A Brief Clinical Assessment of Cognitive Deficit with Impaired Daily Living Functioning in Parkinson’s Patients with and without Dementia

Cognitive decline in Parkinson’s disease (PD) is defined as dementia which affects activities of daily living (ADL) function. Dementia is one of the recognized issues in the treatment of Parkinson’s disease patients (PDP) as it is becoming a major contributor to morbidity. The objective of our study was to evaluate the cognitive decline in Parkinson’s disease patients (PDP) and the influence of cognition on daily living function deterioration in cognitively impaired and cognitively unimpaired PDP. Cognitively impaired PDP (n = 24), and cognitively unimpaired PDP (n = 16) were administered MoCA and MMSE performance based tests for cognitive measurements and Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) to determine everyday functioning. The significances of MoCA and MMSE among cognitively impaired PDP and cognitively unimpaired PDP in univariant analysis were P < 0.001 and P < 0.05. In partial correlation, MoCA was strongly related to ADL function as compare to MMSE (r = 0.623, P = 0.001). Cognitively impaired PDP showed significantly lower score on visuo-construction and attention. Among all variables of MoCA domains, attention is strongly associated with instrumental activity daily living (IADL) scores (logistic regression coefficient = 0.672, P = 0.01). These results suggest that dementia affects daily living performances especially the IADL tasks like attention and execution. Therefore, the assessment of complex daily activities particularly IADL is probably useful for the diagnosis of early stage cognitive impairment in PDP. Further MMSE test is less sensitive than MoCA for detecting significant cognitive decline in PDP and impaired attention is an important determinant of ADL functions in cognitively impaired PDP.

Deference or Proportionality: Two Concepts of Margin of Appreciation in the Strasbourg Court and Their Influences

The margin of appreciation is controversial and difficult to understand. Since its first reference in the case of Greece vs. UK, the meaning of this doctrine has evolved from deference to derogation from the European Convention to an inflation of language used or misused by the Strasbourg Court to preserve the State's 'room for manoeuvre' or 'latitude of deference or error.' In this paper, I divide the concept of margin of appreciation into two categories: the substantive and structural concept. The Strasbourg Court usually generously defers to national decisions in structural scrutiny where it has to respect European pluralism and the collective interests of the contracting parties unless domestic decisions are regarded as 'manifestly unreasonable.' In contrast, the European Human Rights Court scrutinizes carefully in the substantive sense of margin of appreciation. Some factors or test approaches will be identified first, by which the Court substantively narrows or limits the scope of margin preserved for the States. The result of two conceptual margins of appreciation may be reciprocally transformed in some circumstances. When the collective good surely undermines the core of Convention rights, the Court will not stand with the domestic argument since it must ensure the implementation of pan-European human rights standards. On the other side, the Court has no capacity to further increase strict scrutiny in cases where there is a complicated relationship between the means and ends in the proportionality test, implying that domestic courts are better placed than the supranational court given the fact that they know better the local reality and have more local knowledge.

The Guqin——Cultivator of Ancient Scholars

IN earlier times,mastery of music,Chinese chess,calligraphy,and painting attested to a Chinese scholar＇s level of cultural accomplishment.Music came top of the list,and that played on the guqin,a zitherlike instrument,was prominent in the lives of literary ancients.