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Miyawaki CE, McClellan A, Bouldin ED. Feasibility of training family caregivers of people living with dementia online to deliver life review depression intervention at home. Aging Ment Health 2024:1-10. [PMID: 39244654 DOI: 10.1080/13607863.2024.2400597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES To alleviate the high prevalence of depressive symptoms and dementia in older Americans (≥65 years), we developed a depression intervention, Caregiver-Provided Life Review (C-PLR), and taught family caregivers life review skills online compared to a synchronous group virtual training, and examined the feasibility and delivery impact (N = 20 dyads). METHOD In a cross-sectional, mixed-methods dyadic design, we recruited family caregiver-care recipient dyads nationwide, collected the pre- and post-intervention measures on care recipients' depression (primary outcome), life satisfaction, caregivers' burden, caregiving rewards, and dyads' relationship quality (secondary outcomes), and compared them using t-tests. We took fidelity scores to measure caregivers' feasibility of delivering life reviews adhering to the protocol. RESULTS Care recipients' depressive symptoms declined significantly following the C-PLR intervention (p = 0.034) and caregivers' rewards increased from the pre- to post-period (p = 0.019). Caregivers' qualitative interviews supported the quantitative results that online-trained caregivers' ability to deliver the intervention with high adherence to protocol (15.9 ± 0.27 out of 16) without increasing caregiver burden. CONCLUSION This pilot study suggested that the C-PLR could make a positive impact on both caregivers' and care recipients' mental health. This innovative, cost-effective, and easily implemented activity can be used by any dyad regardless of whether they have any health-related deficits.
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Affiliation(s)
| | - Angela McClellan
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Erin D Bouldin
- School of Medicine, University of Utah, Salt Lake City, UT, USA
- Health Systems Research, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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Breslow AS, Lopez M, Warren B, Levin J, Sharma A, Watnick D, Sims G, Cavic E, Bassey O, Fisher MR, Bauman LJ. Lessons Learned from a Community-led, Pilot Teletherapy Group for Older Women Living with Depression and HIV. AIDS Behav 2024:10.1007/s10461-024-04468-y. [PMID: 39222185 DOI: 10.1007/s10461-024-04468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Older women with HIV face challenges to their quality of life, including neurocognitive decline, early-onset menopause, and chronic health issues. Chief among these concerns is depression, the most common psychiatric comorbidity among people living with HIV, with rates twice as high among women as men. However, tailored interventions among older women living with HIV and depression are lacking. Following the ADAPT-ITT framework to adapt existing interventions for cultural relevance among groups of people living with HIV, the study team revised an evidence-based intervention, the 'Stress Management and Relaxation Training/Expressive Supportive Therapy Women's Project (SMART/EST),' for online implementation. Working with two community stakeholders, the study team conducted focus groups, theater testing, and manual adaptation. This resulted in the development of e-SMART/EST, an online teletherapy group co-facilitated by a Licensed Psychologist and a credentialed Peer Counselor. The adapted, eight-session weekly intervention was tested with an exploratory pilot sample of eight older women (55 years and older) with HIV and depression. Participants rated the acceptability, feasibility, and appropriateness of the intervention, as well as symptoms of depression and HIV-related quality of life before and after the group. The e-SMART/EST Women's Project demonstrated high acceptability, feasibility, and appropriateness. Engagement was high, as women attended an average of 6.8 sessions. In qualitative interviews, participants reported peer co-facilitation, culturally relevant themes (e.g., HIV-related minority stress, critical consciousness, grief, and sex and pleasure), mindfulness techniques, and cohesion with other women as main favorable elements of the intervention. Barriers to online implementation included technological issues, distractions due to remote participation, and hindered emotional attunement compared with in-person group therapy. Findings support further research to test similar interventions in full-scale trials with older women living with depression and HIV.
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Affiliation(s)
- Aaron S Breslow
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA.
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA.
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 4A-47, Bronx, NY, 10461, USA.
| | - Michelle Lopez
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Barbara Warren
- LGBT Programs and Policies, Office for Diversity and Inclusion, Mount Sinai Health System, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jules Levin
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
- National AIDS Treatment Advocacy Project, New York, NY, USA
| | - Anjali Sharma
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dana Watnick
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ginette Sims
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Cavic
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Obioesio Bassey
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Marla R Fisher
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Mount Sinai Morningside/West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
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Shim M, Kavanaugh M, Lacson C, Goldstein-Levitas N, Chang H, Zhang F, Palekar N, Gonzalez A, Fisher K. Connected through movement: a feasibility study of online mindfulness-based dance/movement therapy for older adults with age-related cognitive decline during COVID-19. Aging Ment Health 2024:1-10. [PMID: 38910361 DOI: 10.1080/13607863.2024.2364754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/31/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Social isolation and loneliness pose significant public health risks, especially among older adults experiencing age-related cognitive decline (ACD). This mixed methods feasibility study explored the potential of an online mindfulness-based dance/movement therapy (M-DMT) program to alleviate loneliness, enhance psychological well-being, and promote physical activity among older adults experiencing ACD during the COVID-19 pandemic. METHOD Sixteen participants engaged in a 12-week online group M-DMT program. Feasibility was assessed via enrollment and retention rates, attendance, adverse events, credibility/expectancy, participant perceptions, and satisfaction. Qualitative data were collected to capture participants' perspectives on the intervention's usefulness and perceived benefits. The intervention's preliminary impact on loneliness, depression, positive affect, psychological well-being, and physical activity was also examined. RESULTS The study met all feasibility criteria, with 65% reporting post-intervention improvement. Significant reductions in loneliness and depression, along with enhanced positive affect and psychological well-being, were observed. Though physical activity increased, statistical significance was not achieved. Qualitative feedback highlighted improved social connectedness, overall quality of life, body awareness, kinematic strategy, and satisfaction with the program. CONCLUSION Online M-DMT holds promise in addressing well-being and loneliness challenges in older adults experiencing ACD. Further research is necessary to validate and expand upon these promising findings.
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Affiliation(s)
- Minjung Shim
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Melissa Kavanaugh
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Clarissa Lacson
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | | | - Hansoo Chang
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Fenquing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Nikhil Palekar
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Adam Gonzalez
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Kathleen Fisher
- Department of Graduate Nursing, Drexel University, Philadelphia, PA, USA
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Van Bogart K, Harrington EE, Witzel DD, Kang JE, Sliwinski MJ, Engeland CG, Graham-Engeland JE. Momentary loneliness and intrusive thoughts among older adults: the interactive roles of mild cognitive impairment and marital status. Aging Ment Health 2024:1-8. [PMID: 38907581 DOI: 10.1080/13607863.2024.2368643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES Loneliness is associated with maladaptive cognitions, yet little is known about the association between loneliness and intrusive thinking during older adulthood. Links between loneliness and intrusive thoughts may be particularly strong among individuals with mild cognitive impairment (MCI), who may have greater difficulty regulating emotion and intrusive thoughts. In contrast, having close relationships (e.g. being married) may serve as a protective factor as marital status is associated with better overall well-being. METHOD Participants were 316 older adults (recruited from the Bronx, NY, as part of a larger study) without dementia at study intake (40% Black; 13% Hispanic, Mage = 77.45 years, 67% women) who completed ecological momentary assessments five times daily for 14 consecutive days (13,957 EMAs total). Multilevel modeling was used to examine the association between momentary loneliness and intrusive thoughts and whether MCI and marital status interacted to moderate this association. RESULTS There was a significant three-way interaction (β = -0.17, p < 0.05), such that lagged momentary loneliness was positively associated with intrusive thoughts (3-4 h later) for those with MCI who were not married. CONCLUSION Findings suggest that among older adults with MCI, being married may be a protective factor and being unmarried may be a risk factor for experiencing loneliness and subsequent intrusive thoughts.
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Affiliation(s)
- Karina Van Bogart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | | | - Dakota D Witzel
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Jee Eun Kang
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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De Sanctis P, Mahoney JR, Wagner J, Blumen HM, Mowrey W, Ayers E, Schneider C, Orellana N, Molholm S, Verghese J. Linking Dementia Pathology and Alteration in Brain Activation to Complex Daily Functional Decline During the Preclinical Dementia Stages: Protocol for a Prospective Observational Cohort Study. JMIR Res Protoc 2024; 13:e56726. [PMID: 38842914 PMCID: PMC11190628 DOI: 10.2196/56726] [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: 01/30/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Progressive difficulty in performing everyday functional activities is a key diagnostic feature of dementia syndromes. However, not much is known about the neural signature of functional decline, particularly during the very early stages of dementia. Early intervention before overt impairment is observed offers the best hope of reducing the burdens of Alzheimer disease (AD) and other dementias. However, to justify early intervention, those at risk need to be detected earlier and more accurately. The decline in complex daily function (CdF) such as managing medications has been reported to precede impairment in basic activities of daily living (eg, eating and dressing). OBJECTIVE Our goal is to establish the neural signature of decline in CdF during the preclinical dementia period. METHODS Gait is central to many CdF and community-based activities. Hence, to elucidate the neural signature of CdF, we validated a novel electroencephalographic approach to measuring gait-related brain activation while participants perform complex gait-based functional tasks. We hypothesize that dementia-related pathology during the preclinical period activates a unique gait-related electroencephalographic (grEEG) pattern that predicts a subsequent decline in CdF. RESULTS We provide preliminary findings showing that older adults reporting CdF limitations can be characterized by a unique gait-related neural signature: weaker sensorimotor and stronger motor control activation. This subsample also had smaller brain volume and white matter hyperintensities in regions affected early by dementia and engaged in less physical exercise. We propose a prospective observational cohort study in cognitively unimpaired older adults with and without subclinical AD (plasma amyloid-β) and vascular (white matter hyperintensities) pathologies. We aim to (1) establish the unique grEEG activation as the neural signature and predictor of decline in CdF during the preclinical dementia period; (2) determine associations between dementia-related pathologies and incidence of the neural signature of CdF; and (3) establish associations between a dementia risk factor, physical inactivity, and the neural signature of CdF. CONCLUSIONS By establishing the clinical relevance and biological basis of the neural signature of CdF decline, we aim to improve prediction during the preclinical stages of ADs and other dementias. Our approach has important research and translational implications because grEEG protocols are relatively inexpensive and portable, and predicting CdF decline may have real-world benefits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56726.
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Affiliation(s)
- Pierfilippo De Sanctis
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jeannette R Mahoney
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Johanna Wagner
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emmeline Ayers
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudia Schneider
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Natasha Orellana
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Sophie Molholm
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joe Verghese
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
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Portela Hara AC, Aching NC, Marques LM, Barbosa SP, Souza DR, Fregni F, Battistella LR, Simis M. The role of clinical and demographic predictors for understanding the cognitive impairment in Spinal Cord Injury (SCI) patients. Spinal Cord 2024; 62:336-342. [PMID: 38609569 DOI: 10.1038/s41393-024-00986-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
STUDY DESIGN Using a cross-sectional design, we extracted sociodemographic and clinical data from 488 Spinal Cord Injury (SCI) patients during their initial assessment before receiving intensive rehabilitation treatment. OBJECTIVES The primary objectives of this study were to ascertain the prevalence of cognitive impairment in the study sample and specify the key clinical and demographic predictors of cognitive functioning in SCI patients. SETTING Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil. METHODS We utilized independent univariate and multivariate regression models with the Montreal Cognitive Assessment (MoCA) scale, adapted for individuals with visual impairment. Moreover, we consider scores from the execution tasks (visuospatial/executive) as the dependent variable. RESULTS Our findings demonstrate that approximately 80% of the evaluated study sample exhibited cognitive impairment. Through the multivariate regression models, we show that several factors, including age, education, depression levels, and the use of analgesics and/or opioids, are significant predictors of total cognitive scores. These factors are independent of the clinical features associated with SCI, such as age, sex, education, and time since the injury. CONCLUSIONS The results indicate a high prevalence of significant cognitive impairment within the sample, with age, education, depression levels, and the use of analgesics and/or opioids emerging as the primary predictors of total cognitive scores, independent of the clinical features correlated to SCI. These findings hold significant implications for both clinical research and practice, offering valuable guidance for comprehensive management throughout hospitalization and rehabilitation.
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Affiliation(s)
- Ana Clara Portela Hara
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nicole C Aching
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas M Marques
- Mental Health Department, Santa Casa of Sao Paulo Medical Science School, São Paulo, SP, Brazil
| | - Sara P Barbosa
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniel R Souza
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Linamara R Battistella
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcel Simis
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Stein AL, Tolle KA, Stover AN, Shidler MD, Krikorian R. Detecting mild cognitive impairment remotely with the modified memory impairment screen by telephone. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:404-416. [PMID: 36951391 DOI: 10.1080/13825585.2023.2189688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
The original Memory Impairment Screen by Telephone (MIST) was designed to identify individuals with dementia but was relatively ineffective for identification of less severe impairment observed in mild cognitive impairment (MCI). We expanded the original MIST to create a modified instrument (mMIST) with greater sensitivity to less severe memory impairment. Older men and women with subjective cognitive decline were assessed by phone with the mMIST and subsequently classified independently with MCI or non-pathological cognitive decline. Participants with MCI produced lower scores on the mMIST than did participants without MCI, 10.8 ± 2.7 vs 13.3 ± 1.3, t = 5.68, p < 0.001, and performance on the mMIST predicted performances on the California Verbal Learning Test (CVLT), Verbal Paired Associate Learning Test (VPAL), Montreal Cognitive Assessment (MoCA) total score, and MoCA memory index score, p < 0.001. Receiver operating characteristic (ROC) analyses identified the optimal cut score on the mMIST to distinguish participants with and without MCI with Sensitivity = 73.1%, Specificity = 79.1%, and AUC = 0.79. Predictive values for distinguishing the amnestic form of MCI (aMCI) from non-amnestic MCI were Sensitivity = 81.8%, Specificity = 30%, and AUC = 0.82. These findings indicate that the mMIST is a valid screening instrument for identifying MCI. It can be administered remotely at low cost and low participant burden. Also, the mMIST has potential utility for remote cross-sectional and longitudinal evaluation in research and clinical contexts. Further investigation is indicated to corroborate its utility for assessment of aging patients and research participants.
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Affiliation(s)
- Amanda L Stein
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
| | - Kathryn A Tolle
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
- Neurobehavioral Consultants LLC, Indianapolis, IN, US Current affiliation
| | - Amanda N Stover
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
- Department of Public Health Sciences, Clemson University, Clemson, SC, US Current affiliation
| | - Marcelle D Shidler
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
| | - Robert Krikorian
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
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Lakshminarayanan S, Aboobacker M, Brar A, Manoj MP, Elsaid Ismail Elnimer MM, Marepalli A, Shukla KJ, Yousaf MS, Taqveem A, Hassan MJ. Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies. Cureus 2024; 16:e59436. [PMID: 38826940 PMCID: PMC11140540 DOI: 10.7759/cureus.59436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Perioperative neurocognitive disorders (PNDs) affect a large percentage of people who undergo surgeries that need general anesthesia. There is an increased risk of death and a major disruption to postoperative self-care as a result of this. This study compiles all the relevant materials that the authors have found to investigate postnatal depression and its causes, as well as the methods used to determine the probability and severity of PNDs and how to reduce their risk before surgery. Postnatal depression can have many causes, and this text explores some of them. These include a history of alcohol or opiate use, immunological dysregulation, advanced age, educational background, infections, neurocognitive impairment, and pre-existing chronic inflammatory disorders. It also delves into various methods used to gauge the likelihood and severity of postpartum depression. The following assessment tools were covered: the Clock Drawing Test, Domain-Specific Tests, the Mini-Mental State Examination, and the Montreal Cognitive Assessment. In addition to biochemical markers, neuroimaging techniques play an important role in diagnosis. The Frailty Fried assessment, which measures inertia, sluggishness, lack of physical activity, fatigue, and unintentional weight loss, is a key prognostic sign that is highlighted. There is strong evidence that the index, which is derived from these five characteristics, may accurately predict the likelihood of PNDs. Risk mitigation strategies are also covered in this research. Preoperative brain plasticity-based therapies, such as physical exercise and intensive cognitive training, can significantly reduce the incidence and severity of postoperative neurocognitive disorders. A peripheral nerve block, monitoring cerebral oxygen saturation, dexmedetomidine, and a reduction in anesthesia depth are all ways to improve anesthetic procedures. Methods that lower blood pressure should be avoided, the body temperature should be kept down during surgery, or the time without liquids should be lengthened; all of these raise the risk of postoperative nausea and vomiting and make it worse. Potential approaches include a Mediterranean diet, physical activity, cognitive stimulation, smoking cessation, alcohol reduction, avoidance of anticholinergic medications, and non-steroidal anti-inflammatory drug stewardship, although there is no definitive evidence for successful postoperative neurocognitive rehabilitation procedures. More standardized diagnostic criteria, evaluation methods, and PND classification are urgently needed, according to this study. Different cases of PNDs are characterized by different combinations of tests, cutoff values, and methods because there is a broad variety of diagnostic tests used to make the diagnosis. Until now, PNDs and pre-existing neurocognitive disorders have been diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). With an aging population comes an increase in the occurrence and prevalence of PNDs, which calls for a specific way to classify and describe the condition.
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Affiliation(s)
| | - Mohazin Aboobacker
- Neurosurgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | - Anureet Brar
- Neurology, Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar, IND
| | | | | | | | - Krutarth Jay Shukla
- Medicine, Gujarat Cancer Society Medical College Hospital and Research Centre, Ahmedabad, IND
| | | | - Ahsen Taqveem
- Microbiology, Government College University Faisalabad, Faisalabad, PAK
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Mart MF, Semler MW, Jenkins CA, Wang G, Casey JD, Ely EW, Jackson JC, Kiehl AL, Bryant PT, Pugh SK, Wang L, DeMasi S, Rice TW, Bernard GR, Freundlich RE, Self WH, Han JH. Oxygen-Saturation Targets and Cognitive and Functional Outcomes in Mechanically Ventilated Adults. Am J Respir Crit Care Med 2024; 209:861-870. [PMID: 38285550 PMCID: PMC10995564 DOI: 10.1164/rccm.202310-1826oc] [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: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Among mechanically ventilated critically ill adults, the PILOT (Pragmatic Investigation of Optimal Oxygen Targets) trial demonstrated no difference in ventilator-free days among lower, intermediate, and higher oxygen-saturation targets. The effects on long-term cognition and related outcomes are unknown.Objectives: To compare the effects of lower (90% [range, 88-92%]), intermediate (94% [range, 92-96%]), and higher (98% [range, 96-100%]) oxygen-saturation targets on long-term outcomes.Methods: Twelve months after enrollment in the PILOT trial, blinded neuropsychological raters conducted assessments of cognition, disability, employment status, and quality of life. The primary outcome was global cognition as measured using the Telephone Montreal Cognitive Assessment. In a subset of patients, an expanded neuropsychological battery measured executive function, attention, immediate and delayed memory, verbal fluency, and abstraction.Measurements and Main Results: A total of 501 patients completed follow-up, including 142 in the lower, 186 in the intermediate, and 173 in the higher oxygen target groups. Median (interquartile range) peripheral oxygen saturation values in the lower, intermediate, and higher target groups were 94% (91-96%), 95% (93-97%), and 97% (95-99%), respectively. Telephone Montreal Cognitive Assessment score did not differ between lower and intermediate (adjusted odds ratio [OR], 1.36 [95% confidence interval (CI), 0.92-2.00]), intermediate and higher (adjusted OR, 0.90 [95% CI, 0.62-1.29]), or higher and lower (adjusted OR, 1.22 [95% CI, 0.83-1.79]) target groups. There was also no difference in individual cognitive domains, disability, employment, or quality of life.Conclusions: Among mechanically ventilated critically ill adults who completed follow-up at 12 months, oxygen-saturation targets were not associated with cognition or related outcomes.
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Affiliation(s)
- Matthew F. Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
| | | | | | | | | | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
| | - James C. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
| | - Amy L. Kiehl
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship
| | - Patsy T. Bryant
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship
| | | | | | | | - Todd W. Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine
| | | | | | - Wesley H. Self
- Department of Emergency Medicine
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Jin H. Han
- Critical Illness, Brain Dysfunction, and Survivorship
- Department of Emergency Medicine
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
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Lord AR, Amitrano NR, González DA. Reliability and validity of the Montreal Cognitive Assessment's auditory items (MoCA-22). Clin Neuropsychol 2024; 38:783-798. [PMID: 37743611 DOI: 10.1080/13854046.2023.2261634] [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: 04/25/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
Objective: To evaluate the latent structure, internal consistency, convergent and discriminant validity, diagnostic accuracy, and criterion validity of the Montreal Cognitive Assessment's auditory items (MoCA-22), which has previously been evaluated in small samples if at all. Methods: 11,284 participants completed the MoCA over 1-2 visits to an Alzheimer Disease Research Center (Mage = 69.2, Meducation = 15.9, 57.6% women, 92.4% non-Hispanic white). MoCA-22 items were probed with alpha, omega, confirmatory factor analysis, and test-retest correlations. Scores were related to measures of neurocognition, daily functioning, behavioral-psychological symptoms (BPS), and vision performance for convergent-discriminant and criterion validity. Dementia stage was used to calculate area under the receiver operating characteristic (AUC-ROC) curves and cutoffs for mild cognitive impairment (MCI) and dementia. Results: A single-factor had good fit (CFI = .961; TLI = .945; RMSEA = .061; SRMR = .031), with good internal consistency (Omega total = .83) and test-retest consistency (ICC = .92 at 2.7 years). The strongest convergent correlations were with general cognition and executive functioning, while discriminant validity was demonstrated with its weakest and negative correlations being with BPS. There was strong classification accuracy in distinguishing MCI from normal cognition (AUC = .79; optimal cutoff point < 18), and mild-to-moderate dementia from MCI (AUC = .85; optimal cutoff point < 13). Furthermore, the MoCA-22 had negligible-to-small differences among those with and without vision limitations. Conclusions: These findings add to the evidence of the MoCA-22's utility and it serves as a useful cognitive screening tool with sound reliability and validity.
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Affiliation(s)
- Alinda Rafaela Lord
- Department of Psychology, Adler University, Chicago, IL, USA
- Parkinson's Disease and Movement Disorders Care Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Nicholas R Amitrano
- Parkinson's Disease and Movement Disorders Care Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Department of Psychology, Wheaton College, Wheaton, IL, USA
| | - David Andrés González
- Parkinson's Disease and Movement Disorders Care Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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11
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Droś J, Segiet N, Początek G, Klimkowicz-Mrowiec A. Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study - Part of the PROPOLIS Study). Neurol Sci 2024; 45:1109-1119. [PMID: 37851292 PMCID: PMC10858086 DOI: 10.1007/s10072-023-07129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION With increasing life expectancy and the rising incidence of stroke in young adults, it is important to know the long-term prognosis of this condition. Post-stroke delirium and post-stroke dementia are common complications of stroke that negatively affect prognosis. The purpose of this study was to evaluate five-year mortality from stroke and to assess the influence of post-stroke delirium and post-stroke dementia on mortality and disability over the five-year period. METHODS Consecutive patients admitted to the stroke unit for acute stroke or transient ischemic attacks were screened for in-hospital delirium. At the three- and twelve-month follow-up, the same patients underwent neurocognitive testing. Diagnoses of in-hospital delirium and dementia after three and twelve months based on DSM-5 criteria. Five years after stroke surviving patients were reevaluated. Outcome assessment included place of stay, current functional status assessed by the modified Rankin Scale (mRS), or death. RESULTS At the five-years of follow-up, data were collected from 575 of 750 patients originally included in the study (76.67%). The mortality rate was 51.65%. In-hospital post-stroke delirium and post-stroke dementia diagnosed three and twelve months after stroke were independent risk factors for death and an increase in mRS score of ≥ 1 or ≥ 2 points. There was no significant association with institutionalization rate. CONCLUSIONS More than half of post-stroke patients die within five years of follow-up. Post-stroke delirium and post-stroke dementia are associated with an increased risk of death and disability.
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Affiliation(s)
- Jakub Droś
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Natalia Segiet
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriela Początek
- The Doctoral School of the Medical University of Silesia, Katowice, Poland
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
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12
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Mora AM, Kogut K, Sandhu NK, Ridgway D, Patty CM, Renteria M, Morga N, Rodriguez MT, Romero M, Valdovinos JM, Torres-Nguyen A, Guzman O, Martinez M, Doty RL, Padilla A, Flores E, Brown PM, Eskenazi B. SARS-CoV-2 infection and long COVID among California farmworkers. J Rural Health 2024; 40:292-302. [PMID: 37715721 DOI: 10.1111/jrh.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The purpose of this cross-sectional study was to determine the prevalence of long COVID and identify its clinical manifestations among farmworkers in California. METHODS We collected data on sociodemographic characteristics, anthropometrics, clinical chemistries and anti-SARS-CoV-2 immunoglobulin G antibodies, self-reported SARS-CoV-2 infection history, and standardized health tests and scales from 297 farmworkers in California between February and July 2022. RESULTS Most participants were born in Mexico or Central America, had less than a high school diploma, and were overweight or obese. The prevalence of long COVID (defined as self-reported SARS-CoV-2 infection with symptoms >28 days) among farmworkers with a suspected or test-confirmed infection was 61.8%. Participants with long COVID had higher mean [95% CI] body mass index (32.9 [31.6-34.1]) and high-sensitivity C-reactive protein levels (4.8 [3.7, 6.0]) than those with no COVID-19 history (30.5 [29.3-31.7], and 3.3 [2.2, 4.3], respectively). Farmworkers with long COVID also reported greater fatigue, dyspnea, taste and smell problems, and overall poorer mental and physical health, than those with no COVID-19 history. Farmworkers with long COVID had increased odds of functional limitations compared to those with a self-reported SARS-CoV-2 infection with symptoms ≤28 days (OR [95% CI]: 7.46 [3.26, 17.09]). CONCLUSIONS A significant proportion of farmworkers experience long COVID with persistent symptoms that limit their ability to perform their work. A comprehensive approach that addresses the unique needs and challenges of farmworkers is warranted given this population's high prevalence of long COVID and the essential nature of their work.
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Affiliation(s)
- Ana M Mora
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Katherine Kogut
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Nimrat K Sandhu
- Department of Public Health, University of California, Merced, California, USA
| | - Derry Ridgway
- Health Sciences Research Institute, University of California, Merced, California, USA
| | - Chris M Patty
- Kaweah Health Medical Center, Visalia, California, USA
| | - Melissa Renteria
- Department of Public Health, University of California, Merced, California, USA
| | - Norma Morga
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Maria T Rodriguez
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Monica Romero
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Jose M Valdovinos
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | | | - Omar Guzman
- Kaweah Health Medical Center, Visalia, California, USA
| | | | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ana Padilla
- Community and Labor Center, University of California, Merced, California, USA
| | - Edward Flores
- Community and Labor Center, University of California, Merced, California, USA
| | - Paul M Brown
- Department of Public Health, University of California, Merced, California, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
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13
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Tsushima WT, Abe JR, Siu AM. The Memory Assessment Scale: A Population-based Cognitive Impairment Screening Instrument. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:75-80. [PMID: 38456160 PMCID: PMC10915864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This study re-examined the Memory Assessment Scale (MAS), a brief memory test developed in Hawai'i in 1987, to assess whether it remains a valid and reliable cognitive impairment screening tool in Hawai'i. Patients suspected of having neurocognitive dysfunction were divided into 2 groups (those with and without mild cognitive impairment) based on their results on a battery of neuropsychological tests. No differences in MAS scores were found between patients with and without mild cognitive impairment. Further research with the MAS comparing patients with mild cognitive disorder to healthy controls is indicated to further examine the efficacy of this population-based test.
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Affiliation(s)
| | - Justin R. Abe
- University of Southern California, Los Angeles, CA (JRA)
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14
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Kattlun F, Hertel E, Geis C, Scherag A, Wickel J, Finke K. Persistent neurocognitive deficits in cognitively impaired survivors of sepsis are explained by reductions in working memory capacity. Front Psychol 2024; 15:1321145. [PMID: 38449763 PMCID: PMC10915060 DOI: 10.3389/fpsyg.2024.1321145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mounting evidence suggests that many cognitively impaired sepsis survivors show long-term neurocognitive deficits in neuropsychological tasks. To date, the underlying mechanisms of these deficits are insufficiently understood. Based on previous evaluations we hypothesized that visual attention and working memory may be affected in a sample of cognitively impaired sepsis survivors. Methods We utilized psychophysical whole-and partial-report paradigms based on the computational theory of visual attention (TVA) to determine (i) whether sepsis survivors show changes in basic parameters of visual attention and working memory, (ii) whether the affected parameters are related to neuropsychological test results in a standard battery in sepsis survivors and matched healthy control participants, (iii) whether between-group differences in these basic parameters of visual attention could account for underperformance of sepsis survivors in neuropsychological tests when adjusting for potentially relevant clinical variables. Results We showed that, in sepsis survivors, the maximum number of elements consciously maintained in an instant, i.e. the working memory storage capacity K, is reduced (sepsis survivors: M = 3.0; healthy controls: M = 3.4). Moreover, K explained variance in neurocognitive outcomes -17% in attentional and 16 % in executive functions - in a standard neuropsychological battery. The association remained stable when adjusting for clinical variables. Discussion Thus, in our sample of cognitively impaired sepsis survivors, a reduction in working memory capacity seems to be a critical determinant of the neurocognitive sequelae. It should be the subject of future work on mechanisms but may also serve as surrogate outcome measure in interventional studies.
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Affiliation(s)
- Fabian Kattlun
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Elizabeth Hertel
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Christian Geis
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - André Scherag
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Jonathan Wickel
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
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15
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Lentoor AG, Motsamai TB. Neurocognitive Dysfunction and predictors in non-CNS cancer patients: Rationale and methods for the neuro-oncology research at a South African academic hospital. Heliyon 2024; 10:e23007. [PMID: 38148796 PMCID: PMC10750072 DOI: 10.1016/j.heliyon.2023.e23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/28/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Background The focus on central nervous system (CNS) malignancies has overshadowed scant but substantial research that suggests non-central nervous cancer patients experience cancer-related cognitive impairment (CRCI), which affects higher-order brain function and influences their quality of life. Despite such evidence of the occurrence of CRCI among non-CNS cancer patients, the factors associated with the CRCIs remain a highly debated issue with discrepancies noted. Whether non-CNS cancer itself can affect the brain independent of cancer treatment is an important question to unpack. This necessitates further research, particularly in the sub-Saharan region where the evidence is limited. Methods This study aims to assess the effect of chemotherapy-associated cognitive and affective changes in non-CNS cancer patients. A non-experimental, time-series, correlational design will be used, in which a battery of computerized neuropsychological tests will be administered, including the e-MoCA, the CNS Vital Signs, the Patient Health Questionnaire-4, the Center for Epidemiologic Studies Depression Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment of Cancer Therapy-Fatigue, and the Semi-structured Interview Schedule. Descriptive and inferential statistical analysis will be conducted, as well as NVivo thematic analysis of the qualitative data. The scope of the neurocognitive issues and risk factors that may be present in cancer patients and survivors in a developing environment could be determined by this study. Implications The study is expected to extend research on the extent at which cancer and cancer treatments are associated with neurocognitive changes among non-CNS cancer patients and their impact on their quality of life in the local context. The results are expected to inform treatment providers to develop treatment guidelines tailored for individuals diagnosed with cancer and who have received cancer treatment, as well as individualized psychosocial interventions aimed at addressing psychological challenges associated with quality of life among cancer survivors.
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Affiliation(s)
- Antonio G. Lentoor
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa, Pretoria, South Africa
| | - Tiro Bright Motsamai
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa, Pretoria, South Africa
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Souza BRA, Nóbrega KCC, Silva BEDAD, Gonçalves RA, Martins TS, Santos GF, Frazão AH, Roque AC, Nascimento IAPDS, Piemonte MEP. The Impact of Motor, Non-Motor, and Social Aspects on the Sexual Health of Men Living with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:565-574. [PMID: 38427499 DOI: 10.3233/jpd-230212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Sexual health (SH) is influenced by several biological, mental, and social factors that may be negatively impacted by Parkinson's disease (PD). Despite its prevalence and relevance for quality of life, the factors that affect SH in men with PD (MwPD) are still poorly understood. Objectives To investigate the impact of motor, non-motor, and social aspects on the SH in MwPD. Methods We conducted a cross-sectional study of 80 men (mean-age 53.55±10.8) in stages 1-3 of Hoehn and Yahr classification (H&Y), who reported having an active sex life in the last six months. The following data were collected for each person: 1) Demographic and clinical features; 2) global cognitive capacity (T-MoCA); 3) Non-Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part I); 4) Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part II); 5) Fatigue (FSS); 6) Self-esteem (RSES); 7) Sleep disorder (PDSS); 8) Couple relationship quality (DAS); 9) Depressive signals (BDI); 10) Short-term sexual health by International Index of Erectile Function (IIFE); and 11) Long-term sexual health by Sexual Quotient-Male (SQ-M). Results Our results showed that although several motor, non-motor, and social factors were correlated with SH, only motor disability levels in daily living predicted short-term SH and erectile dysfunction, while only depression predicted long-term SH in MwPD. Age, disease onset, and medication daily dosage were not correlated with SH. Conclusions Our findings confirm that multidimensional factors can affect the SH of MwPD and emphasize that only a multi-professional team can offer proper care to improve SH in MwPD.
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Affiliation(s)
| | - Kátia Cirilo Costa Nóbrega
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Thalyta Silva Martins
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | - Geovanna Ferreira Santos
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | - André Helene Frazão
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Elisa Pimentel Piemonte
- Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo, Brazil
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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Shah-Zamora D, Anderson S, Barton B, Fleisher JE. Virtual Group Music Therapy for Apathy in Parkinson's Disease: A Pilot Study. J Geriatr Psychiatry Neurol 2024; 37:49-60. [PMID: 37201184 DOI: 10.1177/08919887231176755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the effect of virtual group music therapy on apathy in people with Parkinson's disease (PD). INTRODUCTION Apathy affects 40% of people with PD, lacks effective therapies, and independently predicts poorer quality of life and greater caregiver burden. Music therapy is the clinical application of music to address a person's physical or emotional needs and is effective in treating apathy in dementia. METHODS People with idiopathic PD and apathy (Movement Disorders Society-Unified Parkinson's Disease Rating Scale, apathy item ≥ 2) and their caregivers participated in twelve, weekly virtual group music therapy sessions, with session attendance signifying adherence. Participants completed pre- and post-intervention assessments of apathy (Apathy Scale (AS)), quality of life (Parkinson's Disease Questionnaire-short form), functional ability (Schwab & England Activities of Daily Living Scale), depression (Beck Depression Inventory (BDI-II)), and cognition (Montreal Cognitive Assessment-Blind). Among secondary outcomes, we assessed caregiver burden (Zarit Burden Interview-short form) and strain (Multidimensional Caregiver Strain Index). RESULTS Sixteen PD participants (93.8% men, mean age 68.3 ± 8.4 years, median 6 years PD duration) and their caregivers (93.8% women, mean age 62.6 ± 11 years) completed the study. All PD participants and 88% of caregivers were >70% adherent to the intervention. Apathy (AS, effect size = 0.767, P = 0.002) and depression (BDI-II, effect size = 0.542, P = 0.03) improved, with no change in caregiver measures. CONCLUSION Group music therapy is an effective treatment for apathy in PD and may improve mood. The virtual format is a feasible alternative to in-person sessions with high adherence and satisfaction.
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Affiliation(s)
- Deepal Shah-Zamora
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Rush University Medical Center, Chicago, IL, USA
| | | | - Brandon Barton
- Rush University Medical Center, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
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Morgenstern LB, Briceño EM, Mehdipanah R, Chang W, Lewandowski-Romps L, Gonzales XF, Levine DA, Langa KM, Garcia N, Khan N, Zahuranec DB, Heeringa SG. A Community-Based Study of Dementia in Mexican American and Non-Hispanic White Individuals. J Alzheimers Dis 2024; 97:649-658. [PMID: 38143352 PMCID: PMC10866536 DOI: 10.3233/jad-230729] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Little information is available on the prevalence of cognitive impairment in Mexican American persons. OBJECTIVE To determine the prevalence of mild cognitive impairment (MCI) and dementia in those 65 years and older among Mexican American and non-Hispanic white individuals in a community. METHODS This was a population-based cohort study in Nueces County, Texas, USA. Participants were recruited using a random housing sample. The Harmonized Cognitive Assessment (HCAP) participant and informant protocol was performed after Montreal Cognitive Assessment (MoCA) screening. An algorithm was used to sort participants into diagnostic categories: no cognitive impairment, MCI, or dementia. Logistic regression determined the association of ethnicity with MCI and dementia controlling for age, gender, and education. RESULTS 1,901 participants completed the MoCA and 547 the HCAP. Mexican Americans were younger and had less educational attainment than non-Hispanic whites. Overall, dementia prevalence was 11.6% (95% CI 9.2-14.0) and MCI prevalence was 21.2% (95% CI 17.5-24.8). After adjusting for age, gender, and education level, there was no significant ethnic difference in the odds of dementia or MCI. Those with ≤11 compared with ≥16 years of education had much higher dementia [OR = 4.9 (95% CI 2.2-11.1)] and MCI risk [OR = 3.5 (95% CI 1.6-7.5)]. CONCLUSIONS Dementia and MCI prevalence were high in both Mexican American and non-Hispanic white populations. Mexican American persons had double the odds of mild cognitive impairment and this was attenuated when age and educational attainment were considered. Educational attainment was a potent predictor of cognitive impairment.
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Affiliation(s)
- Lewis B. Morgenstern
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI 48109
| | - Roshanak Mehdipanah
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI 48109
| | - Wen Chang
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
| | | | - Xavier F. Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences, Corpus Christi, TX 78412
| | - Deborah A. Levine
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI 48109
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI 48109
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI 48105
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Noreen Khan
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Darin B. Zahuranec
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Steven G. Heeringa
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
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Wichmann S, Lange T, Perner A, Gluud C, Itenov TS, Berthelsen RE, Nebrich L, Wiis J, Brøchner AC, Nielsen LG, Behzadi MT, Damgaard K, Andreasen AS, Strand K, Järvisalo M, Strøm T, Eschen CT, Vang ML, Hildebrandt T, Andersen FH, Sigurdsson MI, Thomar KM, Thygesen SK, Troelsen TT, Uusalo P, Jalkanen V, Illum D, Sølling C, Keus F, Pfortmueller CA, Wahlin RR, Ostermann M, Aneman A, Bestle MH. Furosemide versus placebo for fluid overload in intensive care patients-The randomised GODIF trial second version: Statistical analysis plan. Acta Anaesthesiol Scand 2024; 68:130-136. [PMID: 37691474 DOI: 10.1111/aas.14320] [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: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Fluid overload is associated with increased mortality in intensive care unit (ICU) patients. The GODIF trial aims to assess the benefits and harms of fluid removal with furosemide versus placebo in stable adult patients with moderate to severe fluid overload in the ICU. This article describes the detailed statistical analysis plan for the primary results of the second version of the GODIF trial. METHODS The GODIF trial is an international, multi-centre, randomised, stratified, blinded, parallel-group, pragmatic clinical trial, allocating 1000 adult ICU patients with moderate to severe fluid overload 1:1 to furosemide versus placebo. The primary outcome is days alive and out of hospital within 90 days post-randomisation. With a power of 90% and an alpha level of 5%, we may reject or detect an improvement of 8%. The primary analyses of all outcomes will be performed in the intention-to-treat population. For the primary outcome, the Kryger Jensen and Lange method will be used to compare the two treatment groups adjusted for stratification variables supplemented with sensitivity analyses in the per-protocol population and with further adjustments for prognostic variables. Secondary outcomes will be analysed with multiple linear regressions, logistic regressions or the Kryger Jensen and Lange method as suitable with adjustment for stratification variables. CONCLUSION The GODIF trial data will increase the certainty about the effects of fluid removal using furosemide in adult ICU patients with fluid overload. TRIAL REGISTRATIONS EudraCT identifier: 2019-004292-40 and ClinicalTrials.org: NCT04180397.
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Affiliation(s)
- Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- The Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Theis S Itenov
- Department of Anaesthesia, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Rasmus E Berthelsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Jørgen Wiis
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, University Hospital of Southern Denmark, Kolding, Denmark
| | - Louise G Nielsen
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | - Meike T Behzadi
- Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Kjeld Damgaard
- Department of Anaesthesia and Intensive Care, Regionshospital Nordjylland, Hjoerring, Denmark
| | - Anne S Andreasen
- Department of Intensive Care, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Mikko Järvisalo
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hameenlinna, Finland
| | - Thomas Strøm
- Department of Anaesthesia and Intensive Care, Sygehus Soenderjylland, Aabenraa, Denmark
| | - Camilla T Eschen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Gentofte Hospital, Gentofte, Denmark
| | - Marianne L Vang
- Department of Intensive Care, Regionshospitalet Randers, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Finn H Andersen
- Department of Intensive Care, Aalesund Hospital, Moere and Romsdal Health Trust, Aalesund, Norway
- Faculty of Medicine and Health Science, Department of Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Martin I Sigurdsson
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Katrin M Thomar
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
| | - Sandra K Thygesen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Thomas T Troelsen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Panu Uusalo
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Dorte Illum
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Rebecka R Wahlin
- Department of Anaesthesia and Intensive Care, Sodersjukhuset AB, Stockholm, Sweden
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St. Thomas' Hospital, London, UK
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Baron DH, Coulthard E, David C, Sinclair LI. The risk of developing dementia in the COVID-19 pandemic; a cohort study. Int J Geriatr Psychiatry 2024; 39:e6041. [PMID: 38217550 PMCID: PMC10952166 DOI: 10.1002/gps.6041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The effects of the COVID-19 pandemic on cognitive decline are not fully understood. Higher social activity and relationships have been associated with decreased risk of dementia. We hypothesised that risk of transition to dementia would increase after the start of the first national lockdown. METHODS We obtained data from the Brains for Dementia (BDR) cohort, which has collected roughly annual data on 3726 older adults with and without dementia since 2008. Data continued to be collected during the lockdowns, although by telephone and/or video call instead of in person. Individuals diagnosed with dementia at study entry were excluded from this study as were individuals with only one visit. Cognitive status was classified using the Clinical Dementia Rating (CDR) global score. Poisson regression with cubic splines to account for differences in age was used to compare the incidence of dementia before and after March 1st 2020. RESULTS Out of 2242 individuals, 208 individuals developed dementia before and 50 developed dementia after 01/03/20. The incidence rate ratio of developing dementia after 01/03/20 was 0.847 (0.538-1.335) p = 0.570. In our secondary analysis we found that the positive association between mild cognitive impairment (MCI) and dementia incidence decreased after 1/3/20 (interaction effect p = 0.031). CONCLUSION The incidence of dementia as defined using the CDR global score did not change significantly after the first lockdown began, but we found evidence that lockdown decreased the positive association between MCI and dementia incidence. This may reflect that individuals were progressing to dementia more rapidly and thus missing the MCI stage or that assessing patients over the phone made diagnosing MCI more challenging.
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Affiliation(s)
- Daniel Hendrik Baron
- Dementia Research GroupUniversity of BristolBristolUK
- Frimley Health NHS Foundation TrustSurreyUK
| | | | - Carslake David
- Population Health SciencesUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
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21
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Grothe J, Kropidlowski A, Luppa M, Elgner M, Funke K, Pabst A, Schomerus G, Dietzel J, Saur D, Sommerlad A, Riedel-Heller SG, Luck T. Psychometric Evaluation of the A-NKS: A Diagnostic Instrument to Assess Impairment of Activities of Daily Living in Mild and Major Neurocognitive Disorder According to DSM-5. J Alzheimers Dis 2024; 97:373-394. [PMID: 38143348 PMCID: PMC10789319 DOI: 10.3233/jad-230627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Activities of daily living (ADL) functioning are important in the diagnosis of neurocognitive disorders (NCD), yet no standardized and validated instrument exist based on international classification systems. OBJECTIVE We aimed to psychometrically evaluate the differentiated assessment of ADL and instrumental ADL (IADL) impairments due to NCD according to DSM-5 criteria (Instrument für die Erfassung von Alltagsbeeinträchtigungen bei Neurokognitiven Störungen; A-NKS). METHODS We conducted a pilot study involving 92 participant-informant dyads of participants with mild or major NCDs, cognitively healthy individuals, and an informant, to test acceptability, internal consistency, and convergent validity with similar measures. RESULTS Both A-NKS versions demonstrated excellent internal consistency (α= 0.95 -0.99) and correlate with other instrumental ADL instruments (participant [informant]: Barthel Index: rs = -0.26, p≤0.05 [rs = -0.30, p≤0.01]; Amsterdam IADL: rs = 0.59, p≤0.01 [rs = 0.48, p≤0.01]; SIDAM ADL: rs = 0.46, p≤0.001 [rs = 0.47, p≤0.001]). Additionally, there are correlations with the scale autonomy of the WHOQOL-OLD (rs = -0.50, p≤0.001 [rs = -0.37, p≤0.001]) and physical, as well as cognitive activities (rs = -0.39, p≤0.001 [rs = -0.50, p≤0.001]). They were well-accepted by participants and informants. CONCLUSIONS The A-NKS is an instrument with acceptable psychometric properties to assess ADL due to neurodegenerative decline in healthy individuals, and those with mild or major NCD. Further research is needed to confirm reliability and validity and investigate the factor structure.
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Affiliation(s)
- Jessica Grothe
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Adam Kropidlowski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Elgner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
- German Center for Mental Health (DZPG), Site Jena Magdeburg-Halle, Germany
| | - Katja Funke
- Department of Orthopedics, Trauma and Reconstructive Surgery of the University Hospital Halle (Saale), Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute for Social Medicine, Rehabilitation Sciences and Health Services Research (ISRV), Department of Economics and Social Sciences, University of Applied Sciences Nordhausen, Nordhausen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
| | - Jens Dietzel
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
| | - Dorothee Saur
- Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Faculty of Applied Social Sciences, University of Applied Sciences Erfurt, Erfurt, Germany
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22
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Nester CO, Gao Q, Katz MJ, Mogle JA, Wang C, Derby CA, Lipton RB, Saykin AJ, Rabin LA. Does the Cognitive Change Index Predict Future Cognitive and Clinical Decline? Longitudinal Analysis in a Demographically Diverse Cohort. J Alzheimers Dis 2024; 98:319-332. [PMID: 38393900 PMCID: PMC11376207 DOI: 10.3233/jad-230752] [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] [Indexed: 02/25/2024]
Abstract
Background The Cognitive Change Index (CCI) is a widely-used measure of self-perceived cognitive ability and change. Unfortunately, it is unclear if the CCI predicts future cognitive and clinical decline. Objective We evaluated baseline CCI to predict transition from normal cognition to cognitive impairment in nondemented older adults and in predementia groups including, subjective cognitive decline, motoric cognitive risk syndrome, and mild cognitive impairment. Different versions of the CCI were assessed to uncover any differential risk sensitivity. We also examined the effect of ethnicity/race on CCI. Methods Einstein Aging Study participants (N = 322, Mage = 77.57±4.96, % female=67.1, Meducation = 15.06±3.54, % non-Hispanic white = 46.3) completed an expanded 40-item CCI version (CCI-40) and neuropsychological evaluation (including Clinical Dementia Rating Scale [CDR], Montreal Cognitive Assessment, and Craft Story) at baseline and annual follow-up (Mfollow - up=3.4 years). CCI-40 includes the original 20 items (CCI-20) and the first 12 memory items (CCI-12). Linear mixed effects models (LME) and generalized LME assessed the association of CCI total scores at baseline with rate of decline in neuropsychological tests and CDR. Results In the overall sample and across predementia groups, the CCI was associated with rate of change in log odds on CDR, with higher CCI at baseline predicting faster increase in the odds of being impaired on CDR. The predictive validity of the CCI broadly held across versions (CCI-12, 20, 40) and ethnic/racial groups (non-Hispanic black and white). Conclusions Self-perception of cognitive change on the CCI is a useful marker of dementia risk in demographically/clinically diverse nondemented samples. All CCI versions successfully predicted decline.
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Affiliation(s)
- Caroline O Nester
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychology, Queens College, City University of New York, Queens, NY, USA
| | - Qi Gao
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J Katz
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacqueline A Mogle
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - Cuiling Wang
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol A Derby
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana Alzheimer's Disease Research Center, IU Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura A Rabin
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychology, Brooklyn College, City University of New York, Brooklyn, NY, USA
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23
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Nascimento IAPDS, Nobrega KCC, Souza BRA, Barone IC, Checchio G, Ponciano VP, de Paula CGC, Possani AN, Penha NC, Helene AF, Roque AC, Savica R, Piemonte MEP. Comparison of disability level between Early and Late Onset Parkinson's Disease using WHODAS 2. Front Neurol 2023; 14:1281537. [PMID: 38033768 PMCID: PMC10684903 DOI: 10.3389/fneur.2023.1281537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Parkinson's disease (PD) is a degenerative neurological disorder that usually affects people over the age of 60. However, 10%-20% of patients have an early onset of PD (EOPD). Objectives To compare disability levels according to the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2) between people with EOPD and those with late-onset PD (LOPD). Methods We conducted a cross-sectional study with 95 EOPD patients (mean-age 44.51 ± 4.63, H&Y 1.93 ± 0.93) and 255 LOPD patients (mean-age 63.01 ± 7.99, H&Y 2.02 ± 0.95). Demographic information, clinical characteristics, cognitive evaluation by Telephone-Montreal-Cognitive-Assessment (T-MoCA), functionality self-evaluation by WHODAS-2 and the Unified-Parkinson's-Disease-Rating-Scale (MDS-UPDRS), parts I and II, were documented for each patient by an individual remote interview. Results Analysis showed a statistically significant difference between EOPD and LOPD in two domains of WHODAS-2 only: cognition (Z-adjusted = 2.60; p-value adjusted <0.009) and activities of daily living related to work/school (Z-adjusted = 2.34; p-value adjusted <0.01). T-MoCA scores confirmed more impaired cognition capacity in LOPD (Z-adjusted = 2.42; p-value adjusted <0.01). The two groups had no significant differences in levodopa daily dosage, Hoehn and Yahr (H&Y) stages, disease time duration, and MDS-UPDRS I and II scores. Conclusion People living with EOPD face similar disability levels as those with LOPD, except for cognition, where LOPD patients exhibited higher levels of disability than EOPD and for work activities where the EOPD exhibited higher levels of disability than LODP. These results highlight the challenges faced by people with EOPD in interacting with society and living with the disease for a longer time. The WHODAS-2 can be a useful tool to assess disability and tailor interventions for people with PD of different age groups.
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Affiliation(s)
| | - Kátia Cirilo Costa Nobrega
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Bruno Rafael Antunes Souza
- Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Isabela Carneiro Barone
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Giovanna Checchio
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Vitória Pereira Ponciano
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Clara Greif Cerveira de Paula
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Arieni Nunes Possani
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Natália Cardoso Penha
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - André Frazão Helene
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Roque
- Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Maria Elisa Pimentel Piemonte
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
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24
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Malvitz M, Zahuranec DB, Chang W, Heeringa SG, Briceño EM, Mehdipanah R, Gonzales XF, Levine DA, Langa KM, Garcia N, Morgenstern LB. Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals. J Am Geriatr Soc 2023; 71:3520-3529. [PMID: 37382492 PMCID: PMC10755064 DOI: 10.1111/jgs.18493] [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: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease and Alzheimer's disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort. METHODS This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann-Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia. RESULTS There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire. CONCLUSIONS The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.
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Affiliation(s)
- Madelyn Malvitz
- University of Michigan Medical School Department of Neurology
| | | | - Wen Chang
- University of Michigan Institute of Social Research
| | | | - Emily M. Briceño
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Physical Medicine and Rehabilitation
| | - Roshanak Mehdipanah
- University of Michigan School of Public Health Department of Health Behavior and Health Education
| | | | - Deborah A. Levine
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute of Social Research
- University of Michigan Medical School Department of Internal Medicine
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor
| | - Nelda Garcia
- University of Michigan Medical School Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan Medical School Department of Neurology
- University of Michigan School of Public Health Center for Social Epidemiology and Population Health
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25
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Markle-Reid M, Fisher K, Walker KM, Beauchamp M, Cameron JI, Dayler D, Fleck R, Gafni A, Ganann R, Hajas K, Koetsier B, Mahony R, Pollard C, Prescott J, Rooke T, Whitmore C. The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial. BMC Geriatr 2023; 23:687. [PMID: 37872479 PMCID: PMC10594728 DOI: 10.1186/s12877-023-04403-1] [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: 04/01/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions). METHODS This pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses. RESULTS Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58-8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51-11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes. CONCLUSIONS Although participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04278794 . Registered May 2, 2020.
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Affiliation(s)
- Maureen Markle-Reid
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada.
- Health Research Methods, Department of Health, Evidence and Impact, Faculty of Health Sciences, and the Centre of Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, HSC 2C, Hamilton, ON, L8S 4K1, Canada.
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada.
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada.
| | - Kathryn Fisher
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada
| | - Kimberly M Walker
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- Upstream Lab, MAP Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Ontario, M5B 1T8, Toronto, Canada
| | - Marla Beauchamp
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 160-500 University Ave, Toronto, ON, M5V 1V7, Canada
| | - David Dayler
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Rebecca Fleck
- Rehabilitation Program, Parkwood Institute, St. Joseph's Health Care London, 268 Grosvenor Street, Ontario, N6A 4V2, London, Canada
| | - Amiram Gafni
- Health Research Methods, Department of Health, Evidence and Impact, Faculty of Health Sciences, and the Centre of Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, HSC 2C, Hamilton, ON, L8S 4K1, Canada
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada
| | - Ken Hajas
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Barbara Koetsier
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Robert Mahony
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Chris Pollard
- Hotel Dieu Shaver Health, and Rehabilitation Centre, 541 Glenridge Ave, St. Catherines, ON, L2T 4C2, Canada
| | - Jim Prescott
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
| | - Tammy Rooke
- CarePartners, 139 Washburn Drive, Kitchener, ON, N2R 1S1, Canada
| | - Carly Whitmore
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON, L8S 4K1, Canada
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada
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Van Bogart K, Scott SB, Harrington KD, Felt JM, Sliwinski MJ, Graham-Engeland JE. Examining the Bidirectional Nature of Loneliness and Anxiety Among Older Adults in Daily Life. J Gerontol B Psychol Sci Soc Sci 2023; 78:1676-1685. [PMID: 37527478 PMCID: PMC10561887 DOI: 10.1093/geronb/gbad105] [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: 02/21/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Loneliness in later life increases the risk for adverse health outcomes; however, less is known about how loneliness is maintained. Anxiety may play an important role in maintaining loneliness, but little is known about how this connection plays out over time in daily life. This study thus focused on the within-person associations between momentary loneliness and anxiety among older adults. METHODS Participants were 317 diverse older adults (40% Black; 13% Hispanic, mean age = 77.45 years, 67% women) systematically recruited from the Bronx, NY, who completed ecological momentary assessments 5 times daily for 14 consecutive days. Multilevel models tested bidirectional contemporaneous, momentary cross-lagged (t - 1), day-level cross-lagged (average day to end of day), and day-to-day cross-lagged associations between loneliness and anxiety. Separate sensitivity analyses controlled for concurrent overall mood valence or depressed state. Gender and mild cognitive impairment (MCI) status were tested as moderators at all timescales. RESULTS Significant bidirectional associations between loneliness and anxiety were found at the contemporaneous and momentary cross-lagged (t - 1) timescales. Higher average daily loneliness predicted higher end-of-day anxiety, but not vice versa. Loneliness and anxiety were not significantly associated from day to day. Sensitivity analyses revealed some associations varied depending on inclusion of either concurrent mood valence or depressed state. Neither gender nor MCI status moderated associations at any timescale. DISCUSSION Findings shed light on the complex temporal ordering of loneliness and anxiety in daily life and extend contemporary theoretical notions of loneliness, including the possibility of interventions that target key moments in daily life.
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Affiliation(s)
- Karina Van Bogart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Stacey B Scott
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Karra D Harrington
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - John M Felt
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Smith V, Younes K, Poston KL, Mormino EC, Young CB. Reliability of remote National Alzheimer's Coordinating Center Uniform Data Set data. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12498. [PMID: 38034852 PMCID: PMC10687343 DOI: 10.1002/dad2.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) neuropsychological battery is being used to track cognition in participants across the country, but it is unknown if scores obtained through remote administration can be combined with data obtained in person. METHODS The remote UDS battery includes the blind version of the Montreal Cognitive Assessment (MoCA), Number Span, Semantic and Phonemic Fluency, and Craft Story. For these tests, we assessed intraclass correlation coefficients (ICCs) between in-person and remote scores in 3838 participants with both in-person and remote UDS assessments, and we compared annual score changes between modalities in a subset that had two remote assessments. RESULTS All tests exhibited moderate to good reliability between modalities (ICCs = 0.590-0.787). Annual score changes were also comparable between modalities except for Craft Story Immediate Recall, Semantic Fluency, and Phonemic Fluency. DISCUSSION Our findings generally support combining remote and in-person scores for the majority of UDS tests.
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Affiliation(s)
- Viktorija Smith
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Kyan Younes
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Christina B. Young
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
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Chappelle SD, Gigliotti C, Léger GC, Peavy GM, Jacobs DM, Banks SJ, Little EA, Galasko D, Salmon DP. Comparison of the telephone-Montreal Cognitive Assessment (T-MoCA) and Telephone Interview for Cognitive Status (TICS) as screening tests for early Alzheimer's disease. Alzheimers Dement 2023; 19:4599-4608. [PMID: 36939111 PMCID: PMC10509307 DOI: 10.1002/alz.13039] [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: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Remote screening for cognitive impairment associated with Alzheimer's disease (AD) has grown in importance with the expected rise in prevalence of AD in an aging population and with new potential treatment options. METHODS The Telephone Interview for Cognitive Status (TICS) and new telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) were administered to participants independently classified through in-person clinical evaluation as cognitively normal (CN; n = 167), mild cognitive impairment (MCI; n = 25), or dementia (n = 23). Cerebrospinal fluid AD biomarkers were measured (n = 79). RESULTS TICS and T-MoCA were highly correlated (r = 0.787; P < 0.001): groups differed on both (CN DISCUSSION TICS and T-MoCA are effective for remotely detecting cognitive impairment associated with AD in older adults. Strong correlation between tests provides construct validity for the newer T-MoCA. HIGHLIGHTS Construct validity for the telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) was newly established against the Telephone Interview for Cognitive Status (TICS). TICS and T-MoCA effectively detected cognitive impairment with remote administration. Both tests negatively correlated with a composite cerebrospinal fluid Alzheimer's disease (AD) biomarker (tau/amyloid beta 1-42).
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Affiliation(s)
- Sheridan D Chappelle
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Christina Gigliotti
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Gabriel C Léger
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Guerry M Peavy
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Diane M Jacobs
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Sarah J Banks
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Emily A Little
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Douglas Galasko
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - David P Salmon
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
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Wiredu K, O’Connor S, Naseem H, Brauer BL, Kettenbach AN, Frost HR, Shaefi S, Gerber SA. Intraoperative plasma proteomic changes in cardiac surgery: In search of biomarkers of post-operative delirium. Proteomics Clin Appl 2023; 17:e2200066. [PMID: 36567636 PMCID: PMC10290728 DOI: 10.1002/prca.202200066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Delirium presents a significant healthcare burden. It complicates post-operative care in up to 50% of cardiac surgical patients with worse outcomes, longer hospital stays and higher cost of care. Moreover, the nature of delirium following cardiac surgery with cardiopulmonary bypass (CPB) remains unclear, the underlying pathobiology is poorly understood, status quo diagnostic methods are subjective, and diagnostic biomarkers are currently lacking. OBJECTIVE To identify diagnostic biomarkers of delirium and for insights into possible neuronal pathomechanisms. EXPERIMENTAL DESIGN Comparative proteomic analyses were performed on plasma samples from a nested matched cohort of patients who underwent cardiac surgery. Validation by targeted proteomics was performed in an independent set of samples. Biomarkers were assessed for biological functions and diagnostic accuracy. RESULTS Forty-seven percent of subjects demonstrated delirium. Of 3803 proteins identified from patient samples by multiplexed quantitative proteomics, 16 were identified as signatures of exposure to CPB, and 11 biomarkers distinguished delirium cases from non-cases (AuROC = 93%). Notable among these biomarkers are C-reactive protein, serum amyloid A-1 and cathepsin-B. CONCLUSIONS AND CLINICAL RELEVANCE The interplay of systemic and central inflammatory markers sheds new light on delirium pathogenesis. This work suggests that accurate identification of cases may be achievable using panels of biomarkers.
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Affiliation(s)
- Kwame Wiredu
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Anesthesia, Critical Care and Pain Medicine, Mass General Hospital, Boston MA
- Department of Anaesthesia, Harvard Medical School, Boston MA
| | - Sean O’Connor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Heba Naseem
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Brooke L. Brauer
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Arminja N. Kettenbach
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Hildreth R. Frost
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Shahzad Shaefi
- Department of Anaesthesia, Harvard Medical School, Boston MA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Scott A. Gerber
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Brännmark C, Klasson S, Stanne TM, Samuelsson H, Alt Murphy M, Sunnerhagen KS, Åberg ND, Jalnefjord O, Björkman-Burtscher I, Jood K, Tatlisumak T, Jern C. FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke. BMJ Open 2023; 13:e072493. [PMID: 37164469 PMCID: PMC10173956 DOI: 10.1136/bmjopen-2023-072493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Comprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, the FIND Stroke Recovery Study. We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery. METHODS AND ANALYSIS We recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers. ETHICS AND DISSEMINATION FIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets. TRIAL REGISTRATION NUMBER The protocol is registered at http://www. CLINICALTRIALS gov, Study ID: NCT05708807.
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Affiliation(s)
- Cecilia Brännmark
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Research, Development, Education and Innovation, Gothenburg, Sweden
| | - Sofia Klasson
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tara M Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
| | - Hans Samuelsson
- Institute of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
- Region Västra Göraland, Sahlgrenska University Hospital, Department of Rehabilitation Medicin, Gothenburg, Sweden
| | - Margit Alt Murphy
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N David Åberg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oscar Jalnefjord
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medical Physics and Biomedical Engineering, Gothenburg, Sweden
| | - Isabella Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
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Kang J, Fang C, Li Y, Yuan Y, Niu K, Zheng Y, Yu Y, Wang G, Li Y. Effects of qCON and qNOX-guided general anaesthesia management on patient opioid use and prognosis: a study protocol. BMJ Open 2023; 13:e069134. [PMID: 37130687 PMCID: PMC10163456 DOI: 10.1136/bmjopen-2022-069134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION The adverse effects of general anaesthetic drugs (especially opioids) cannot be ignored. However, current nociceptive-monitoring techniques still lack consistency in guiding the use of opioids. This trial will study the demand for opioid use and patient prognosis in qCON and qNOX-guided general anaesthesia management. METHODS AND ANALYSIS This prospective, randomised, controlled trial will randomly recruit 124 patients undergoing general anaesthesia for non-cardiac surgery in equal numbers to either the qCON or BIS group. The qCON group will adjust intraoperative propofol and remifentanil dosage according to qCON and qNOX values, while the BIS group will adjust according to BIS values and haemodynamic fluctuations. The differences between the two groups will be observed in remifentanil dosing and prognosis. The primary outcome will be intraoperative remifentanil use. Secondary outcomes will include propofol consumption; the predictive ability of BIS, qCON and qNOX on conscious responses, noxious stimulus and body movements; and changes in cognitive function at 90 days postoperatively. ETHICS AND DISSEMINATION This study involves human participants and was approved by the Ethics Committee of the Tianjin Medical University General Hospital (IRB2022-YX-075-01). Participants gave informed consent to participate in the study before taking part. The study results will be published in peer-reviewed journals and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059877.
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Affiliation(s)
- Jiamin Kang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Chongliang Fang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yuanjie Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yuan Yuan
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuxin Zheng
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yize Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
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Rico BMH, Aliberti MJR, da Silva NOT, Busse AL, Suemoto CK, Avelino-Silva TJ, Magaldi RM, Apolinario D. Advancing cognitive assessment in telemedicine: Validity and reliability of the telephone 10-point cognitive screener. J Am Geriatr Soc 2023; 71:977-980. [PMID: 36273404 DOI: 10.1111/jgs.18091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Bruno Marcondes Hottum Rico
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Natalia Oliveira Trajano da Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Alexandre Leopold Busse
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Regina Miksian Magaldi
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Daniel Apolinario
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Hospital do Coracao (Hcor), Associacao Beneficente Siria, Sao Paulo, Brazil
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Correa-Naranjo MI, Camargo-Camargo L, Acosta-Camargo L, Ramos-Clason EC, López-Velásquez N. MoCA-T como herramienta de evaluación remota para precisar deterioro cognitivo en pacientes con SAHOS moderado a severo. NEUROLOGÍA ARGENTINA 2023. [PMCID: PMC9930070 DOI: 10.1016/j.neuarg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
La pandemia de COVID-19 ha dado lugar al surgimiento de herramientas tecnológicas que permiten la valoración de pacientes de forma remota. La prueba de evaluación cognitiva de Montreal, versión telefónica (MoCA-T), es una de ellas. Se considera como un recurso de la telemedicina que permite la tamización cognitiva a distancia en épocas de pandemia y en la población con dificultades en el acceso a los centros de salud. El deterioro cognitivo leve (DCL) es un hallazgo usual en pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS); sin embargo, no se ha estudiado la aplicación de pruebas telefónicas para su tamización cognitiva. El objetivo principal de este trabajo es determinar la frecuencia de deterioro cognoscitivo mediante la aplicación de MoCA-T como prueba de tamización remota en pacientes con SAHOS moderado y severo. Para ello, se aplicó la prueba de MoCA-T en 104 pacientes entre 18 y 65 años con diagnóstico polisomnográfico de SAHOS moderado y severo, excluyéndose a pacientes con comorbilidades que afectasen las capacidades cognoscitivas. Se obtuvieron resultados anormales de MoCA-T en el 43% de los pacientes, siendo los dominios cognitivos de la memoria y la atención los más comúnmente afectados. Finalmente, los resultados anormales de MoCA-T se correlacionaron con la autopercepción de las dificultades en la memoria, estando más frecuentemente alterada en quienes manifestaron quejas cognitivas. La prueba MoCA-T podría ser una herramienta tecnológica breve, validada y factible para realizar el tamizaje cognitivo de pacientes con SAHOS en épocas de pandemia y en pacientes con barreras asistenciales.
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Affiliation(s)
- Maria Isabel Correa-Naranjo
- Médico. Residente IV año Neurología Clínica, Programa de Neurología, Universidad del Sinú EBZ, Seccional Cartagena, Colombia,Autor para correspondencia
| | - Loida Camargo-Camargo
- Médico. Esp. Neurología. Docente programa de Neurología Clínica, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Laura Acosta-Camargo
- Médico. Esp. Neurología. Docente programa de Neurología Clínica, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Enrique Carlos Ramos-Clason
- Médico. M. Sc. Salud Pública. Coordinador de investigaciones posgrados médico quirúrgicos, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Norman López-Velásquez
- Neuropsicólogo, Doctor en Neurociencia Cognitiva, Docente programa de Psicología, Universidad de la Costa, Barranquilla, Colombia
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Saucier J, Jose C, Beroual Z, Al-Qadi M, Chartrand S, Libert E, Losier MC, Cooling K, Girouard G, Jbilou J, Chamard-Witkowski L. Cognitive inhibition deficit in long COVID-19: An exploratory study. Front Neurol 2023; 14:1125574. [PMID: 37122293 PMCID: PMC10140516 DOI: 10.3389/fneur.2023.1125574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objectives An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition. Methodology A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1-4, 5-8, 9-12, and 13-16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy. Results Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period. Discussion This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.
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Affiliation(s)
- Jacob Saucier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Caroline Jose
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Zaynab Beroual
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mohammad Al-Qadi
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Simon Chartrand
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Eméraldine Libert
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Marie-Claire Losier
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Kendra Cooling
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Gabriel Girouard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Jalila Jbilou
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- School of Psychology, Université de Moncton, Moncton, NB, Canada
| | - Ludivine Chamard-Witkowski
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
- *Correspondence: Ludivine Chamard-Witkowski,
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Wang C, Nester CO, Chang K, Rabin LA, Ezzati A, Lipton RB, Katz MJ. Tracking cognition with the T-MoCA in a racially/ethnically diverse older adult cohort. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12410. [PMID: 36950700 PMCID: PMC10026378 DOI: 10.1002/dad2.12410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 03/10/2023]
Abstract
Introduction We investigated the utility of the Telephone-Montreal Cognitive Assessment (T-MoCA) to track cognition in a diverse sample from the Einstein Aging Study. Methods Telephone and in-person MoCA data, collected annually, were used to evaluate longitudinal cognitive performance. Joint models of T-MoCA and in-person MoCA compared changes, variance, and test-retest reliability measured by intraclass correlation coefficient by racial/ethnic group. Results There were no significant differences in baseline performance or longitudinal changes across three study waves for both MoCA formats. T-MoCA performance improved over waves 1-3 but declined afterward. Test-retest reliability was lower for the T-MoCA than for the in-person MoCA. In comparison with non-Hispanic Whites, non-Hispanic Blacks and Hispanics performed worse at baseline on both MoCA formats and showed lower correlations between T-MoCA and in-person versions. Conclusions The T-MoCA provides valuable information on cognitive change, despite racial/ethnic disparities and practice effects. We discuss implications for health disparity populations. Highlights We assessed the comparability of Telephone-Montreal Cognitive Assessment (T-MoCA) and in-person MoCA for tracking cognition.Changes within 3 years in T-MoCA were similar to that for the in-person MoCA.T-MoCA is subject to practice effects and shows difference in performance by race/ethnicity.Test-retest reliability of T-MoCA is lower than that for in-person MoCA.
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Affiliation(s)
- Cuiling Wang
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Caroline O. Nester
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Katherine Chang
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Laura A. Rabin
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Ali Ezzati
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
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Klinedinst TC, Ciro CA, Kendzor DE. A pilot, randomized, feasibility study to improve health self-management behaviors in older adults with multiple chronic conditions and functional limitations: Protocol for the Behavioral Activation and Occupational Therapy Trial (BA+OT). JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231163037. [PMID: 36911183 PMCID: PMC9998403 DOI: 10.1177/26335565231163037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
Background Approximately 45% of older adults in the U.S. have 2 or more chronic health conditions (e.g., arthritis, hypertension, diabetes) in addition to functional limitations that prevent performance of health self-management activities. Self-management continues to be the gold standard for managing MCC, but functional limitations create difficulty with these activities (e.g., physical activity, symptom monitoring). Restricted self-management accelerates the downward spiral of disability and accumulating chronic conditions which, in turn, increases rates of institutionalization and death by 5-fold. Currently, there are no tested interventions designed to improve independence in health self-management activities in older adults with MCC and functional limitations. Research suggests that older adults are more likely to change behavior with interventions that assist with planning health-promoting daily activities, especially when contending with complex medical regimens and functional limitations. Our team asserts that combining occupational therapy (OT) and behavioral activation (BA) shows promise to improve health self-management in populations with chronic conditions and/or functional limitations. This innovative combination uses the goal setting, scheduling/monitoring activities, and problem-solving components of the BA approach as well as the environmental modification, activity adaptation, and focus on daily routines from OT practice. Objectives We will test the effect of this combined approach in a Stage I, randomized controlled pilot feasibility study compared to enhanced usual care. We will recruit 40 older adults with MCC and functional limitation and randomize 20 to the PI- delivered BA-OT protocol. This research will inform modification and larger-scale testing of this novel intervention.
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Affiliation(s)
- Tara C Klinedinst
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center- Schusterman Campus, Tulsa, OK, USA.,Department of Internal Medicine, OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Carrie A Ciro
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Darla E Kendzor
- TSET Heath Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Hausman HK, Dai Y, O’Shea A, Dominguez V, Fillingim M, Calfee K, Carballo D, Hernandez C, Perryman S, Kraft JN, Evangelista ND, Van Etten EJ, Smith SG, Bharadwaj PK, Song H, Porges E, DeKosky ST, Hishaw GA, Marsiske M, Cohen R, Alexander GE, Wu SS, Woods AJ. The longitudinal impact of the COVID-19 pandemic on health behaviors, psychosocial factors, and cognitive functioning in older adults. Front Aging Neurosci 2022; 14:999107. [PMID: 36506467 PMCID: PMC9732386 DOI: 10.3389/fnagi.2022.999107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Older adults are at a greater risk for contracting and experiencing severe illness from COVID-19 and may be further affected by pandemic-related precautions (e.g., social distancing and isolation in quarantine). However, the longitudinal impact of the COVID-19 pandemic on older adults is unclear. The current study examines changes in health behaviors, psychosocial factors, and cognitive functioning in a large sample of older adults using a pre-pandemic baseline and longitudinal follow-up throughout 9 months of the COVID-19 pandemic. Methods: One hundred and eighty-nine older adults (ages 65-89) were recruited from a multisite clinical trial to complete additional virtual assessments during the COVID-19 pandemic. Mixed effects models evaluated changes in health behaviors, psychosocial factors, and cognitive functioning during the pandemic compared to a pre-pandemic baseline and over the course of the pandemic (i.e., comparing the first and last COVID-19 timepoints). Results: Compared to their pre-pandemic baseline, during the pandemic, older adults reported worsened sleep quality, perceived physical health and functioning, mental health, slight increases in depression and apathy symptoms, reduced social engagement/perceived social support, but demonstrated better performance on objective cognitive tasks of attention and working memory. Throughout the course of the pandemic, these older adults reported continued worsening of perceived physical health and function, fewer depression symptoms, and they demonstrated improved cognitive performance. It is important to note that changes on self-report mood measures and cognitive performance were relatively small regarding clinical significance. Education largely served as a protective factor, such that greater years of education was generally associated with better outcomes across domains. Conclusions: The present study provides insights into the longitudinal impact of the COVID-19 pandemic on health behaviors, psychosocial factors, and cognitive functioning in a population disproportionately affected by the virus. Replicating this study design in a demographically representative older adult sample is warranted to further inform intervention strategies targeting older adults negatively impacted by the COVID-19 pandemic.
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Affiliation(s)
- Hanna K. Hausman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Yunfeng Dai
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL,, United States
| | - Andrew O’Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Vanessa Dominguez
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Matthew Fillingim
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Kristin Calfee
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Daniela Carballo
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Cindy Hernandez
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Sean Perryman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Jessica N. Kraft
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nicole D. Evangelista
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Emily J. Van Etten
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Samantha G. Smith
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Pradyumna K. Bharadwaj
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Hyun Song
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Eric Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Steven T. DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Georg A. Hishaw
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer’s Disease Consortium, Tucson, AZ, United States
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Gene E. Alexander
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States,Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer’s Disease Consortium, Tucson, AZ, United States
| | - Samuel S. Wu
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL,, United States
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States,*Correspondence: Adam J. Woods
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Yu K, Wild K, Dowling NM, Kaye JA, Silbert LC, Dodge HH. Emotional characteristics of socially isolated older adults with MCI using tablet administered NIH toolbox: I-CONECT study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12372. [PMID: 36381558 PMCID: PMC9652485 DOI: 10.1002/dad2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022]
Abstract
Introduction Examining the emotional functioning of individuals with mild cognitive impairment (MCI) could help describe their cognitive status and inform the development of interventions. This study compared the emotional characteristics of socially isolated older adults with and without MCI. Methods We used baseline data from the Internet-based Conversational Engagement Clinical Trial. Emotional characteristics were assessed with the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB). MCI status was determined with a consensus clinical diagnosis. Results This study included 163 participants (mean age = 81.2 years, non-Hispanic Black = 20.7%, MCI = 52.8%). MCI was associated with higher negative affect and lower psychological well-being. Non-Hispanic Black participants scored lower in sadness, higher in positive affect, and higher in meaning and purpose than non-Hispanic White participants. Conclusion Older adults with MCI experience more negative emotions and worse psychological well-being than those with normal cognition. The NIHTB-EB appears to be a sensitive tool to detect emotional characteristics associated with cognitive decline.
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Affiliation(s)
- Kexin Yu
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Katherine Wild
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - N. Maritza Dowling
- Department of Acute and Chronic CareSchool of Nursingand Department of Epidemiology & BiostatisticsMilken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeffrey A. Kaye
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Lisa C. Silbert
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Hiroko H. Dodge
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of NeurologyHarvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
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Becker CJ, Heeringa SG, Chang W, Briceño EM, Mehdipanah R, Levine DA, Langa KM, Gonzales XF, Garcia N, Longoria R, Springer MV, Zahuranec DB, Morgenstern LB. Differential Impact of Stroke on Cognitive Impairment in Mexican Americans and Non-Hispanic White Americans. Stroke 2022; 53:3394-3400. [PMID: 35959679 PMCID: PMC9613525 DOI: 10.1161/strokeaha.122.039533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association between stroke and dementia is well established. Less is known about this association in underrepresented ethnic groups. In a large ethnically diverse cohort, we examined whether history of stroke was associated with cognitive impairment, and whether this relationship differed by ethnicity (Mexican American [MA] versus non-Hispanic White). METHODS This was a population-based cohort study conducted in Nueces County, TX, a biethnic community with a large and primarily nonimmigrant MA population. Residents aged ≥65 were recruited door-to-door or by telephone between May 2018 and December 2021. The primary exposure was history of stroke, obtained by self-report. Demographic, medical, and educational histories were also obtained. The primary outcome was the Montreal Cognitive Assessment (MoCA), a scale that evaluates multiple domains of cognitive performance. Scores were divided into 3 ordinal categories, roughly corresponding to normal cognition (MoCA 26-30), mild cognitive impairment (MoCA 20-25), or probable dementia (MoCA 0-19). RESULTS One thousand eight hundred one participants completed MoCA screening (55% female; 50% MA, 44% Non-Hispanic White, 6% other), of whom 12.4% reported history of stroke. Stroke prevalence was similar across ethnicities (X2 2.1; P=0.34). In a multivariable cumulative logit regression model for the ordinal cognition outcome, a stroke by ethnicity interaction was observed (P=0.01). Models stratified by ethnicity revealed that stroke was associated with cognitive impairment across ethnicities, but had greater impact on cognition in non-Hispanic Whites (cumulative odds ratio=3.81 [95% CI, 2.37-6.12]) than in MAs (cumulative odds ratio=1.58 [95% CI, 1.04-2.41]). Increased age and lower educational attainment were also associated with cognitive impairment, regardless of ethnicity. CONCLUSIONS History of stroke was associated with increased odds of cognitive impairment after controlling for other factors in both MA and Non-Hispanic White participants. The magnitude of the impact of stroke on cognition was less in MA than in Non-Hispanic White participants.
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Affiliation(s)
- Christopher J Becker
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor (S.G.H., W.C., K.M.L.)
| | - Wen Chang
- Institute for Social Research, University of Michigan, Ann Arbor (S.G.H., W.C., K.M.L.)
| | - Emily M Briceño
- Department of Physical Medicine and Rehabilitation (E.M.B.), University of Michigan Medical School, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor (S.G.H., W.C., K.M.L.)
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education (R.M.), University of Michigan School of Public Health, Ann Arbor
| | - Deborah A Levine
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
- Department of Internal Medicine (D.A.L., K.M.L.), University of Michigan Medical School, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine (D.A.L., K.M.L.), University of Michigan Medical School, Ann Arbor
| | | | - Nelda Garcia
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
| | - Ruth Longoria
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
| | - Mellanie V Springer
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
| | - Darin B Zahuranec
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
| | - Lewis B Morgenstern
- Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor
- Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor
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Mart MF, Semler MW, Bernard G, Casey JD, Ely EW, Freundlich R, Jackson JC, Kiehl A, Jenkins C, Wang G, Lindsell C, Bryant P, Rice TW, Self WH, Stollings J, Wanderer JP, Wang L, Han JH. Cognitive Outcomes in the Pragmatic Investigation of optima L Oxygen Targets (CO-PILOT) trial: protocol and statistical analysis plan. BMJ Open 2022; 12:e064517. [PMID: 36319061 PMCID: PMC9628689 DOI: 10.1136/bmjopen-2022-064517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Long-term cognitive impairment is one of the most common complications of critical illness among survivors who receive mechanical ventilation. Recommended oxygen targets during mechanical ventilation vary among international guidelines. Different oxygen targets during mechanical ventilation have the potential to alter long-term cognitive function due to cerebral hypoxemia or hyperoxemia. Whether higher, intermediate or lower SpO2 targets are associated with better cognitive function at 12-month follow-up is unknown. METHODS AND ANALYSIS The Pragmatic Investigation of optimaL Oxygen Targets (PILOT) trial is an ongoing pragmatic, cluster-randomised, cluster-crossover trial comparing the effect of a higher SpO2 target (target 98%, goal range 96%-100%), an intermediate SpO2 target (target 94%, goal range 92%-96%) and a lower SpO2 target (target 90%, goal range 88%-92%) on clinical outcomes in mechanically ventilated patients admitted to the medical intensive care unit at a single centre in the USA. For this ancillary study of long-term Cognitive Outcomes (CO-PILOT), survivors of critical illness who are in the PILOT trial and who do not meet exclusion criteria for CO-PILOT are approached for consent. The anticipated number of patients for whom assessment of long-term cognition will be performed in CO-PILOT is 612 patients over 36 months of enrolment. Cognitive, functional and quality of life assessments are assessed via telephone interview at approximately 12 months after enrolment in PILOT. The primary outcome of CO-PILOT is the telephone version of the Montreal Cognitive Assessment. A subset of patients will also complete a comprehensive neuropsychological telephone battery to better characterise the cognitive domains affected. ETHICS AND DISSEMINATION The CO-PILOT ancillary study was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.
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Affiliation(s)
- Matthew F Mart
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gordon Bernard
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan D Casey
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - E Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Robert Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James C Jackson
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Amy Kiehl
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Cathy Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Guanchao Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patsy Bryant
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joanna Stollings
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li Wang
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jin Ho Han
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Magnani JW, Ferry D, Swabe G, Martin D, Chen X, Brooks MM, Kimani E, Paasche-Orlow MK, Ólafsson S, Bickmore T, El Khoudary SR. Design and rationale of the mobile health intervention for rural atrial fibrillation. Am Heart J 2022; 252:16-25. [PMID: 35691371 PMCID: PMC9444050 DOI: 10.1016/j.ahj.2022.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a highly morbid condition which requires long-term adherence to oral anticoagulation and may be associated with adverse quality of life and health care utilization. We developed a relational agent-an interactive smartphone-based intervention accessible regardless of digital or health literacy-to assist individuals residing in rural, Western Pennsylvania, with AF with chronic disease self-management. METHODS The "Mobile health intervention for rural atrial fibrillation" is a single center, parallel-arm randomized clinical trial for adults with AF funded by the National Institute of Health's National Heart, Lung, and Blood Institute to enroll 264 participants. All participants receive a smartphone with data plan: The intervention is a 4 month relational agent coupled with the AliveCor Kardia for heart rate and rhythm monitoring provided by smartphone, and the control a pre-installed, smartphone-based application for health-related information (WebMD). The study uses remote recruitment and engagement to enroll individuals who would otherwise be unlikely to participate in clinical research due to rurality. The primary outcome of the trial is adherence to oral anticoagulation, determined by proportion of days covered, as measured at 12 months. The secondary outcomes are quality of life, both AF-specific and general, and health care utilization. The study entails a baseline visit, a 4 month intervention phase, and 8 and 12 month follow-up visits. CONCLUSIONS This mobile health trial tests the effectiveness of a smartphone-based relational agent to improve clinical and patient-reported outcomes in rural-dwelling individuals.
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Affiliation(s)
- Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
| | - Danielle Ferry
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Gretchen Swabe
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Deborah Martin
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Xirun Chen
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Everlyne Kimani
- Human Computer Interaction Institute, Northeastern University, Boston, MA
| | | | - Stefán Ólafsson
- Human Computer Interaction Institute, Northeastern University, Boston, MA; Department of Computer Science, Reykjavik University, Iceland
| | - Timothy Bickmore
- Human Computer Interaction Institute, Northeastern University, Boston, MA
| | - Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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42
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Oravecz Z, Harrington KD, Hakun JG, Katz MJ, Wang C, Zhaoyang R, Sliwinski MJ. Accounting for retest effects in cognitive testing with the Bayesian double exponential model via intensive measurement burst designs. Front Aging Neurosci 2022; 14:897343. [PMID: 36225891 PMCID: PMC9549774 DOI: 10.3389/fnagi.2022.897343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Monitoring early changes in cognitive performance is useful for studying cognitive aging as well as for detecting early markers of neurodegenerative diseases. Repeated evaluation of cognition via a measurement burst design can accomplish this goal. In such design participants complete brief evaluations of cognition, multiple times per day for several days, and ideally, repeat the process once or twice a year. However, long-term cognitive change in such repeated assessments can be masked by short-term within-person variability and retest learning (practice) effects. In this paper, we show how a Bayesian double exponential model can account for retest gains across measurement bursts, as well as warm-up effects within a burst, while quantifying change across bursts in peak performance. We also highlight how this approach allows for the inclusion of person-level predictors and draw intuitive inferences on cognitive change with Bayesian posterior probabilities. We use older adults' performance on cognitive tasks of processing speed and spatial working memory to demonstrate how individual differences in peak performance and change can be related to predictors of aging such as biological age and mild cognitive impairment status.
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Affiliation(s)
- Zita Oravecz
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
- Institute for Computational and Data Sciences, Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
| | - Karra D. Harrington
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
| | - Jonathan G. Hakun
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
- Department of Neurology, Pennsylvania State University, Hershey, PA, United States
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ruixue Zhaoyang
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
| | - Martin J. Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
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Cooper L, Krishnan S, Javedan H, Bader AM, Tulabaev S. A proposal for virtual, telephone-based preoperative cognitive assessment in older adults undergoing elective surgery. Perioper Med (Lond) 2022; 11:41. [PMID: 35978385 PMCID: PMC9385236 DOI: 10.1186/s13741-022-00274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 06/12/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the feasibility of administering the MoCA 5-minute test/Telephone (T-MoCA), an abbreviated version of the Montreal Cognitive Assessment to older adults perioperatively DESIGN: A feasibility study including patients aged ≥ 70 years scheduled for surgery from December 2020 to March 2021 SETTING: Preoperative virtual clinic PATIENTS: Patients ≥70 years undergoing major elective surgery INTERVENTION: A study investigator called eligible patients prior to surgery, obtained consent, and completed the preoperative cognitive assessment. Follow-up assessment was completed 1-month postoperatively, and participating clinicians were surveyed at the completion of the study. MEASUREMENTS An attention test, T-MoCA, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Generalized Anxiety Disorder 2-item (GAD-2) MAIN RESULTS: Overall, 37/40 (92.5%) patients completed the pre- and post-operative assessments. The cohort was 50% female, white (97.5%), with a median age of 76 years (interquartile range (IQR) 73-79), and education level was higher than high school in 82.5% of patients. Preoperatively, the median number of medications was 8 (IQR 7-11), 27/40 (67.5%) had medications with anticholinergic effects, and 6/40 (15%) had benzodiazepines. Median completion time of the phone assessment was 10 min (IQR 8.25-12) and 4 min (IQR 3-5) for the T-MoCA with a median T-MoCA score of 13 (IQR 12-14). Most patients (37/40) completed the post-operative assessment, and 6/37 (16.2%) reported they had experienced a change in memory or attention post-operatively. Clinician's survey reported ease and feasibility in performing T-MoCA as a preoperative cognitive evaluation. CONCLUSION Preoperative cognitive assessment of older adults using T-MoCA over the phone is easy to perform by clinicians and had a high completion rate by patients. This test is feasible for virtual assessments. Further research is needed to better define validity and correlation with postoperative outcomes.
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Affiliation(s)
- Lisa Cooper
- Division of Aging, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
| | - Sindhu Krishnan
- Department of Anesthesiology, Perioperative Medicine and Pain, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
| | - Houman Javedan
- Division of Aging, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
| | - Angela M. Bader
- Department of Anesthesiology, Perioperative Medicine and Pain, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Samir Tulabaev
- Division of Aging, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
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Rallapalli V, Schauer J, Souza P. Preference for Combinations of Hearing Aid Signal Processing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3100-3116. [PMID: 35881878 DOI: 10.1044/2022_jslhr-22-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to determine how multiple types of signal processing activated together influence listeners' preferences. METHOD Participants were adults with mild to moderately severe sensorineural hearing loss. Stimuli were spatialized low-context sentences mixed with six-talker babble at 3 and 8 dB signal-to-noise ratios (SNRs). Stimuli were processed with three common hearing aid processing algorithms: wide dynamic range compression (WDRC), frequency compression (FC), and digital noise reduction (DNR). A full-factorial design with two levels for each algorithm (WDRC & DNR: mild versus strong; FC: ON versus OFF; clinically relevant ranges) was evaluated. Preference was measured using a paired-comparison task within a choice-based conjoint analysis framework. Remote data collection methods were used. A signal fidelity metric quantified the acoustic effects across conditions. RESULTS At 3 dB SNR, participants preferred a combination of Slow WDRC and Mild DNR, although the mean preference was small (odds ratio close to 1). At both SNRs when Strong DNR was used, Fast WDRC was preferred over Slow WDRC. This may be related to signal fidelity, which was lower for the combination of Fast WDRC and Mild DNR and higher for the combination of Slow WDRC and either Mild DNR or Strong DNR. There was no effect of FC on preference or signal fidelity. CONCLUSIONS WDRC and DNR together influenced both listeners' preferences and signal fidelity in the investigated listening conditions. On average, the small effect sizes suggest that minor fine-tuning adjustments to hearing aid algorithms may not result in a substantial change in clinical outcomes.
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Affiliation(s)
- Varsha Rallapalli
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jacob Schauer
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pamela Souza
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Knowles Hearing Center, Northwestern University, Evanston, IL
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45
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Wichmann S, Itenov TS, Berthelsen RE, Lange T, Perner A, Gluud C, Lawson-Smith P, Nebrich L, Wiis J, Brøchner AC, Hildebrandt T, Behzadi MT, Strand K, Andersen FH, Strøm T, Järvisalo M, Damgaard KAJ, Vang ML, Wahlin RR, Sigurdsson MI, Thormar KM, Ostermann M, Keus F, Bestle MH. Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: a trial protocol for a randomised, blinded trial (GODIF Trial). Acta Anaesthesiol Scand 2022; 66:1138-1145. [PMID: 35898170 PMCID: PMC9541596 DOI: 10.1111/aas.14121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
Background Fluid overload is a risk factor for mortality in intensive care unit (ICU) patients. Administration of loop diuretics is the predominant treatment of fluid overload, but evidence for its benefit is very uncertain when assessed in a systematic review of randomised clinical trials. The GODIF trial will assess the benefits and harms of goal directed fluid removal with furosemide versus placebo in ICU patients with fluid overload. Methods An investigator‐initiated, international, randomised, stratified, blinded, parallel‐group trial allocating 1000 adult ICU patients with fluid overload to infusion of furosemide versus placebo. The goal is to achieve a neutral fluid balance. The primary outcome is days alive and out of hospital 90 days after randomisation. Secondary outcomes are all‐cause mortality at day 90 and 1‐year after randomisation; days alive at day 90 without life support; number of participants with one or more serious adverse events or reactions; health‐related quality of life and cognitive function at 1‐year follow‐up. A sample size of 1000 participants is required to detect an improvement of 8% in days alive and out of hospital 90 days after randomisation with a power of 90% and a risk of type 1 error of 5%. The conclusion of the trial will be based on the point estimate and 95% confidence interval; dichotomisation will not be used. ClinicalTrials.gov identifier: NCT04180397. Perspective The GODIF trial will provide important evidence of possible benefits and harms of fluid removal with furosemide in adult ICU patients with fluid overload.
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Affiliation(s)
- Sine Wichmann
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Theis S Itenov
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Rasmus E Berthelsen
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia Lawson-Smith
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Jørgen Wiis
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, University Hospital of Southern Denmark, Kolding, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Meike T Behzadi
- Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Finn H Andersen
- Department of Intensive Care, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway.,Department of Circulation and Medical Imaging, Faculty of medicine and health science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Strøm
- Department of Anaesthesia and Intensive Care, Sygehus Sønderjylland, Aabenraa, Denmark
| | - Mikko Järvisalo
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Kjeld A J Damgaard
- Department of Anaesthesia and Intensive Care, Regionshospital Nordjylland, Hjørring, Denmark
| | - Marianne L Vang
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Rebecka R Wahlin
- Department of Anaesthesia and Intensive Care, Södersjukhuset AB, Stockholm, Sweden
| | - Martin I Sigurdsson
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Icelandi
| | - Katrin M Thormar
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St. Thomas' Foundation Trust, London, UK
| | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Morten H Bestle
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Valdes E, Fuchs B, Morrison C, Charvet L, Lewis A, Thawani S, Balcer L, Galetta SL, Wisniewski T, Frontera JA. Demographic and social determinants of cognitive dysfunction following hospitalization for COVID-19. J Neurol Sci 2022; 438:120146. [PMID: 35031121 PMCID: PMC8739793 DOI: 10.1016/j.jns.2022.120146] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/28/2021] [Accepted: 01/04/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Persistent cognitive symptoms have been reported following COVID-19 hospitalization. We investigated the relationship between demographics, social determinants of health (SDOH) and cognitive outcomes 6-months after hospitalization for COVID-19. METHODS We analyzed 6-month follow-up data collected from a multi-center, prospective study of hospitalized COVID-19 patients. Demographic and SDOH variables (age, race/ethnicity, education, employment, health insurance status, median income, primary language, living arrangements, and pre-COVID disability) were compared between patients with normal versus abnormal telephone Montreal Cognitive Assessments (t-MOCA; scores<18/22). Multivariable logistic regression models were constructed to evaluate predictors of t-MoCA. RESULTS Of 382 patients available for 6-month follow-up, 215 (56%) completed the t-MoCA (n = 109/215 [51%] had normal and n = 106/215 [49%] abnormal results). 14/215 (7%) patients had a prior history of dementia/cognitive impairment. Significant univariate predictors of abnormal t-MoCA included older age, ≤12 years of education, unemployment pre-COVID, Black race, and a pre-COVID history of cognitive impairment (all p < 0.05). In multivariable analyses, education ≤12 years (adjusted OR 5.21, 95%CI 2.25-12.09), Black race (aOR 5.54, 95%CI 2.25-13.66), and the interaction of baseline functional status and unemployment prior to hospitalization (aOR 3.98, 95%CI 1.23-12.92) were significantly associated with abnormal t-MoCA scores after adjusting for age, history of dementia, language, neurological complications, income and discharge disposition. CONCLUSIONS Fewer years of education, Black race and unemployment with baseline disability were associated with abnormal t-MoCA scores 6-months post-hospitalization for COVID-19. These associations may be due to undiagnosed baseline cognitive dysfunction, implicit biases of the t-MoCA, other unmeasured SDOH or biological effects of SARS-CoV-2.
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Affiliation(s)
- Eduard Valdes
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Benjamin Fuchs
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Chris Morrison
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sujata Thawani
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
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Stallmach A, Kesselmeier M, Bauer M, Gramlich J, Finke K, Fischer A, Fleischmann-Struzek C, Heutelbeck A, Katzer K, Mutschke S, Pletz MW, Quickert S, Reinhart K, Stallmach Z, Walter M, Scherag A, Reuken PA. Comparison of fatigue, cognitive dysfunction and psychological disorders in post-COVID patients and patients after sepsis: is there a specific constellation? Infection 2022; 50:661-669. [PMID: 34997542 PMCID: PMC8741139 DOI: 10.1007/s15010-021-01733-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sequelae of COVID-19 can be severe and longlasting. We compared frequencies of fatigue, depression and cognitive dysfunction in survivors of SARS-CoV-2-infection and sepsis. METHODS We performed a prospective cohort study of 355 symptomatic post-COVID patients who visited our out-patient clinic for post-COVID-19 care. We compared them with 272 symptomatic patients from the Mid-German Sepsis Cohort, which investigates the long-term courses of sepsis survivors. Possible predictors for frequent clinical findings (fatigue, signs of depression, cognitive dysfunction) in post-COVID were investigated with multivariable logistic regression. RESULTS Median age of the post-COVID patients was 51 years (range 17-86), 60.0% were female, and 31.8% required hospitalization during acute COVID-19. In the post-COVID patients (median follow-up time: 163 days) and the post-sepsis patients (180 days), fatigue was found in 93.2% and 67.8%, signs of depression were found in 81.3% and 10.9%, and cognitive dysfunction was found in 23.5% and 21.3%, respectively. In post-COVID, we did not observe an association between fatigue or depression and the severity of acute COVID-19. In contrast, cognitive dysfunction was associated with hospitalization (out-patient versus in-patient) and more frequent in post-COVID patients treated on an ICU compared to the MSC patients. CONCLUSION In post-COVID patients, fatigue and signs of depression are more common than in sepsis survivors, independent from the acute SARS-CoV-2-infection. In contrast, cognitive dysfunction is associated with hospitalization. Despite the differences in frequencies, owing to the similarity of post-COVID and post-sepsis sequelae, this knowledge may help in implementing follow-up approaches after SARS-CoV-2 infection.
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Affiliation(s)
- Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany.
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany.
| | - Miriam Kesselmeier
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Michael Bauer
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Judith Gramlich
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Anne Fischer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Carolin Fleischmann-Struzek
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Astrid Heutelbeck
- Occupational, Social and Environmental Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Katrin Katzer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Stephanie Mutschke
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefanie Quickert
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Konrad Reinhart
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Zoe Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
| | - Martin Walter
- Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - André Scherag
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, Am Klinikum 1, 07743, Jena, Germany
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48
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Neal J, Hutchings PB, Phelps C, Williams D. Football and Dementia: Understanding the Link. Front Psychiatry 2022; 13:849876. [PMID: 35693952 PMCID: PMC9184440 DOI: 10.3389/fpsyt.2022.849876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Football, also known as soccer or association football, is popular but has a potential link with dementia developing in retired players. The FA and soccer regulators in the USA have imposed guidelines limiting players exposure to heading, despite controversy whether this dementia is caused by heading the ball, a form of mild repetitive head injury (RHI), over many years. Substantial data exist showing that many ex-North American Football players develop a specific neurodegenerative disease: chronic traumatic encephalopathy (CTE), the neuropathological disorder of boxers. In the United Kingdom evidence for the neuropathological basis of footballers' dementia has been slow to emerge. A 2017 study revealed that in six ex-soccer players four had CTE with Alzheimer's disease (AD) and two had AD. A 2019 study showed that ex-footballers were 3.5 times more likely to die from dementia or other neuro-degenerative diseases than matched controls. We argue that in childhood and adolescence the brain is vulnerable to heading, predicated on its disproportionate size and developmental immaturity. RHI in young individuals is associated with early neuroinflammation, a potential trigger for promoting neurodegeneration in later life. Evidence is available to support the guidelines limiting heading for players of all ages, while professional and non-players should be included in prospective studies to investigate the link between soccer and dementia.
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Affiliation(s)
- James Neal
- Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Paul B Hutchings
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
| | - Ceri Phelps
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
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49
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Yang C, Zhang T, Huang K, Xiong M, Liu H, Wang P, Zhang Y. Increased both cortical activation and functional connectivity after transcranial direct current stimulation in patients with post-stroke: A functional near-infrared spectroscopy study. Front Psychiatry 2022; 13:1046849. [PMID: 36569623 PMCID: PMC9784914 DOI: 10.3389/fpsyt.2022.1046849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have shown that cognitive impairment is common after stroke. Transcranial direct current stimulation (tDCS) is a promising tool for rehabilitating cognitive impairment. This study aimed to investigate the effects of tDCS on the rehabilitation of cognitive impairment in patients with stroke. METHODS Twenty-two mild-moderate post-stroke patients with cognitive impairments were treated with 14 tDCS sessions. A total of 14 healthy individuals were included in the control group. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cortical activation was assessed using functional near-infrared spectroscopy (fNIRS) during the verbal fluency task (VFT). RESULTS The cognitive function of patients with stroke, as assessed by the MMSE and MoCA scores, was lower than that of healthy individuals but improved after tDCS. The cortical activation of patients with stroke was lower than that of healthy individuals in the left superior temporal cortex (lSTC), right superior temporal cortex (rSTC), right dorsolateral prefrontal cortex (rDLPFC), right ventrolateral prefrontal cortex (rVLPFC), and left ventrolateral prefrontal cortex (lVLPFC) cortical regions. Cortical activation increased in the lSTC cortex after tDCS. The functional connectivity (FC) between the cerebral hemispheres of patients with stroke was lower than that of healthy individuals but increased after tDCS. CONCLUSION The cognitive and brain functions of patients with mild-to-moderate stroke were damaged but recovered to a degree after tDCS. Increased cortical activation and increased FC between the bilateral cerebral hemispheres measured by fNIRS are promising biomarkers to assess the effectiveness of tDCS in stroke.
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Affiliation(s)
- Caihong Yang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.,School of Psychology, Central China Normal University, Wuhan, Hubei, China
| | - Tingyu Zhang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Kaiqi Huang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Menghui Xiong
- Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.,Department of Rehabilitation Medicine, Tianyang District People's Hospital, Baise, Guangxi, China
| | - Yan Zhang
- School of Educational Science, Huazhong University of Science and Technology, Wuhan, Hubei, China
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50
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Cerino ES, Katz MJ, Wang C, Qin J, Gao Q, Hyun J, Hakun JG, Roque NA, Derby CA, Lipton RB, Sliwinski MJ. Variability in Cognitive Performance on Mobile Devices Is Sensitive to Mild Cognitive Impairment: Results From the Einstein Aging Study. Front Digit Health 2021; 3:758031. [PMID: 34927132 PMCID: PMC8677835 DOI: 10.3389/fdgth.2021.758031] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background and Objective: Within-person variability in cognitive performance has emerged as a promising indicator of cognitive health with potential to distinguish normative and pathological cognitive aging. We use a smartphone-based digital health approach with ecological momentary assessments (EMA) to examine differences in variability in performance among older adults with mild cognitive impairment (MCI) and those who were cognitively unimpaired (CU). Method: A sample of 311 systematically recruited, community-dwelling older adults from the Einstein Aging Study (Mean age = 77.46 years, SD = 4.86, Range = 70-90; 67% Female; 45% Non-Hispanic White, 40% Non-Hispanic Black) completed neuropsychological testing, neurological assessments, and self-reported questionnaires. One hundred individuals met Jak/Bondi criteria for MCI. All participants performed mobile cognitive tests of processing speed, visual short-term memory binding, and spatial working memory on a smartphone device up to six times daily for 16 days, yielding up to 96 assessments per person. We employed heterogeneous variance multilevel models using log-linear prediction of residual variance to simultaneously assess cognitive status differences in mean performance, within-day variability, and day-to-day variability. We further tested whether these differences were robust to the influence of environmental contexts under which assessments were performed. Results: Individuals with MCI exhibited greater within-day variability than those who were CU on ambulatory assessments that measure processing speed (p < 0.001) and visual short-term memory binding (p < 0.001) performance but not spatial working memory. Cognitive status differences in day-to-day variability were present only for the measure of processing speed. Associations between cognitive status and within-day variability in performance were robust to adjustment for sociodemographic and contextual variables. Conclusion: Our smartphone-based digital health approach facilitates the ambulatory assessment of cognitive performance in older adults and the capacity to differentiate individuals with MCI from those who were CU. Results suggest variability in mobile cognitive performance is sensitive to MCI and exhibits dissociative patterns by timescale and cognitive domain. Variability in processing speed and visual short-term memory binding performance may provide specific detection of MCI. The 16-day smartphone-based EMA measurement burst offers novel opportunity to leverage digital technology to measure performance variability across frequent assessments for studying cognitive health and identifying early clinical manifestations of cognitive impairment.
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Affiliation(s)
- Eric S. Cerino
- Department of Psychological Sciences, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, AZ, United States
- Center for Healthy Aging, College of Health and Human Development, Pennsylvania State University, University Park, PA, United States
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Cuiling Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jiyue Qin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Qi Gao
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jinshil Hyun
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jonathan G. Hakun
- Center for Healthy Aging, College of Health and Human Development, Pennsylvania State University, University Park, PA, United States
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Nelson A. Roque
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Carol A. Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Martin J. Sliwinski
- Center for Healthy Aging, College of Health and Human Development, Pennsylvania State University, University Park, PA, United States
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