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Jung M, Smith AB, Giordani B, Clark DG, Gradus-Pizlo I, Wierenga KL, Lake KR, Pressler SJ. Computerized Cognitive Training and 24-Month Mortality in Heart Failure. J Cardiovasc Nurs 2024; 39:E51-E58. [PMID: 37494830 PMCID: PMC10808269 DOI: 10.1097/jcn.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Cognitive dysfunction predicts mortality in heart failure (HF). Computerized cognitive training (CCT) has shown preliminary efficacy in improving cognitive function. However, the relationship between CCT and mortality is unclear. Aims were to evaluate (1) long-term efficacy of CCT in reducing 24-month mortality and (2) age, HF severity, global cognition, memory, working memory, depressive symptoms, and health-related quality of life as predictors of 24-month mortality among patients with HF. METHODS In this prospective longitudinal study, 142 patients enrolled in a 3-arm randomized controlled trial were followed for 24 months. Logistic regression was used to achieve the aims. RESULTS Across 24 months, 16 patients died (CCT, 8.3%; control groups, 12.8%). Computerized cognitive training did not predict 24-month mortality (odds ratio [OR], 0.65). Older age (OR, 1.08), worse global cognition (OR, 0.73), memory (OR, 0.81), and depressive symptoms (OR, 1.10) at baseline predicted 24-month mortality. CONCLUSIONS Efficacious interventions are needed to improve global cognition, memory, and depressive symptoms and reduce mortality in HF.
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Affiliation(s)
- Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Asa B. Smith
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Bruno Giordani
- University of Michigan, School of Medicine Department of Psychiatry Michigan Alzheimer’s Disease Research Center, Suite C, 2101 Commonwealth Blvd. Ann Arbor MI 48105
| | - David G. Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA 92868-32988
| | - Kelly L. Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
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Pressler SJ, Jung M, Giordani B, Titler MG, Gradus-Pizlo I, Lake KR, Wierenga KL, Clark DG, Perkins SM, Smith DG, Mocci E, Dorsey SG. Evaluating depressive symptoms, BDNF Val66Met, and APOE-ε4 as moderators of response to computerized cognitive training in heart failure. Heart Lung 2023; 59:146-156. [PMID: 36805256 PMCID: PMC10065971 DOI: 10.1016/j.hrtlng.2023.02.002] [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: 09/09/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). OBJECTIVES The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). METHODS 256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. RESULTS As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. CONCLUSIONS Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center and Department of Psychiatry, Suite C, 2101 Commonwealth Blvd., Ann Arbor, MI 48105, United States.
| | - Marita G Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109-5482, United States.
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA 92868-32988, United States.
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Kelly L Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - David G Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202, United States.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, United States.
| | - Dean G Smith
- Louisiana State University School of Public Health 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112.
| | - Evelina Mocci
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
| | - Susan G Dorsey
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
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Mhanna M, Sauer MC, Al-Abdouh A, Jabri A, Abusnina W, Safi M, Beran A, Mansour S. Cognitive behavioral therapy for depression in patients with heart failure: a systematic review and metanalysis of randomized control trials. Heart Fail Rev 2023:10.1007/s10741-023-10308-3. [PMID: 37017817 DOI: 10.1007/s10741-023-10308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/06/2023]
Abstract
Major depression (MD) is prevalent in patients with heart failure (HF) and contributes to increased risk of hospitalization and mortality. The implementation of cognitive behavioral therapy (CBT) has become a key strategy for treating HF patients' depression. We performed a comprehensive literature search for studies that evaluated the efficacy of adjunctive CBT compared to the standard of care (SOC) in HF patients with MD. The primary outcome was the depression scale (post-intervention and by the end of follow-up). The secondary outcomes were the quality of life (QoL), self-care scores, and 6-min walk test distance(6-MW). The standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A total of 6 RCTs with 489 patients (244 in the CBT group and 245 in the SOC group) were included. As compared to the SOC, CBT was associated with a statistically significant improvement in the post-interventional depression scale (SMD: -0.45, 95%CI: -0.69, -0.21; P < 0.01) and by the end of follow-up (SMD: -0.68, 95%CI: -0.87, -0.49; P < 0.01). Furthermore, CBT significantly improved the QoL (SMD: -0.45, 95%CI: -0.65, -0.24; P < 0.01). However, there were no differences in the self-care scores (SMD: 0.17, 95%CI: -0.08, 0.42; P = 0.18) or in 6-MW (SMD: 0.45, 95%CI: -0.39, 1.28; P = 0.29) between the two groups. According to our meta-analysis of published clinical studies, CBT may be more effective than standard therapy at enhancing depression scores and quality of life. To assess the long-term clinical effects of CBT in heart failure patients, larger and more powerful RCTs are required.
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Affiliation(s)
- Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, 200 Hawkins Dr, E 315GH, Iowa City, USA.
| | - Michael C Sauer
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Ahmad Jabri
- Department of Cardiology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA
| | - Waiel Abusnina
- Division of Cardiology, Creighton University, Omaha, NE, USA
| | - Mohammed Safi
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Azizullah Beran
- Department of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Shareef Mansour
- Division of Cardiology, Department of Medicine, University of Iowa, 200 Hawkins Dr, E 315GH, Iowa City, USA
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Wu Y, Chen L, Zhong F, Zhou K, Lu C, Cheng X, Wang S. Cognitive impairment in patients with heart failure: molecular mechanism and therapy. Heart Fail Rev 2023:10.1007/s10741-022-10289-9. [PMID: 36593370 DOI: 10.1007/s10741-022-10289-9] [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] [Accepted: 11/28/2022] [Indexed: 01/04/2023]
Abstract
Heart failure (HF) is associated with multiple organ dysfunction and many comorbidities. Its incidence is high among the elderly and is a major health burden worldwide. Cognitive impairment (CI) is highly prevalent in older patients with HF, which is an abnormality in one or more of the items of cognition, attention, memory, language, psychomotor function, and visual spatial acuity. Studies have shown that the incidence of CI in HF patients is between 13 and 54%, and patients with both conditions have poor self-care ability and prognosis, as well as increased mortality rates. However, the mechanisms of CI development in HF patients are still unclear. In this review, we describe the epidemiology and risk factors as well as measures of improving CI in HF patients. We update the latest pathophysiological mechanisms related to the neurocognitive changes in HF patients, expounding on the mechanisms associated with the development of CI in HF patients.
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Affiliation(s)
- Yanan Wu
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Liwen Chen
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Feng Zhong
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kaiyi Zhou
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Chao Lu
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xiao Cheng
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
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Pressler SJ, Jung M, Gradus-Pizlo I, Titler M, Smith D, Gao S, Lake KR, Burney H, Clark D, Wierenga K, Dorsey SG, Giordani B. Randomized Controlled Trial of a Cognitive Intervention to Improve Memory in Heart Failure. J Card Fail 2021; 28:519-530. [PMID: 34763080 DOI: 10.1016/j.cardfail.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The objective of this 3-arm randomized controlled trial was to evaluate efficacy of computerized cognitive training (CCT) to improve primary outcomes of delayed recall memory and serum brain-derived neurotrophic factor (BDNF) levels and secondary outcomes of working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL) among patients with heart failure (HF). METHODS AND RESULTS Patients (N = 256) were randomly assigned to 8 weeks of CCT using BrainHQ, computerized crossword puzzles active control intervention, and usual care. All patients received weekly nurse enhancement interventions. Data were collected at enrollment and baseline visits and at 10 weeks and 4 and 8 months. In mixed effects models, there were no statistically significant group or group by time differences in outcomes. There were statistically significant differences over time in all outcomes in all groups. Patients improved over time on measures of delayed recall memory, working memory, IADL, and HRQL and had decreased serum BDNF. CONCLUSIONS CCT did not improve outcomes compared with the active control intervention and usual care. Nurse enhancement interventions may have led to improved outcomes over time. Future studies are needed to test nurse enhancement interventions in combination with other cognitive interventions to improve memory in HF. LAYSUMMARY In 256 patients with heart failure, 8 weeks of computerized cognitive training, computerized crossword puzzles, or usual care were studied for effects on (1st) recall memory and serum brain-derived neurotrophic factor (BDNF) and (2nd) working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL). Measurements were at baseline, 10 weeks, 4- and 8-months. Nurse enhancement interventions (e.g., support, assessment) were provided. Recall memory, working memory, IADL, and HRQL improved over time. There were no statistically significant differences among treatment groups over time. BDNF unexpectedly decreased. Nurse enhancement interventions may explain improved outcomes. Future studies are needed.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA
| | - Marita Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, Michigan 48109-5482
| | - Dean Smith
- Louisiana State University School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Heather Burney
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - David Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202
| | - Kelly Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Susan G Dorsey
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21201
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center, Suite C, 2101 Commonwealth Blvd. Ann Arbor MI 48105
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Shyu YIL, Lin CC, Kwok YT, Shyu HY, Kuo LM. A community-based computerised cognitive training program for older persons with mild dementia: A pilot study. Australas J Ageing 2021; 41:e82-e93. [PMID: 34036705 DOI: 10.1111/ajag.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 02/19/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Computerised cognitive training programs can improve cognitive function in patients with moderate-to-severe dementia or brain injuries and healthy older adults. However, most previous studies were not randomised controlled trials and did not examine older adults with mild dementia. The current study sought to analyse the effects of a computerised cognitive training program using a randomised controlled trial. METHODS In a single-blinded randomised clinical trial, 30 older individuals with mild dementia were split into an experimental (n = 15) and a control (n = 15) group to analyse the effects of a computerised cognitive training program. Outcomes were assessed before and after each program session, and 1 and 3 months afterwards. RESULTS Participants in the experimental group had better overall subjective memory, subjective retrospective memory and global quality of life, with fewer depressive symptoms than those in the control group 3 months following the program. CONCLUSIONS Our computerised cognitive training program improved subjective memory and quality of life in patients with mild dementia and decreased their depressive symptoms. These results may be useful for health-care providers caring for people with mild dementia.
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Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yam-Ting Kwok
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Hann-Yeh Shyu
- Division of Neurology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Li-Min Kuo
- Department of Gerontological Health Care, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Halloway S, Schoeny ME, Barnes LL, Arvanitakis Z, Pressler SJ, Braun LT, Volgman AS, Gamboa C, Wilbur J. A study protocol for MindMoves: A lifestyle physical activity and cognitive training intervention to prevent cognitive impairment in older women with cardiovascular disease. Contemp Clin Trials 2021; 101:106254. [PMID: 33383230 PMCID: PMC7954878 DOI: 10.1016/j.cct.2020.106254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition. METHODS The study design is a randomized controlled trial with a 2 × 2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1) Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks. DISCUSSION This study will test efficacy of a lifestyle-focused intervention to prevent or delay cognitive impairment in older women with CVD and may identify relevant serum biomarkers that could be used as early indicators of intervention response.
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Affiliation(s)
- Shannon Halloway
- Rush University, College of Nursing, 600 S. Paulina, Suite 1080, Chicago, IL 60612, USA.
| | - Michael E Schoeny
- Rush University, College of Nursing, 600 S. Paulina, Suite 1080, Chicago, IL 60612, USA.
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, 1750 W. Harrison, Chicago, IL 60612, USA.
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center, 1750 W. Harrison, Chicago, IL 60612, USA; Rush Medical College, 600 S. Paulina Street, Suite 524, Chicago, IL 60612, USA.
| | - Susan J Pressler
- Indiana University, School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Lynne T Braun
- Rush University, College of Nursing, 600 S. Paulina, Suite 1080, Chicago, IL 60612, USA.
| | | | - Charlene Gamboa
- Rush University, College of Nursing, 600 S. Paulina, Suite 1080, Chicago, IL 60612, USA.
| | - JoEllen Wilbur
- Rush University, College of Nursing, 600 S. Paulina, Suite 1080, Chicago, IL 60612, USA.
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Ku M, Gates P, Renehan S. Feasibility of an online cognitive rehabilitation programme in patients with a haematological malignancy undergoing autologous stem cell transplantation. Intern Med J 2021; 51:1665-1672. [PMID: 33465274 DOI: 10.1111/imj.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/25/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chemotherapy-related cognitive impairment (CRCI) is a known adverse event that can impact cancer survivors, resulting in long-standing effect on quality of life and activities of daily living. Currently, there is limited knowledge regarding the aetiology and therapy for CRCI. Although CRCI following autologous stem cell transplantation (AuSCT) is emerging as a potentially significant concern for patients with underlying haematological malignancies, it is an area that requires further research. AIMS This pilot study aimed to assess (i) the prevalence of CRCI in patients with haematological malignancies both pre-AuSCT and post-AuSCT and (ii) the feasibility of a cognitive rehabilitation programme (CRP) in survivorship care post-AuSCT. METHODS Over a 12-month period, consecutive patients planned for AuSCT were approached for the study. Enrolled patients were administered a 9-week course of CRP, commencing day 40 ± 5 post-AuSCT. Participants were evaluated using a neuropsychological tool and validated questionnaires at baseline, pre-CRP (day 40 ± 5 post-AuSCT), post-CRP and 6 months post-CRP. RESULTS Thirty-two patients were enrolled. The mean age was 59 years (SD = 11.5), 23 (72%) were male and 18 (56%) had multiple myeloma. Participants reported high satisfaction using the CRP, and most devoted significant amount of time as requested. CONCLUSIONS While there appeared to be a low incidence of significant CRCI in our patient population, the incorporation of CRP in survivorship care appeared to be feasible. A larger randomised study examining the efficacy of CRP should be further explored.
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Affiliation(s)
- Matthew Ku
- Department of Clinical Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Priscilla Gates
- Autologous Bone Marrow Transplant/Survivorship, Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia.,Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Steffi Renehan
- Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
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Pressler SJ, Giordani B, Titler M, Gradus-Pizlo I, Smith D, Dorsey SG, Gao S, Jung M. Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study. J Cardiovasc Nurs 2019; 33:344-355. [PMID: 29601367 PMCID: PMC5995611 DOI: 10.1097/jcn.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.
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Affiliation(s)
- Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
| | - Bruno Giordani
- University of Michigan School of Medicine, Neuropsychology Program, Department of Psychiatry, 2101 Commonwealth Dr., Ste. C, Ann Arbor, MI 48104,
| | - Marita Titler
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109,
| | - Irmina Gradus-Pizlo
- University of California, Irvine, Division of Cardiology, 101 City Drive South, City Tower 400, Orange, CA 92868,
| | - Dean Smith
- Louisiana State University Health Sciences Center School of Public Health, 2020 Gravier St., New Orleans, LA 70112,
| | - Susan G. Dorsey
- University of Maryland School of Nursing Department of Pain and Transitional Symptom Science, Room 727, 655 West Lombard St., Baltimore, MD 21201,
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 W. 10 St., Suite 3000,
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
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Abstract
Cognitive behavioral therapy has emerged as an important approach to alleviate the depression of patients with heart failure. However, the use of cognitive behavioral therapy for heart failure has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of cognitive behavioral therapy for alleviating depression for heart failure.PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of cognitive behavioral therapy on heart failure are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model.Eight RCTs involving 480 patients are included in the meta-analysis. Compared with control intervention for heart failure, cognitive behavioral therapy can substantially decrease depression scale (Std. MD = -0.27; 95% CI = -0.47 to -0.06; P = 0.01), but has no substantial influence on the quality of life (Std. MD = 0.21; 95% CI = -0.01 to 0.42; P = 0.06), self-care scores (Std. MD = 0.12; 95% CI = -0.18 to 0.42; P = 0.44), and 6-minute walk test distance (Std. MD = 0; 95% CI = -0.28 to 0.28; P = 0.99).Cognitive behavioral therapy is associated with significantly decreased depression scale, but with no substantial impact on the quality of life, self-care scores, and 6-minute walk test distance for heart failure.
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Affiliation(s)
- Yan Peng
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Junjie Fang
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
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Abstract
BACKGROUND Cognitive impairment is highly prevalent in patients with heart failure (HF), negatively impacting self-care and consequently increasing mortality. Although computerized cognitive training (CCT) has been found to be efficacious in improving cognition in older adults, little is known about the efficacy of CCT in patients with HF. PURPOSE This brief systematic review examined the feasibility and efficacy of CCT on cognitive functioning in patients with HF. METHODS PubMed, Embase, and PsychINFO electronic databases were searched to identify randomized controlled trials (RCTs) of CCT in patients with HF published from January 1, 2000, to December 31, 2017. A narrative synthesis of intervention effectiveness on individual cognitive domains and functional outcomes was provided. Risk of bias of the studies was also rated. RESULTS The search yielded 4 RCTs describing 3 cognitive training interventions (n = 138). Preliminary evidence indicated that CCT may enhance the processing speed and working memory of patients with HF. Intervention effects also seemed to confer transferrable benefits to functional outcomes of daily living. The outcomes of the assembled studies were assessed using the Grades of Recommendation, Assessment, Development and Evaluation system, and the quality of the evidence was found to be of moderate to low quality. CONCLUSION Computerized cognitive trainings show promise in enhancing the cognition of patients with HF. The stability of the current findings would need to be tested in RCTs with larger sample sizes to validate the use of CCTs in targeting cognitive impairment and self-care abilities for patients with HF.
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Chialà O, Vellone E, Klompstra L, Ortali GA, Strömberg A, Jaarsma T. Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure. Heart Lung 2018; 47:465-470. [PMID: 30087002 DOI: 10.1016/j.hrtlng.2018.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity. OBJECTIVES The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients. METHODS This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment. RESULTS The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT. CONCLUSIONS The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients.
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Affiliation(s)
- Oronzo Chialà
- University of Rome Tor Vergata, Via Battaglioni d'Assalto, Rome 24 - 00143, Italy.
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Leonie Klompstra
- Department of Social and Welfare studies, Division of Nursing, Linköping University, Linköping, Sweden
| | | | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, and Department of Cardiology, Linköping University, Linköping, Sweden and Program in Nursing Science, University of California Irvine, Irvine, United States
| | - Tiny Jaarsma
- Department of Social and Welfare studies, Division of Nursing, Linköping University, Linköping, Sweden and Mary McKillop Institute, Australian Catholic University, Melbourne Australia
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Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update. Curr Heart Fail Rep 2017; 14:71-77. [PMID: 28213768 PMCID: PMC5357484 DOI: 10.1007/s11897-017-0324-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of the Review As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful. Recent Findings Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Summary Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.
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14
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.
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O’Brien JL, Lister JJ, Fausto BA, Clifton GK, Edwards JD. Cognitive Training Enhances Auditory Attention Efficiency in Older Adults. Front Aging Neurosci 2017; 9:322. [PMID: 29046634 PMCID: PMC5632656 DOI: 10.3389/fnagi.2017.00322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 09/19/2017] [Indexed: 11/24/2022] Open
Abstract
Auditory cognitive training (ACT) improves attention in older adults; however, the underlying neurophysiological mechanisms are still unknown. The present study examined the effects of ACT on the P3b event-related potential reflecting attention allocation (amplitude) and speed of processing (latency) during stimulus categorization and the P1-N1-P2 complex reflecting perceptual processing (amplitude and latency). Participants completed an auditory oddball task before and after 10 weeks of ACT (n = 9) or a no contact control period (n = 15). Parietal P3b amplitudes to oddball stimuli decreased at post-test in the trained group as compared to those in the control group, and frontal P3b amplitudes show a similar trend, potentially reflecting more efficient attentional allocation after ACT. No advantages for the ACT group were evident for auditory perceptual processing or speed of processing in this small sample. Our results provide preliminary evidence that ACT may enhance the efficiency of attention allocation, which may account for the positive impact of ACT on the everyday functioning of older adults.
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Affiliation(s)
- Jennifer L. O’Brien
- Department of Psychology, University of South Florida St. Petersburg, St. Petersburg, FL, United States
| | - Jennifer J. Lister
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL, United States
| | | | - Gregory K. Clifton
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL, United States
| | - Jerri D. Edwards
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of South Florida, Tampa, FL, United States
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Alcorn T, Hart E, Smith AE, Feuerriegel D, Stephan BCM, Siervo M, Keage HAD. Cross-sectional associations between metabolic syndrome and performance across cognitive domains: A systematic review. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:186-199. [DOI: 10.1080/23279095.2017.1363039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Tara Alcorn
- School of Psychology, Social Work and Social Policy, University of South Australia, Australia
| | - Elise Hart
- School of Psychology, Social Work and Social Policy, University of South Australia, Australia
| | - Ashleigh E. Smith
- Alliance for Research in Exercise Nutrition and Activity (ARENA), The Sansom Institute for Health Research, Health Sciences, University of South Australia, Australia
| | - Daniel Feuerriegel
- School of Psychology, Social Work and Social Policy, University of South Australia, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Blossom C. M. Stephan
- Institute of Health and Society and Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine and Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah A. D. Keage
- School of Psychology, Social Work and Social Policy, University of South Australia, Australia
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17
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Affiliation(s)
- Barbara Riegel
- From the School of Nursing, University of Pennsylvania, Philadelphia.
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Cognitive Outcomes of Cardiovascular Surgical Procedures in the Old: An Important but Neglected Area. Heart Lung Circ 2016; 25:1148-1153. [PMID: 27726955 DOI: 10.1016/j.hlc.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023]
Abstract
Older individuals can now undergo invasive cardiovascular procedures without serious concern about mortality, and the numbers and proportions of the over 65s and 85s doing so in Australia has been increasing over the last 20 years. There is overwhelming evidence linking cardiovascular conditions to late-life (65 years and over) cognitive impairment and dementia including Alzheimer's Disease, primarily due to impaired cerebrovascularisation and cascading neuropathological processes. Somewhat paradoxically, these cardiovascular interventions, carried out with the primary aim of revascularisation, are not usually associated with short- or long-term improvements in cognitive function in older adults. We discuss factors associated with cognitive outcomes post-cardiovascular surgeries in patients over 65 years of age. There are many opportunities for future research: we know almost nothing about cognitive outcomes following invasive cardiac procedures in the oldest old (85 years and over) nor how to predict the cognitive/delirium outcome using pre-surgical data, and lastly, intervention opportunities exist both pre and postoperatively that have not been tested. As our population ages with increased cardiovascular burden and rates of cardiovascular interventions and surgeries, it is critical that we understand the cognitive consequences of these procedures, who is at greatest risk, and ways to optimise cognition.
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