Education and participation in leisure activities appear to be highly relevant variables in Alzheimer’s disease (AD) and usually form the basis of the Cognitive Reserve construct. Objective: [A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD. Methods: Functional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, “Participation in leisure activities throughout life” while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody’s Index. Results: AD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives. Conclusion: AD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.

Follow-Up Study

SUMMARY

One hundred and fifty-six enuretic and 170 control children were examined to identify neurological abnormalities and group dissimilarities. Developmental and perinatal histories were checked and the Test of Motor Impairment administered. The enuretic group had greater fine and gross motor clumsiness and perceptual dysfunction than the control group. Children who had been small for gestational age, who had suffered asphyxia or shown neurological symptoms during the neonatal period had a higher risk of developing daytime or day- and night-time enuresis at a later stage. With the exception of toxaemia, perinatal risk signs were not seen in the children with night-time enuresis only, but they had the slowest growth rate. It is suggested that there are at least two different groups of enuretic children: those with daytime or day- and night-time enuresis, whose condition is associated with neurological damage; and those with an obvious delay in maturation of central nervous bladder control, who have night-time enuresis only.



RESUME

Historique de developpement et donnees neurologiques chez les enfants enuretiques



Cent cinquante six enfants enuretiques et 170 controles ont ete examines pour identifier les anomalies neurologiques et les differences de groupes. L'anamnese du developpement et de la periode perinatale a ete verifiee et le test d'alteration motrice administre. Le groupe enuretique avait plus de maladresses dans le geste fin et l'activite motrice generale, plus de troubles perceptifs que le groupe controle. Les enfants petits pour Page de gestation, qui avaient soufferts d'asphyxie ou presentes des sympromes neurologiques durant la periode neo-natale avaient plus de risques de developper ulterieurement une enuresie de jour ou de jour et de nuit. A l'exception de la toxemie les risques peri-nataux n'etaient pas majores chez les enfants presentant une enuresie de nuit seulement mais ils avaient une vitesse de croissance ralentie. L'auteur suggere qu'il y a au moins deux groupes d'enfants enuretiques: ceux qui presentent une enuresie de jour ou de jour et de nuit et dont la condition est associee a un dommage neurologique; et ceux qui ont un delai manifeste de maturation du controle nerveux centrale de la vessie, qui ont seulement une enuresie de nuit.



ZUSAMMENFASSUNG

Entwicklungsanamnese und neurologische Befunde bei Kindern mit Enuresis



165 Kinder mit Enuresis und 170 Kontrollkinder wurden untersucht, um neurologische Auffalligkeiten und Gruppenunterschiede festzustellen. Es wurden der Entwicklungsverlauf und die Anamnese der Perinatalperiode uberpruft und der Test of Motor Impairment durchgefuhrt. Kinder, die hypotroph waren, die wahrend der Neonatalperiode eine Asphyxie oder neurologische Symptome hatten, hatten ein hoheres Risiko, spater eine Enuresis diurna oder eine Enuresis diurna und nocturna zu bekommen. Mit Ausnahme einer Toxikose wurden perinatale Risikofaktoren bei Kindern mit einer ausschlieslich nachtlichen Enuresis nicht beobachtet, sie hatten jedoch die langsamste Wachstumstrate. Die Autoren sind der Meinung, das es mindestens zwei Gruppen von enuretischen Kindern gibt: die mit Enuresis diurna, oder Enuresis diurna und nocturna, bei denen die Symptomatik mit neurologischen Storungen einhergeht, und die mit einer Verzogerung der zentralnervosen Reifung der Blasenkontrolle, die nur eine Enuresis nocturna haben.



RESUMEN

Historia evolutiva y hallazgos neurologicos en ninos enureticos



Ciento cincuenta y seis ninos enureticos y y 170 controles fueron examinados para identificar anomalias neurologicas y otras disimilaridades de grupo. Se comprobo la historia de desarrollo y perinatal y se paso el test de Alteracion Motora. El grupo enuretico tenia una mayor torpeza motora fina y grosera y mayor disfuncion perceptual que el grupo control. Los ninos que habian sido pequenos para su edad gestacional, que habian sufrido asfixia o mostrado signos neurologicos durante el periodo neonatal tenian un riesgo mayor de desarrollar una enuresis diurna o diurnanocturna en un estadio mas avanzado Con excepcion de toxemia, no se vieron signos de riesgo perinatal en ninos con solo enuresis nocturna, pero tuvieron la velocidad de crecimiento mas lenta. Se sugiere que hay por lo menos dos grupos diferentes de ninos enureticos: los diurnos y noctumodiurnos cuyo problema esta asociado a una lesion neurologica y aquellos con un retraso obvio de la maduracion en el control de la vejiga y que tienen solo enuresis nocturna.

Developmental history and neurological findings in enuretic children.

. Aetiological factors for enuresis in 68 nightwetting (NW) and 73 day and mixed day and nightwetting (DW/MW) children were examined against a random sample of 142 control children drawn from a population of 3375 seven-year-old children. Twenty-six variables concerning age, sex, social background, life changes, familial and perinatal history, development, growth, neurological damage, psychic structure and urinary tract disorders were included in the logistic regression analysis. The familial influence on enuresis was clearly seen in both nightwetters and daywetters. The NW children were further discriminated from the controls by items connected with delayed development, such as slower growth and poorer visuomotor and spatial perception. Marital separation or birth of a sibling were also found to be precipitating factors especially for nightwetters. The DW/MW children were discriminated from the controls by perinatal risk factors, signs of neurological dysfunction and smaller voided volume, and especially secondary daywetters by urinary tract infections. These models showed that there are similarities between nocturnal and diurnal enuresis, although there are still many differences and every individual case requires consideration of all these disposing factors.

Aetiological and precipitating factors for childhood enuresis.

OBJECTIVE To review the medical and psychological literature concerning enuresis treatments in light of the Chambless criteria for empirically supported treatment. METHOD A systematic search of the medical and psychological literature was performed using Medline and Psychlit. RESULTS Several review studies and numerous well-controlled experiments have clearly documented the importance of the basic urine alarm alone as a necessary component in the treatment of enuresis or combined with the "Dry-Bed Training" intervention, establishing them as "effective treatments." Other multicomponent behavioral interventions that also include the urine alarm such as "Full Spectrum Home Training" have further improved the outcome for bed-wetters, but are classified as "probably efficacious" at this time because independent researchers have not replicated them. Less rigorously examined approaches that focus on improving compliance with treatment or include a "cognitive" focus (i.e., hypnosis) warrant further study. CONCLUSIONS We recommend a "biobehavioral" perspective in the assessment and treatment of bed-wetting and suggest that combining the urine alarm with desmopressin offers the most promise and could well push the already high success rates of conditioning approaches closer to 100%. Much important work is yet to be completed that elucidates the mechanism of action for the success of the urine alarm and in educating society about its effectiveness so that its availability is improved.

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Empirically Supported Treatments in Pediatric Psychology: Nocturnal Enuresis

Life changes and protective factors of 156 enuretic and 170 non-enuretic 7-yr-old children were analysed using the multi-item Life Change Unit method and psychological examination. Of the single life events, divorce or separation were seen to increase the risk of enuresis. The weighted life change scores were significantly higher for the enuretics than for the controls at age levels of 3, 5 and 6 yrs. Secondary night-wetting was precipitated by increased life stress, but this was not the case with secondary day-wetting. Repression showed a predominance in enuretics. A strong ego was found to serve as a protective factor against enuresis under changing life conditions.

Arthur Ginsburg

Papers

Enuresis Incidence and pertinence of genitourinary disease in healthy enuretic children

Prostatic secretion and urethral flow. New concepts and preliminary data.

Charged Gold Leaf in Urology: 1. Urethral Meatotomy

Photostudies of urethral varices "hemorrhoids": a forgotten lesion.

Understanding and managing enuresis in children.