Dementia and Geriatric Cognitive Disorders Extra最新文献

{"title":"Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability.","authors":"Mayuka Oki,&nbsp;Miyuki Matsumoto,&nbsp;Yukiko Yoshikawa,&nbsp;Mitsuko Fukushima,&nbsp;Akira Nagasawa,&nbsp;Tomokazu Takakura,&nbsp;Yukiko Suzuki","doi":"10.1159/000514285","DOIUrl":"https://doi.org/10.1159/000514285","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to determine the main risk factors for falls in patients with Alzheimer disease (AD) by comparing balance, cognition, and visuospatial ability between those who have experienced a fall and those who have not.</p><p><strong>Methods: </strong>Forty-seven AD patients were admitted to a ward for patients with dementia (22 men and 25 women). The balance of patients was evaluated using the Functional Reach Test (FRT), the one-leg standing duration, and the Timed Up and Go (TUG) test. The Mini-Mental State Examination-Japanese (MMSE-J) was used to evaluate cognition. For visuospatial ability assessment, the Clock-Drawing Test (CDT) as well as overlapping figure identification and shape discrimination in the Visual Perception Test for Agnosia (VPTA) were used. The patients were allocated to either the fall group or the nonfall group based on their history of falls in the past year. The relationships between patients' characteristics and evaluation outcomes were compared and examined. Logistic regression analysis was performed using a fall as the objective variable. The area under the curve (AUC) and the cutoff value were calculated.</p><p><strong>Results: </strong>Of the 47 participants, 22 had experienced falls within the past year (46.8%). The results of the FRT, one-leg standing duration, the TUG, the CDT, and the VPTA were significantly lower in the fall group. No significant difference between the MMSE-J scores of the fall group and those of the nonfall group was observed. The results of the logistic regression analysis indicated that falls in AD patients were significantly associated with the FRT. It was found that a shorter FRT distance (cm) had a significant impact on falls. For the FRT, the fall-related AUC was 0.755. At a cutoff value of 24.5 cm, the level of sensitivity was 68.0%, and the level of specificity was 77.3%.</p><p><strong>Conclusions: </strong>The findings of this study indicate that balance and visuospatial abilities are risks factors for falls in AD patients. In contrast, cognitive impairment was not a risk factor for falls. It was demonstrated that the FRT could be an appropriate risk predictor for falls in AD patients. In particular, falls in AD patients were strongly affected by a reduced dynamic balance.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"58-63"},"PeriodicalIF":2.3,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38890263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Properties of the Persian Montreal Cognitive Assessment in Mild Cognitive Impairment and Alzheimer Disease.","authors":"Vahid Rashedi, Mahshid Foroughan, Negin Chehrehnegar","doi":"10.1159/000514673","DOIUrl":"10.1159/000514673","url":null,"abstract":"<p><strong>Introduction: </strong>The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD).</p><p><strong>Method: </strong>One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered.</p><p><strong>Results: </strong>The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively.</p><p><strong>Discussion: </strong>The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"51-57"},"PeriodicalIF":1.4,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/64/dee-0011-0051.PMC8077519.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38972035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice.","authors":"Alcina Matos Queirós,&nbsp;Armin von Gunten,&nbsp;Manuela Martins,&nbsp;Nathalie I H Wellens,&nbsp;Henk Verloo","doi":"10.1159/000514118","DOIUrl":"https://doi.org/10.1159/000514118","url":null,"abstract":"<p><strong>Introduction: </strong>As Earth's population is rapidly aging, the question of how best to care for its older adults suffering from psychiatric disorders is becoming a constant and growing preoccupation. Depression is one of the most common psychiatric disorders among older adults, and depressed nursing home residents are at a particularly high risk of a decreased quality of life. The complex requirements of supporting and caring for depressed older adults in nursing homes demand the development and implementation of innovative clinical and organizational models that can ensure early identification of the disorder and high-quality multidisciplinary services for dealing with it. This perspective article aims to provide an overview of the literature and the state of the art of and the urgent need for research on the epidemiology and clinical treatment of depression among older adults.</p><p><strong>Method: </strong>In collaboration with a medical librarian, we conducted literature and bibliometric reviews of published articles in Medline Ovid SP from inception until September 30, 2020, to identify studies related to depression, depressive symptoms, mood disorders, dementia, cognitive disorders, and health complications in long-term care facilities and nursing homes.</p><p><strong>Results: </strong>We had 38,777 and 40,277 hits for depression and dementia, respectively, in long-term care facilities or nursing homes. The search equation found 536 and 1,447 studies exploring depression and dementia, respectively, and their related health complications in long-term care facilities or nursing homes.</p><p><strong>Conclusion: </strong>Depression's relationships with other health complications have been poorly studied in long-term care facilities and nursing homes. More research is needed to understand them better.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"38-44"},"PeriodicalIF":2.3,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing Staff's Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study.","authors":"Benedicte Sørensen Strøm,&nbsp;Hilde Lausund,&nbsp;Anne Marie Mork Rokstad,&nbsp;Knut Engedal,&nbsp;Alka Goyal","doi":"10.1159/000514092","DOIUrl":"https://doi.org/10.1159/000514092","url":null,"abstract":"<p><strong>Background: </strong>Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude.</p><p><strong>Aim: </strong>To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India.</p><p><strong>Method: </strong>An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services.</p><p><strong>Findings: </strong>The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia - a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way.</p><p><strong>Conclusion: </strong>The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"29-37"},"PeriodicalIF":2.3,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reported Cognitive Decline Based on the Ascertain Dementia 8 Questionnaire May Be Effective for Detecting Mild Cognitive Impairment and Dementia in the Community: The Wakuya Project.","authors":"Mari Kasai,&nbsp;Tomohiro Sugawara,&nbsp;Junko Takada,&nbsp;Keiichi Kumai,&nbsp;Kei Nakamura,&nbsp;Kenichi Meguro","doi":"10.1159/000514324","DOIUrl":"https://doi.org/10.1159/000514324","url":null,"abstract":"<p><strong>Introduction: </strong>To assess cognitive impairment, self-awareness is an important issue. The Ascertain Dementia 8 questionnaire (AD8) is a brief observation checklist for detecting mild cognitive impairment (MCI) and dementia. After analyzing the reliability and validity of a self-reported Japanese version of the AD8 (AD8-J), we compared self- and informant-reported versions of the AD8-J.</p><p><strong>Methods: </strong>A total of 93 community residents aged 75 years or older living in Wakuya, Northern Japan, agreed to participate in this study; 35 were rated as Clinical Dementia Rating (CDR) 0 (healthy), 46 as CDR 0.5 (defined herein as MCI), and 12 as CDR 1 or above (dementia, confirmed by the DSM-IV). We examined the reliability and validity using a receiver operating characteristic (ROC) curve. We analyzed the differences between self-reported and informant-reported AD8-J using a repeated measures ANOVA.</p><p><strong>Results: </strong>The self-reported AD8-J showed a satisfactory reliability (i.e., Cronbach coefficient, α = 0.71; Guttman split half method coefficient = 0.60). For CDR 0 vs. CDR 0.5 or above, the area under the ROC curve was 0.74 and the cutoff score was 1/2, with a sensitivity of 70.7% and a specificity of 65.7%. Analysis of the subscores of AD8 suggested that, from the early stage of dementia, the subjects showed a subjective decline in memory and interest in hobbies/activities, as well as problems with judgment.</p><p><strong>Conclusion: </strong>It is suggested that the self-reported AD8-J was effective in detecting MCI and dementia. We could use it for detecting MCI and dementia, including in those living alone, in the primary health checkup.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"45-50"},"PeriodicalIF":2.3,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25551206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Pain Behaviors in Dementia: Letter to the Editor with Reference to the Article by Morrison et al. (2020).","authors":"Mustafa Atee, Thomas Morris, Stephen Macfarlane, Jeffery D Hughes, Colm Cunningham","doi":"10.1159/000513881","DOIUrl":"10.1159/000513881","url":null,"abstract":"","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"16-18"},"PeriodicalIF":1.5,"publicationDate":"2021-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/e0/dee-0011-0016.PMC7989828.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal Fluid Hypocretin and Nightmares in Dementia Syndromes.","authors":"Lynn Marie Trotti,&nbsp;Donald L Bliwise,&nbsp;Glenda L Keating,&nbsp;David B Rye,&nbsp;William T Hu","doi":"10.1159/000509585","DOIUrl":"https://doi.org/10.1159/000509585","url":null,"abstract":"<p><strong>Background/aims: </strong>Hypocretin promotes wakefulness and modulates REM sleep. Alterations in the hypocretin system are increasingly implicated in dementia. We evaluated relationships among hypocretin, dementia biomarkers, and sleep symptoms in elderly participants, most of whom had dementia.</p><p><strong>Methods: </strong>One-hundred twenty-six adults (mean age 66.2 ± 8.4 years) were recruited from the Emory Cognitive Clinic. Diagnoses were Alzheimer disease (AD; <i>n</i> = 60), frontotemporal dementia (FTD; <i>n</i> = 21), and dementia with Lewy bodies (DLB; <i>n</i> = 20). We also included cognitively normal controls (<i>n</i> = 25). Participants and/or caregivers completed sleep questionnaires and lumbar puncture was performed for cerebrospinal fluid (CSF) assessments.</p><p><strong>Results: </strong>Except for sleepiness (worst in DLB) and nocturia (worse in DLB and FTD) sleep symptoms did not differ by diagnosis. CSF hypocretin concentrations were available for 87 participants and normal in 70, intermediate in 16, and low in 1. Hypocretin levels did not differ by diagnosis. Hypocretin levels correlated with CSF total τ levels only in men (<i>r</i> = 0.34; <i>p</i> = 0.02). Lower hypocretin levels were related to frequency of nightmares (203.9 ± 29.8 pg/mL in those with frequent nightmares vs. 240.4 ± 46.1 pg/mL in those without; <i>p</i> = 0.05) and vivid dreams (209.1 ± 28.3 vs. 239.5 ± 47.8 pg/mL; <i>p</i> = 0.014). Cholinesterase inhibitor use was not associated with nightmares or vivid dreaming.</p><p><strong>Conclusion: </strong>Hypocretin levels did not distinguish between dementia syndromes. Disturbing dreams in dementia patients may be related to lower hypocretin concentrations in CSF.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"19-25"},"PeriodicalIF":2.3,"publicationDate":"2021-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000509585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Has Made the Elderly Lonelier.","authors":"Mahdi Naeim,&nbsp;Ali Rezaeisharif,&nbsp;Aziz Kamran","doi":"10.1159/000514181","DOIUrl":"https://doi.org/10.1159/000514181","url":null,"abstract":"<p><p>Loneliness is a major risk factor for the elderly and can double their problems. When COVID-19 started, things became more difficult for the elderly. The news that the elderly are at a higher risk for severe COVID-19 than others made the elderly lonelier. This is a library type study that was conducted over 2 months using valid scientific sources and books. Based on the findings of this study, we believe that focusing on education and reminding people of the necessary dos and don'ts of illness, modifying their diet, emphasizing masking, and even familiarizing the elderly with social media and virtual activities will prevent them from suffering loneliness.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"26-28"},"PeriodicalIF":2.3,"publicationDate":"2021-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the 18-Item Dementia Elderly Odayaka Scale in Japan: Evaluation before and after Intervention.","authors":"Hiromi Tsujimura,&nbsp;Makoto Osawa,&nbsp;Setsuko Makita","doi":"10.1159/000512120","DOIUrl":"https://doi.org/10.1159/000512120","url":null,"abstract":"<p><strong>Introduction: </strong>We have developed the Dementia Elderly Odayaka Scale (DEOS) to evaluate psychosocial aspects in older people. The DEOS can be used to assess well-being, such as personhood and social interaction.</p><p><strong>Objective: </strong>The aim of this study was to apply the 18-item DEOS in participants with dementia and to examine the characteristics and usefulness of this scale.</p><p><strong>Methods: </strong>Facility staff provided care for the participants while taking into consideration each participant's individuality and strong points. The DEOS was applied at the beginning of the interventions and at 1 and 2 months after the start of the interventions. The changes in the participants' behaviors and their DEOS scores were then evaluated over time.</p><p><strong>Results: </strong>We examined 13 participants (2 men, 11 women) between the ages of 68 and 91 years. In 60% of the participants the DEOS score increased over time. When care interventions were tailored toward communication and leadership for the 2 men, according to each of their individualities, we observed increases in their scores for \"social interaction\" at 1 and 2 months thereafter. We also observed increases in the scores for \"Expression of emotions\" category in 2 of the 5 cases who received an aromatherapy massage.</p><p><strong>Discussion/conclusion: </strong>The changes in the scores over time and the contents of the field notes were consistent with each other, suggesting that the DEOS can be used both to evaluate the effects of interventions and to plan care that takes advantage of each participant's positive aspects.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"10-15"},"PeriodicalIF":2.3,"publicationDate":"2021-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000512120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-Centred Care Transformation in a Nursing Home for Residents with Dementia.","authors":"Peiyan Ho,&nbsp;Rachel Chin Yee Cheong,&nbsp;Siew Pei Ong,&nbsp;Carol Fusek,&nbsp;Shiou Liang Wee,&nbsp;Philip Lin Kiat Yap","doi":"10.1159/000513069","DOIUrl":"https://doi.org/10.1159/000513069","url":null,"abstract":"<p><strong>Background: </strong>Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient.</p><p><strong>Objectives: </strong>To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents' well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016).</p><p><strong>Methods: </strong>Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents' well-being and staff attrition were measured before and after PCC implementation.</p><p><strong>Results: </strong>There were statistically significant improvements in resident well-being (Δ = 0.44, <i>p</i> = 0.029), Positive Engagement Potential (Δ = 0.17, <i>p</i> = 0.002), and Occupational Diversity (Δ = 0.12, <i>p</i> = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC.</p><p><strong>Conclusions: </strong>Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.</p>","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"11 1","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000513069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}