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Wolters CA, Yu SL, Hagen JW, Kail, R. Short-term memory and strategy use in children with insulin-dependent diabetes mellitus. J Consult Clin Psychol 1996 64 1397-1405. 42. Aronen ET, Vuontela V, Steenari MR, Salmi J, Carlson S. Working memory, psychiatric symptoms, and academic performance at school. Neurobiol Learn Mem 2005 83 33-42. 136. Ryan CM, Freed MI, Rood JA, Cobitz AR, Waterhouse BR, Strachan MWJ. Improving metabolic control leads to better working memory in adults with Type 2 diabetes. Diabetes Care 2006 29 345-351.
Furthermore, future studies using more sensitive neuroimaging paradigms, such as fMRI, might be more informative with respect to the apparent subtle changes in brain functioning. One example of such a study (27) reported a different pattern of brain activation in a group of patients with type 1 diabetes during a cognitively demanding working-memory task. Patients with diabetic retinopathy showed significantly less de-activation in the anterior cingulate and the right orbital frontal gyrus than those without retinopathy. Since the actual performance on this task was similar in the two groups, this different pattern of brain activation may reflect a compensatory mechanism (27).
The traditional indication for vitrectomy is a non-clearing vitreous hemorrhage. The exact timing of surgery is variable. It would be great if you could just memorize one number, but there is no automatic time to operate. There are guaranteed risks with surgery vitrectomy carries about a 2 to 5 complication rate, and that number goes up in eyes that are sicker or out of control. On the other hand, doing nothing can also be risky because you can't see the retina to be sure it is safe from problems such as macular edema or a progressive traction detachment. The real issue is deciding at what time the risks of observation become worse than the risk of intervention. Perhaps the most important factor is how aggressive the patient's retinopathy happens to be.
Diabetes has a marked effect on brain function and structure in children and adolescents. As a group, diabetic children are more likely to perform more poorly than their nondiabetic peers in the classroom and earn lower scores on measures of academic achievement and verbal intelligence. Specialized neuropsychological testing reveals evidence of dysfunction in a variety of cognitive domains, including sustained attention, visuoperceptual skills, and psychomotor speed. Children diagnosed early in life - before 7 years of age - appear to be most vulnerable, showing impairments on virtually all types of cognitive tests, with learning and memory skills being particularly affected. Results from neu-rophysiological, cerebrovascular, and neuroimaging studies also show evidence of CNS anomalies. Earlier research attributed diabetes-associated brain dysfunction to episodes of recurrent hypoglycemia, but more recent studies have
Long-Term Memory and Learning Memory refers to the ability to encode, store, and retrieve information. Episodic memory is related to memory for personal events and facts, which are closely linked to the context in which the information was acquired. This may entail autobiographical memories, such as remembering a wedding day, or memory for recently acquired information, such as words on a list or pictures presented in a test session. semantic memory is related to facts or knowledge that are not related to one's personal experience, but are shared by most people within a given cultural system and of which the context of acquisition is lost, such as knowing that Rome is the capital of Italy, that grass is green or that Roosevelt was an American president. Both episodic memory and semantic memory are forms of declarative long-term memory information is encoded and stored for conscious retrieval at a later point in time (that can be either 1 min later or five decades). Non-declarative...
When exploring cognitive complaints, a careful history is the basis for a good examination. A reliable informant is essential in this process, since the patient is often unaware of his own deficits. Important issues to assess in detail are premorbid functioning, the onset, time course and nature of cognitive complaints. Was the onset acute or insidious What were the first observed problems The first complaints may often prove to be of great diagnostic relevance (43). Cognitive domains to be explored are memory, language, executive function, praxis and visuospatial ability. In AD, memory deficits are often the first symptoms. When assessing memory complaints it is useful to divide memory into episodic memory and semantic memory. Episodic memory comprises anterograde memory and retrograde memory. Anterograde memory is the recall of new episodic information, for example, recalling messages and news facts does the patient need lists Has he become repetitive Examples of retrograde memory...
Long-term memory and learning Working memory Premorbid academic functioning (crystallized intelligence) and actual problem-solving ability (fluid intelligence) The ability to acquire new information or to retrieve previously stored information, either related to personal memories (episodic) or general knowledge (semantic) The capacity to actively maintain and manipulate information for a brief period of time (seconds to minutes), includes short-term memory
I A study from the Journal of Diabetes and Its Complications from January 1999 looked at children diagnosed with diabetes before age 10. Eighteen of 55 patients had a history of severe hypoglycemia with seizures. The children were given tests for memory, academic achievement, and fine motor speed coordination. Their siblings without diabetes were tested for comparison. In most cases, there was no difference in the test performances of the diabetic children and their nondiabetic siblings their test results were the same and were normal. The exceptions were children with a history of severe hypoglycemia with seizures, who did more poorly on tests of memory skills, short-term memory, and memory of words. The children with severe hypoglycemia without seizures didn't show this abnormality.
The debate still rages over mercury amalgam fillings. No one disputes the extreme toxicity of mercury compounds and mercury vapor. The ADA feels that mercury amalgam fillings are safe because they do not vaporize or form toxic compounds to a significant degree. Opponents cite scientific studies that implicate mercury amalgams as disease causing. Many dentists advocate mercury amalgam fillings simply because they are accepted by the ADA, which they believe protects them from malpractice litigation. Why risk your health and life on their opinions Remember everything corrodes and everything seeps, so amalgams must too.
Although quite a few studies have looked at neuropsychological test performance and school achievement in children with diabetes, this remains an area of some controversy (36). Some studies report that children with type 1 diabetes perform more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills (37,38), whereas other studies report that test performances are within the normal range (39). However, the observation that children with an early onset of diabetes (e.g., before the age of 6) are at increased risk for slowing of intellectual development is quite consistent (36,40). This increased vulnerability of younger children may be attributable to an increased sensitivity of the developing brain to the adverse effects of both hypo- and hyperglycemia (40,41).
As strange as it sounds, eating fat can actually help you lose weight. Not only that, your memory and your immune system will benefit from eating fat. It is an extremely bad idea to eliminate fat completely from your diet. Good fats are absolutely essential. These good fats come from things like Enova Oil, canola oil, extra virgin olive oil, flax seed, almonds, walnuts and cold-water fish. Eating the right kind of fat and getting rid of the wrong kind is what is needed.
(144-148), though not invariably (149). These observations will need to be confirmed in properly designed randomized clinical trials on the effects of intensified glucose-lowering therapy versus standard treatment (150). A recent randomized trial comparing the effects of rosiglitazone to glyburide therapy found similar and statistically significant cognitive improvement in both treatment groups on measures of working memory, but not on learning and cognitive speed (144). The magnitude of the improvement was correlated with the degree to which fasting plasma glucose improved (correlation coefficient r 0.30). The DCCT trial, however, showed no differences in cognitive functioning after 6.5 years between type 1 diabetes patients who received conventional treatment versus those who received intensive treatment (151). Cognitive performance also remained similar in the two groups after 18 years of follow-up (133).
This problem has been compounded further by researchers who have either failed to assess neuropsychological function in a comprehensive fashion or have used tests with questionable, or unknown, psychometric properties for a pediatric population. As an example, a number of seminal studies either ignored the assessment of learning and memory skills completely (8), used tests that had been developed for adults but not children (9), or relied on mnestic tests from the research laboratory with questionable or unproven psychometric properties (10, 11). This would, at least in part, explain why there exists no consensus about the impact of diabetes on a cognitive process which is a key determinant to classroom success effective learning and memory abilities (11-14).
Early research in cognitive functioning focused on type 2 diabetes as a theoretical model of accelerated aging e.g., Kent (101) but, more recently, there has been interest in potential changes in cognition that might make patient adherence to treatment more difficult (102). Both chronically elevated high blood sugars and recurrent low blood sugar levels have the potential to independently contribute to cognitive dysfunction, for example through changes to the blood-brain barrier transport of glucose. Verbal learning and memory skills may be especially disrupted in type 2 diabetes, but mainly for patients older than 60 years of age (103-105). Other cognitive skills, such as attention, executive function, and psychomotor efficiency, were less affected. Although most research on cognition in diabetes has been conducted with type 1 patients, studies show that middle-aged type 2 individuals are apparently protected, insofar as researchers have only infrequently reported learning and memory...
Several other nutrients also might protect against cognitive decline and Alzheimer's disease. Acetyl-L-carnitine, 2 grams daily, has been found to improve attention spans, long-term memory, and verbal abilities in some Alzheimer's patients. Phosphatidyl serine, a phosphorus-containing fat, is essential for the health of cell membranes, particularly brain cells. Dosages of 300 mg daily have been found helpful in improving memory, but 100 mg also might work in mild cases of memory impairment.
In this chapter, methodological aspects of neuropsychological assessment will be discussed. First, a brief theoretical neuropsychological framework is presented related to the study of brain-behavior interactions. We will focus on the use of global screening tests, specific neuropsychological tests, computerized assessment, and the development of a test battery that is optimized for use in young and older diabetes patients. The important cognitive domains will be introduced in relation to their assessment intelligence, executive function, learning and memory, attention and working memory, perception, language, and information-processing speed. The chapter will address psychometric aspects, such as validity and reliability, as well as sensitivity, which are important for the interpretation of test results. other psychological constructs that are potential confounders for cognitive performance in diabetes patients are discussed, such as coping, personality, motivation, and mood....
The developing brain is extremely vulnerable to all types of cerebral trauma. Studies of children who have experienced closed head injuries suggest that the consequences may be delayed, with subtle cerebral damage becoming evident with time as normal developmental milestones are delayed. A large number of studies have examined the impact of recurrent hypoglycaemia in childhood (Ryan et al., 1985 Golden et al., 1989 Bjorgaas et al., 1997b Hershey et al., 1999 Rovet and Ehrlich, 1999 Northam et al., 2001 Wysocki et al., 2003). Almost without exception, the results have shown a possible link between severe hypoglycaemia and decrements in cognitive performance and that those children most at risk of cognitive impairment have been those diagnosed early in life - usually less than five years of age (Ryan et al., 1985 Golden et al., 1989 Bjorgaas et al., 1997b Northam et al., 2001). Deficiencies have been found in several cognitive domains but are more likely in those originating in the...
Children and adolescents with a later onset of diabetes also manifest cognitive dysfunction, particularly on tests requiring sustained attention, visuoperceptual skills, and psychomotor speed (2, 9, 11, 13, 14, 37). The magnitude of these effects tends to be relatively modest, with estimates generally approximating 0.2 or less (47), although there is much variation across different studies. Whether learning and memory skills are also compromised - as they clearly are in children with an earlier onset of diabetes -remains controversial (12). Some studies have reported no evidence of mnes-tic deficits (9) while others sometimes (11, 37, 57) but not invariably (14) find deficits on certain types of memory tests, particularly those having a visuospatial component. The extent to which higher order cognitive processes are compromised cannot be determined at the present time because of Regardless of age at onset, cognitive abnormalities may appear relatively early in the course of diabetes....
Oh yeah, there is one other simple thing to do if you have a patient with hemorrhages and swellings in the retina, and you may not think of it because you have been too busy memorizing how to talk to a patient about IOL reimbursement or something. You can look extremely bad, however, if you don't consider this particular entity and perform the simple test required to detect it. It was mentioned in Chapters 10, 20 and 22, and if you can't think of it, you really should go ahead and do that cornea fellowship. (Hint look at Table 2).
Tremor is the result of ongoing poisoning It is important to find the poison as soon as you can since the rest of the body will soon be affected, too. Search your memory for the new things that happened in the last two weeks. It is a herculean task but only gets harder each day, so keep notes as you ask Is there new carpeting Is there a new furnace Is there a different water supply Is there a new hair dresser Did somebody bring a vase of fresh flowers Is there a new laundry person Was the place sprayed for insects Is there a new medicine (drug) or supplement Was remodeling done Is there a new food
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