocking ELISA test. Analyses on 7 sera with VN titers of 1:4-1:64 showed that titers obtained with the PRV g92(gIII) blocking ELISA test were from 2- to 16-fold greater than the VN titers. The accuracy and sensitivity of the PRV g92(gIII) blocking ELISA test was further demonstrated by analyses of 40 unknown sera supplied in the National Veterinary Services Laboratories 1988 PRV check test kit.

Animals↗
PubMed1993

Congenital syphilis: the diagnostic value of the rheumatoid factor in symptomatic patients.

The rheumatoid factor (RF) latex test was used as a side-room investigation for congenital syphilis. Thirty-four infants aged 0-4 months with suggestive clinical signs and unknown serological tests for syphilis were studied. Nineteen were subsequently diagnosed as having congenital syphilis on the basis of positive serology, while 15 infants had other conditions. The sensitivity of the RF latex test was 95% with a specificity of 80%. Reactive tests were seen only in neonates with congenital infections (p < 0.001). The total IgM test had a similar sensitivity in the diagnosis of congenital syphilis but its specificity (14%) was significantly less (p < 0.001). In areas where the prevalence of congenital syphilis is high, the RF latex test is useful for rapid diagnosis of the condition while confirmatory tests are awaited.

Humans↗
PubMed2000

The longitudinal relationship of clinical symptoms, cognitive functioning, and adaptive life in geriatric schizophrenia.

Cognitive dysfunction is increasingly being recognized as a major contributor to the adaptive impairment seen in most patients with schizophrenia. Reported here is a prospective longitudinal evaluation of the relationship between cognitive and adaptive functioning in elderly patients with schizophrenia. It was hypothesized that baseline cognitive and negative, but not positive symptoms, would be predictive of cross-sectional impairment and longitudinal outcome. Subjects were 168 elderly patients with schizophrenia, free of major neurological disorders, who were residents of a long-term psychiatric facility. Subjects were assessed at baseline and again an average of 15months later. The PANSS was used to assess the severity of symptoms of schizophrenia. Cognitive symptoms were assessed using the components of the CERAD cognitive battery. Social and adaptive functioning was assessed using the SAFE scale. Spearman correlations were determined among clinical variables, and the rank ordering of prediction of SAFE scale scores at follow-up was determined using a stepwise regression procedure. At follow-up, adaptive life skills correlated with cognitive performance and negative symptoms (Spearman rho values 0. 41-0.57, all p values <0.0001), but not positive symptoms (r=0.09, n. s.). Among cognitive tasks, verbal learning and memory were most highly correlated with adaptive skills at follow-up. These results confirm and extend previous studies that indicate that cognitive impairments are predictive, both cross-sectionally and longitudinally, of adaptive life skills in persons with schizophrenia. Negative symptoms, but not positive symptoms, were correlated with impaired adaptive skills. Taken together, these results underscore the need to develop more effective treatments for cognitive and negative symptoms in schizophrenia.

Activities of Daily Living↗