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Murea M, Raimann JG, Divers J, Maute H, Kovach C, Abdel-Rahman EM, Awad AS, Flythe JE, Gautam SC, Niyyar VD, Roberts GV, Jefferson NM, Shahidul I, Nwaozuru U, Foley KL, Trembath EJ, Rosales ML, Fletcher AJ, Hiba SI, Huml A, Knicely DH, Hasan I, Makadia B, Gaurav R, Lea J, Conway PT, Daugirdas JT, Kotanko P. Comparative effectiveness of an individualized model of hemodialysis vs conventional hemodialysis: a study protocol for a multicenter randomized controlled trial (the TwoPlus trial). Trials 2024; 25:424. [PMID: 38943204 PMCID: PMC11212207 DOI: 10.1186/s13063-024-08281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Most patients starting chronic in-center hemodialysis (HD) receive conventional hemodialysis (CHD) with three sessions per week targeting specific biochemical clearance. Observational studies suggest that patients with residual kidney function can safely be treated with incremental prescriptions of HD, starting with less frequent sessions and later adjusting to thrice-weekly HD. This trial aims to show objectively that clinically matched incremental HD (CMIHD) is non-inferior to CHD in eligible patients. METHODS An unblinded, parallel-group, randomized controlled trial will be conducted across diverse healthcare systems and dialysis organizations in the USA. Adult patients initiating chronic hemodialysis (HD) at participating centers will be screened. Eligibility criteria include receipt of fewer than 18 treatments of HD and residual kidney function defined as kidney urea clearance ≥3.5 mL/min/1.73 m2 and urine output ≥500 mL/24 h. The 1:1 randomization, stratified by site and dialysis vascular access type, assigns patients to either CMIHD (intervention group) or CHD (control group). The CMIHD group will be treated with twice-weekly HD and adjuvant pharmacologic therapy (i.e., oral loop diuretics, sodium bicarbonate, and potassium binders). The CHD group will receive thrice-weekly HD according to usual care. Throughout the study, patients undergo timed urine collection and fill out questionnaires. CMIHD will progress to thrice-weekly HD based on clinical manifestations or changes in residual kidney function. Caregivers of enrolled patients are invited to complete semi-annual questionnaires. The primary outcome is a composite of patients' all-cause death, hospitalizations, or emergency department visits at 2 years. Secondary outcomes include patient- and caregiver-reported outcomes. We aim to enroll 350 patients, which provides ≥85% power to detect an incidence rate ratio (IRR) of 0.9 between CMIHD and CHD with an IRR non-inferiority of 1.20 (α = 0.025, one-tailed test, 20% dropout rate, average of 2.06 years of HD per patient participant), and 150 caregiver participants (of enrolled patients). DISCUSSION Our proposal challenges the status quo of HD care delivery. Our overarching hypothesis posits that CMIHD is non-inferior to CHD. If successful, the results will positively impact one of the highest-burdened patient populations and their caregivers. TRIAL REGISTRATION Clinicaltrials.gov NCT05828823. Registered on 25 April 2023.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
| | | | - Jasmin Divers
- Department of Foundations of Medicine, Center for Population and Health Services Research, NYU Grossman Long Island School of Medicine, New York, NY, USA
| | - Harvey Maute
- Department of Foundations of Medicine, Center for Population and Health Services Research, NYU Grossman Long Island School of Medicine, New York, NY, USA
| | - Cassandra Kovach
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Emaad M Abdel-Rahman
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
| | - Alaa S Awad
- Division of Nephrology, University of Florida, Jacksonville, FL, USA
| | - Jennifer E Flythe
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Samir C Gautam
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vandana D Niyyar
- Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Glenda V Roberts
- External Relations and Patient Engagement, Division of Nephrology, Department of Medicine, Kidney Research Institute and Center for Dialysis Innovation, University of Washington, Seattle, WA, USA
| | | | - Islam Shahidul
- Department of Foundations of Medicine, Center for Population and Health Services Research, NYU Grossman Long Island School of Medicine, New York, NY, USA
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Alison J Fletcher
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Sheikh I Hiba
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Anne Huml
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Daphne H Knicely
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
| | - Irtiza Hasan
- Division of Nephrology, University of Florida, Jacksonville, FL, USA
| | | | - Raman Gaurav
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Janice Lea
- Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Paul T Conway
- American Association of Kidney Patients, Tampa, FL, USA
| | - John T Daugirdas
- Division of Nephrology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Peter Kotanko
- Department of Internal Medicine, Section on Nephrology, LLC Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Teismann H, Schubert R, Reilmann R, Berger K. Effects of age and sex on outcomes of the Q-Motor speeded finger tapping and grasping and lifting tests-findings from the population-based BiDirect Study. Front Neurol 2022; 13:965031. [PMID: 36247774 PMCID: PMC9561931 DOI: 10.3389/fneur.2022.965031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Q-Motor is a suite of motor tests originally designed to assess motor symptoms in Huntington's disease. Among others, Q-Motor encompasses a finger tapping task and a grasping and lifting task. To date, there are no systematic investigations regarding effects of variables which may affect the performance in specific Q-Motor tests per se, and normative Q-Motor data based on a large population-based sample are not yet available. Objective We investigated effects of age and sex on five selected Q-Motor outcomes representing the two core Q-Motor tasks speeded finger tapping and grasping and lifting in a community sample of middle-aged to elderly adults. Furthermore, we explored effects of the potentially mediating variables educational attainment, alcohol consumption, smoking status, and depressive symptoms. Moreover, we explored inter-examiner variability. Finally, we compared the findings to findings for the Purdue Pegboard test. Methods Based on a sample of 726 community-dwelling adults and using multiple (Gaussian) regression analysis, we modeled the motor outcomes using age, sex, years in full-time education, depressive symptoms in the past seven days, alcohol consumption in the past seven days, and smoking status as explanatory variables. Results With regard to the Q-Motor tests, we found that more advanced age was associated with reduced tapping speed, male sex was associated with increased tapping speed and less irregularity, female sex was associated with less involuntary movement, more years of education were associated with increased tapping speed and less involuntary movement, never smoking was associated with less involuntary movement compared to current smoking, and more alcohol consumed was associated with more involuntary movement. Conclusion The present results show specific effects of age and sex on Q-Motor finger tapping and grasping and lifting performance. In addition, besides effects of education, there also were specific effects of smoking status and alcohol consumption. Importantly, the present study provides normative Q-Motor data based on a large population-based sample. Overall, the results are in favor of the feasibility and validity of Q-Motor finger tapping and grasping and lifting for large observational studies. Due to their low task-complexity and lack of placebo effects, Q-Motor tests may generate additional value in particular with regard to clinical conditions such as Huntington's or Parkinson's disease.
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Affiliation(s)
- Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- *Correspondence: Henning Teismann
| | | | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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3
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Tollitt J, Odudu A, Montaldi D, Kalra PA. Cognitive impairment in patients with moderate to severe chronic kidney disease: the Salford kidney cohort study. Clin Kidney J 2020; 14:1639-1648. [PMID: 34084459 PMCID: PMC8162857 DOI: 10.1093/ckj/sfaa178] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Cognitive impairment in chronic kidney disease (CKD) is common and underrecognized [1, 2]. Determining risk factors for cognitive impairment and whether speed of CKD progression is an important consideration may help identify cognitive impairment by nephrologists. Vascular disease is thought to underpin cognitive impairment in CKD and by segregating CKD patients with proven vascular disease, we may also be able to discover other important associations with cognitive impairment in CKD patients. Method A total of 250 patients in a UK prospective cohort of CKD patients underwent two cognitive assessments: Montreal Cognitive Assessment test and Trail Making Test. Cognitive impairment was defined using validated population cut-offs (cognitive impairment) and relative cognitive impairment. Relative cognitive impairment was defined by <1 standard deviation below the mean Z-score on any completed test. Two multivariable logistical regression models identified variables associated with cognitive impairment and realtive cognitive impairment. Results About 44 and 24.8% of patients suffered cognitive impairment and relative cognitive impairment, respectively. Depression, previous stroke and older age were significantly associated with cognitive impairment. Older age was significantly associated with relative cognitive impairment (P ≤ 0.05) and higher proteinuria and the use of psychodynamic medications were also significantly associated with relative cognitive impairment (P = 0.05). Delta estimated glomerular filtration rate (eGFR) in patients with cognitive impairment and relative cognitive impairment compared with those having normal cognition was similar (−0.77 versus −1.35 mL/min/1.73 m2/year, P = 0.34 for cognitive impairment and −1.12 versus −1.02 mL/min/1.73 m2/year, P = 0.89 for relative cognitive impairment). Conclusion Risk factors for cognitive impairment in CKD include previous stroke, depression or anxiety, higher proteinuria and prescription of psychodynamic medications. Patients with a faster eGFR decline do not represent a group of patients at increased risk of cognitive impairment.
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Affiliation(s)
- James Tollitt
- Renal Department, Salford Royal NHS Trust, Salford, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Aghogho Odudu
- Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK.,Renal Department, Manchester Foundation Trust, Manchester, UK
| | - Daniela Montaldi
- Department for Memory Neurosciences, University of Manchester, Oxford Road, Manchester, UK
| | - Philip A Kalra
- Renal Department, Salford Royal NHS Trust, Salford, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
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Li Y, Pi HC, Yang ZK, Dong J. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol 2020; 33:839-848. [PMID: 31643008 PMCID: PMC7381472 DOI: 10.1007/s40620-019-00661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. METHOD A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for global cognitive function, trail-making tests A and B for executive function and subtests of the battery for the assessment of neuropsychological status for immediate and delayed memory, visuospatial skills and language ability. RESULTS The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m2 and 17.5 l/w/1.73 m2, respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. CONCLUSION The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.
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Affiliation(s)
- Yi Li
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
- Renal Division, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hai-Chen Pi
- Emergency Department, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China.
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Strelcyk O, Zahorik P, Shehorn J, Patro C, Derleth RP. Sensitivity to Interaural Phase in Older Hearing-Impaired Listeners Correlates With Nonauditory Trail Making Scores and With a Spatial Auditory Task of Unrelated Peripheral Origin. Trends Hear 2020; 23:2331216519864499. [PMID: 31455167 PMCID: PMC6755865 DOI: 10.1177/2331216519864499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Interaural phase difference (IPD) discrimination upper frequency limits and just-noticeable differences (JNDs), interaural level difference (ILD) JNDs, and diotic intensity JNDs were measured for 20 older hearing-impaired listeners with matched moderate sloping to severe sensorineural hearing losses. The JNDs were measured using tone stimuli at 500 Hz. In addition to these auditory tests, the participants completed a cognitive test (Trail Making Test). Significant performance improvements in IPD discrimination were observed across test sessions. Strong correlations were found between IPD and ILD discrimination performance. Very strong correlations were observed between IPD discrimination and Trail Making performance as well as strong correlations between ILD discrimination and Trail Making performance. These relationships indicate that interindividual variability in IPD discrimination performance did not exclusively reflect deficits specific to any auditory processing, including early auditory processing of temporal information. The observed relationships between spatial audition and cognition may instead be attributable to a modality-general spatial processing deficit and/or individual differences in global processing speed.
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Affiliation(s)
- Olaf Strelcyk
- 1 Sonova U.S. Corporate Services, Warrenville, IL, USA
| | - Pavel Zahorik
- 2 Department of Otolaryngology and Communicative Disorders, University of Louisville, Louisville, KY, USA.,3 Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA.,4 Heuser Hearing Research Center, Louisville, KY, USA
| | - James Shehorn
- 4 Heuser Hearing Research Center, Louisville, KY, USA
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Baillin F, Lefebvre A, Pedoux A, Beauxis Y, Engemann DA, Maruani A, Amsellem F, Kelso JAS, Bourgeron T, Delorme R, Dumas G. Interactive Psychometrics for Autism With the Human Dynamic Clamp: Interpersonal Synchrony From Sensorimotor to Sociocognitive Domains. Front Psychiatry 2020; 11:510366. [PMID: 33324246 PMCID: PMC7725713 DOI: 10.3389/fpsyt.2020.510366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
The human dynamic clamp (HDC) is a human-machine interface designed on the basis of coordination dynamics for studying realistic social interaction under controlled and reproducible conditions. Here, we propose to probe the validity of the HDC as a psychometric instrument for quantifying social abilities in children with autism spectrum disorder (ASD) and neurotypical development. To study interpersonal synchrony with the HDC, we derived five standardized scores following a gradient from sensorimotor and motor to higher sociocognitive skills in a sample of 155 individuals (113 participants with ASD, 42 typically developing participants; aged 5 to 25 years; IQ > 70). Regression analyses were performed using normative modeling on global scores according to four subconditions (HDC behavior "cooperative/competitive," human task "in-phase/anti-phase," diagnosis, and age at inclusion). Children with ASD had lower scores than controls for motor skills. HDC motor coordination scores were the best candidates for stratification and diagnostic biomarkers according to exploratory analyses of hierarchical clustering and multivariate classification. Independently of phenotype, sociocognitive skills increased with developmental age while being affected by the ongoing task and HDC behavior. Weaker performance in ASD for motor skills suggests the convergent validity of the HDC for evaluating social interaction. Results provided additional evidence of a relationship between sensorimotor and sociocognitive skills. HDC may also be used as a marker of maturation of sociocognitive skills during real-time social interaction. Through its standardized and objective evaluation, the HDC not only represents a valid paradigm for the study of interpersonal synchrony but also offers a promising, clinically relevant psychometric instrument for the evaluation and stratification of sociomotor dysfunctions.
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Affiliation(s)
- Florence Baillin
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France.,Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Aline Lefebvre
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France.,Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Amandine Pedoux
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Yann Beauxis
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Denis A Engemann
- Parietal Project-Team, INRIA Saclay - Île de France, Palaiseau, France
| | - Anna Maruani
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Frédérique Amsellem
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - J A Scott Kelso
- Human Brain and Behavior Laboratory, Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, FL, United States.,Intelligent Systems Research Centre, University of Ulster, Derry Londonderry, United Kingdom
| | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Richard Delorme
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France.,Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Guillaume Dumas
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France.,Human Brain and Behavior Laboratory, Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, FL, United States.,Department of Psychiatry, Université de Montréal, Montreal, QC, Canada.,CHU Sainte-Justine Centre de Recherche, Precision Psychiatry and Social Physiology Laboratory, Montreal, QC, Canada
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Zhao Y, Zhang Y, Yang Z, Wang J, Xiong Z, Liao J, Hao L, Liu G, Ren Y, Wang Q, Duan L, Zheng Z, Dong J. Sleep Disorders and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Kidney Blood Press Res 2019; 44:1115-1127. [PMID: 31537006 DOI: 10.1159/000502355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.
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Affiliation(s)
- Youlu Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yuhui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Guiling Liu
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Yeping Ren
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Liping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | - Zhaoxia Zheng
- Renal Division, Handan Central Hospital, Hebei, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China, .,Institute of Nephrology, Peking University, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China,
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Nie XD, Wang Q, Zhang YH, Xiong ZY, Liao JL, Hao L, Liu GL, Duan LP, Zheng ZX, Ren YP, Dong J. Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Perit Dial Int 2019; 39:465-471. [PMID: 31501292 DOI: 10.3747/pdi.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion Depression was a significant risk factor for worsening of CI in PD patients.
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Affiliation(s)
- Xue-dan Nie
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yu-hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Ye-ping Ren
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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The Reliability and Validity of the Action Fluency Test in Healthy College Students. Arch Clin Neuropsychol 2019; 34:1175-1191. [DOI: 10.1093/arclin/acz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/04/2019] [Accepted: 03/12/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
This study examined the test–retest reliability and construct validity of the Action Fluency Test (AFT) as a measure of executive functioning.
Method
Using a correlational design, 128 healthy college students (M Age = 19.24, SD = 2.01; M education = 13.29 years, SD = 0.81) completed the AFT, and measures of verbal and figural fluency, executive functioning and other relevant constructs (e.g., vocabulary, working memory, and attention).
Results
Coefficients of stability were acceptable for AFT correct words (r = .76; p < .01), but not for errors (r = .41) or perseverations (r = .14). No practice effects were observed upon repeat testing (M interval = 39.21 days). Divergent validity evidence was mixed. AFT scores were unrelated to working memory and perceptual-reasoning abilities; however, correlations with vocabulary (r = .32; p < .01) and information-processing speed (r = .30; p < .01) were greater than associations between AFT scores and executive measures. Regarding convergent validity, AFT scores correlated with other fluency tasks (r = .4 range), but correlations with measures of executive functioning were absent or small. Action and letter fluency correlated with measures of attentional control and inhibition; however, these associations were no longer significant after controlling for shared variance with information-processing speed.
Conclusions
Findings are consistent with previous research suggesting vocabulary and information-processing speed underlie effective fluency performance to a greater extent than executive functioning. The AFT measures unique variance not accounted for by semantic and letter fluency tasks, and therefore may be used for a variety of research and clinical purposes.
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Novak P, Pimentel Maldonado DA, Novak V. Safety and preliminary efficacy of intranasal insulin for cognitive impairment in Parkinson disease and multiple system atrophy: A double-blinded placebo-controlled pilot study. PLoS One 2019; 14:e0214364. [PMID: 31022213 PMCID: PMC6483338 DOI: 10.1371/journal.pone.0214364] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 03/12/2019] [Indexed: 12/14/2022] Open
Abstract
Parkinson disease (PD) is associated with cognitive impairment. We aimed to determine the effects of intranasal insulin (INI) on cognition and motor performance in PD. This was a proof of concept, randomized, double-blinded, placebo-controlled trial evaluating the effects of 40 international units (IU) of insulin or saline once daily for four weeks on cognitive and functional performance. Of 16 subjects enrolled, eight in the INI group and six in the placebo group completed verbal fluency (FAS), Unified Parkinson Disease Scale (UPDRS), and modified Hoehn and Yahr scale (HY, PD severity) at baseline and post-treatment and were included in the analyses. After treatment, the INI group had a better total FAS score (p = 0.02) (41 ± 8.2 vs. 30.8 ± 7.1, mean ±SD, p = 0.02) compared to the placebo group. The INI group also had improved HY (p = 0.04) and UPDRS-Motor (Part III) (p = 0.02) scores when compared to baseline. One INI treated patient with multiple system atrophy (MSA) remained stable and did not show disease progression. The placebo group had no change. INI administration was well tolerated and there were no hypoglycemic episodes or serious study related adverse events or medications interactions. INI is safe in PD and MSA patients and may provide clinically relevant functional improvement. Larger studies are warranted to determine the INI effect in treatment of cognitive and motor impairment in Parkinson disease. Trial Registration: ClinicalTrial.gov NCT02064166.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, University of Massachusetts, Worcester, Massachusetts, United States of America
- * E-mail:
| | | | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Liao JL, Zhang YH, Xiong ZB, Hao L, Liu GL, Ren YP, Wang Q, Duan LP, Zheng ZX, Xiong ZY, Dong J. The Association of Cognitive Impairment with Peritoneal Dialysis-Related Peritonitis. Perit Dial Int 2019; 39:229-235. [PMID: 30852523 DOI: 10.3747/pdi.2018.00180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background:Research on the association between cognitive impairment (CI) and peritoneal dialysis (PD)-related peritonitis is limited. Therefore, we investigated whether CI contributed to the risk of PD-related peritonitis.Methods:This prospective cohort study enrolled 458 patients from 5 PD centers between 1 March 2013, and 30 November 2013, and continued until 31 May 2016. We used the Modified Mini-Mental State Examination (3MS) to assess general cognition, the Trail-Making Test to assess executive function, and subtests of the Battery for the Assessment of Neuropsychological Status to assess immediate and delayed memory, visuospatial skills, and language ability. Patients were assigned to CI and non-CI groups based on their 3MS scores. The first episode of peritonitis was the primary endpoint event. Treatment failure of peritonitis was defined as peritonitis-associated death or transfer to hemodialysis. We used competing risk models to analyze the association between CI and the risk of peritonitis. The association of CI with treatment failure after peritonitis was analyzed using logistic regression models.Results:Ninety-four first episodes of peritonitis were recorded during a median follow-up of 31.4 months, 18.1% of which led to treatment failure. No significant group differences were observed for the occurrence, distribution of pathogenic bacteria, or outcomes of first-episode peritonitis. Immediate memory dysfunction was independently associated with a higher risk of PD-related peritonitis (hazard ratio [HR] 1.736, 95% confidence interval [CI] 1.064 - 2.834, p < 0.05), adjusting for confounders.Conclusions:Immediate memory dysfunction was a significant, independent predictor of PD-related peritonitis. Neither general nor specific domains of CI predicted treatment failure of peritonitis.
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Affiliation(s)
- Jin-Lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yu-Hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zi-Bo Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-Ling Liu
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Ye-Ping Ren
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Renal Division, Handan Central Hospital, Hebei, China
| | - Li-Ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Zu-Ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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12
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Zhang YH, Yang ZK, Wang JW, Xiong ZY, Liao JL, Hao L, Liu GL, Ren YP, Wang Q, Duan LP, Zheng ZX, Dong J. Cognitive Changes in Peritoneal Dialysis Patients: A Multicenter Prospective Cohort Study. Am J Kidney Dis 2018; 72:691-700. [DOI: 10.1053/j.ajkd.2018.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 04/19/2018] [Indexed: 02/08/2023]
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13
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An association of cognitive impairment with diabetes and retinopathy in end stage renal disease patients under peritoneal dialysis. PLoS One 2017; 12:e0183965. [PMID: 28859133 PMCID: PMC5578503 DOI: 10.1371/journal.pone.0183965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes and retinopathy have been considered as risk factors of cognitive impairment (CI) in previous studies. We investigated both of these two factors and their relationship with global and specific cognitive functions in end stage renal disease patients under peritoneal dialysis (PD). Methods In this multicenter cross-sectional study, 424 clinically stable patients were enrolled from 5 PD units, who performed PD for at least three months and completed fundoscopy examination if they had diabetes. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), Trail-Making Test forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skills, and language ability. Results PD Patients with DM and Retinopathy had significantly higher prevalence of CI, executive dysfunction, impaired immediate memory and visuospatial skill, compared with patients in non-DM group. By multivariate logistic regression analyses, DM and retinopathy rather than DM only were significantly associated with increased risk for CI, executive dysfunction, impaired immediate memory and visuospatial skill, odds ratios(ORs) and 95% confidence intervals were 2.09[1.11,3.92], 2.89[1.55,5.37], 2.16 [1.15,4.06] and 2.37[1.32,4.22], respectively (all P < 0.05). Conclusions Diabetic PD patients with retinopathy were at two times risk for overall cognitive impairment, executive dysfunction, impaired immediate memory and visuospatial skill as compared to non-diabetic PD patients.
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Wang Q, Yang ZK, Sun XM, Du Y, Song YF, Ren YP, Dong J. Association of Social Support and Family Environment with Cognitive Function in Peritoneal Dialysis Patients. Perit Dial Int 2017; 37:14-20. [PMID: 28153965 DOI: 10.3747/pdi.2016.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Cognitive impairment (CI) is a common phenomenon and predictive of high mortality in peritoneal dialysis (PD) patients. This study aimed to analyze the association of social support and family environment with cognitive function in PD patients. ♦ METHODS: This is a cross-sectional study of PD patients from Peking University First Hospital and the Second Affiliated Hospital of Harbin Medical University. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), executive function was measured by the A and B trail-making tests, and other cognitive functions were measured by the Repeatable Battery for the Assessment of Neuropsychological Status. Social support was measured with the Social Support Scale developed by Xiaoshuiyuan and family environment was measured with the Chinese Version of the Family Environment Scale (FES-CV). ♦ RESULTS: The prevalence of CI and executive dysfunction among the 173 patients in the study was, respectively, 16.8% and 26.3%. Logistic regression found that higher global social support (odds ratio [OR] = 1.09, 1.01 - 1.17, p = 0.027) and subjective social support predicted higher prevalence of CI (OR = 1.13, 1.02 - 1.25, p = 0.022), adjusting for covariates. Analyses of the FES-CV dimensions found that greater independence was significantly associated with better immediate memory and delayed memory. Moreover, higher scores on achievement orientation were significantly associated with poorer language skills. ♦ CONCLUSIONS: Our findings indicate that social support is negatively associated with the cognitive function of PD patients and that some dimensions of the family environment are significantly associated with several domains of cognitive function.
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Affiliation(s)
- Qin Wang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Zhi-Kai Yang
- Department of Nephrology, Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Xiu-Mei Sun
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yun Du
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yi-Fan Song
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Ye-Ping Ren
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Department of Nephrology, Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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Performance of the Modified Mini-Mental State Examination (3MS) in Assessing Specific Cognitive Function in Patients Undergoing Peritoneal Dialysis. PLoS One 2016; 11:e0166470. [PMID: 27911914 PMCID: PMC5135044 DOI: 10.1371/journal.pone.0166470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/28/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE While Cognitive impairment (CI) has been identified as an independent risk factors for mortality in patients undergoing peritoneal dialysis (PD), it is inadequately assessed. We evaluated the applicability of the Modified Mini-Mental State Examination (3MS) in assessing specific cognitive function and compared it to a detailed neuropsychological test battery as the reference standard. METHODS In this multicentric cross-sectional study, we enrolled 445 clinically stable patients from five PD units, who were undergoing PD for at least 3 months. The 3MS was evaluated for general cognitive function. A detailed neuropsychological battery including domains of immediate memory, delayed memory, executive function, language, and visuospatial ability were evaluated as reference standards. Sensitivity and specificity of the 3MS was determined by using receiver operating characteristic (ROC) analysis. RESULTS The CI prevalence evaluated by 3MS was 23.6%. PD patients with CI performed worse in all cognitive domains. The 3MS correlated well with specific cognitive domains. However, 18.5%, 57.4%, 12.6%, 8.8%, and 41.2% of patients whom were idendified as normal by 3MS still showed executive dysfunction, immediate memory impairment, delayed memory impairment, and language-ability and visuospatial-ability impairment, respectively. The 3MS identified patients having specific cognitive dysfunction with varied extent of diagnostic value, with 0.50, 0.42, 0.35, 0.34, and 0.26 of Youden index in executive function, delayed memory, language ability, immediate memory, and visuospatial ability, respectively. CONCLUSIONS The 3MS is not a comprehensive instrument for major cognitive domains in PD patients. It could, however, be used for executive dysfunction and delayed memory impairment screening.
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Jayanti A, Foden P, Brenchley P, Wearden A, Mitra S. The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice. Kidney Int Rep 2016; 1:240-249. [PMID: 29142928 PMCID: PMC5678624 DOI: 10.1016/j.ekir.2016.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/16/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction Kidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice. Methods Cross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one's cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice. Results Within the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores (P < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality. Discussion Patients' self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of "metaconcentration" is also strongly associated with poorer outcome on the TMT part B.
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Affiliation(s)
- A Jayanti
- Renal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UK
| | - P Foden
- Department of Biostatistics, University of Manchester, Manchester, UK
| | - P Brenchley
- Renal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UK
| | - A Wearden
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - S Mitra
- Renal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UK
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Goldsmith DR, Haroon E, Woolwine BJ, Jung MY, Wommack EC, Harvey PD, Treadway MT, Felger JC, Miller AH. Inflammatory markers are associated with decreased psychomotor speed in patients with major depressive disorder. Brain Behav Immun 2016; 56:281-8. [PMID: 27040122 PMCID: PMC4939278 DOI: 10.1016/j.bbi.2016.03.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/15/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023] Open
Abstract
Previous data have demonstrated that administration of inflammatory cytokines or their inducers leads to altered basal ganglia function associated with reduced psychomotor speed. Decreased psychomotor speed, referred to clinically as psychomotor retardation, is a cardinal symptom of major depressive disorder (MDD) and has been associated with poor antidepressant treatment response. We therefore examined the association between plasma inflammatory markers and psychomotor speed in ninety-three un-medicated patients with MDD. Psychomotor speed was assessed by a range of neuropsychological tests from purely motor tasks (e.g. movement latency and finger tapping) to those that involved motor activity with increasing cognitive demand and cortical participation (e.g. Trails A and Digit Symbol Substitution Task (DSST)). Linear regression analyses were performed to determine the relationship of inflammatory markers and psychomotor task performance controlling for age, race, sex, education, body mass index, and severity of depression. MDD patients exhibited decreased psychomotor speed on all tasks relative to normative standards. Increased IL-6 was associated with decreased performance on simple and choice movement time tasks, whereas MCP-1 was associated with decreased performance on the finger tapping task and DSST. IL-10 was associated with increased performance on the DSST. In an exploratory principle component analysis including all psychomotor tasks, IL-6 was associated with the psychomotor speed factor. Taken together, the data indicate that a peripheral inflammatory profile including increased IL-6 and MCP-1 is consistently associated with psychomotor speed in MDD. These data are consistent with data demonstrating that inflammation can affect basal ganglia function, and indicate that psychomotor speed may be a viable outcome variable for anti-inflammatory therapies in depression and other neuropsychiatric disorders with increased inflammation.
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Affiliation(s)
- David R. Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329,Corresponding Author: David R. Goldsmith, MD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA 30329 United States, Fax: +1-404-727-4746, Tel: +1-404-727-1564,
| | - Ebrahim Haroon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329
| | - Bobbi J. Woolwine
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329
| | - Moon Y. Jung
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329
| | - Evanthia C. Wommack
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136,Research Service, Bruce W. Carter VA Medical Center, Miami, FL
| | | | - Jennifer C. Felger
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329,Winship Cancer Institute, Emory University, Atlanta, GA 30322
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329,Winship Cancer Institute, Emory University, Atlanta, GA 30322
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Anderson RE, Birge SJ. Cognitive Dysfunction, Medication Management, and the Risk of Readmission in Hospital Inpatients. J Am Geriatr Soc 2016; 64:1464-8. [PMID: 27305636 DOI: 10.1111/jgs.14200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether cognitive dysfunction, in particular impaired executive function, may be a risk factor for early readmission in older adults independently managing their medications. DESIGN Prospective observational study. SETTING Tertiary hospital. PARTICIPANTS Individuals aged 65 years and older discharged to home from the medicine service of a tertiary hospital (N = 452). MEASUREMENTS Participants underwent a cognitive assessment including the Short Blessed Test (SBT), the executive function component of the Montreal Cognitive Assessment, and the Trail-Making Test Part B (TMT-B). Hospital use and demographic data were obtained. A logistic regression model was used to fit the likelihood of readmission on the basis of participant characteristics, medication management, and cognitive performance. Likelihood of hospital readmission within 30 days was determined. RESULTS For participants managing medications themselves, adjusted 30-day odds of readmission increased 13% on average with each point decrease in SBT score (P = .003) and 9% on average with each 0.01 decrease in TMT-B score (P = .02). For participants who were independent in medication management with more than seven medications, the odds of 30-day readmission increased 16% on average with each point decrease in SBT score (P = .01) and 15% on average with each 0.01 decrease in TMT-B score (P = .03). CONCLUSION Cognitive dysfunction, particularly executive dysfunction, is a risk factor for readmission in individuals managing their own medications. This risk is greater in individuals taking more than seven medications. The interaction of cognitive function, medication management, and number of medications may enhance risk-stratification efforts to identify individuals at risk of early readmission.
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Affiliation(s)
- Ryan E Anderson
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley J Birge
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Dong J, Pi HC, Xiong ZY, Liao JL, Hao L, Liu GL, Ren YP, Wang Q, Duan LP, Zheng ZX. Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study. Am J Kidney Dis 2016; 67:111-8. [DOI: 10.1053/j.ajkd.2015.06.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 11/11/2022]
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Liu GL, Pi HC, Hao L, Li DD, Wu YG, Dong J. Vitamin D Status Is an Independent Risk Factor for Global Cognitive Impairment in Peritoneal Dialysis Patients. PLoS One 2015; 10:e0143782. [PMID: 26630385 PMCID: PMC4668056 DOI: 10.1371/journal.pone.0143782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/08/2015] [Indexed: 12/12/2022] Open
Abstract
Objective Vitamin D (VD) deficiency is an independent risk factor for cognitive impairment (CI) in the general population, but VD status in peritoneal dialysis (PD) patients has not been investigated. In this study, we aimed to investigate the relationship between serum VD levels and global and specific cognitive functions in PD patients. Design and Setting Cross-sectional study, simultaneously conducted at two PD centers. Patients Clinically stable patients (n = 273) undergoing PD for at least 3 months were enrolled over a period of one year. Main outcome Measures Demographic and comorbidity data were recorded, and routine biochemical parameters and serum 25-hydroxyvitamin D (25(OH) D) levels of overnight fasted patients were determined. Global cognitive function was assessed by the Modified Mini-Mental State Examination (3MS) score; executive function, by the trail making tests (Trails A and B); and immediate memory, delayed memory, and language ability by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) sub-tests. Results In the univariate analysis, serum 25(OH) D levels significantly correlated with 3MS scores (r = -0.139; P = 0.02), and Trail A (r = -0.188; P = 0.002) and B (r = -0.154; P = 0.01) completion times. In the multivariate analysis, 25(OH) D was found to be independently associated with global CI, but not with executive dysfunction. Serum 25(OH) D could not predict scores of immediate/delayed memory and language ability. Conclusions VD deficiency is highly prevalent in PD patients and is an independent risk factor for global CI in this patient cohort.
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Affiliation(s)
- Gui-Ling Liu
- Renal Division, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hai-Chen Pi
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| | - Li Hao
- Renal Division, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dan-Dan Li
- Renal Division, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yong-Gui Wu
- Renal Division, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- * E-mail:
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
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Coleman AR, Moberg PJ, Ragland JD, Gur RC. Comparison of the Halstead-Reitan and Infrared Light Beam Finger Tappers. Assessment 2015; 4:277-86. [PMID: 26613776 DOI: 10.1177/107319119700400307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computer mediated motor tests can provide highly reliable means for evaluating gross and subtle aspects of psychomotor speed and rhythmicity. A computer mediated test of finger and foot tapping, making use of infrared light beam technology, was recently developed, but little is known regarding its psychometric properties. The purpose of this study was to compare performance of healthy right-handed respondents on the new Light Beam Finger & Foot Tapping Device to a traditional finger tapping test used in the Halstead-Reitan Neuropsychological Battery. Performance on the Halstead-Reitan Finger Tapping Test and on the Light Beam Finger Tapping Test was compared in 16 men and 17 women. The light beam test showed similar psychometric properties to those of the Halstead-Reitan Finger Tapping Test, and scores were moderately correlated between the two tests. Respondents had faster scores on the light beam test; on both tests men were faster than women, and all respondents tapped faster with their dominant hand. Tapping was faster on the Light Beam Finger Tapping Test, possibly because it does not require application of pressure to a mechanical key and a smaller movement registers a tap. In addition to measures of right- and left-hand tapping speed, the light beam test assesses synchronous and alternating tapping and foot tapping. Scores between these subtests showed moderate to high correlations.
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Abstract
The effects of acute aerobic exercise on cognitive functions in humans have been the subject of much investigation; however, these studies are limited by several factors, including a lack of randomized controlled designs, focus on only a single cognitive function, and testing during or shortly after exercise. Using a randomized controlled design, the present study asked how a single bout of aerobic exercise affects a range of frontal- and medial temporal lobe-dependent cognitive functions and how long these effects last. We randomly assigned 85 subjects to either a vigorous intensity acute aerobic exercise group or a video watching control group. All subjects completed a battery of cognitive tasks both before and 30, 60, 90, or 120 min after the intervention. This battery included the Hopkins Verbal Learning Test-Revised, the Modified Benton Visual Retention Test, the Stroop Color and Word Test, the Symbol Digit Modalities Test, the Digit Span Test, the Trail Making Test, and the Controlled Oral Word Association Test. Based on these measures, composite scores were formed to independently assess prefrontal cortex- and hippocampal-dependent cognition. A three-way mixed Analysis of Variance was used to determine whether differences existed between groups in the change in cognitive function from pre- to post-intervention testing. Acute exercise improved prefrontal cortex- but not hippocampal-dependent functioning, with no differences found between delay groups. Vigorous acute aerobic exercise has beneficial effects on prefrontal cortex-dependent cognition and these effects can last for up to 2 hr after exercise.
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Xu R, Pi HC, Xiong ZY, Liao JL, Hao L, Liu GL, Ren YP, Wang Q, Zheng ZX, Duan LP, Dong J. Hyponatremia and Cognitive Impairment in Patients Treated with Peritoneal Dialysis. Clin J Am Soc Nephrol 2015; 10:1806-13. [PMID: 26231192 PMCID: PMC4594065 DOI: 10.2215/cjn.02240215] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/11/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyponatremia has been identified as a relevant factor for cognitive impairment but has not been investigated in patients receiving peritoneal dialysis (PD). This study investigated the relationship between hyponatremia and cognitive functions in PD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A total of 476 clinically stable patients from five PD units who were older than 18 years of age and had undergone PD for at least 3 months between March 2013 and March 2014 were enrolled in this multicenter cross-sectional study. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS); executive function, by trail making tests A (trails A) and B (trails B); and immediate memory, delayed memory, and language ability, by subtests of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Hyponatremia was defined as serum sodium level ≤135 mmol/L, which was calculated as the mean of measurements taken over the preceding 3 months. RESULTS Fifty patients (10.5%) had hyponatremia; these patients tended to be older and less educated, to have less inflammation, and to have the higher prevalence of cognitive impairment. They also had lower scores on RBANS subtests. After adjustment for demographic and clinical confounders, hyponatremia was independently associated with lower 3MS score (coefficient, -5.28; 95% confidence interval [CI], -8.44 to -2.13) and longer completion time of trials A (coefficient, 22.68; 95% CI, 3.44 to 41.92) and B (coefficient, 45.56; 95% CI, 1.30 to 89.81). After additional adjustment for laboratory measures, hyponatremia was still associated with 3MS score and completion time of trails A. Hyponatremia was independently associated with CI (odds ratio, 2.17; 95% CI, 1.02 to 4.94) and executive dysfunction (odds ratio, 2.43; 95% CI, 1.01 to 5.87) using multivariate logistic regression analysis. Sensitivity analyses with multivariable models that included propensity score still supported the association between hyponatremia and cognitive impairment. CONCLUSIONS Hyponatremia was associated with global and specific cognitive impairment in PD patients.
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Affiliation(s)
- Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health, Beijing, China; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hai-chen Pi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health, Beijing, China; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, Second Hospital of Anhui Medical University, Anhui, China
| | - Ye-Ping Ren
- Renal Division, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China; and
| | - Qin Wang
- Renal Division, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China; and
| | | | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health, Beijing, China; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China;
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Votruba KL, Persad C, Giordani B. Patient Mood and Instrumental Activities of Daily Living in Alzheimer Disease: Relationship Between Patient and Caregiver Reports. J Geriatr Psychiatry Neurol 2015; 28:203-9. [PMID: 26071443 DOI: 10.1177/0891988715588829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 01/28/2015] [Indexed: 11/15/2022]
Abstract
This retrospective study investigated the relationship between self-reports and caregiver perceptions of patients' depressive symptoms and the respective ability of these reports to predict instrumental activities of daily living (IADLs) beyond what is accounted for by cognitive abilities in 71 patients with mild Alzheimer disease. Patients completed the Geriatric Depression Scale-Short Form, and caregivers completed the Behavior Rating Scale for Dementia assessing their perception of patients' depressive symptoms. Caregivers also completed IADL items from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory. Cognitive measures included the Mini-Mental State Examination, Logical Memory from the Wechsler Memory Scale III, and Trail Making Test, Part B. The relationship between self-reported depressive symptoms and caregiver report of patients' depressive symptoms showed a trend toward significance (r = .22, P = .06). Measures of depressive symptoms significantly predicted 12.5% of the variance in IADLs performance, beyond that accounted for by patient demographics and cognitive functioning. Interestingly, patients' reports, rather than caregivers', were particularly useful in this prediction.
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Affiliation(s)
- Kristen L Votruba
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
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Christidi F, Kararizou E, Triantafyllou N, Anagnostouli M, Zalonis I. Derived Trail Making Test indices: demographics and cognitive background variables across the adult life span. AGING NEUROPSYCHOLOGY AND COGNITION 2015; 22:667-78. [DOI: 10.1080/13825585.2015.1027650] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hubel KA, Reed B, Yund EW, Herron TJ, Woods DL. Computerized measures of finger tapping: effects of hand dominance, age, and sex. Percept Mot Skills 2014; 116:929-52. [PMID: 24175464 DOI: 10.2466/25.29.pms.116.3.929-952] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computerized measures of digit tapping rate were obtained over 3 successive, 10-sec. periods in the right and left index fingers, from a community sample of 1,519 participants (ages 18 to 65 years; 607 men, 912 women). Differences between the dominant and non-dominant hands were found for tapping rate, movement initiation, and button down times, and the decline in tapping rate over the successive, 10-sec. periods. Declines were found in tapping rate in older participants in association with increased intertap variability. Men had higher tapping rates than women in all age ranges. The computerized finger tapping test is an efficient and precise measure of tapping speed and kinetics of potential utility in research and clinical studies of motor performance.
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Affiliation(s)
- Kerry A Hubel
- Human Cognitive Neurophysiology Laboratory, VANCHCS, Martinez, CA 94553, USA
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Silverman IW. Age as a moderator of the secular trend for grip strength in Canada and the United States. Ann Hum Biol 2014; 42:199-209. [PMID: 25041340 DOI: 10.3109/03014460.2014.934920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine whether grip strength changed on average over recent decades at each of two age levels (children and adolescents versus adults) in Canada and the US. METHODS For each sex, weighted least squares regression analyses were performed on mean grip strength values as reported in studies conducted from the 1960s onwards. RESULTS Grip strength did not change significantly as a function of year tested in children and adolescents, whereas it declined as a negatively accelerated function of year tested in adults. CONCLUSION The results are contrary to what might be expected given that body weight has increased in both countries in recent decades and given that grip strength has been found to be positively correlated with body weight. It is suggested that there was a concurrent change in a factor that operated to counteract the effect of increased body weight on grip strength, a prime candidate being a decrease in levels of serum vitamin D. It is also suggested that the secular decline in adult grip strength can be explained by a factor that affects muscular function but which has a long latency period, a prime candidate here being obesity history.
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Affiliation(s)
- Irwin W Silverman
- Department of Psychology, Bowling Green State University , Bowling Green, OH , USA
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Causby R, Reed L, McDonnell M, Hillier S. Use of objective psychomotor tests in health professionals. Percept Mot Skills 2014; 118:765-804. [PMID: 25068745 DOI: 10.2466/25.27.pms.118k27w2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evaluation of psychomotor skills is undertaken in a number of broad contexts. This includes testing of health professional populations as a measure of innate ability, to evaluate skill acquisition, or to compare professions. However, the use of psychomotor tests is frequently confounded by a lack of understanding of a particular tool's psychometric properties, strengths, and weaknesses. To identify and appraise the most commonly used tests on health professional populations, 86 articles were reviewed and the top nine tests identified. Few tests have had sufficient validity or reliability testing on health professionals. Based on the evidence available, use of the Grooved Pegboard Test, the Purdue Pegboard Test, or the Finger Tapping Test is recommended for the evaluation of dexterity in a health professional population; however, this choice may be dependent on the task(s) to which findings are generalised. More rigorous evaluation of validity and other psychometric properties is required.
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Affiliation(s)
- Ryan Causby
- 1 International Centre for Allied Health Evidence, University of South Australia
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Andrews K, Shuttleworth-Edwards A, Radloff S. Normative Indications for Xhosa Speaking Unskilled Workers on the Trail Making and Stroop Tests. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2012.10820538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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Hubel KA, Reed B, Yund EW, Herron TJ, Woods DL. COMPUTERIZED MEASURES OF FINGER TAPPING: EFFECTS OF HAND DOMINANCE, AGE, AND SEX1,2. Percept Mot Skills 2013. [DOI: 10.2466/25.29.pms.116.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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te Beek ET, Tatosian D, Majumdar A, Selverian D, Klaassen ES, Petty KJ, Gargano C, van Dyck K, McCrea J, Murphy G, van Gerven JMA. Placebo- and amitriptyline-controlled evaluation of central nervous system effects of the NK1 receptor antagonist aprepitant and intravenous alcohol infusion at pseudo-steady state. J Clin Pharmacol 2013; 53:846-56. [PMID: 23775877 DOI: 10.1002/jcph.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Recent interest in NK1 receptor antagonists has focused on a potential role in the treatment of drug addiction and substance abuse. In the present study, the potential for interactions between the NK1 receptor antagonist aprepitant and alcohol, given as an infusion at a target level of 0.65 g/L, was evaluated. Amitriptyline was included as positive control to provide an impression of the profile of central nervous system (CNS) effects. In a double-blind, randomized, placebo- and amitriptyline-controlled study, the pharmacokinetics and CNS effects of aprepitant and alcohol were investigated in 16 healthy volunteers. Cognitive and psychomotor function tests included the visual verbal learning test (VVLT), Bond and Lader visual analogue scales (VAS), digit symbol substitution test (DSST), visual pattern recognition, binary choice reaction time, critical flicker fusion (CFF), body sway, finger tapping, and adaptive tracking. Alcohol impaired finger tapping and body sway. Amitriptyline impaired DSST performance, VAS alertness, CFF, body sway, finger tapping, and adaptive tracking. No impairments were found after administration of aprepitant. Co-administration of aprepitant with alcohol was generally well tolerated and did not cause significant additive CNS effects, compared with alcohol alone. Therefore, our study found no indications for clinically relevant interactions between aprepitant and alcohol.
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Affiliation(s)
- Erik T te Beek
- Centre for Human Drug Research, Leiden, The Netherlands.
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Kurella Tamura M, Unruh ML, Nissenson AR, Larive B, Eggers PW, Gassman J, Mehta RL, Kliger AS, Stokes JB. Effect of more frequent hemodialysis on cognitive function in the frequent hemodialysis network trials. Am J Kidney Dis 2012; 61:228-37. [PMID: 23149295 DOI: 10.1053/j.ajkd.2012.09.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/18/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cognitive impairment is common in patients with end-stage renal disease receiving hemodialysis 3 times per week. STUDY DESIGN Randomized clinical trial. SETTING & PARTICIPANTS 218 individuals participating in the Frequent Hemodialysis Network (FHN) Daily Trial and 81 participating in the FHN Nocturnal Trial. INTERVENTION The Daily Trial tested in-center hemodialysis 6 times per week versus 3 times per week. The Nocturnal Trial tested home nocturnal hemodialysis 6 times per week versus home or in-center hemodialysis 3 times per week. OUTCOMES Cognitive function was measured at baseline, month 4, and month 12. The primary outcome was performance on the Trail-Making Test, Form B, a measure of executive function, and a secondary outcome was performance on the Modified Mini-Mental State Examination, a measure of global cognition. The domains of attention, psychomotor speed, memory, and verbal fluency were assessed in 59 participants in the Daily Trial and 19 participants in the Nocturnal Trial. RESULTS We found no benefit of frequent hemodialysis in either trial for the primary cognitive outcome (Daily Trial: OR for improvement, 0.99; 95% CI, 0.59-1.66; Nocturnal Trial: OR, 1.19; 95% CI, 0.48-2.96). Similarly, there was no benefit of frequent hemodialysis in either trial on global cognition, the secondary cognitive outcome. Exploratory analyses in the Daily Trial suggested possible benefits of frequent hemodialysis for memory and verbal fluency, but not for attention and psychomotor speed. Exploratory analyses in the Nocturnal Trial suggested no benefit of frequent hemodialysis on attention, psychomotor speed, memory, or verbal fluency. LIMITATIONS Unblinded intervention, small sample. CONCLUSIONS Frequent hemodialysis did not improve executive function or global cognition.
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Affiliation(s)
- Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M, Poreh A, Ruzicka E. Czech Version of the Trail Making Test: Normative Data and Clinical Utility. Arch Clin Neuropsychol 2012; 27:906-14. [DOI: 10.1093/arclin/acs084] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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te Beek ET, Moerland M, de Boer P, van Nueten L, de Kam ML, Burggraaf J, Cohen AF, van Gerven JMA. Pharmacokinetics and central nervous system effects of the novel dopamine D2 receptor antagonist JNJ-37822681. J Psychopharmacol 2012; 26:1119-27. [PMID: 21890591 DOI: 10.1177/0269881111415733] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Using the rate of dissociation from the D(2) receptor as a means to screen novel compounds for antipsychotic drug candidates, the centrally acting and fast-dissociating selective dopamine D(2) receptor antagonist JNJ-37822681 was developed. In a blinded, placebo-controlled, randomized first-in-human study, JNJ-37822681 was administered orally to 27 healthy male volunteers at doses of 0.5, 2, 5, 10, 15 and 20 mg. Safety, pharmacokinetics and central nervous system effects were evaluated by measuring prolactin levels, eye movements, adaptive tracking, visual analogue scales, body sway, finger tapping and electroencephalography. JNJ-37822681 was well tolerated and somnolence was the most frequently reported adverse effect. Peak plasma concentrations increased more than proportional to dose, but increases in the area under curve (AUC) were dose-proportional. Prolactin elevations started at doses of 5 mg, whereas small decreases in adaptive tracking were demonstrated at 10 mg doses. At higher doses, JNJ-37822681 caused a small decrease in saccadic peak velocity, smooth pursuit, alertness, finger tapping and electroencephalography activity, and an increase in body sway. This effect profile is likely to be the result of the selectivity of JNJ-37822681 for the D(2) receptor, leading to strong D(2) receptor-mediated elevations in serum prolactin, but fewer effects on more complex central nervous system functions, which are likely to involve multiple neurotransmitters.
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Affiliation(s)
- Erik T te Beek
- Centre for Human Drug Research, Zernikedreef 10, Leiden, The Netherlands.
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Tamayo F, Casals-Coll M, Sánchez-Benavides G, Quintana M, Manero R, Rognoni T, Calvo L, Palomo R, Aranciva F, Peña-Casanova J. Spanish normative studies in a young adult population (NEURONORMA young adults project): Guidelines for the span verbal, span visuo-spatial, Letter-Number Sequencing, Trail Making Test and Symbol Digit Modalities Test. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Estudios normativos españoles en población adulta joven (Proyecto NEURONORMA jóvenes): normas para las pruebas span verbal, span visuoespacial, Letter-Number Sequencing, Trail Making Test y Symbol Digit Modalities Test. Neurologia 2012; 27:319-29. [DOI: 10.1016/j.nrl.2011.12.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/17/2011] [Indexed: 11/21/2022] Open
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Peña-Casanova J, Casals-Coll M, Quintana M, Sánchez-Benavides G, Rognoni T, Calvo L, Palomo R, Aranciva F, Tamayo F, Manero R. Estudios normativos españoles en población adulta joven (Proyecto NEURONORMA jóvenes): métodos y características de la muestra. Neurologia 2012; 27:253-60. [DOI: 10.1016/j.nrl.2011.12.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/07/2011] [Indexed: 11/16/2022] Open
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Peña-Casanova J, Casals-Coll M, Quintana M, Sánchez-Benavides G, Rognoni T, Calvo L, Palomo R, Aranciva F, Tamayo F, Manero R. Spanish normative studies in a young adult population (NEURONORMA young adults project): Methods and characteristics of the sample. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Piper BJ, Li V, Eiwaz MA, Kobel YV, Benice TS, Chu AM, Olsen RHJ, Rice DZ, Gray HM, Mueller ST, Raber J. Executive function on the Psychology Experiment Building Language tests. Behav Res Methods 2012; 44:110-23. [PMID: 21534005 PMCID: PMC3705215 DOI: 10.3758/s13428-011-0096-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The measurement of executive function has a long history in clinical and experimental neuropsychology. The goal of the present report was to determine the profile of behavior across the lifespan on four computerized measures of executive function contained in the recently developed Psychology Experiment Building Language (PEBL) test battery http://pebl.sourceforge.net/ and evaluate whether this pattern is comparable to data previously obtained with the non-PEBL versions of these tests. Participants (N = 1,223; ages, 5-89 years) completed the PEBL Trail Making Test (pTMT), the Wisconsin Card Sort Test (pWCST; Berg, Journal of General Psychology, 39, 15-22, 1948; Grant & Berg, Journal of Experimental Psychology, 38, 404-411, 1948), the Tower of London (pToL), or a time estimation task (Time-Wall). Age-related effects were found over all four tests, especially as age increased from young childhood through adulthood. For several tests and measures (including pToL and pTMT), age-related slowing was found as age increased in adulthood. Together, these findings indicate that the PEBL tests provide valid and versatile new research tools for measuring executive functions.
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Affiliation(s)
- Brian J Piper
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA.
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Şevik AE, Anıl Yağcıoğlu AE, Yağcıoğlu S, Karahan S, Gürses N, Yıldız M. Neuropsychological performance and auditory event related potentials in schizophrenia patients and their siblings: a family study. Schizophr Res 2011; 130:195-202. [PMID: 21592733 DOI: 10.1016/j.schres.2011.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/10/2011] [Accepted: 04/17/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various neuropsychological domains, and P300 auditory event-related potentials (ERP) and mismatch negativity (MMN) exhibit abnormalities in schizophrenia patients and their first-degree relatives. The aims of this study were to compare cognitive and P300/MMN measurements in schizophrenia patients, their siblings, and controls, and to identify the degree of familial influence on each measure. METHODS Thirty patients diagnosed with schizophrenia according to DSM-IV, 20 unaffected siblings and 25 healthy controls were able to complete all neuropsyhological and neurophysiological assessments. All participants were administered SCID-I and the patients were also evaluated regarding symptom severity and functioning. Neuropsychological battery testing results and P300/MMN measurements were obtained for all the participants. RESULTS Both schizophrenia patients and their siblings had lower working memory, as measured by the Auditory Consonant Trigram Test (ACT), and lower MMN amplitude scores than the controls. In addition, the patients had lower attention, verbal memory, executive function, visuomotor speed, and figural memory scores than both the siblings and controls, and lower verbal fluency scores than controls. MMN and P300 amplitudes were lower and P300 latency longer in the schizophrenia patients, as compared to controls. P300 latency was also longer in the schizophrenia patients as compared to siblings and, MMN amplitudes were significantly lower in the siblings compared to controls. Working memory performance measured by ACT significantly predicted inclusion in both the patient and sibling groups and showed significant familial influence. MMN amplitude significantly predicted inclusion only to the patient group and did not show significant familial influence. CONCLUSION The schizophrenia patients exhibited impairment in various cognitive domains and P300/MMN measurements, versus impairment only in working memory and MMN amplitude in their siblings. Working memory seems to have a relatively strong familial influence among all the neuropsychological and neurophysiological parameters evaluated.
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Affiliation(s)
- Ali Emre Şevik
- Başkent University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
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Unruh M, Kurella Tamura M, Larive B, Rastogi A, James S, Schiller B, Gassman J, Chan C, Lockridge R, Kliger A. Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study. Am J Nephrol 2011; 33:398-406. [PMID: 21474924 DOI: 10.1159/000326343] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/22/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients. METHODS Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality. RESULTS The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001). CONCLUSION These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.
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Affiliation(s)
- Mark Unruh
- University of Pittsburgh, Presbyterian Hospital C1111, Pittsburgh, PA 15213, USA.
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44
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Hunt TN, Ferrara MS. Age-related differences in neuropsychological testing among high school athletes. J Athl Train 2010; 44:405-9. [PMID: 19593423 DOI: 10.4085/1062-6050-44.4.405] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Clinicians have questioned the need to obtain annual baseline neuropsychological tests in high school athletes. If no difference among academic grades exists, annual baseline testing may not be necessary. OBJECTIVE To examine differences at baseline testing on pencil-and-paper neuropsychological tests among grade levels in high school athletes. DESIGN Cross-sectional, between-groups design. SETTING Schools participating in a Georgia high school athletics association. PATIENTS OR OTHER PARTICIPANTS High school football players (n = 198) in the 9th through 12th grades, with a mean age of 15.78 +/- 1.16 years. MAIN OUTCOME MEASURE(S) Participants were divided into 4 groups by grade and were administered a symptom checklist and brief neuropsychological test battery. Grade level served as the independent variable. Symptom and individual test scores within the neuropsychological test battery served as dependent variables. RESULTS Differences were noted among grades on the Trail Making Test A (F(3,194) = 3.23, P = .024, eta(2) = 0.048), Trail Making Test B (F(3,194) = 3.93, P = .009, eta(2) = 0.057), Symbol Digit Modalities Test (F(3,194) = 4.38, P = .005, eta(2) = 0.064), dominant tap (F(3,194) = 3.14, P = .026, eta(2) = 0.046), and nondominant tap (F(3,194) = 4.902, P = .003, eta(2) = 0.070). Using the Bonferroni correction (P <or= .00625), we found differences between the 9th grade and 11th and 12th grades. CONCLUSIONS Baseline neuropsychological test scores in high school athletes improved as a function of age, with differences between the 9th grade and 11th and 12th grades. Because the differences were driven by 9th-grade test scores, baseline testing should be completed, at minimum, upon entrance into 9th and 10th grades; however, annual testing is still recommended until additional research is conducted.
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Affiliation(s)
- Tamerah N Hunt
- The Ohio State University Sports Medicine Center, Columbus, OH 43221, USA.
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Greer SE, Brewer KK, Cannici JP, Pennett DL. Level of Performance Accuracy for Core Halstead-Reitan Measures by Pooling Normal Controls from Published Studies: Comparison with Existing Norms in a Clinical Sample. Percept Mot Skills 2010; 111:3-18. [DOI: 10.2466/03.22.27.pms.111.4.3-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Halstead-Reitan Neuropsychological Test Battery offers a multifaceted, empirically supported interpretive framework for neuropsychological assessment founded upon raw scores referenced to a brain-damaged sample. Complementary approaches have used T scores from normal samples often composed of community volunteers or medical patients, augmented by regression. By pooling normal controls of all types from published studies, a sample large enough for stratification of core Halstead-Reitan measures by age and education was obtained (206 studies, N = 17,980). Comparisons based on T scores with two published normative systems in an outpatient sample produced a continuum: liberal norms for medical patients, intermediate pooled values from many types of subjects, and stringent norms for community volunteers. Features recommending clinical application of pooled norms include enhanced accuracy in clinical situations precluding a full battery, few empty cells or inversions for nonelderly subjects, and a screening application based upon a very large Trail Making Test sample (Trails B: n > 14,000).
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Tsushima WT, Lum M, Geling O. Sex differences in the long-term neuropsychological outcome of mild traumatic brain injury. Brain Inj 2010; 23:809-14. [PMID: 19697169 DOI: 10.1080/02699050903200530] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE To investigate possible sex differences in neuropsychological functioning among patients following mild traumatic brain injury (TBI). METHODS AND PROCEDURES Retrospective records analysis of the neuropsychological test results of 102 participants with head injury, including 62 males and 40 females. MAIN OUTCOME AND RESULTS A multivariate analysis of variance indicated that females and males performed similarly on neuropsychological tests, on average, approximately 2 years after minor head trauma. A sex-by-age interaction effect was found on the Category and Trail Making A Tests, with a pattern similar to those obtained in a previous research. CONCLUSIONS Although past research has found that females develop more TBI-related neuropsychological deficits than males in the immediate post-injury period, the present study found that, overall, sex differences in the performance of patients with mild TBI on a variety of neuropsychological tests were insignificant. More investigation into the sex-by-age interaction effect appears warranted.
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Affiliation(s)
- William T Tsushima
- Department of Psychiatry and Psychology, Straub Clinic and Hospital, Honolulu, Hawaii, USA.
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Kurella Tamura M, Larive B, Unruh ML, Stokes JB, Nissenson A, Mehta RL, Chertow GM. Prevalence and correlates of cognitive impairment in hemodialysis patients: the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol 2010; 5:1429-38. [PMID: 20576825 DOI: 10.2215/cjn.01090210] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is common among persons with ESRD, but the underlying mechanisms are unknown. This study evaluated the prevalence of cognitive impairment and association with modifiable ESRD- and dialysis-associated factors in a large group of hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Cross-sectional analyses were conducted on baseline data collected from 383 subjects participating in the Frequent Hemodialysis Network trials. Global cognitive impairment was defined as a score <80 on the Modified Mini-Mental State Exam, and impaired executive function was defined as a score >or=300 seconds on the Trailmaking B test. Five main categories of explanatory variables were examined: urea clearance, nutritional markers, hemodynamic measures, anemia, and central nervous system (CNS)-active medications. RESULTS Subjects had a mean age of 51.6 +/- 13.3 years and a median ESRD vintage of 2.6 years. Sixty-one subjects (16%) had global cognitive impairment, and 110 subjects (29%) had impaired executive function. In addition to several nonmodifiable factors, the use of H1-receptor antagonists and opioids were associated with impaired executive function. No strong association was found between several other potentially modifiable factors associated with ESRD and dialysis therapy, such as urea clearance, proxies of dietary protein intake and other nutritional markers, hemodynamic measures, and anemia with global cognition and executive function after adjustment for case-mix factors. CONCLUSIONS Cognitive impairment, especially impaired executive function, is common among hemodialysis patients, but with the exception of CNS-active medications, is not strongly associated with several ESRD- and dialysis-associated factors.
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Affiliation(s)
- Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California 94304, USA.
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Anderson TM, Knight RG. The long-term effects of traumatic brain injury on the coordinative function of the central executive. J Clin Exp Neuropsychol 2010; 32:1074-82. [DOI: 10.1080/13803391003733560] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tracy M. Anderson
- a School of Psychiatry , University of New South Wales , Sydney, Australia
- b Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital , Sydney, Australia
| | - Robert G. Knight
- c Department of Psychology , University of Otago , Dunedin, New Zealand
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Liem-Moolenaar M, Gray FA, de Visser SJ, Franson KL, Schoemaker RC, Schmitt JAJ, Cohen AF, van Gerven JMA. Psychomotor and cognitive effects of a single oral dose of talnetant (SB223412) in healthy volunteers compared with placebo or haloperidol. J Psychopharmacol 2010; 24:73-82. [PMID: 18755817 DOI: 10.1177/0269881108094524] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central Nervous System (CNS) effects of talnetant, an NK-3 antagonist in development for schizophrenia, were compared to those of haloperidol and placebo. The study was randomised, double-blind, three-way crossover of talnetant 200 mg, haloperidol 3 mg or placebo. Twelve healthy males participated and EEG, saccadic and smooth pursuit eye movements, adaptive tracking, body sway, finger tapping, hormones, visual analogue scales (VAS) for alertness, mood and calmness and psychedelic effects, left/right distraction task, Tower of London and Visual and Verbal Learning Task were assessed. Haloperidol showed (difference to placebo; 95% CI; p-value) decreases in EEG alpha power (-0.87microV; -1.51/-0.22; p = 0.0110), saccadic inaccuracy (2.0%; 0.5/3.6; p = 0.0133), smooth pursuit eye movements (-7.5%; -12.0/-3.0; p = 0.0026), adaptive tracking (-3.5%; -5.4/-1.7; p = 0.0009), alertness (-6.8 mm; -11.1/-2.4; p = 0.0039), negative mood (-4.6 mm; -8.6/-0.6; p = 0.0266), the ability to control thoughts (1.2 mm; 0.2/2.3; p = 0.0214), and an increase of serum prolactin (ratio 4.1; 3.0/5.6; p < 0.0001). Talnetant showed decreased alpha power (-0.69 muV; -1.34/-0.04; p = 0.0390), improved adaptive tracking (1.9%; 0.1/3.7; p = 0.0370) and reduced calmness on VAS Bond and Lader (-4.5 mm; -8.0/-1.0; p = 0.0151). Haloperidol effects were predominantly CNS-depressant, while those of talnetant were slightly stimulatory. The results suggest that talnetant penetrates the brain, but it remains to be established whether this dose is sufficient and whether the observed effect profile is class-specific for NK3-antagonists.
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Pitel AL, Beaunieux H, Lebaron N, Joyeux F, Desgranges B, Eustache F. Two case studies in the application of errorless learning techniques in memory impaired patients with additional executive deficits. Brain Inj 2009; 20:1099-110. [PMID: 17060144 DOI: 10.1080/02699050600909961] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE The purpose of the present study was to examine in what extent errorless learning can be applied to amnesic patients with additional executive dysfunction. RESEARCH DESIGN Two case studies were used in which two patients with severe closed head-injury were compared according to their different neuropsychological profiles. METHODS AND PROCEDURES Patients were taught complex semantic information about their therapists and cognitive procedures needed to programme an electronic organizer. MAIN OUTCOMES AND RESULTS Both semantic and procedural results suggest that the errorless method can be very helpful for teaching complex new knowledge to amnesic patients with mild executive impairment, whereas the presence of a dysexecutive syndrome may hamper the success of this form of memory rehabilitation. CONCLUSIONS The present study puts forward that executive deficits should be taken into account when neuropsychologists are planning to use errorless techniques.
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Affiliation(s)
- Anne Lise Pitel
- Inserm, EPHE, Université de Caen, Basse-Normadie, Unité EO219, 14033, Caen Cedex, and Centre Hospitalier, Service de Rééducation et de Réadaptation Neurologique, Aunay sur Odon, France
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