The Effects Of Infrastructural Facilities

The Effects Of Infrastructural Facilities Infrastructure are the basic facilities, services, and installations needed for the functioning of a community or society, such as transportation and communications systems, water and power lines, and public institutions including schools, post offices, and prisons. Large infrastructure projects generally stimulate demand for nearby real estate .these infrastructural projects usually create abundance of jobs as well as follow on demand for goods and services. They also provide a more effective use and connectivity of the available economic resources and the resulting increase in economy activity from new and more disposable income will in turn typically boost. Economic growth, thats why people will want to purchase or rent residential estate in location within close proximity to major works, Major infrastructure project can take many forms and often include transport, infrastructure improvement such as link roads, railway line extension, new bridges and major freeways. Other projects could be new shopping malls and commercial precincts, new power stations, improve communication facilities industrial areas and business parks, new hospital, school and universities. These can all have an impact property values and demand for residential properties. It is also worthy to note that the quality and quantity of infrastructure available in a given place societies is the yardstick for measuring the general level of development of that area and a major determinants of property development and their respective value trends. The provision or not of these facilities can positively development affect the rate of property development in a given area and this in turn can improve the property value due to the corresponding boost on economics activities achieved through the better accessibility (road) or the higher degree of convenience from the use of these infrastructural facilities. 1.2 Statement of Problem The infrastructure of a city is a major determinant on the demand of houses. One of the major problems affecting housing demand in Lokoja. The poor infrastructure provision in the study area affects the rate of housing Demand in the area, this is because people will only buy or rent houses in areas were the infrastructure provision is sustainably available,this will help to enhance the livability in the community. The poor infrastructure provision in Adankolo is a major determinant on the decrease in the rate of housing demands in the study area. Those who are living in the study area have no choice because they cannot afford the rent in other livable towns . Housing is an enclosed component or structure that has services which support the comfort and existence of human living. These services or facilities are numerous some of which include; kitchen, toilet, refuse disposals, good road networks, electricity, telecommunication and others. Ogedengbe and Oyedele, (2006) carried a research on effects of waste disposal on property values, similarly Robet in his work The Effects of Road Infrastructure on Property Values emphasized more on just road as a facility affecting demandvalues, Whereas many other facilities affect values of residential properties. This now poses a gap between these previous empirical studies hence there is need to reconsider many other facilities as they affect housing demand and housing demand of residential properties. 1.3 Aim and Objectives The aim of this study is to ascertain the effects of infrastructural facilities on housing demand in Lokoja metropolis. OBJECTIVES To identify the various infrastructure available in the study area. To examine the adequacy of infrastructural facilities provision on the residential properties in the study area To recommend possible solution to the problems of housing in the study area. 1.4 Scope of the study This research work intends to determine the effects of infrastructural facilities on housing demand in Lokoja. It is limited to Lokoja metropolis alone with particular emphasis on two areas namely; peace community ganaja village and Adankolo for comparative analysis. 1.5 Justification Although challenges surrounding life and human wants are limited and endless, however these study focuses on the effects of infrastructural facilities on housing demand in Lokoja. And this particular studywill serve as a guide to the following. Urban and regional planners and other allied professionals such as builders, architect, engineers, and others in their various field of activities .for example, these study would give the city managers the ideas of important of infrastructural facilities in there different areas. It serves as a tool to all researchers in the field particularly in the study area.(Lokoja) 1.6 The Study Area Lokoja, Nigeria is located at 7.80236 [latitude in decimal degrees], 6.743 [longitude in decimal degrees] at an elevation/altitude of meters. The average elevation of Lokoja, Nigeria is 55 meters.Lokoja is also a Local Government Area of Kogi State with an area of 3180 km ² and a population of 195,261 at the 2006 census. It is bounded by the Niger in the north and east upstream from the capital until the border with Kwara State, and includes the city of Lokoja. The postal code of the area is 260.The original site of Lokoja, is a 1,349-foot- (411-metre-) high mass of oolitic iron ore. The town has a hydroelectric power generating plant. It is situated on the local highway between Kabba and Ayangbe and has ferry service across the Niger River. Formerly the capital of Kabba province, Lokoja was part of Kwara from 1967 to 1991, when it became the capital of the newly formed state of Kogi. CLIMATE Climate: The site has a tropical climate that comprises of two season namely dry and wet seasons. The wet seasons starts from the month of April and ends in October, while the dry season starts from November and continues till March. The two seasons are affected by the south-westerly winds coming from the Atlantic Ocean and north-easterly winds which come from the Sahara Desert. Another weather phenomenon (micro climate) is associated with the presence of inselbergs. This feature exerts an influence on local weather greater than their size. Rainfall: Rainfall data obtained from the Department of Meteorological Services Lokoja for 25 years (1989- 2005) reveals that the maximum daily rainfall figures of Lokoja town are as follows: Humidity and Temperature: The highest temperatures in the study area always tend to occur at the end of the dry season close to the spring equinox. Thus March has the highest temperature of about 34.5 c, while the lowest temperature occur in the middle of the dry season in December/January, when outgoing radiation is encouraged by low humidity, clear skies and longer nights. The temperature at this time falls as low as 22.8 c. In the dry season there is a decrease in relative humidity from south to north in the study area caused by the higher elevation in the north. In the rainy season, this variation disappears and associated with the high relative humidity is an extensive cloud cover over the region. ECONOMY Agriculture is main stay in Lokoja area economy, various crops are widely grown in the area which includes; coffee, cocoa, palm oil, cashews, groundnuts, maize, cassava, yam, rice and melon.The state is home to the largest iron and steel industry in Nigeria known as Ajaokuta Steel Company Limited. One of the largest cement factories in Africa, the Obajana Cement Factory . MAP OF NIGERIA DEPICTING STUDY AREA Limitation of the Study The major problem in the field of study is language barrier and through these, the researcher that did not understand their language (respondents) will find it difficult to express his mind freely to those that did not understand English language which is the general language in Nigeria, among the respondents. Another problem is illiteracy among the respondents; because some of the respondent finds it difficult to fill questionnaire which is the main information needed from them for the completion of the project. Lastly regardless of these limitations, data collected are sufficient enough to reach the research objectives. 1.8 Definition of Terms Infrastructures It can be generally defined as the set of interconnected structural elements that provide framework supporting an entire structure of development The term typically refers to the technical structures that support a society, such as roads, bridges, water supply, sewers, electrical grids, telecommunications, and so forth, and can be defined as the physical components of interrelated systems providing commodities and services essential to enable, sustain, or enhance societal living conditions The terms housing demand and housing needs are often confused. There are Some key differences between housing demand and housing needs that must beclarified. The meaning assigned to both terms is erroneously similar in manydocuments. The following statement is extracted from the study of housing- Demand models published by the Housing Branch in Hong Kong which asserts that: Housing needs Housing needs is defined as the number of existing ornew households requiring adequate housing. Anadequately housed household is one that lives in selfcontained living quarters made of permanent material.(Liu, Wu, et al. 1996) They also proffer a workable definition of housing demand, viz: Housing demand Housing demand is defined as the number of householdsactually seeking accommodation. In the public sector,demand is assumed to be equal to housing needs. In theprivate sector, demand is constrained by affordability. Facility may refer to: An installation, contrivance, or other things which facilitates something; a place for doing something: Literature Review Infrastructure has been variously defined, according to William Merish and Catherine Brown described infrastructure as the systematic framework which underpins a communitys ability to fulfill its mission of providing a basis of its citizen to productive and to nurture social equity.Omuojine(1997) described it as the stock of fixed capital assets in a country for example Road, railways, Airports, Hospitals, Waterway, power stations, water works, and telecommunication network. It serves as slender threads that weaves together human want and value with those of the environment.Literally, it refers to fixed facilities or installation traditionally provided by public sector. Omuojine (1997) classified it as followed. Transportation including road, railway, airports, seaports and water way. Water supply including water works and Dams Electricity including power stations Telecommunication including postal, telephone, telex, fax, mile services. Health including Hospital, maternity home, and health centers. Sanitation and solid waste disposal. Drainage and Embankments. Infrastructures have certain characteristics viz. Requires large lump sum investment. Entails considerable economic of scale which results in monopolies. Has a high level of externalities both positives and negatives. Intermediate input characteristics. Possess important networks effects. Posses difficulties in cost recovery. While these characteristics have generally remained true, the exact character trait will depends on whether it is urban, rural or inter rural. Infrastructure or trunk and feeder type of fixed/ moving facilities, or the operator of the facility i.e. Whether public or private, central/ state, local Government agencies. Infrastructures include the aggregate of all facilities that enables a society to function effectively, by providing the physical facilities, which moves people, goods, commodities, water, waste, Electricity, road, sewerage and information infrastructure provides an enabling environment for growth and enhanced quality of life.PojuOnibokun (1985) infrastructure is therefore; universally regarded as the engine that drives the city. The linkage between the economy activities and infrastructure continue to grow stronger and more critical as an economic activity becomes increasingly more complicated and global in scope. Lawal (1997). Through the provision of urban infrastruct ure is tradition all the presence of government, the growing difficulties and limitation of public finance and the reality of the wide gap between the demand and supply of infrastructures services with all its pervasive effect inevitably compel urban authorities to look to the private sector and community. Based organization (cbos) for partnership. Babawale (2004) infrastructure is generally poor in developing countries. Although it differs widely among countries and sectors. In Nigeria for instance most households and private companies get electricity form private generating sets because of power holding of Nigeria unreliability. This imposed extra cost on companies and environmental effects on neighbors. There is no water supply in most cities and therefore no waste disposal system. HOUSING DEMAND Housing demand is defined as the housing need people backed up with the purchasing power or the ability and willingness to pay. According to You (1993). As quoted in Olufemi(1993), housing demand could be expressed in term of purchasing power, a function of income, family size, location and tradition etc. Housing demand is different from need. It is only when the need (desire) is backed up with price or rent that we talk of effective demand.According to Robinson (1979), there are three main component of housing demand and these are. From new households, demand from movers between tenure group and demand from existing household within a particular tenure groups. The author also noted that renting is an important feature of demand. This is because the majority of household who could not build or purchase their own home often result to renting. Demand for housing differs from place to place across the socio- economic groups. For instant demand in the city differs from that of the rural areas. Demand also differs among high, medium, and low income groups. Housing demand also changes with time and with social and economic situations. In Nigeria for instance there is a noticeable change in the demand for different type of units. As income and building technology changes. There has been gradually change from the demand for row housing or face to face tenement to more modern housing types such as self contain and flats apartment as well as duplexes. Generally,housing market or sub market of the low income group demonstrates a great diversity of demand, which result from two major factors (UNCHS, 1996) first is there disposal income and the second is how much they are prepared to spend on housing. The amount of money they are willing to spend on housing is in turn determined by the type of accommodation available, the location, s ize, and quality of the houses in terms of infrastructure and services available, and the level of security offered. The demand for housing is a reflection of the ability of household to pay for them. Thus, an examination of households, income and prices of housing unit provides a basis for accessing housing demand, an assessment of the housing demand situation in Nigeria by the UNCHS (1993) reveals that the different income groups are confined to different options. Generally, the poor economic situation in Nigeria during and in the post. Structure adjustment program (SAP) period has affected the purchasing power of the majority. Although household income have risen, in numerical terms, by a factor of about five since 1987, the purchasing power has declined by a factor of about eight(UNCHS,1993). It is therefore observed that the household income of the lowest income group are too low to allow them to exercise any effective demand for formal housing in the open market consequently, majority of the low income household cannot afford any form of formal housing without subsidy. Thus they resort to sur vival outside the formal housing market. For this group the UNCHS (1993) observed that. the present 20% of the household do not earn enough to participate in formal housing market in the urban area. They resort to various informal housing arrangements for themselves. This arrangement includes the setting -up of shanty dwellings of their own on land belonging to them(squatting), renting shanty dwelling, colonization of uncompleted multiples storey buildings, occupation of vacant spaces in public buildings at night,etc. BASIC CONCEPT OF HOUSING. Housing is an empirical word as Salau (1990) has written The confusion of given an exact meaning of definition to housing is perhaps due to the multi-dimensional nature of housing itself Agboola (1998) stated that Housing involves series of processes by which resources such as land, labour, finance and building materials are combine to produce new housing. It involves also the upgrading of existing housing to the demanders .He explained further that housing particular delivery system encompasses the process that allocates housing unit to households in particular country and that housing delivery is stimulated and sustained by the demand and supply mechanism this of course,means that in a free market economy like Nigeria, the forces of demand and supply for housing stock, may determine what stocks come into the housing delivery market and who among the demander get what from the market?. According to Baurue (1981), Housing is the provision of all forms of infrastructures for a conducive living environment whereas habitable and standard houses bythe residential or commercial or any other forms of building properly arranged in a statutorily planned area meeting all the forms of planning rules and ordinances in housings.World health Organization (WHO). Defined housing as a residential environment which includes in addition to the physical structures. The main uses for shelter, all necessary services, facilities, equipment and devices needed or desire for physical or social wellbeing of the family and individuals. Ayeni(1984) defines housing as not only referring to the shelter provided by the structure but also the lot on which the shelter stands and the services provided to the lots such as waterand energy supply, waste disposal, drainage, fire and police protection and kick lighter (1986)defined the term housing in its entire ramification to refer to more than just a dwelling but also included all that is within and surrounds thedwelling. Salau(1990) transcends the physical dimensions of shelter and include the general environment within which the structure is located and the availability of essentialsocial services and infrastructural facilities, which ultimately ensure the satisfaction of the population. National housing policy (1991), housing forms an important part of peoples life and it is rather inseparable from them as it provides the users of occupiers shelters, security, privacy, prestige and a means of self-expression. It is a basic need as everyone requires a shelter, which for most people means a home that, is a permanent base in which the greater part of time is spent. Ozo (1987), asserted that a house must be a home;that is , a resting place in which to try to fulfill the fundamental purpose of human society,namely a secure , rewarding, happy or atleast a reliable life.to the individual family,a house as both a shelter and symbols of physical protection and psychological identity of economic valueand a foundation for security and self respect.Olotuali (1997) stated that housing provides the framework of meeting mans need for shelterand it is all encompassing phenomenon of the creation of the environment, in which man grows and lives and grows.Bourne (1981)summed housing up as a physical entity, a good artifact, an economic good, a capital stockand a statue symbol all at once.Madge(1968) assorted that housing is an important element in all capital formation and the largest single component in total building of any nation. According to Omole(2001), housing is more than a mere shelter in its proper definition , housing can be defined as a residential environment which man uses for shelter and the environment of the structure needed or design for his physical and mental health as well as the social being. Ozo (1987), a house is certainly the bulkiest, the most difficult to move and most durable consumer good. In view of the enormous resources requiredin acquiring housing (since it can hardly be purchase out of ones income in less developed countries). It is true measure of the social- economic statues of a society. Looking at the definitions above .therefore a good housing or shelter development of a group of people and a nation at large. A well determined settlement equally determined the productivity and consumption ration as well as economic, moral and welfare terms of the people or nation. THE NIGERIAN HOUSING MARKET The Nigerian housing market is highly untapped and undeveloped despite lot of opportunities that abound in the sector (Akeju 2007). This is basically due to many reasons amongst which includes. Lack of finance Government policy Lack of infrastructural development High level of poverty. There is continuous increase in the average price of house due to increase in cost of building materials and inflation in the economy. This has highly contributed to the upward trend in the house trend in the house price which has significantly affected the number of unit of houses constructed annually. The Government efforts at addressing the problem have not been successful due to its unsustainable approach of providing houses to the people, the houses are grossly inadequate and unaffordable by the larger proportion of the masses for which they are meant for. There are efforts by the private individuals to help in alleviating these housing problems. The bulk of the housing problems is prevalent in urban cities, but there are lot of un occupied and dilapidated houses in the rural areas to urban centers for greener pastures. Most individual that are involved in property development build for their own uses or are home owners, while the few ones involves in building for commercial purposes, build shops and space to let for offices because if the high rental income accruing from such commercial properties. The residential developments in most cases are illegal, informal and untitled. This is due to long, undue delay to title registration and laxity in enforcing development control regulations by the official of the urban and regional planning department (Fasakin and Ogunmakin 2006). Private sectors contribution toward alleviating this housing problems has been I the form of individual efforts, cooperative societies or association, corporate bodies, estate agents, nongovernmental organization / charity organization and foreign investors, their contributions toward alleviating housing problems in Nigeria are briefly discussed below. INDIVIDUALS This represent the greatest source of contribution from the private sector in most urban centers where the housing problem is very prevalent , a greater proportion of the population dwells in residential houses built by private individuals. These individual financed the project through their personal savings, borrowing from family, friends and lenders or cooperative movements. It can be categorically stated that number of housing unit built by individual have been very substantial when compared with other source of constructing houses. (2) COOPERATIVE BODIES The idea of cooperatives housing have started long time ago when individual planning to own a house seek help from relative, in town, neighbors and friends (Wahab 1988). This concept has been successfully tested and certified in countries like Italy, United Kingdom, Zambia, Sweden and Philippines (Daramola, 2006). It is suited to meet the need of low income earner who constitutes the vast majority of Nigerians. The member of the cooperative are able to enjoy housing loan for the construction of their own housing unit. (3) CORPORATE BODIES. The federal government of Nigeria has realized that they cannot solve the housing problem alone. Has involved the cooperate bodies to contributes their own goals towards the achieving the objectives of housing for all. It was evident that most of the companies have totally neglect for housing needs of their workers. These consequently made the Government come to the rescue of the workers. These consequently made the Government come to the rescue of the workers through the promulgation of employee housing scheme (special provision). Decree 54 of 1979, thus compelling any employer of 500 employees to provide minimum housing of 50 units of which 75% should available for non-executive staff. (4) ESTATE DEVELOPER / AGENTS The private developer or estate agents activities were concentrated in Lagos in 1990 and they play significant roles in the development of the Nigeria housing market (Efin. A and Finmark trust,2010), they ensure adequate shelter is provided to meet the demand of the increasing number of people having housing need. They often employ various finance techniques such as turnkey, pre-letting and joint finance to construct housing unit for the people (Nubi 2000). (5) NON GOVERNMENTAL ORGANISATION AND VOLUNTARY ORGANISATION. In recent year there is increasing trends by non-governmental organization and voluntary organization such as religion bodies to contribute their own effort at addressing the housing problems faced by the people in both rural and urban cities. They assist resetting displaced people having housing problem as a result of natural disaster like war, flood, famine, earthquakes, and etc. (6) FOREIGN PARTNERS / INVESTORS. The government through its various development policies has attempted to encourage foreign investors in the housing market. This is usually in the form of foreign partnership with the local estate developers.These provided more capital base for the estate company, thus making them to be involved in large capital based project. The company are usually handling Government housing project which are capital intensive and required more technical expertise and knowledge. THE ECONOMICS OF HOUSING Housing as a product is regarded as a commodity with an exchange value, according to Angel et.al (1992), housing is viewed as a commodity with an exchange value rather than as goods to be produced and allocated outside the market place. Hence the housing sector is composed as a vast set of exchange relations, driven by supply and demand forces which permit all part of the sector despite the existence of apparently distinctive sub markets. (Agunbiade 1993). The units in the standing stock to be traded in the market have a contribution of attributes and qualities, which determines their selling prices. Such attributes include age and durability of structures, total floor space, structural design and internal layout, location accessibility, ancillary services present, security, aesthetics and the general environmental condition. These attributes distinguish one unit from the other. Thus the structural condition of units and the flow of services they yield determine the value of housing unit in the market. According to Robinson (1979) there are two measure of value in the housing market, these are rent and price. Rent is the payment made for a flow of housing services received over a specific period of time while price is the capital value associated with a particular unit of stockin the ordinary sense, we could argue that the value of housing unit (V) is equalto its price (P) i.e. V = P . However in some cases, the different between the exchange value and the actual value is refers to as subsidy, which is often, paid by Government or corporate bodies to their employees. Thus, subsidy could be regarded as a distortion to the actual market determined price or rent of a housing unit. Housing need, supply and housing price in an economy involved complex processes that are influenced by social and economic force. The understanding of the nature and attributes of the demand and supply of housing is therefore important in any housing study. However, before we address the issue of need, demand, supply and price. It is ideal to consider the characteristics of housing as a product 2.5 ROLE OF INFRASTRUCTURAL FACILITIES ON DEVELOPMENT Ratchiffe (1995) classical rent theory conceptualizes that general improvement in access routes (Roads) have positive effect on the areas land values; Boyce and Allen (1974) in Denver studied the impact of accessibility and amenities on property values. They selected several study areas then applied six (6) criteria encompassing accessibility, amenities and property characteristics and used regression analysis to investigate 24,082 property transactions. They identified a positive impact of infrastructural facilities on property values. Stopper and Meybury (1971) claimed that the relevance of transportations facilities in influencing urban growth and development is reflected in most North. American and Europeans town which shows a growth pattern derived largely from transactional routes. Abouchar (1977) investigated the impact of a subway on property value on Toronto, he studies the metropolitan Toronto subway system through on analysis of the operations of welfare criteria with the basic objective of distinguishing the impact of the subway on property value (demand and price) by looking at year to year relative percentage changes in property values in and out of the subway corridor. However, his analysis concluded that the subway had no effect on the property value in the subway area. The validity of findings and conclusion are questionable as the study did not fulfill the requirement of a before and after approach because the analysis of the property market was concluded in 1992 the date the subway began its operation. Abdulateef (1997) observed a positive impact of road transportation and communication on land use development and property values, the provision of infrastructural facilities in any socio economic unit whether a nation, region or community could have either a positive or negative impact on property value. For instance, the provision of an incinerator in a residential district will have a negative effect on the value of the properties in that area while the provision of infrastructural facilities like good roads network, water and electricity supply, drainage system, good refuse collection treatment and disposal system etc enhances values to unpre cedented level just as the inadequacy or lack or these facilities adversely affect value as a paradox. 2.6 IDENTIFICATION OF PUBLIC UTILITIES MANAGEMENT AGENCIES IN NIGERIA The prominent public agencies for the provision and management of the infrastructural facilities in Nigeria are: Power holding company of Nigeria Plc. In charge of electricity generation, distribution and supply to consumers (PHCN) Nigeria telecommunications limited (NITEL) State water corporation State waste management boards Federal road maintenance agencies (FEMA) Nigerian communications commission (NCC) Federal air

Cognitive Impairment And Alzheimers Disease Health And Social Care Essay

Apathy is one of the commonest symptoms in Alzheimers disease and is associated with frontal lobe disfunction. Apathy is associated with high health professional load and has several negative effects.Purposes:The primary purpose of this survey is to analyze an association between apathy and frontal lobe disfunction in patients with memory jobs. We besides aimed to look into the association between apathy badness and health professional load along with the relationship between apathy and practiceMethods:This was a retrospective cross sectional survey. We selected 162 back-to-back patients diagnosed with Alzheimer ‘s dementedness and Amnestic Mild Cognitive Impairment who had comprehensive battery of neuropsychological trials and a behavior evaluation graduated table of involvement for this survey recorded in the database. Correlation between apathy with and without depression were tested against frontal lobe trial including Trail doing A, Trial doing B, Letter Fluency, Ideationa l Fluency, Category eloquence, Abstract Thinking and Executive working subtest of CAMGOG-R. Similarly correlativity analysis was besides done to look into association between apathy and caregiver load every bit good as practice.Consequences:Statistically important relationship were found between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. Relationship between apathy and health professional load were extremely important. Further bomber analysis, found apathy to be significantly associated with health professional load in both AD and aMCI patients.DecisionsApathy is associated with frontal lobe disfunction particularly impaired executive map and conceptional eloquence even when controlled for depression. It is extremely associated with health professional load both in AD & A ; aMCI.Hence early acknowledgment and direction of apathy is of import bettering the forecast of patients with AD & A ; aMCI.Table OF CONTENTSABSTRACT 3Chapter 1: Overview OF APATHY 5- 18Chapter 2: Introduction 19 – 20Chapter 3: AIMS & A ; OBJECTIVES 21Chapter 4: Methodology 21 – 28Chapter 5: RESULTS 28- 40Chapter 6: DISCUSSION & A ; CONCLUSIONS 40 – 44REFERENCES 45 -48APPENDIX A: Clinical RESEARCH PROTOCOLAPPENDIX B: ETHIC APPROVAL LETTERAPPENDIX C: NHS R & A ; D APPROVAL LETTEROVERVIEW OF APATHYDefinitionApathy is derived from the Grecian term apatheia intending deficiency of poignancy, or passions, and is normally referred as absence of feeling, emotions, involvement, or concern. ( Marin, 1990 ) Marin was the first to gestate apathy at both symptomatological and syndromal degrees and defined apathy as â€Å" deficiency of motive non attributable to decrease degree of consciousness, cognitive damage, or emotional hurt † ( Marin, 1990 ) .Motivation is a psychological construct and therefore it hard to quantify and measure up it.Hence to do it more clinically qualifiable and quantifiable, Apathy was proposed as a behavioral alteration from the person ‘s baseline and measured as a decrease in spontaneous and purposeful activity. ( Levy and Dubois, 2006 ) . A Starkstein and co-workers have developed a set of diagnostic standards for apathyA these standards specify the undermentioned as nucleus characteristics of apathy: lessened motive, inaugural and involvement, and blunting of emotions ( Starkstein and Leentjens, 2008 ) . In malice of assorted definitions of apathy being proposed, confusion continue to reign sing the nosological place of apathy.Nevertheless progressively apathy is being recognised as an of import constituent of neuropsychiatric research and that ‘s why dependable instance description and designation is necessary, to help communicating, research and intervention. This led to the development of consensus diagnostic standards for apathy in Alzheimer ‘s disease and other neuropsychiatric upsets ( Robert et al. , 2009 ) .DIAGNOSTIC CRITERIAThe revised consensus standards for apathy follow the same general construction as the standards proposed by Starkstein et Al in 2001 ( Robert et al. , 2009 ) . For a diagnosing of Apathy the patient should carry through the standards A, B, C and DStandards ALoss of or diminished motive in comparing to the patient ‘s old degree of operation and which is non consistent with his age or civilization. These alterations in motive may be reported by the patient himself or by the observations of others.Criteria BPresence of at least one symptom in at least two of the three following spheres for a period of at least four hebdomads and present most of the clipDomain B1: Loss of, or diminished, purposive behavior as evidenced by at least one of the followers: Loss of self-initiated behavior ( for illustration: starting conversation, making basic undertakings of daily life, seeking societal activities, pass oning picks ) Loss of environment-stimulated behavior ( for illustration: responding to conversation, take parting in societal activities )Domain B2: Loss of, or diminished, purposive cognitive activity as evidenced by at least one of the followers: Loss of self-generated thoughts and wonder for modus operandi and new events ( i.e. , disputing undertakings, recent intelligence, societal chances, personal/family and societal personal businesss ) . Loss of environment-stimulated thoughts and wonder for modus operandi and new events ( i.e. , in the individuals abode, vicinity or community )Domain B3: Loss of, or diminished, emotion as evidenced by at least one of the followers: Loss of self-generated emotion, observed or self-reported ( for illustration, subjective feeling of weak or absent emotions, or observation by others of a dulled affect ) Loss of emotional reactivity to positive or negative stimulations or events ( for illustration, observer-reports of unchanging affect, or of small emotional reaction to exciting events, personal loss, serious unwellness, emotional-laden intelligence )Criteria CThese symptoms ( A-B ) cause clinically important damage in personal, societal, occupational, or other of import countries of operation.Criteria DThe symptoms ( A-B ) are non entirely explained or due to physical disablements ( e.g. sightlessness and loss of hearing ) , to drive disablements, to decrease degree of consciousness or to the direct physiological effects of a substance ( e.g. drug of maltreatment, a medicine ) .PrevalenceApathy is an of import and often happening symptom in a assortment of neuropsychiatric upsets. Dementia and schizophrenic disorders are among the common causes of apathy ( ref ) . The prevalence for apathy in Alzheimer ‘s disease ranged between 32.1 % ( Holthoff et al. , 2005 ) and 93.2 % ( Sr ikanth et al. , 2005 ) . Point prevalence for apathy in Alzheimer ‘s disease ranged from 32.1 % 19A to 58.7 % ( Aharon-Peretz et al. , 2000, Holthoff et al. , 2005 ) . Table 1: Prevalence of Apathy Across Disorders ( Ishii et al. , 2009 )DisordersPrevalenceMild Cognitive Impairment 14.7 % a?’39.8 % Parkinson ‘s disease 17.0 % a?’45.7 % Progressive supranuclear paralysis 22 % a?’91 % Huntington ‘s disease 59 % a?’82 % Corticobasal devolution 40 % A Frontotemporal dementedness 89 % a?’100 % Dementia with Lewy organic structure 52 % Multiple induration 20 % a?’31 % Stroke 15.2 % a?’42 % Vascular dementedness 22.6 % a?’93.6 % Traumatic encephalon hurt 20 % a?’70 % Amyotrophic sidelong induration 55.6 % Hiv 12 % Cardiovascular disease 29 %CONDITIONS ASSOCIATED WITH APATHYApathy can be a symptom in a figure of neurological or psychiatric syndromes. Neurological Disorders include Traumatic encephalon hurt, Stroke affecting the frontal-subcortical circuit, Alzheimer ‘s disease ( AD ) , Dementia with Lewy organic structure ( DLB ) , Creutzfeldt-Jakob disease, Frontotemporal dementedness ( FTD ) , HIV dementedness, Parkinson ‘s disease ( PD ) , Progressive supranuclear paralysis, Anoxic brain disorder, Cerebral tumor, Chronic subdural haematoma, Huntington ‘s disease, Limbic phrenitis, Multiple induration, Bingwanger ‘s encephalopathy, Wernicke-Korsakoff syndrome, Kluver Bucy syndrome, Hydrocephalus, Delirium Psychiatric Disorders such as Depression, Schizophrenia, Psychoses and Adjustment upset Psychotropic drugs: . Dopamine adversaries are by and large associated with lessened motive, whilst agonists can increase it. Cannabis dependance, pep pill and cocaine backdown have all been implicated as a causative factor. An amotivational, or apathy, syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary. This inauspicious consequence has been noted to be dose-dependent and reversible, but is frequently unrecognised ( Garland and Baerg, 2001 ) . Medical Disorders such as Apathetic thyrotoxicosis, Drug intoxications/withdrawal, Hypothyroidism, Lyme disease, Pseudoparahypothyroidism, Chronic weariness syndrome, Testosterone lack, Vitamin B12 lack, Other enfeebling conditions ( eg, malignance, CCF, nephritic or hepatic failure ) .IS APATHY AND DEPRESSION THE SAME?Apathy has frequently been treated as a portion of depression and it can frequently be diagnostically disputing to distinguish between the two due to frequent carbon monoxide morbidities and a considerable convergence in cardinal symptoms. However they are different concepts and it is of import to distinguish them because of predictive and intervention deductions. Apathy can besides ensue from the intervention for depression. There are theoretical concern that serotonergic re-uptake inhibitors ( SSRIs ) may impact the counterweight of 5-hydroxytryptamine and Dopastat, which can take to apathy, and SSRI-induced apathy has been progressively reported.Table 2: Differences and convergences in the clinical symptoms of apathy and depression ( table adapted from Landes et al. , 2005 )Apathy SymptomsDepressive SymptomsShared SymptomsLack of emotional response Indifference Diminished motive Lack of productiveness Poor Persistence Low societal & amp ; occupational battle Person is by and large satisfied Low temper Feelingss of guilt, Suicidal ideations Insomnia Reduced appetency Pessimism Self-criticism Hopelessness Worthlessness Loss of involvement Psychomotor deceleration Fatigue/hypersomnia Lack of penetrationEffectss of ApathyApathy has important negative effects and therefore early designation and diagnose is critical. In Alzheimer ‘s Disease ( AD ) patients, apathy is associated with hapless penetration into cognitive and behavioral alterations ( Derouesne et al. , 1999 ) along with greater cognitive every bit good as functional diminution ( Holtta et al. , 2012 ) . Apathetic patients are frequently misperceived as lazy by the household taking to increasing resentfulness. Apathy may impact patient perceptual experience of quality of life ( Gerritsen et al. , 2005 ) and is significantly associated with activities of day-to-day life ( ADLs ) damage ensuing in increased patient and health professional distress.. It is besides significantly associated with older age and a higher incidence of depression and craze ( Holtta et al. , 2012 ) . Apathy has been shown to be associated with frontal lobe disfunction particularly executive map in dementedness ( Ready et al. , 2003 ) and these frontal lobe maps are indispensable to a individual ‘s ability to transport out mundane planning and determination devising along with health-promoting behaviors, such as medicine direction, dietetic and lifestyle alterations, self-monitoring of responses, and follow-up with wellness attention professionals ( Kuo and Lipsitz, 2004 ) . Apathy affects the quality and degree of familiarity in a relationship and hence enjoyment of each other ‘s company. This leads to impairment of the relationship, increased health professional load and an increased the hazard of institutionalisation ( Spruytte et al. , 2001 ) ( de Vugt et al. , 2003 ) . Apathy besides has of import diagnostic and intervention deductions.It may forestall patients from seeking an early formal appraisal and may interfere with attachment to pharmacologic intervention for memory loss and engagement in compensatory schemes, such as keeping an accurate and up-to-date memory notebook ( Ready et al. , 2003 ) . Apathy may hold important predictive value.Apathy has been described to increase the hazard of patterned advance from MCI to dementia. In nursing place patients with Alzheimer ‘s dementedness, apathy has been associated with physical damage, dependence, hapless nutritionary position and significantly increased 2-year mortality rates ( Holtta et al. , 2012 ) .PATHO-PHYSIOLOGY OF APATHYApathy has been shown to be associated with a break of the frontal-subcortical neural circuit. Assorted surveies have concluded that the neural circuit that originates from the anterior cingulate cerebral mantle, so proceeds to the ventral striate body, globus pallidus, and thalamus, with a concluding cringle back to the anterior cingulate cerebral mantle is related to apathy ( Bonelli and Cummings, 2007 ) .Autopsy surveies have shown that neurofibrillary tangles load were significantly higher in the anterior cingulate cerebral mantle in apathy ( Marshall et al. , 2006 ) .Similarly structural magne tic resonance imagination ( MRI ) surveies have shown that apathy badness correlated with wasting of bilateral anterior cingulate and left auxiliary motor country ( Apostolova et al. , 2007 ) .Studies with Single photon emanation imaging have besides shown that apathetic AD patients had significantly decreased perfusion in the anterior cingulate, the inferior and median convolution frontalis and the orbito frontal convolution ( Robert et al. , 2006 )FigureA 1.A Behavioural and cognitive alterations associated with break of specific frontal-subcortical circuits ( Ball et al. , 2010 ) .Dopamine is the principle neurotransmitter of purposive behaviour, modulating motive, rousing, motor response, and sensorimotor integrating. There is a strong relationship between D2 receptor stimulation and anterior cingulated cortex metamorphosis. The anterior cingulate cerebral mantle appears to be of importance in motive and wages ( Devinsky et al. , 1995 ) and receives exceptionally heavy dopaminer gic ( DA ) excitation originating from ventral tegmental country ( VTA ) nerve cells ( Williams and Goldman-Rakic, 1998 ) . Cholinergic and serotonergic tracts besides play a neuromodulatory function in the motivational circuitry. Acetylcholine ( ACh ) and DA systems appear to organize striatal wages map in a feed-forward, complementary mode ( Williams and Adinoff, 2008, Zhou et al. , 2003 ) . Serotonin is chiefly an repressive neurotransmitter can straight impact frontal lobe activities and they can indirectly modulate frontal lobe activity by suppressing the release of Dopastat ( Daw et al. , 2002 ) . Positron Emission Tomography surveies have important decreases of 5-HT2AA receptor densitiesA in the frontal lobe in patients with apathy ( Franceschi et al. , 2005 ) .ASSESSMENT OF APATHYThere are assorted graduated tables available to determine and quantify apathy. A recent literature reappraisal has identified around 14 graduated tables of which seven were full apathy graduated ta bles and eight were apathy subscales embedded in larger graduated tables ( Clarke et al. , 2011 ) . The most widely used graduated table were the Apathy Evaluation Scale AES ) and the Neuropsychiatric Inventory ( NPI ) .Neuropsychiatric Inventory ( NPI )The NPI is a graduated table that assesses and quantifies neurobehavioral perturbations in dementedness patients and besides quantify health professional hurt caused by such behaviors ( Clarke et al. , 2011, Cummings et al. , 1994 ) . The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy ( Cummings et al. , 1994 ) . The NPI, and therefore the NPI-apathy subscale, is depe ndable, widely used, and has been validated in many different scenes.Apathy rating graduated table ( AES )The AES is an Eighteen-item graduated table capturing symptomatology over last 4 hebdomads. This scale buttockss and quantifies the affectional, behavioural, and cognitive spheres of apathy. It specifically assesses apathy and discriminates it from depression. Each point can be rated on the 4 point likert Scale. It takes around 10-20 min to be completed by a trained interviewer. This trial has a good interrater dependability and is widely usedPOTENTIAL TREATMENT OPTIONS FOR APATHYNonpharmacologic Treatment of ApathyThere are many non pharmacological intercessions that have anecdotal and qualitative grounds of effectivity in the apathy but merely a few of them has quality research confirmation in footings of effectivity ( Brodaty and Burns, 2011 ) . Open-label surveies have shown that multisensory behavior therapy and music therapy have positive consequence in cut downing apathy and could hike the consequence of anti dementedness drugs ( Ferrero-Arias et al. , 2011, Staal et al. , 2007 ) . Cognitive stimulation therapy that provides activities affecting cognitive processing, within a societal context, with an accent on enjoyment has been shown to be effectual in cut downing apathy in early Alzheimer ‘s Disease ( Buettner et al. , 2011 ) . Treatment of apathy requires multidisciplinary attack along with health professional psycho instruction about the pathological nature of apathetic province. The health professionals should besides be encouraged to present new beginnings of pleasances, involvements and stimulation along with increasing chance for socialization. It is besides of import that the patient ‘s general medical conditions are assertively treated and centripetal shortages corrected along with environmental alterations such as usage of adaptative devices such as wheelchair, seeable Clocks, calendars and equal lighting to increase the reward potency of the environment and thereby enhance motive. Although there is presently lack of research grounds, it is possible the other non pharmacological intercessions such as originative activities, cookery, Montessori methods, and behavioural elements, frequently separately tailored, exercising, multisensory stimulation, favored therapy, and particular attention unit s have the possible to cut down apathy ( Brodaty and Burns, 2011 ) .Pharmacologic Treatment of ApathyAcetylcholinesterase InhibitorsAChIs are chiefly used for handling cognitive symptoms in dementedness but recent surveies have shown positive effects on noncognitive symptoms such as apathy, depression, anxiousness, and purposeless motor behaviours. Consequences from randomized controlled tests have shown that AChIs including donepezil, galantamine and rivastigmine are clearly good in the intervention of apathy. There is no clear indicant that any one AChI is superior.NDMA Receptor AntagonistMemantine is a specificA N-methyl-D-aspartate receptor adversary and is the lone drug approved for handling terrible AD.A It appears to work by modulating the activity of glutamate, leting a controlled sum of Ca to flux into nerve cells ( enabling information processing, storage, and retrievalA 98 ) protecting nerve cells against glutamatergic excitotoxicity and, potentially, holding a neuroprote ctive consequence by cut downing toxic Ca inflow. There is grounds from randomized, double-blind, placebo-controlled tests, which indicated important betterments in apathy degrees for patients treated with MemantineMajor tranquilizersTypical Consequences from Randomized, double-blind, placebo-controlled test in nondepressed inmates with dementedness found no alteration in apathy degrees Atypical Surveies look intoing the effects of untypical major tranquilizers on apathy have reported important betterments in symptomsA farther 12-week open-label survey 130 of risperidone in 135 patients with AD showed increasing and important betterment in apathy. An RCT of 652 nursing place occupants with terrible AD reported betterment in apathy for occupants treated with olanzapine 5 mg/day but non with 1, 2.5, or 7.5 mg/day, and there was no accommodation for multiple comparingsAntidepressantsBupropion is aA dopamineA andA norepinephrine re-uptake inhibitorA and releaser. It is approximately twice as potent an inhibitor of Dopastat re-uptake than of norepinephrine reuptake.A Besides reuptake suppression of Dopastat and noradrenaline, bupropion besides causes the release of Dopastat and noradrenaline. Hence theoretically should profit apathy but there have been no good quality tests with Bupropion. There is grounds signifier clinical instance series that bupropion may profit apathy ( Corc oran et al. , 2004 ) Assorted tests of antidepressants in the interventions of apathy have mostly been negative, supplying extra support that depression and apathy are different concepts. There is good quality grounds from assorted randomised controlled trails that antidepressants do no alteration in apathy degrees. Interestingly apathy syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary and hence SSRI must be used with cautiousnesss clinicians need to be proactive in supervising for this inauspicious consequence ( Barnhart et al. , 2004 )PsychostimulantsEvidence from instance studies and little open-label surveies in non demented populations suggests that psychostimulants such as dextroamphetamine and Ritalin may be effectual in the intervention of apathy.Results from a recent double-blind, randomized, placebo-controlled crossing over test of Ritalin for the intervention of apathy suggest modest benefit s in a subset of AD patients, but that tolerability may be a concern in this population ( Herrmann et al. , 2008 ) .A There are instance studies that have reported that Modai ¬?nil may profit apathy syndrome in the older patients and is more tolerable ( Camargos and Quintas, 2011 )Dopaminergic agentsThere are merely few surveies on the effectivity of dopaminergic agents as a intervention for apathy and such surveies have been chiefly focussed on Parkinson ‘s disease and station shot conditions.Bromocriptine, aA Dopastat agonist, in case-series studiesA have been found to be effectual in cut downing apathy symptoms in shot and hypoxic encephalon hurt patients ( Barrett, 1991, Debette et al. , 2002, Krishnamoorthy and Craufurd, 2011 ) . There is nevertheless no good quality research grounds of their effectivity in handling apathy in Alzheimer ‘s disease ( van Reekum et al. , 2005 ) .Amantadine is aA N-methyl-D-aspartic acid receptor adversary, which may indirectly height en dopaminergic transmittal and confer neuroprotective effects, similar to its parallel, memantine has been shown to be effectual in bettering executive map and apathy symptoms in chronic encephalon hurt, dementedness and Parkinson ‘s disease ( Drayton et al. , 2004, Wu and Garmel, 2005 ) . Levodopa/carbidopa besides appears to better motive in assorted neurological and psychiatric upsets harmonizing to instance surveies of patients ( Bakheit et al. , 2011, Drubach et al. , 1995 ) Pramipexole, another Dopastat agonist with D3-preferring receptor adhering profile, is used in the early-stage Parkinson ‘s disease ( PD ) .A meta-analysis of placebo-controlled surveies have shown good consequence on temper and motivational symptoms in PD patients ( Leentjens et al. , 2009 ) . Similarly Ropinirole, Dopastat D2/D3 receptor agonist been reported to better apathy and temper in patients with Parkinson disease ( Czernecki et al. , 2008 )IntroductionApathy is a neurobehavioral syndrome which is defined as quantitative decrease of voluntary, purposive behavior ( Levy and Dubois, 2006 ) .It extremely prevailing across a big assortment of neurological, psychiatric, and medical conditions and is the most common neuropsychiatric symptom of Alzheimer ‘s disease with an mean point prevalence of 60 % in outpatients with Alzheimers Disease. ( Clarke et al. , 2011, Robert et al. , 2004 ) Apathy is a major hazard factor for transition to dementia in MCI topics and follow up surveies have shown that rates of transition to dementia in MCI with apathetic symptoms were up to 60 % as compared to 24 % for MCI without apathy and depression ( Vicini Chilovi et al. , 2009 ) . Apathy was thought to be upset of sub cortical encephalon construction but interestingly it appears to be really commoner in cortical encephalon upsets with averaged point prevalence of about 60 % as compared to 40 % in upsets of sub cortical constructions ( van Reekum et al. , 2005 ) . The frontal lobes play an of import function in back uping higher-level cognitive map, dwelling of executive accomplishments and working memory. Executive maps are higher-order cognitive procedures that orchestrate simple thoughts, motions and actions into complex purposive behaviors. They include be aftering, induction, coincident information processing, ordinance, judgement, abstraction, and job resolution. Damage of executive working consequences in disinhibition, concrete thought, perseveration, deficiency of enterprise, apathy, and loss of cognitive i ¬Ã¢â‚¬Å¡exibility ( Tsoi et al. , 2008a ) . A significant organic structure of grounds suggests that apathy typically occur following harm to prefrontal cortical-striatal circuits in the encephalon, and are seen in many neurological and psychiatric upsets, including all of the common signifiers of dementedness: Alzheimer disease ( AD ) , vascular dementedness ( VaD ) , and Frontotemporal dementedness. ( Craig et al. , 1996 ) .Studies have shown that Apathy in AD patients was associated with more terrible hypoperfusion in frontal parts on functional imagination ( Craig et al. , 1996 ) . A few surveies have tried to look into the relationship between apathy in dementedness and frontal lobe disfunction. Apathy in AD has been shown to be significantly associated with hapless public presentation on executive map trials, such as the Trail-Making Test and the Stroop colour intervention trial ( McPherson et al. , 2002 ) . Executive disfunction, particularly shortages impacting verbal eloquence and conceptional eloquence, was a important forecaster of apathy in dementedness ( Tsoi et al. , 2008a ) . There has been really small literature about relationship between practice and apathy in Alzheimer ‘s disease. It is known that frontal systems behavioral jobs are associated with higher health professional load after commanding for dementedness badness and health professional depression. There has been conflicting studies about part of apathy towards caregiver burden. Few surveies have shown that apathy was associated with greater grade of health professional load ( Chow et al. , 2009 ) ( Leroi et al. , 2012 ) while another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were prognostic of load and apathy was considered less troublesome to health professionals ( Davis and Tremont, 2007 )AIMS & A ; OBJECTIVES:The primary purpose of this survey is to analyze the association between apathy with or without depression and frontal lobe disfunction in patients with memory jobs. The secondary purpose is to look into association between apathy badness and the health professional load In add-on, this survey will look into the association between apathy and practice in AD and MCI as there are presently limited surveies that have looked into association between them.DESIGN/ METHODOLOGY:Ethical motives Approval: A The survey was approved by The National ResearchA EthicsA Service ( NRES ) Committee for East of England, King College London every bit good as the NEPFT NHS R & A ; D officePutingThe survey was done at the West Essex Neurocognitive Clinic which is third referral Centre and is based at three locations viz. St Margaret ‘s Hospital, Epping, Princess Alexandra Hospital, Harlow and Rectory Lane Health Centre, Loughton. The catchment country serves population of aged people of greater London and Essex, UK. The Clinic provides a specialised, multidisciplinary, hospital-based appraisal for people with cognitive jobs Majority of the patient ‘s referred are those with mild cognitive damages or patients hard to name due to combination of medical, neurolog ical, societal and neuropsychological factors. The clinic is focused on research and preparation and is involved in assorted imagination, cognitive and intervention surveies, every bit good as encephalon contribution programme. Referral standards are based on a history of cognitive damage, which is likely to be caused by degenerative alterations of the encephalon with the MMSE mark of at least 20/30, complex presentations due to interplay of varying degrees medical, neurological and neuropsychological factors and hard to name instances. Patients must be aged in surplus of 40 old ages ( reflecting appropriate referral of people with possible immature onset dementedness ) and must be able to give informed consent. The appraisal is done by a trained and experient clinician along with a psychologist/assistant psychologist. Assessment encompasses a assortment of trials aimed at set uping diagnosing and badness of unwellness. The appraisals of involvement for this survey includes A standard psychiatric interview Behavioural Pathology in Alzheimer ‘s Disease Scale ( BEHAVE-AD ) sum 75 where higher mark indicates more disturbed behavior ; Apathy/Indifference sub-scale ( NPI ) total/12 – higher mark indicates greater apathy ; Hospital Anxiety and Depression Scale ( HADS ) -total on each scale/21 -score of 7 or less indicates no important symptoms, mark of 8 – 10 indicates mild symptoms, mark of 11 + indicates moderate symptoms ; Instrumental Activities of Daily Living Scale ( IADL ) total/31 -higher tonss indicates increased dependence upon the source or ‘carer ‘ ; Clinical Dementia Rating ( CDR ) total/5 -higher mark indicates more badly affected cognitive and occupational/social operation ; Screen for Caregiver Burden ( SCB ) total/100 – higher mark indicates client is perceived to be a greater load by the source or ‘carer ‘ ; Neuropsychometric Assessment is done by the Psychologist/Assistant psychologist. The battery of neuropsychometric trials done of involvement to this survey includes: Estimated pre-morbid rational operation ( National Adult Reading Test – NART ) , Cambridge Cognitive Examination-Revised ( CAMCOG-R ) Trail doing A & A ; Trial devising B Letter Fluency, Category eloquence, Ideational Fluency Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) Subjects: This was a retrospective Cross-sectional survey. The survey population comprised 160 back-to-back patients with newly-diagnosed Alzheimer ‘s disease and amnestic-MCI, All the patients at the clip of their initial neurocognitive clinic appraisal had a thorough neurological and psychiatric scrutiny by a trained and experiences clinician along with extended neuropsychometric appraisal by a psychologist. Health professionals and next-of-kin were besides interviewed.At the clip of the appraisal all patients had capacity to give an informed consent to undergo the appraisal. Their capacity was assessed by a member of clinical squad familiar with, and trained in usage of the Mental Capacity Act. In add-on, patients have either agreed or disagreed to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. Eligibility standards: All patients diagnosed with Alzheimer ‘s disease and amnesic Mild Cognitive Impairment who had the undermentioned probes recorded on database: NPI apathy mark, frontal lobe map trial i.e Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking, CAMCOG-R, age, gender, HAD Depression mark, Care giver load and Praxis. All these patients would be eligible to take a portion in the survey. Inclusion standards: Eligible patients who gave an informed consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Exclusion standards: Patients who did non consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Patients whose depression scores on HAD were more than 8 were besides excluded.MeasuresApathy will be measured as the apathy sub-score on the NPI. The NPI was developed to measure and quantify neurobehavioral perturbations in dementedness patients and to quantify health professional hurt caused by such behaviours. The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy. The NPI, and therefore the NPI-apathy subscale, is widely used and has been validated in many different samples such as ambulatory patients with dementedness, outpatients with AD, multicultural samples, and nursing place occupants. Cognitive damage will be measured by the mark on Cambridge Cognitive Examination-Revised ( CAMCOG-R ) . This neuropsychological battery steps cognitive shortage in a figure of cognitive spheres – mark & lt ; 80/105 suggests the presence of a dementedness, mark of 80-90/105 is fringy. Frontal Lobe disfunction will be measured by the tonss obtained from the undermentioned frontal lobe map trial i.e. Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) . The Trail Making Tests ( TMTs ) are popular neuropsychological instruments used either entirely as a showing instrument for observing neurological disease and neuropsychological damage or as portion of a larger battery of trials. The trials are believed to mensurate the cognitive spheres of treating velocity, sequencing, mental flexibleness and visual-motor accomplishments Part A is by and large presumed to be a trial of ocular hunt and motor velocity accomplishments, whereas portion B is considered besides to be a trial of higher degree cognitive accomplishments such as mental flexibleness. TMT-A requires chiefly visuoperceptual abilities, TMT-B chiefly reflects working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, supplying a comparatively pure index of executive control abilities.Average DeficientDrag A 29 seconds 78 seconds Trail B 75 seconds 273 seconds Letter Fluency undertakings require coevals of words get downing with specific letters within a limited clip it has been. Letters F, A, and S ( FAS ) version of the The Controlled Oral Word Association Test is used in this survey. The trial disposal takes about five proceedingss. The mark is the amount of all admissible words for the three letters ( Loonstra et al. , 2001 ) . Category Fluency undertaking require persons to bring forth examples of specific semantic classs such as the names of animate beings or fruits. CF trial is a really speedy ( normally taking 1 min ) , easy to administrate trial that proved to be utile in the diagnosing of mild AD. The most common version involves the semantic class of animate beings. Surveies have shown that tonss below 15 in the CF ( animals/min ) had a sensitiveness of 88 % and a specificity of 96 % , in distinguishing AD patients from normal controls, bespeaking that a 1-minute trial can be helpful to clinicians to place persons in the early phases of the disease ( Caning et al. , 2004 ) . Category Fluency and Letter Fluency require frontally mediated executive retrieval mechanisms. Both besides require entree to phonological/lexical shops. But, merely class eloquence besides requires entree to more widely distributed semantic shops as the topic searches for examples suiting the mark class ( Cerhan et al. , 2002 ) .Datas AnalysisDependent variable is Apathy mark. Independent variables are CAMCOG-R tonss, tonss of the undermentioned frontal lobe testsTrail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual concluding ) every bit good as tonss of health professional load and practice. All these variables will be analysed as uninterrupted informations. The consequences will be graphed to look into if the distribution is about normal and the spread secret plan used to measure the one-dimensionality of the association. Correlation analysis, measured as a correlativity coefficient R, will be used to look into for the presence, the strength and way of a relationship between these variables. Cut-off point of 0.4 will be considered to be important. Depending on the one-dimensionality one of the two correlativity coefficients will be calculated. Ranked correlativity will be used in the statistical analysis if the relationship between the two variables in non-linear. Rank correlativity coefficients, such as Spearman ‘s rank correlativity coefficient measures the extent to which, as one variable additions, the other variable tends to increase, without necessitating that addition to be represented by a additive relationship. If, as the one variable addition, the other lessenings, the rank correlativity coefficients will be negative. If the two variables appear to hold additive relationship Spearman correlativity coefficient will be calculated. The closer the coefficient is to either a?’1 or 1, the stronger the correlativity between the variables. Correlation Negative Positive Small a?’0.3 to a?’0.1 0.1 to 0.3 Medium a?’0.5 to a?’0.3 0.3 to 0.5 Large a?’1.0 to a?’0.5 0.5 to 1.0 If the variables are independent so the correlativity is 0. However, the antonym is non true because the correlativity coefficient detects merely additive dependences between two variables.Power computationStatisticalA powerA analysesA wasA doneA byA usingA G*PowerA 3.1 ( Faul et al. , 2009 ) TypeA IA error=0.05A TypeA IA error=0.01A TypeA IA error=0.001 Power=80 % A 34A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 56A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 84 Power=90 % A 47A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 72A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 106 Power=99 % A 85A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 117A A A A A A A A A A A A A A A A A A A A A A A A A A A 159 ThisA indicatesA thatA inA orderA toA determineA aA correlationA ofA magnitudeA 0.4A atA P & lt ; 0.05A atA aA powerA levelA ofA 80 % , A thisA studyA needsA aA minimumA ofA 34A participants.AConsequenceOne hundred and 60 patients with AD or amnesic MCI who met the above-described standards were enrolled in the survey. Of these 68 patients had a diagnosing of Alzheimer ‘s disease and 92 had a diagnosing of amnesic MCI. The demographic information of the topics are summarized in Table 1. No statistically important differences in age, instruction, gender, premorbid intelligence, or old ages in instruction consequences were observed between the two groups. However as expected, there was statistically important difference in footings of the IADL, CAMCOG-R, CDR & A ; MMSETable 1: Demographic and clinical featuresAverage AD ( SD )Average MCI ( SD )P valueNIADL10.34 ( 5.52 ) 8.11 ( 3.42 ) & lt ; .001 160CAMCOG-R76.8 ( 12.66 ) 86.98 ( 8.71 ) & lt ; .001 156MMSE22.19 ( 5.13 ) 25.81 ( 2.55 ) & lt ; .001 158NART105.33 ( 10.00 ) 106.26 ( 12.23 ) .319 124CDR0.82 ( 0.41 ) 0.55 ( 0.17 ) & lt ; .001 159Age74.37 ( 8.61 ) 73.37 ( 8.70 ) .339 160Old ages Ed.11.14 ( 2.91 ) 11.16 ( 2.60 ) .655 154AdMCIChi SquareP valuePercent female51.5 47.8 0.21 .65Percentage with intoxicant history63.2 65.9 1.47 .69Percentage with smoking history42.6 50.0 2.33 .31 The frequence distribution box secret plan suggested that NPI apathy bomber graduated tables are non usually distributed. We did normalcy trials to find whether apathy informations set is well-modelled by a normal distribution or non. We used the Shapiro-Wilk trial as our numerical agencies of measuring normalcy and found that the apathy informations significantly deviate from a normal distribution. Shapiro-Wilk Statistic df NPI Apathy sub graduated table .624 160 As our information ‘s were non parametric, utilizing the Spearman rho correlativity coefficient, correlativities between variables for whole group and subgroups was generated. The Spearman rho correlativity was repeated with depressive subgroups removed. All trials were one-tailed since hypotheses were directional. The exclusion to this was the trial look intoing the relationship between gender and apathy. These hypotheses were non-directional and therefore two-tailed trials were used.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter FluencyClass EloquenceTrail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.222**-.180*.477**-.136*-.071-.166*.009 .010-.213**-.102 Sig. ( 1-tailed ).003.012.000.045.189.019.456 . 464.004.103 Nitrogen157157145156155157152 84156156ConsequencesTable 1: Correlations between variables for whole group and subgroupsCorrelations between variables for whole group and subgroups with depression removed.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter Fluency Class Eloquence Trail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.169*-.125 .475** -.067 -.041 -.123 -.052 .089-.186*.019 Sig. ( 1-tailed ).027.077 .000 .223 .321 .080 .279 .229.017.417 Nitrogen131131 121 131 130 131 127 72130131Relationship between apathy and executive mapIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 157 patients. In these patients, NPI apathy mark was significantly related to executive operation ( rs = -.222, P = .003 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained significantly related to executive operation ( n=131, rs =-.169, p=.027 )Relationship between apathy and trail devising trialsIn the combined sample ( AD and A-MCI ) , informations on trail doing trial A was available for 152 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .009, P = .456 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing A tonss ( n=127, R -.052, p=.279 ) In the combined sample ( AD and A-MCI ) , informations on trail doing trial B was available for 84 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .010, P = .464 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing B tonss ( n=72, R.089, p=.229 )Relationship between apathy and verbal eloquenceIn the combined sample ( AD and A-MCI ) , informations on missive eloquence ( FAS ) was available for 150 patients. In these patients, NPI apathy mark was non significantly related to eloquence ( rs = -.047, P = .284 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to eloquence tonss ( n=130, R -.041, p=.321 )Relationship between apathy and class eloquenceIn the combined sample ( AD and A-MCI ) , informations on class eloquence ( animate beings ) was available for 157 patients. In thes e patients, NPI apathy mark was significantly related to category eloquence ( rs = -.166* , P = .019 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence ( n=131, rs -.123, p=.080 )Relationship between apathy and conceptional eloquenceIn the combined sample ( AD and A-MCI ) , informations on conceptional eloquence was available for 156 patients. In these patients, NPI apathy mark was significantly related to conceptional eloquence ( rs = -.213** , P = .004 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=130, rs -.186* , p=.017 ) .Relationship between apathy and cognitive mapIn the combined sample ( AD and A-MCI ) , informations on CAMCOG-R was available for 156 patients. In these patients, NPI apathy mark was significantly related to cognitive operation ( rs = -.136* , P = .045 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=131, rs -.067, p=.223 )Relationship between apathy and abstract thoughtIn the combined sample ( AD and A-MCI ) , informations on abstract thought was available for 152 patients. In these patients, NPI apathy mark was significantly related to abstract thought ( rs = -.180, P = .013 ) .Relationship between apathy and health professional load.In the combined sample ( AD and A-MCI ) , informations on health professional load was available for 145 patients. In these patients, NPI apathy mark was significantly related to caregiver load ( rs = .477** , P = .000 ) . NPI apathy mark remained significantly related to caregiver burden even when the depressive subgroup of patient was removed ( n=121, rs =.475** , P = .000 ) . The correlativity between apathy and caregiver load were so tested in Alzheimer ‘s disease and amnesic MCI individually and in both subgroups NPI apathy mark was significantly related to caregiver loadNonparametric Correlations: NPI Apathy and Caregiver Burden in AD & A ; aMCIaMCIAdNPI Apathy sub graduated table Correlation Coefficient .458** .480** Sig. ( 1-tailed ) .000 .000 Nitrogen 68 53 A arrested development analysis was carried out to understand the relationship between a health professional load and MMSE, Depression Scores, Apathy, Behave -AD Scores, executive map mark, IADL.Arrested development Analysis CoefficientsaModel Unstandardized Coefficients Standardized Coefficients T Bacillus Std. Mistake BetaNPI Apathy sub graduated table1.130.240.3944.703IADL.360.167.1812.155Behave -AD mark .303 .211 .113 1.438 HADS-depression mark .016 .212 .006 .074 Executive map mark -.113 .200 -.047 -.566 MMSE mark .024 .193 .010 .125 a. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline It is clear from the multiple arrested development analysis that merely NPI apathy tonss and IADL were significantly related to caregiver load. However the other variables which included Behave AD tonss, HADS depression tonss, Executive map tonss and MMSE were non significantly related to the health professional load tonssModel SummaryModel Roentgen R Square Adjusted R Square Std. Mistake of the Estimate Change Statisticss R Square Change F Change df1 df2 1 .542a .293 .288 7.668 .293 59.353 1 143 2 .592b .350 .341 7.377 .057 12.488 1 142 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline ANOVAc Model Sum of Squares df Mean Square F 1 Arrested development 3489.675 1 3489.675 59.353 Residual 8407.663 143 58.795 Entire 11897.338 144 2 Arrested development 4169.290 2 2084.645 38.305 Residual 7728.048 142 54.423 Entire 11897.338 144 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline c. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline Further sub analysis suggests that NPI apathy contributes to about 29 % of the health professional load and IADL contributes to around 5 % of the health professional loadRelationship between apathy and practiceIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 156 patients. In these patients, NPI apathy mark was non significantly related to praxis ( rs = -.102, P = .103 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained non significantly related to praxis ( n=131, rs =.019, p=.417 )Relationship between apathy and genderMann-Whitney TrialRanksgenderNitrogenMean RankNPI Apathy sub graduated table male 81 85.38 female 79 75.50 Entire 160Test StatisticsaNPI Apathy sub graduated tableMann-Whitney U 2804.500 Wilcoxon W 5964.500 Omega -1.621 Asymp. Sig. ( 2-tailed ) .105 a. Grouping Variable: gender From the above saloon graph, with mistake bars, it appears that males have higher apathy tonss as compared to females. We used the Mann-Whitney U trial to look into if the relationship of apathy with gender is statistically important. However this did non accomplish statistically significance ( U = 2804.500, P = 0.105 )DiscussionApathy is one of the commonest symptoms in Alzheimer ‘s disease. Evidence from assorted clinical, radiological and neuropathological surveies suggests that apathy in Alzheimer ‘s disease is frontally mediated and has important negative deduction. Our survey is a realistic survey with moderate power affecting both Alzheimer Disease and Amnestic-MCI. This is the first survey as per our cognition in which the relationship of apathy with and without depression in a combined sample of AD & A ; aMCI were tested against a scope of frontal lobe map trials which included executive map mark, abstract believing mark, Category Fluency, missive Fluency, conceptional eloquence mark and test doing A & A ; B trials. Few surveies have at the same time investigated the relation of apathy with such a big scope of frontal lobe map trials.Relationship between apathy and executive mapWe found statistically important tie ining between apathy and executive map with and without depression corroborating findings from other surveies ( McPherson et al. , 2002 ) . Deficits in frontal lobe map were significantly worse when symptoms of apathy were combined with depression corroborating the determination from a Nipponese survey with a smaller figure of pati ents ( Nakaaki et al. , 2008 ) .This determination has of import clinical significance because hapless tonss in executive map influence memory abilities by forestalling people to use compensatory schemes that can assist them retrieve information and maintain functional abilities. It is besides associated with greater neuropsychiatric perturbations particularly a greater grade of agitated and disinhibited behaviors ( Chen et al. , 1998 ) . Assorted surveies have shown that impaired executive map is associated with increased pace variableness ensuing in higher incidence falls in patient with AD ( Allali et al. , 2010 ) . In Amnestic MCI, executive map damages is associated with early functional diminution in older grownups ( McGough et al. , 2011 ) . Badness of functional damage is good recognized forecasters of institutionalization ( Rozzini et al. , 2006 ) .Relationship between apathy and conceptional eloquenceSuccessful completion of Ideational eloquence undertakings require speede d productiveness every bit good as the accomplishments of self-monitoring, working memory, scheme coevals, and divergent thought ( Vannorsdall et al. , 2012 ) . We found statistically important tie ining between apathy and conceptional eloquence with and without depression.This is similar to the determination from another survey where Ideational Fluency was found to be significantly associated with apathy ( Tsoi et al. , 2008b )Relationship between apathy and Category FluencyWe found that NPI apathy mark was significantly related to category eloquence but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence. There are conflicting consequences about the relationship between apathy and class eloquence. One survey ( n=72 ) found no important relationship ( McPherson et al. , 2002 ) but another more recent survey ( n=42 ) found statistically important relationship ( Tsoi et al. , 2008b ) .Relationship between ap athy and abstract thoughtWe found that NPI apathy mark was significantly related to abstract believing but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to abstract believingRelationship between apathy and cognitive mapSimilar to consequences from other surveies, NPI apathy mark was significantly related to cognitive working proposing that apathy was related to poorer cognitive map.However when the group of patients with depressive symptoms were removed, the NPI apathy did non stay score significantly related to cognitive map.Relationship between apathy and missive EloquenceNo statistically important relationship was found. This is consistent with current literature grounds ( McPherson et al. , 2002 )Relationship between apathy and test doing A & A ; B trialsNo statistically important relationship was found between apathy and both TMT- A & A ; TMT-B in our survey. However another survey had found a statistically important relationship between TMB trial and apathy tonss in Alzheimer ‘s dementedness ( McPherson et al. , 2002 ) In drumhead among the frontal lobe trial we found that statistically important relationship between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. When the groups were reanalysed after taking patients with depressive symptoms, the relation between apathy and abstract thought every bit good as category eloquence became non important.We think that this may be do the power of the survey has reduced when the depressive subgroups were removed.The 2nd possible ground is that apathy and depression portion many common symptoms and therefore the patients we removed utilizing a rigorous diagnostic standards of HAD depression standards were truly patients with apathy.Relationship between apathy and health professional loadIn our survey, series of explorative Spearman rho correlativity confirmed the important relationship between apathy and health professional load with and without depression. We did farther bomber analysis and found apa thy to be significantly related to caregiver load in both AD and aMCI patients. Our survey is the first as per our cognition that confirms that apathy is significantly related to caregiver load in amnestic MCI reverse to the popular belief. The relation of apathy to caregiver load was confirmed by other surveies ( Chow et al. , 2009, Leroi et al. , 2012 ) nevertheless another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were most prognostic of load instead than apathy itself ( Davis and Tremont, 2007 ) . However we did a arrested development analysis and found that apathy approximately accounted for 30 % of health professional load but found no important relationship with behave AD tonss, HADS depression tonss, Executive map tonss and MMSE tonss We besides found a higher incidence of apathy in females as compared to males but farther statistical testing showed no important relationship. In our sample NPI apathy mark was significantly related to cognitive operation as confirmed by other surveies but when patients with depressive symptoms were removed the relationship with cognitive damage was nonsignificant. Our survey has few restrictions.First of all this was a retrospective cross sectional survey and so has its drawbacks, nevertheless it realistic, cross-sectional survey. Another possible job is that the subjective nature of the information ‘s nevertheless the information ‘s were collected as a portion of comprehensive neurocognitive appraisal in a third Centre by trained and experient clinicians. Prospective surveies would hold been better but would hold needed extended resources and clip. The sample size was moderate and consisted of assorted sample of Alzheimer ‘s disease and Amnestic MCI, nevertheless it was reasonably powered and amnesic MCI is considered as prodromic Alzheimer ‘s disease. We had used merely one graduated table for mensurating apathy.The NPI Apathy subscale is a portion of NPI devised to buttockss and quantifies neurobehavioral perturbations in dementedness and non specifically developed to mensurate apathy.AEP would hold been a better pic k as it is specifically developed to mensurate apathy, nevertheless the trial would necessitate preparation and would take a well longer period which would non hold been practical in a normal clinic scene This survey has shown high association of apathy with health professional load both in AD & A ; aMCI and given our anterior cognition of the significantly inauspicious effect, we would go on screen actively for apathy and utilize more specific apathy graduated table along with the NPI graduated table in future

Organization That Helps The Disabled: United Cerebral Palsy Essay

â€Å"We strive to build a better world for tomorrow—today. † This is one of the missions of United Cerebral Palsy, a non-profit organization that helps people with cerebral palsy and other related disabilities. It is committed to bring out change and foster hope for disabled people. It is a national organization that has tons of affiliates and is considered to be one of America’s largest health charitable organizations. Cerebral palsy is a serious disability that should not be neglected. It is â€Å"a collection of motor disorders caused by brain damage that happens before, during, or after birth. 2 A child with cerebral palsy has abnormalities in movement patterns and demonstrates poor balance and coordination. Still, a person who is diagnosed with cerebral palsy should never lose hope. This is because the disorder is not a progressive one. This means that it is static and does not go worse as time goes by. There are medical treatments being given by experts to manage cerebral palsy and achieve maximum potential in growth and development. â€Å"Cerebral† pertains to the brain, and â€Å"palsy† means muscle weakness or poor control. 3 It is a disease which is not merely caused by malfunctioning of nerves or muscles. However, it can also result in muscle spasticity which may grow, worsen, or stay unchanged. Although it is a disease that cannot be cured, there are trainings and therapies that can help improve the functioning. 4 Through dedicated organizations such as the United Cerebral Palsy, these trainings, therapies, and additional services can be provided to patients who are afflicted with this disability, improving their lives as a result. United Cerebral Palsy was founded in the 1940’s during the time when people with cerebral palsy do not see a ray of hope to change their conditions. The said organization stressed that â€Å"there were not many options for people with cerebral palsy and other disabilities and their families. †5 Most cases of cerebral palsy among families opted to confine the patient to institutions separated from the rest of the society. Parents of children with cerebral palsy who decided to keep their child inside their homes suffered from isolation, helplessness, and frustration. They had to endure this suffering until the year 1948, when the fate of cerebral palsy patients was changed through the aid of two New York families. Leonald Goldenson, the president of United Paramount Theater and ABC Television, together with his wife Isabelle, coordinated with Jack Hausman a prominent New York businessman and his wife Ethel. The two couples were blessed with children diagnosed with cerebral palsy. The two families decided that they need to take action in order to improve their children’s quality of life. They made it possible by posting an ad in the New York Herald Tribune to encourage families who wanted change for their family members with cerebral palsy. The ad was received warmly by â€Å"hundreds of early parents of children with cerebral palsy and other disabilities. † Upon seeing the ad, they immediately responded it and decided to get actively involved in the crusade that the Goldensons and Hausmans started. 7 Hence, the National Foundation for Cerebral Palsy was founded. Around 12,000 people from various parts of the â€Å"United States, Canada, Europe, and South America† gathered to participate in the first ever Cerebral Palsy Conference. From its first name, it was changed to United Cerebral Palsy (UCP) and was recognized as a national organization in 1949. After that, many affiliates of UCP were established across America. The organization’s cause increased the public’s awareness on the truth behind cerebral palsy and what the organization can offer to families and people who are confronted by problems regarding developmental disabilities. UCP also caught the media’s attention, making the organization more known to many people. UCP is also composed of highly acclaimed people from the entertainment and political arena. This is an organization with a cause that used various means of letting the public know how it can support and be part of the fight to improve the lives of cerebral palsy patients. There were films that are produced to raise funds for the organization which starred famous celebrities such as John Wayne, Gene Kelly, Henry Fonda and Danny Thomas. 10 From such films, not only the public’s awareness about cerebral palsy was increased, the funding needed to support the movement was obtained as well. Marie Kilillea, one of UCP’s volunteer, wrote a novel entitled Karen which became a best seller in 1952 and has never been out of print ever since. Public school students of that time were required to read the novel in order to know more about cerebral palsy. The organization even managed to launch its first ever telethon entitled Celebrity Parade which discussed everything about cerebral palsy. The said program was aired for 15 hours and was able to raise funds summing up to a total of $972,106. 12 UCP faced several changes and challenges since the year it was founded until the present. It continuously brings hope to the disabled and encourages families to support each other and cooperate with the mission of UCP. In 1990, â€Å"UCP was a major leader in the passage of the Americans with Disabilities Act which, for the first time, extends basic civil rights protections to persons with disabilities in the areas of employment, transportation, public accommodations and telecommunications†13. The organization’s website was launched in 1994, making it accessible for people all over the world. An award from the American Society of Association Executive’s prestigious Summit Award for its ADA Report Card on America and its impact on improving the lives of people with disabilities nationwide was also given to UCP, which brought more honor to the organization. For the succeeding years, television events, educational campaigns, and other public service announcements were made to popularize the organization and its mission. At present, UCP is now on its 58th year of service to the people with cerebral palsy and to the people who give their undying support to the patients. The United Cerebral Palsy mission statement is to â€Å"advance the independence, productivity and full citizenship of people with disabilities through an affiliate network†14. The affiliates of UCP provide financial support to the organization, which is the primary source of the organizations’ funds. The financial statement of the organization can be accessed on their website to let the public know its assets and liabilities. Through the help of its affiliates, UCP offers its helping hand daily to over 170,000 disabled children and adults with disabilities and their families. 15 There are fund raising activities done to accumulate financial resources to support the organization’s needs. Aside from the money gathered from donors and members, there are also services including â€Å"housing, therapy, assistive technology training, early intervention programs, individual and family support, social and recreation programs, community living, state and local referrals, employment assistance and advocacy† given out to cerebral palsy patients and their families. 16 Interview Upon interviewing one of the staff members of UCP (whose name does not want to be mentioned), I was able to gain more knowledge of how the organization works and adheres to its mission. He confidently answered all of my questions about UCP and how people’s involvement is vital for the organization to achieve its goals. Without their help, the organization could not have lasted for many years. He is proud to say that UCP survived 58 years of service to people with cerebral palsy and other disabilities. It has inspired their families by helping them to accept the condition of their family member and by providing them the support and attention that they need. The USP does not stand today as it is because of the funds gathered and the services that were given. The dedication and commitment of each member, affiliate, and staff make UCP fulfills its mission. Because of organizations like USP, people with cerebral palsy and other disabilities can have a taste of normal life by creating a better and normal world for the patients. Conclusion In the case of United Cerebral Palsy, I can say that it is an organization with a heart. It aims to end the feeling of isolation and depression by people who suffer from cerebral palsy, as well as their families. It was founded to ease the burden carried by families who were separated from their family members with cerebral palsy. Through organizations such as UCP, the person with cerebral palsy can also achieve development without moving out of their homes and entering institutions. It is inspiring to know that there are people united by one mission to give a brighter future for people with cerebral palsy and other disabilities, as these people are often pitied, mocked, and bullied. Indeed, USP is an organization that is founded with love, devotion and care.

Mental Health Issues Concerning Refugees - Free Essay Example

Sample details Pages: 7 Words: 1982 Downloads: 10 Date added: 2019/07/01 Category Society Essay Level High school Tags: Refugees Essay Did you like this example? Refugees are at a higher risk for mental disorders than any other population. The Gale Encyclopedia of Public Health defines refugees as individuals who have been displaced from their home or native countries due to various reasons such as: war, drought, and natural disasters (Nienstedt). Refugees exposure to war, trauma, violence and extreme torture throughout premigration and during their escape makes them very susceptible to mental health issues. Don’t waste time! Our writers will create an original "Mental Health Issues Concerning Refugees" essay for you Create order Common mental health problems that affect refugees are post-traumatic stress disorder (PTSD), depression, and anxiety. There are very few programs in place to aid refugees with mental health disorders. The number of health care resources available to refugees is extremely limited, and within this limitation, the inability of medical professionals to appropriately treat immigrant trauma victims is becoming an increasing issue worldwide. The lack of resources and efforts to treat refugees and their mental health issues are the main contributing factor to high mortality rates due to suicide. Refugees are prone to a variety of different mental disorders. Laurence J. Kirmayer, MD, in an article from The US National Library of Medicine National Institutes of Health, concludes that based on testing and analysis, refugees are at an extremely higher risk for psychiatric disorders than any other population worldwide. This increased risk stems from exposure to war, violence, torture, and forced banishment. Trauma as a result of torture is the leading cause of mental health disorders for refugees (Kirmayer et al.). Many other significant factors are contributing to mental health disorders that are often not considered. The Gale Encyclopedia of Public Health reveals that women are often victims of rape along with being victims of patriarchal and abusive gender-power schemas within many refugee camps. Sexual assault is a common occurrence in refugee camps and can cause detrimental issues concerning mental conditions (e.g., post-traumatic stress disorder, stress, and anxiety) (Niens tedt). Writing for the Journal of Traumatic Stress, authors Joanne Haldane and Angela Nickerson from The University of New South Wales School of Psychology underscore the seriousness of this issue by revealing evidence which reinforces that interpersonal trauma, such as torture and sexual assault, is associated with a heightened risk for the development of psychological disorders among refugees (457). Haldane and Nickerson also write that there is a significant relationship between women who have endured interpersonal trauma and mental disorders such as PTSD and anxiety (460). Sexual assault can be an underlying cause of multiple different mental disorders present in female refugees brought upon by traumatic events. Immigrants experience horrifying and violent situations that can become burned into memory and create life-long problems. Fortunately, there are small strides towards a solution to the mental health crisis concerning refugees throughout the world, but much more still needs to be done. Nienstadt reports that refugees living in overfilled immigration camps receive emergency medical health care at best, meaning refugees are most likely not treated by physicians, but emergency medical professionals who do not address the full extent of refugees medical conditions. They also face many difficulties with health care resources outside immigration camps due to language barriers, financial issues, etc. (Nienstedt). The mental health crisis affecting refugees affects populations internationally. Immigrants in refugee camps are almost all completely dependent on international aid and charity, which is far too much for any host nation to handle. In an effort to solve this international financial issue, organizations such as The World Health Organization (WHO), the International Red Cross and Red Crescent Societies, the Disaster Mental Health Institute and the University of South Dakota have come together to form The Rapid Assessment of Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations Available Resources (RAMH). RAMH is considered a diagnostic tool that helps medical professionals and other personnel working in refugee support roles more effectively assess the mental health needs of refugees and other displaced persons (Nienstedt). RAMH is a solution to this financial problem because although there are huge costs to creating and maintaining international refugee programs, the loss of life due to suicide and medical consequences for refugees who are not receiving adequate mental health care cost nations even more money (Nienstedt). Writing for the World Health Organization, Mary Petevi, Dr. Jean Pierre Revel and Dr. Gerard A. Jacobs explain that, based on the results of the RAMH diagnostic tool, immediate and longer-term community based mental health programs can be formed for refugees suffering from a mental illness. Medical professionals closely involved in the analysis of the results will undergo proper training to expand their knowledge on mental health (8). The potential programs created based off of the RAMH results will hopefully increase the condition of immigrants mental health and help them adjust to postmigration life. These programs are a small step in solving the extreme mental health crisis, but there is still a large amount of work that needs to be done to resolve this issue and treat mental illnesses in victims of immigration. Along with prevention programs, there needs to be better access to health care and well-trained physicians. Mental health care is a specific, limited branch of health care and when granted, it is usually inappropriately given. The inability of medical professionals to appropriately diagnose and treat mental disorders is contributing to a large number of patients presenting. A significant problem associated with the quality of care given to refugees is the frequently present language barrier. Most immigrants do not fluently speak the language of the country they are migrating to which presents itself as a problem when trying to receive any health care. In a 2016 Health Evidence Synthesis Report, authors Stefan Priebe, Domenico Giacco, and Rawda El-Nagib, who are part of the World Health Organization, reveal that a mental health diagnosis was not made in more than half of all initial assessments of asylum seekers (11). This lack of diagnoses results from the inability to understand a patients symptoms and concerns through an interpreter, who can only hear a patients words, instead of underst anding what theyre feeling, which can lead to a false diagnosis. This poor language efficiency can negatively influence the effectiveness of psychological treatments (12). The treatments given to refugees can be inaccurate or unnecessary, but the language barriers do not allow medical professionals to accurately understand their patients symptoms to make a correct diagnosis. Although there is an abundance of information available on the issues associated with the language barriers, there is little information on solutions being created to fix these issues. Another major issue associated with the inappropriate treatment in mental health is the lack of trust most refugees possess for public health organizations. Priebe, Giacco and El-Nagib explain the reasoning behind this lack of trust in a Health Evidence Synthesis Report. Refugees are afraid to trust the medical professionals because of their premigration experiences of prosecution and/or a fear of being reported to authorities (12). This fear and mistrust can lead to patients withholding important information about medical issues and concerns out of fear, which can eventually lead to even worse consequences. On top of physician-patient issues, there are issues involved with physician care that desperately need solutions. Authors Ramin Asgary from the New York University School of Medicine and Clyde L. Smith from Harvard School of Medicine reveal that there are moral and professional obligations to train health professionals in treating trauma victims that the Convention Against Tortu re has set. However, physician training to treat trauma victims rarely ever occurs. Asgary and Smith estimate that only 6% of all medical students receive an hour or more of formal training regarding torture (3). Most refugees are victims of torture, so the revelation that only six percent of medical professionals have had the proper training to appropriately assess the refugee population is alarming and is a huge factor contributing to the high rates of suicide due to mental health. Mental health disorders, if not diagnosed and treated correctly, can lead to suicide. High suicide rates make it extremely important for medical professionals dealing with immigrant trauma victims to be adequately trained to assess and handle mental illnesses of all types, but this training is evidently not occurring. An article in The Atlantic written by Danielle Preiss supports this claim by explaining that many Bhutanese refugees that have migrated to the United States have committed suicide due to mental illness. Suicide became so frequent that the Federal Office of Refugee Resettlement (ORR) began to notice this pattern and performed extensive research on the deceased refugees with hopes of discovering the cause of this alarming number. By completing psychological autopsies on the deceased individuals, the ORR discovered that twenty-one percent of them had been struggling with depression. This is close to three times the amount of the regular United States population (Preiss). T hese numbers are evidence that the mental health issues of refugees are potentially linked to an increased mortality rate. Completion of proper training by mental health care professionals and creation of mental health programs could prevent suicides. This is just a small piece of evidence supporting the fact that something urgently needs to be done to help refugees through their mental health disorders and provide more effective treatments. Suicide should not be taken lightlyâ€Å"something drastically needs to change. Refugees are prone to mental health disorders more than any other population in the world. Within the research done on this topic, there was little to no mention of any international mental health policies concerning refugees. Various populations of refugees have been studied and, compared to general populations of different countries, refugees are at a much higher risk for a mental disorder. These findings should indicate a need for prevention and adjustment programs to new countries to avoid the onset of mental disorders, yet close to none are. Due to this inadequate amount of effort to prevent mental health disorders in refugees, mortality rates due to suicide have increased. Training programs need to be put in place for medical professionals treating refugees, along with the creation of international policies protecting refugees right to mental health care resources. These changes would significantly reduce suicide rates. There is not enough being done to decrease suicide rates; there are an estimated sixteen million refugees worldwide, and with the linkage to suicide rates there is the appropriate question of how many more refugee suicides due to depression, post-traumatic stress disorder, or anxiety need to occur in order for someone to stand up and do something about it. Works Cited Asgary, Ramin and Clyde L. Smith. Ethical and Professional Considerations Providing Medical Evaluation and Care to Refugee Asylum Seekers. American Journal of Bioethics, vol. 13, no. 7, July 2013, pp. 3-12. EBSCOhost, doi:10.1080/1526161 .2013.794876 Haldane, Joanne, and Angela Nickerson. The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type. Journal of Traumatic Stress, vol. 29 no.5, Oct. 2016, pp. 457-465. EBSCOhost, doi:10.1002/jts.22132 Kirmayer, Laurence J et al. Common mental health problems in immigrants and refugees: general approach in primary care CMAJ: Canadian Medical Association journal = journal de lAssociation medicale canadienne vol. 183,12 (2011): E959-67. Nienstedt, Andrea. Refugee Health. Gale Encyclopedia of Public Health, edited by Gale, 1st edition, 2013. Credo Reference, https://proxy-lhup.klnpa.org/login?url=https:// search.credoreference.com/content/entry/galegph/refugee_health/0?institutionId=8905. Petevi, Mary, Dr. Jean Pierre Revel, and Dr. Gerard A. Jacobs. Rapid Assessment of Mental Health Needs of Refugees Displaced and Other Populations Affected by Conflict and Post-Conflict Situations. https://www.who.int. World Health Organization, n.d. Web. Preiss, Daniell. Bhutanese Refugees are Killing Themselves at an Astonishing Rate. The Atlantic, 13 April 2013, www.theatlantic.com/international/archive/2013/04/bhutanese- refugees-are-killing-themselves-at-an-astonishing-rate/274959/ Priebe, S., D. Giacco and R. El-Nagib. Public Health Aspects of Mental Health Among Migrants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region. Copenhagen: WHO Regional Office for Europe, 2016. (Health Evidence Network Synthesis Report, No. 47.) https://www.ncbi.nlm.nih.gov/books/NBK391045/