1
|
O’Connell ME, Kadlec H, Griffith LE, Wolfson C, Maimon G, Taler V, Kirkland S, Raina P. Cognitive impairment indicator for the neuropsychological test batteries in the Canadian Longitudinal Study on Aging: definition and evidence for validity. Alzheimers Res Ther 2023; 15:167. [PMID: 37798677 PMCID: PMC10552318 DOI: 10.1186/s13195-023-01317-3] [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: 01/21/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Prevalence of overall cognitive impairment based on each participant's performance across a neuropsychological battery is challenging; consequently, we define and validate a dichotomous cognitive impairment/no cognitive indicator (CII) using a neuropsychological battery administered in a population-based study. This CII approximates the clinical practice of interpretation across a neuropsychological battery and can be applied to any neuropsychological dataset. METHODS Using data from participants aged 45-85 in the Canadian Longitudinal Study on Aging receiving a telephone-administered neuropsychological battery (Tracking, N = 21,241) or a longer in-person battery (Comprehensive, N = 30,097), impairment was determined for each neuropsychological test based on comparison with normative data. We adjusted for the joint probability of abnormally low scores on multiple neuropsychological tests using baserates of low scores demonstrated in the normative samples and created a dichotomous CII (i.e., cognitive impairment vs no cognitive impairment). Convergent and discriminant validity of the CII were assessed with logistic regression analyses. RESULTS Using the CII, the prevalence of cognitive impairment was 4.3% in the Tracking and 5.0% in the Comprehensive cohorts. The CII demonstrated strong convergent and discriminant validity. CONCLUSIONS The approach for the CII is a feasible method to identify participants who demonstrate cognitive impairment on a battery of tests. These methods can be applied in other epidemiological studies that use neuropsychological batteries.
Collapse
Affiliation(s)
- Megan E. O’Connell
- Department of Psychology and Health Studies, University of Saskatchewan, 9 Campus Drive, Arts 182, Saskatoon, SK S7N 5A5 Canada
| | - Helena Kadlec
- Institute On Aging & Lifelong Health, University of Victoria, STN CSC, PO Box 1700, Victoria, BC V8W 2Y2 Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 175 Longwood Rd. S. Suite 309a, Hamilton, ON L8P 0A1 Canada
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, School of Population and Global Health, McGill University, 2001 McGill College Avenue Suite 1200, Montreal, QC H3A 1G1 Canada
| | - Geva Maimon
- CLSA Data Curation Centre, Research Institute of the McGill University Health Centre, 2155 Guy Street, 4th Floor, Montreal, QC H3H 2R9 Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
| | - Susan Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7 Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster Institute for Research On Aging & Labarge Centre for Mobility in Aging, McMaster University, MIP Suite 309A, 1280 Main St. W, Hamilton, ON L8S 4K1 Canada
| |
Collapse
|
2
|
Taylor JL, Barnes JN, Johnson BD. The Utility of High Intensity Interval Training to Improve Cognitive Aging in Heart Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16926. [PMID: 36554807 PMCID: PMC9778921 DOI: 10.3390/ijerph192416926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Adults with cardiovascular disease and heart failure are at higher risk of cognitive decline. Cerebral hypoperfusion appears to be a significant contributor, which can result from vascular dysfunction and impairment of cerebral blood flow regulation. In contrast, higher cardiorespiratory fitness shows protection against brain atrophy, reductions in cerebral blood flow, and cognitive decline. Given that high intensity interval training (HIIT) has been shown to be a potent stimulus for improving cardiorespiratory fitness and peripheral vascular function, its utility for improving cognitive aging is an important area of research. This article will review the physiology related to cerebral blood flow regulation and cognitive decline in adults with cardiovascular disease and heart failure, and how HIIT may provide a more optimal stimulus for improving cognitive aging in this population.
Collapse
Affiliation(s)
- Jenna L. Taylor
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Jill N. Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| |
Collapse
|
4
|
Kitagawa T, Hidaka T, Watanabe N, Naka M, Yamaguchi M, Kanai K, Isobe M, Kihara Y, Nakano Y. Current conditions and significance of outpatient cardiac rehabilitation and home nursing-care services in heart failure patients with mid-range or preserved ejection fraction: post-hoc analysis of the REAL-HF registry. Heart Vessels 2021; 37:745-754. [PMID: 34731295 DOI: 10.1007/s00380-021-01965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
The effects of outpatient cardiac rehabilitation (OCR) implementation and home nursing-care services (HNS) use are not well defined in patients with heart failure (HF) with mid-range or preserved left-ventricular ejection fraction (EF) (HFmrEF or HFpEF). Through a post-hoc analysis of the HF registry in Hiroshima Prefecture of Japan (REAL-HF), we investigated the current conditions and significance of OCR and HNS in HFmrEF or HFpEF patients. The REAL-HF enrolled adult patients hospitalized with HF in eight regional core hospitals. Patients discharged home were followed for conditions of OCR and HNS and the primary endpoints (all-cause death or unscheduled readmission) for 1 year. The patients were classified into HF with reduced EF (< 40%) (HFrEF) or HFmrEF (40% ≤ EF < 50%) or HFpEF (EF ≥ 50%) group. We followed 195 HFrEF and 381 HFmrEF or HFpEF patients. OCR was generally underutilized, especially in HFmrEF or HFpEF patients (rate of completion [5-month program], 3.2%), whereas HFmrEF or HFpEF patients were more likely to use HNS after discharge home than HFrEF patients (44.1% vs. 27.2%, P < 0.0001). Patients with the use of HNS generally had lower scores of Mini-Mental State Examination and EuroQol 5 dimensions than those without. Multivariate analysis adjusted for medical and social factors showed that the completion of OCR was a strong negative predictor of the primary endpoints both in HFrEF (hazard ratio [HR] 0.10; 95% confidence interval [CI] 0.01-0.75; P = 0.025) and HFmrEF or HFpEF (HR 0.11; 95% CI 0.01-0.78; P = 0.028) patients, whereas the use of HNS was a positive predictor only in HFmrEF or HFpEF patients (HR 1.41; 95% CI 1.00-1.97; P = 0.047). In conclusion, continuous OCR, despite its inadequate implementation, was associated with favorable overall outcomes, while the necessity for HNS related to impaired cognitive function and quality of life was associated with poorer overall outcomes in HFmrEF or HFpEF patients discharged home. Further study is warranted to fully consider the factors related to OCR implementation and HNS use.
Collapse
Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan. .,Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.,Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.,Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Makiko Naka
- Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Mizuho Yamaguchi
- Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Kana Kanai
- Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.,Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.,Heart Failure Center, Hiroshima University Hospital, Hiroshima, Japan
| | | |
Collapse
|
5
|
Smith JM, Lee AC, Zeleznik H, Coffey Scott JP, Fatima A, Needham DM, Ohtake PJ. Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome. Phys Ther 2020; 100:1062-1073. [PMID: 32280993 PMCID: PMC7188154 DOI: 10.1093/ptj/pzaa059] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
Abstract
More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.
Collapse
Affiliation(s)
- James M Smith
- Physical Therapy Department, Utica College, 1600 Burrstone Road, Utica, NY 13502 (USA),Address all correspondence to Dr Smith at:
| | - Alan C Lee
- Department of Physical Therapy, Mount St Mary’s University, Los Angeles, California
| | - Hallie Zeleznik
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Arooj Fatima
- Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Pulmonary & Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins University
| | - Patricia J Ohtake
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York
| |
Collapse
|