[in Japanese]

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The authors have developed a neuro-psychological test for dementia based on working memory theory and item response theory, and the test, named TKW test, proved useful for diagnosis of severity and etiology of dementia. In the present study, the authors tried to construct short and concise versions of the test to increase its practical utility in a clinical setting. A new sample of patients was added to the last sample, and the same results were confirmed using the same analytical procedures as in the last study : high agreement between item difficulty estimated from obtained scores and working memory demand, test homogeneity as a prerequisite for application of item response theory, high discriminant power between dementia of the Alzheimer type and vascular dementia, and high concurrent validity with several tests widely used today. Based on these results, six concise versions were constructed in line with the following five selection criteria : item information function, first factor loadings, correlation coefficients of structural matrices in discriminant analysis, item discriminating power, and item difficulty. All concise versions were effective for measurement of severity, and one version, named B2, was the most effective for discrimination between etiological categories. In addition, single versions of the test using only one item were also examined in terms of merit of item response theory. The above five selection criteria plus the maximum working memory demand were used to select items for this version. One item, named hierarchical classification 1, was useful for measurement of severity, and another item, named pointing out the odd kanji of the group, was accurate for discriminating between etiological categories, although these items were necessarily less effective than the whole test because of loss of the total amount of information.

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The purpose of this study was to investigate the effect of cognitive rehabilitation for a stroke patient suffering from longer-term cognitive difficulty without management. Neuropsychological tests were administered to plan the intervention procedure for rehabilitation therapy. The individual exhibits attention and memory deficits after cerebral hemorrhage due to moya-moya disease 10 years earlier and she had undergone no cognitive rehabilitation to date. She was given 10 months of various cognitive rehabilitation trainings for attention and visual perception, stage by stage, both in the hospital and at home. Intensive cognitive rehabilitation resulted in improvement of her WAIS-R and WMS-R scores in spite of the long duration from onset and her ability to use a notebook as a memory aid in daily life. We considered the implications of the study results for future studies of more late-stage intervention.

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In order to find predictors of functional recovery for patients with aphasia, it is necessary to evaluate not only severity of aphasia but also patients' cognitive ability underlying aphasia. In this study, we investigated the influence both of a cognitive function and aphasia on the recovery of basic ADLs for patients with aphasia. Subjects were 80 patients with aphasia after cerebral vascular disease, who admitted to a rehabilitation hospital within three months after onset. Basic ADLs were examined by Barthel Index (BI). Severity of aphasia and cognition were evaluated by using Standard Language Test of Aphasia (SLTA) and Raven's Colored Progressive Matrices (RCPM), respectively. All functional variables were examined at admission, 3 and 6 months after admission. A path analysis model was constructed such that BI could be directly influenced both by SLTA and RCPM. Physical function, age and period from onset to admission were also considered as independent variables in the model. The fitness of the model to our data was confirmed by determination coefficient (R²) for BI throughout the period examined. The path analysis showed that RCPM directly influenced on BI, but no effect of SLTA was found on BI in every period after admission. It was not the severity of aphasia but the cognitive ability to predict the recovery of ADLs for patients with aphasia. It was suggested that rehabilitation approaches to the cognitive function of aphasic patients were needed for their functional recovery.

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