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Tian X, Xu Q, Xia X, Zhang Y, Meng X, Wang A. Efficacy of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke: a predefined exploratory analysis of a multicenter, double-blind, randomized controlled trial. J Neurol 2024; 271:3321-3327. [PMID: 38472398 DOI: 10.1007/s00415-024-12272-w] [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: 01/01/2024] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Ginkgo diterpene lactone meglumine (GDLM) could improve the functional outcome in patients with acute ischemic stroke (AIS). This study aimed to investigate the efficacy of GDLM on cognitive function in patients with AIS. METHODS This is a predefined exploratory analysis of the Efficacy and Safety of Ginkgo Diterpene Lactone Meglumine in Acute Ischemic Stroke trial, which was primarily designed to investigate the efficacy and safety of GDLM versus placebo on functional outcome at 100 centers in China. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) test. The primary outcomes were changes of MoCA from baseline to Day 14 and Day 90 after randomization. RESULTS A total of 3163 patients with completed data on MoCA were enrolled. There was statistically significant difference of changes in MoCA scores between the GDLM group and the placebo group from baseline to Day 14 (mean difference, 0.31; 95% confidence interval [CI], 0.08-0.53; P = 0.007) and to Day 90 after randomization (mean difference, 0.47; 95% CI, 0.22-0.72; P < 0.001). Additionally, GDLM was associated with a higher proportion of patients who reached a clinically significant level of improvement in MoCA from baseline to Day 14 (odds ratio [OR], 1.25; 95% CI, 1.08-1.44; P = 0.002) and Day 90 after randomization (OR, 1.21; 95% CI, 1.03-1.41; P = 0.02). Specially, GDLM could significantly improve the scores of visuo-spatial and executive function and language. CONCLUSIONS In this predefined analysis of patients with AIS, GDLM could improve the 14-day and 90-day cognitive function compared with the placebo.
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Affiliation(s)
- Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Xia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China.
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Lindvall E, Abzhandadze T, Quinn TJ, Sunnerhagen KS, Lundström E. Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100222. [PMID: 38745691 PMCID: PMC11090903 DOI: 10.1016/j.cccb.2024.100222] [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: 11/22/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
Background and aims The Montreal Cognitive Assessment (MoCA) is a widely used instrument for assessing cognitive function in stroke survivors. To interpret changes in MoCA scores accurately, it is crucial to consider the minimal detectable change (MDC) and minimal clinically important difference (MCID). The aim was to establish the MDC and MCID of the MoCA within 6 months after stroke. Methods This cohort study analysed data from the EFFECTS trial. The MoCA was administered at baseline and at 6-month follow-up. The MDC was calculated as the upper limit of the 95 % confidence interval of the standard error of the MoCA mean. The MCID was determined using anchor-based and distribution methods. The visual analogue recovery scale of the Stroke Impact Scale (SIS [primary anchor]) and Euro Quality of Life-5 Dimensions index (EQ-5D [confirmatory anchor]) were used as anchors. The distribution-based method, the Cohen benchmark effect size was chosen. Results In total, 1131 (mean age [SD], 71 [10.6] years) participants were included. The mean (SD) MoCA scores at admission and 6-month follow-up were 22 (5.2) and 25 (4.2), respectively. The MDC of the MoCA was 5.1 points. The anchor method yielded the MCIDs 2 and 1.6 points for SIS and EQ-5D, respectively. Using the distribution method, the MCID for the MoCA was 1 point. Conclusions Even a small change in MoCA scores can be important for stroke survivors; however, larger differences are required to ensure that any difference in MoCA values is a true change and is not related to the inherent variation in the test. Due to small sample sizes, the results of the anchor analysis need to be interpreted with caution.
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Affiliation(s)
- Elias Lindvall
- Department of Medical Sciences, Neurology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
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Moine E, Molinier V, Castanyer A, Calvat A, Coste G, Vernet A, Faugé A, Magrina P, Aliaga-Parera JL, Oliver N, Alexandre F, Heraud N. Safety and Efficacy of Pulmonary Rehabilitation for Long COVID Patients Experiencing Long-Lasting Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:242. [PMID: 38397731 PMCID: PMC10888408 DOI: 10.3390/ijerph21020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.
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Affiliation(s)
- Espérance Moine
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Virginie Molinier
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | | | - Amandine Calvat
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Antonin Vernet
- Clinique du Souffle La Solane, Inicea, 66340 Osséja, France
| | - Audrey Faugé
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - Perrine Magrina
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Nicolas Oliver
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - François Alexandre
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Nelly Heraud
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
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Bonzanino M, Riolo M, Battaglini I, Perna M, De Mattei M. PEALut in the Dietary Management of Patients with Acute Ischemic Stroke: A Prospective Randomized Controlled Clinical Trial. J Clin Med 2024; 13:509. [PMID: 38256644 PMCID: PMC10816980 DOI: 10.3390/jcm13020509] [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: 12/07/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Acute ischemic stroke (AIS), which represents 87% of all strokes, is caused by reduced blood supply to the brain associated with a prolonged inflammatory process that exacerbates brain damage. The composite containing co-ultramicronized Palmitoylethanolamide and luteolin (PEALut) is known to promote the resolution of neuroinflammation, being a promising nutritional approach to contrast inflammatory processes occurring in AIS. This study included 60 patients affected by acute ischemic stroke and undergoing thrombolysis. PEALut 770 mg was administered to 30 patients, twice daily for 90 days, in addition to the standard therapy. Neurological deficit, independence in activities of daily living, disability and cognitive impairment were investigated. In all patients, the severity of AIS defined by the NIHSS score evolved from moderate to minor (p < 0.0001). Patients' independence in daily living activities and disability evaluated using BI and mRS showed a significant improvement over time, with a statistically significant difference in favor of PEALut-treated patients (p < 0.002 for BI, p < 0.0001 for mRS), who achieved also a marked improvement of cognitive function evaluated using MMSE and MoCA tests. PEALut proved to be a safe and effective treatment in addition to thrombolysis in the management of patients with acute ischemic stroke.
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Affiliation(s)
- Massimo Bonzanino
- S. S. Stoke Unit, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marianna Riolo
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Iacopo Battaglini
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marilisa Perna
- S. S. Stoke Unit, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marco De Mattei
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
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Bhatt VR, Wichman C, Koll TT, Fisher AL, Wildes TM, Berger A, Armitage JO, Holstein SA, Maness LJ, Gundabolu K. Longitudinal changes in cognitive and physical function and health-related quality of life in older adults with acute myeloid leukemia. J Geriatr Oncol 2024; 15:101676. [PMID: 38000343 PMCID: PMC11101205 DOI: 10.1016/j.jgo.2023.101676] [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: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Many older adults with acute myeloid leukemia (AML) do not receive chemotherapy because of physicians' and patients' concern for toxicities and functional decline. This highlights the critical and urgent need to generate knowledge of functional changes following new treatments. MATERIALS AND METHODS As a part of a pragmatic single-center trial, 59 older adults ≥60 years with AML completed geriatric assessment and health-related quality of life measures before treatment and at one month and three months after chemotherapy initiation. Changes in scores of various geriatric assessment measures were computed by subtracting the baseline score from the one-month and three-month scores for each patient. Established cut-offs were used to determine a clinically meaningful change (improvement or worsening). This study provides results of descriptive exploratory analyses. RESULTS Patients experienced significant comorbidity burden and a high prevalence of functional impairments before treatment, with 56% of patients having ≥2 comorbid conditions, 69% having abnormal cognitive function (using Montreal Cognitive Assessment), 69% having impaired objective physical function (using Short Physical Performance Battery), and 64% having a positive depression screen (Patient Health Questionnaire-9). Patients (n = 53) received treatment with predominantly low-intensity chemotherapy; six patients received intensive chemotherapy. Among those who completed some or all of the three-month evaluation (N = 43), from baseline before treatment to three months later, cognitive function improved (38.7%) or remained stable (38.7%), objective physical function improved (51.6%) or remained stable (22.6%), and depression scores improved (9.4%) or remained stable (53.1%). Global health status score and role functioning moderately improved by a score of >16. DISCUSSION An exploratory analysis of our phase 2 trial demonstrated improvement or stabilization of cognitive and physical function and depression score at three months in a high proportion of older survivors of AML, despite a high prevalence of frailty and significant comorbidity burden at baseline. These results demonstrate success of treatment in improving cognitive and physical function and depression score, and, if confirmed in larger studies, should encourage oncologists to offer chemotherapy to older adults with AML. CLINICAL TRIAL REGISTRATION The study is registered in the ClinicalTrials.gov ID: NCT03226418.
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Affiliation(s)
- Vijaya R Bhatt
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Thuy T Koll
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Alfred L Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Tanya M Wildes
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Ann Berger
- College of Nursing - Omaha Division, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - James O Armitage
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Sarah A Holstein
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Lori J Maness
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Krishna Gundabolu
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
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Nakanishi N, Liu K, Kawauchi A, Okamura M, Tanaka K, Katayama S, Mitani Y, Ota K, Taito S, Fudeyasu K, Masuka Y, Yoshihiro S, Utsumi S, Nishikimi M, Masuda M, Iida Y, Kawai Y, Hatakeyama J, Hifumi T, Unoki T, Kawakami D, Obata K, Katsukawa H, Sumita H, Morisawa T, Takahashi M, Tsuboi N, Kozu R, Takaki S, Haruna J, Fujinami Y, Nosaka N, Miyamoto K, Nakamura K, Kondo Y, Inoue S, Nishida O. Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study. Crit Care 2023; 27:430. [PMID: 37936249 PMCID: PMC10629074 DOI: 10.1186/s13054-023-04681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors. METHODS We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1-3), important, but not critical (4-6), and critical (7-9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important. RESULTS In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R. CONCLUSION Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.
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Affiliation(s)
- Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4067, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, 113-0033, Japan
| | - Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kohei Tanaka
- Department of Rehabilitation Medicine, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka, 543-0035, Japan
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 Shikata, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Mitani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Kenichi Fudeyasu
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Yuki Masuka
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Shu Utsumi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mamoru Masuda
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi, 440-8511, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo, 060-0011, Japan
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Kengo Obata
- Department of Rehabilitation, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ward, Okayama, 700-8607, Japan
| | - Hajime Katsukawa
- Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo, 102-0073, Japan
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi, 441-0105, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masahiro Takahashi
- Department of Rehabilitation, Sapporo General Hospital, Kita11-Nishi13, Chuou-ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Norihiko Tsuboi
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Shunsuke Takaki
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa-city, Hyogo, 675-8611, Japan
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, 279-0021, Japan
| | - Shigeaki Inoue
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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7
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Hansen KK, Hilberg O, Jensen HI, Løkke A, Farver-Vestergaard I. The Association Between Cognitive Functions and Psychological Factors in Patients with Severe COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:2065-2078. [PMID: 37744734 PMCID: PMC10517680 DOI: 10.2147/copd.s426897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose Patients with COPD experience anxiety, depression, and stress more frequently than in the age and gender-matched general population. This cross-sectional study aimed to examine the relationship between cognitive functions and the psychological factors of anxiety, depression and stress among patients with COPD. Patients and Methods Between January 2021 and January 2023, patients with severe COPD were recruited, along with age-matched controls. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS). The Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT), and a driving simulator were used to assess cognitive impairment. Hierarchical multiple linear regression analyses were used to explain the variance of the correlations. Results In total, 80 patients (mean age = 64yrs) and 22 controls (mean age = 61yrs) participated in the study. Patients reported significantly higher levels of psychological symptoms compared to the controls (p ≤ 0.001). We found no differences in anxiety (p = 0.31), depression (p = 0.66) and stress (p = 0.37) between patients with and without cognitive impairment. However, stress showed to be a significant predictor of decreased attention (higher stress score resulted in decreasing CRT-index, indication a reduced stability in reaction time) (p = 0.02). Psychological factors did not explain additional variance in cognitive functions beyond sociodemographic factors such as age and sex. Conclusion Psychological symptom levels are higher in COPD than controls and perceived stress among patients with COPD appears to be associated with decreased attention. However, psychological factors in general did not appear to contribute to the variance in cognitive functions beyond sociodemographic, physical, and self-perceived symptoms.
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Affiliation(s)
- Kristina Kock Hansen
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Irene Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
| | - Anders Løkke
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
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8
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Müller K, Poppele I, Ottiger M, Zwingmann K, Berger I, Thomas A, Wastlhuber A, Ortwein F, Schultz AL, Weghofer A, Wilhelm E, Weber RC, Meder S, Stegbauer M, Schlesinger T. Impact of Rehabilitation on Physical and Neuropsychological Health of Patients Who Acquired COVID-19 in the Workplace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1468. [PMID: 36674222 PMCID: PMC9864141 DOI: 10.3390/ijerph20021468] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 05/27/2023]
Abstract
Workers, especially healthcare workers, are exposed to an increased risk for SARS-CoV-2 infection. However, less is known about the impact of rehabilitation on health outcomes associated with post-COVID. This longitudinal observational study examined the changes in physical and neuropsychological health and work ability after inpatient rehabilitation of 127 patients (97 females/30 males; age 21-69 years; Mean = 50.62) who acquired COVID-19 in the workplace. Post-COVID symptoms, functional status, physical performance, neuropsychological health, employment, and work ability were assessed before and after rehabilitation. Group differences relating to sex, professions, and acute COVID status were also analyzed. Except for fatigue, the prevalence of all post-COVID symptoms decreased after rehabilitation. Significant improvements in physical performance and neuropsychological health outcomes were determined. Moreover, healthcare workers showed a significantly greater reduction in depressive symptoms compared to non-healthcare workers. Nevertheless, participants reported poor work ability, and 72.5% of them were still unable to work after discharge from rehabilitation. As most participants were still suffering from the impact of COVID-19 at rehabilitation discharge, ongoing strategies in aftercare are necessary to improve their work ability. Further investigations of this study population at 6 and 12 months after rehabilitation should examine the further course of post-COVID regarding health and work ability status.
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Affiliation(s)
- Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Ivo Berger
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Andreas Thomas
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Franziska Ortwein
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Anna-Lena Schultz
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Anna Weghofer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Eva Wilhelm
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | | | - Sylvia Meder
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
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9
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Andrade AQ, Lim R, Kelly T, Parfitt G, Pratt N, Roughead EE. Wrist accelerometer temporal analysis as a prognostic tool for aged care residents: A sub‐study of the
ReMInDAR
trial. J Am Geriatr Soc 2022; 71:1124-1133. [PMID: 36524585 DOI: 10.1111/jgs.18181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Objective measures for screening, prioritizing, and planning care for frail individuals are essential for appropriate aged care provision. This study evaluates metrics derived from actigraphy measures (captured by wrist accelerometer) as a digital biomarker to identify frail individuals at risk of adverse outcomes, including death, hospitalization, and cognitive decline. METHODS This was a secondary study using data from a randomized controlled trial assessing the effectiveness of an ongoing pharmacist service in residential aged care facilities. Three metrics are studied and compared: the Frailty Index, the daily time spent in light time activity, and the temporal correlation of the actigraphy signal, measured by detrended fluctuation analysis. The association between actigraphy-derived metrics at baseline and adverse events within 12 months (death, cognitive decline, and hospitalizations) was assessed using logistic regression. RESULTS Actigraphy records were available for 213 participants living in aged-care, median age of 85 years. Individuals with higher temporal correlation (activity is less random) were at lower risk of death (Standardized OR: 0.49; 95% CI 0.34, 0.7, p < 0.001) and hospitalization (Standardized OR: 0.57; 95% CI 0.42, 0.77, p < 0.001) in 12 months, but there was no difference in cognitive decline (Standardized OR: 1; 95% CI 0.74, 1.35, p = 0.98). The predictive model that included temporal correlation had an area under the curve of 0.70 (CI 0.60-0.80) for death and 0.64 (CI 0.54-0.72) for hospitalization. CONCLUSION Temporal correlation of the actigraphy signal from aged care residents was strongly associated with death and hospitalization, but not cognitive decline. Digital biomarkers may have a place as an objective, accurate, and low-cost patient metric to support risk stratification and clinical planning.
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Affiliation(s)
- Andre Q. Andrade
- Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Thu‐Lan Kelly
- Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity UniSA Allied Health & Human Performance University of South Australia Adelaide Australia
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide Australia
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10
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Farhang M, Rojas G, Martínez P, Behrens MI, Langer ÁI, Diaz M, Miranda-Castillo C. The Impact of a Yoga-Based Mindfulness Intervention versus Psycho-Educational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15374. [PMID: 36430097 PMCID: PMC9690706 DOI: 10.3390/ijerph192215374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a global agreement in the medical community that a significant proportion of dementia cases could be prevented or postponed. One of the factors behind this agreement comes from scientific evidence showing that mind-body interventions such as mindfulness and yoga for the elderly have been related to a range of positive outcomes, including improved cognition performance in seniors with mild cognitive impairment (MCI). OBJECTIVE This study aims to evaluate the effectiveness of a yoga-based mindfulness intervention (YBM) versus psychoeducational sessions for older adults with MCI attending Hospital Clinic Universidad de Chile in Santiago. METHOD Two-arm, individually randomized controlled trial (RCT) will be carried out at Clinical Hospital Universidad de Chile in Santiago. Older people over 60 years with any type of MCI using a score < 21 in the Montreal Cognitive Assessment (MoCA) test and a score of 0.05 in the Clinical Dementia Rating (CDR) Scale; and with preserved activities of daily living will be randomly assigned with an allocation ratio of 1:1 in either the yoga-based mindfulness intervention or the active control group based on the psycho-educational program. People who have performed yoga and/or mindfulness in the last 6 months or/and people with a psychiatric clinical diagnosis will be excluded from the study. Montreal Cognitive Assessment, the Lawton Instrumental Activities of Daily Living Scale (IADL), the Barthel Index (BI), the Pemberton happiness index, the Geriatric Anxiety Inventory (GAI) as well as the Geriatric Depression Scale (GDS-5) will be administered by blinded outcomes assessors before random assignment (Pre-test), the week following the last session of the intervention (post-test), and then after 3- and 6-months follow-up. RESULTS The YBM intervention protocol based on a video recording has been adapted and designed. This is the first RCT to examine the effects of a yoga-based mindfulness intervention in improving cognitive and physical functions and mental health outcomes for Chilean elderly diagnosed with MCI. It is expected to be implemented as an acceptable and effective non-pharmacological option for older people with MCI. CONCLUSION Providing evidence-based programs such as preventive therapy for Alzheimer's disease has relevant implications for public mental health services in Chile.
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Affiliation(s)
- Maryam Farhang
- Escuela de Enfermería, Facultad de Salud y Ciencias Sociales, Universidad de Las Américas, Santiago 8370040, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Institute for Care Research (MICARE), Santiago 8370134, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
| | - Graciela Rojas
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
| | - Pablo Martínez
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, QC J4K A08, Canada
| | - Maria Isabel Behrens
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago 7800284, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana Santiago, Universidad del Desarrollo, Santiago 7800284, Chile
| | - Álvaro I. Langer
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
- Mind-Body Lab, Institute of Psychological Studies, Austral University, Valdivia 5110566, Chile
| | - Marcela Diaz
- Clínica Psiquiátrica Universitaria, Hospital Clínico, Universidad de Chile, Santiago 7800284, Chile
| | - Claudia Miranda-Castillo
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Institute for Care Research (MICARE), Santiago 8370134, Chile
- Faculty of Nursing, Universidad Andres Bello, Santiago 7550000, Chile
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11
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Yu DJ, Yu AP, Bernal JDK, Fong DY, Chan DKC, Cheng CP, Siu PM. Effects of exercise intensity and frequency on improving cognitive performance in middle-aged and older adults with mild cognitive impairment: A pilot randomized controlled trial on the minimum physical activity recommendation from WHO. Front Physiol 2022; 13:1021428. [PMID: 36200056 PMCID: PMC9527311 DOI: 10.3389/fphys.2022.1021428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The World Health Organization physical activity guidelines recommend adults and older adults to accumulate at least 150–300 min of moderate or 75–150 min of vigorous aerobic-type physical activity weekly for health benefits including improvements of cognitive performance. However, the optimal exercise intensity and frequency for maximizing the cognitive benefits remain unclear. Purpose: We conducted a parallel, assessor-blinded, pilot randomized controlled trial to evaluate the effectiveness of different intensities and frequencies of the WHO-recommended minimal volume of aerobic-type physical activity on improving cognitive performance in middle-aged and older adults with mild cognitive impairment (MCI). Methods: Participants were randomly allocated to the stretching exercise control group (CON), once-a-week and thrice-a-week moderate-intensity walking groups (M1 and M3), and once-a-week and thrice-a-week vigorous-intensity walking groups (V1 and V3). Intervention duration was 12 weeks. The primary outcome was global cognitive performance assessed by the Hong Kong version of Montreal Cognitive Assessment. Secondary outcomes were self-report and objective cognitive performances, mental health, sleep quality, and cardiorespiratory fitness. Results: Thirty-seven participants completed the study (CON: n = 7, M1: n = 7, M3: n = 7, V1: n = 8, V3: n = 8). Participants in all four walking exercise groups demonstrated significant improvements in global cognitive performance assessed by the Hong Kong version of the Montreal Cognitive Assessment after the intervention when compared to CON (p < 0.001). The walking exercise interventions also significantly mitigated the anxiety severity (p < 0.005) and improved the cardiorespiratory fitness (p < 0.05) of the participants in the walking exercise groups. Conclusion: 150-min moderate- or 75-min vigorous-intensity walking exercise performed once- or thrice-weekly showed similar effects on improving cognitive performance in middle-aged and older adults with MCI. The 12-week walking exercise interventions also reduced anxiety severity and improved cardiorespiratory fitness of the participants. Clinical Trial Registration:clinicaltrials.gov, identifier NCT04515563
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Affiliation(s)
- Danny J. Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Angus P. Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Joshua D. K. Bernal
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Daniel Y. Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Derwin K. C. Chan
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Calvin P. Cheng
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Parco M. Siu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Parco M. Siu,
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12
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Buyle M, Jung Y, Pavlou M, Gonzalez SC, Bamiou DE. The role of motivation factors in exergame interventions for fall prevention in older adults: A systematic review and meta-analysis. Front Neurol 2022; 13:903673. [PMID: 35989930 PMCID: PMC9388774 DOI: 10.3389/fneur.2022.903673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance.
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Affiliation(s)
- Margot Buyle
- Psychological Sciences Research Institute and Institute of NeuroScience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- *Correspondence: Margot Buyle
| | - Yujin Jung
- Audiology Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Marousa Pavlou
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Doris-Eva Bamiou
- University College London Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
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13
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Wong YG, Hang JA, Francis-Coad J, Hill AM. Using comprehensive geriatric assessment for older adults undertaking a facility-based transition care program to evaluate functional outcomes: a feasibility study. BMC Geriatr 2022; 22:598. [PMID: 35850671 PMCID: PMC9294817 DOI: 10.1186/s12877-022-03255-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The study aimed to evaluate the feasibility of using a comprehensive geriatric assessment (CGA) in a residential transition care setting to measure older adults' functional outcomes. METHODS A convenience sample of older adults (n = 10) and staff (n = 4) was recruited. The feasibility of using assessment tools that comprise a CGA to comprehensively measure function in physical, cognitive, social and emotional domains was evaluated pre- and post-rehabilitation. RESULTS 10 older adults (mean ± SD age = 78.9 ± 9.1, n = 6 male) completed a CGA performed using assessments across physical, cognitive, social and emotional domains. The CGA took 55.9 ± 7.3 min to complete. Staff found CGA using the selected assessment tools to be acceptable and suitable for the transition care population. Older adults found the procedure to be timely and 60% found the assessments easy to comprehend. Participating in CGA also assisted older adults in understanding their present state of health. The older adults demonstrated improvements across all assessed domains including functional mobility (de Morton Mobility Index; baseline 41.5 ± 23.0, discharge 55.0 ± 24.0, p = 0.01) and quality of life (EQ-5D-5L; baseline 59.0 ± 21.7, discharge 78.0 ± 16.0, p < 0.01). CONCLUSIONS Incorporating CGA to evaluate functional outcomes in transition care using a suite of assessment tools was feasible and enabled a holistic assessment.
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Affiliation(s)
- Ying Git Wong
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Jo-Aine Hang
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Jacqueline Francis-Coad
- School of Allied Health, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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14
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Tai Chi versus conventional exercise for improving cognitive function in older adults: a pilot randomized controlled trial. Sci Rep 2022; 12:8868. [PMID: 35614144 PMCID: PMC9131984 DOI: 10.1038/s41598-022-12526-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/03/2022] [Indexed: 11/08/2022] Open
Abstract
Studies have shown that Tai Chi and conventional exercise can modify the brain through distinct mechanisms, resulting in different brain adaptations. Therefore, it is conceivable to speculate that these two exercise modalities may have different effects on improving cognitive function. This study was a parallel group, assessor-blinded, pilot randomized controlled trial comparing the effects of Tai Chi and conventional exercise on improving cognitive function in older persons with mild cognitive impairment (MCI). A total of 34 adults aged ≥ 50 years with MCI were randomized (1:1:1) to the Tai Chi group (TC, n = 10, 3 sessions of 60-min Yang-style Tai Chi training per week for 24 weeks), conventional exercise group (EX: n = 12, 3 sessions of 60-min fitness training per week for 24 weeks), or control group (CON: n = 12, no intervention). Global cognitive function assessed by the Hong Kong version of the Montreal Cognitive Assessment (MoCA-HK) and performance in various cognitive domains were examined at baseline, and 12 and 24 weeks of the intervention. Both exercise groups showed improved global cognitive function as measured by MoCA-HK compared with the control group after 12 and 24 weeks of the intervention, (all P < 0.001). Only TC achieved clinically relevant improvement on global cognitive function at week 12. Both exercise groups achieved clinically relevant improvements at the end of the interventions at week 24. Compared with EX, TC exhibited greater improvements on global cognitive function indicated by MoCA-HK after 12 weeks of the intervention (P < 0.001) and cognitive flexibility indicated by part B/A ratio score of the Trail Making Test throughout the study (all P < 0.05). Both interventions were equally effective in improving the other examined cognitive domains. Further studies are needed to substantiate the superior long-term benefits of Tai Chi on global cognitive function compared with conventional exercise, and dissect the underlying mechanisms of the two exercises on improving cognitive domains and the corresponding brain adaptations. Trial registration: This study was registered at clinicaltrials.gov (Trial registration number: NCT04248400; first registration date: 30/01/2020).
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15
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The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 2022; 275:864-871. [PMID: 35543164 DOI: 10.1097/sla.0000000000005196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis is to examine the effect of DEX on delayed dNCR (cognitive dysfunction ≥ 1 week postoperative) after cardiac surgery. BACKGROUND DEX has salutary effects on cognitive outcomes following cardiac surgery, however, studies are limited by inconsistent assessment tools, timing, and definitions of dysfunction. It is imperative to identify accurate point estimates of effect of DEX on clinically relevant changes in cognitive function. METHODS Randomized trials of adults undergoing cardiac surgery comparing perioperative DEX to placebo or alternate sedation and assessing cognitive function ≥ 1 week postoperative were included. Data was abstracted by three reviewers independently and in parallel according to PRISMA guidelines. The primary outcome is dNCR. To classify as dNCR, cognitive function must decrease by at least the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index ≥1.96). Bias was assessed with the Cochrane Collaboration tool. Data was pooled using a random effects model. RESULTS Nine trials (942 participants) were included in qualitative analysis, of which seven were included in the meta-analysis of dNCR. DEX reduced the incidence of dNCR (OR 0.39, 95% CI 0.25-0.61, P < 0.0001) compared to placebo/no DEX. There was no difference in the incidence of delirium (OR 0.69, 95% CI 0.35-1.34, P = 0.27) or incidence of hemodynamic instability (OR 1.14, 95% CI 0.59-2.18, P = 0.70) associated with perioperative DEX. CONCLUSIONS DEX reduced the incidence of dNCR 1 week after cardiac surgery. Although this meta-analysis demonstrates short term cognitive outcomes are improved after cardiac surgery with perioperative DEX, future trials examining long term cognitive outcomes, using robust cognitive assessments, and new perioperative neurocognitive disorders nomenclature with objective diagnostic criteria are necessary.
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16
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Stienen MN, Germans MR, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Velz J, Sebök M, Eggenberger N, May A, Haemmerli J, Bijlenga P, Schaller K, Guerra-Lopez U, Maduri R, Beaud V, Al-Taha K, Daniel RT, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Maradan-Gachet ME, Gutbrod K, Maldaner N, Neidert MC, Früh S, Schwind M, Bozinov O, Brugger P, Keller E, Marr A, Roux S, Regli L. Longitudinal neuropsychological assessment after aneurysmal subarachnoid hemorrhage and its relationship with delayed cerebral ischemia: a prospective Swiss multicenter study. J Neurosurg 2022; 137:1742-1750. [PMID: 35535839 DOI: 10.3171/2022.2.jns212595] [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: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While prior retrospective studies have suggested that delayed cerebral ischemia (DCI) is a predictor of neuropsychological deficits after aneurysmal subarachnoid hemorrhage (aSAH), all studies to date have shown a high risk of bias. This study was designed to determine the impact of DCI on the longitudinal neuropsychological outcome after aSAH, and importantly, it includes a baseline examination after aSAH but before DCI onset to reduce the risk of bias. METHODS In a prospective, multicenter study (8 Swiss centers), 112 consecutive alert patients underwent serial neuropsychological assessments (Montreal Cognitive Assessment [MoCA]) before and after the DCI period (first assessment, < 72 hours after aSAH; second, 14 days after aSAH; third, 3 months after aSAH). The authors compared standardized MoCA scores and determined the likelihood for a clinically meaningful decline of ≥ 2 points from baseline in patients with DCI versus those without. RESULTS The authors screened 519 patients, enrolled 128, and obtained complete data in 112 (87.5%; mean [± SD] age 53.9 ± 13.9 years; 66.1% female; 73% World Federation of Neurosurgical Societies [WFNS] grade I, 17% WFNS grade II, 10% WFNS grades III-V), of whom 30 (26.8%) developed DCI. MoCA z-scores were worse in the DCI group at baseline (-2.6 vs -1.4, p = 0.013) and 14 days (-3.4 vs -0.9, p < 0.001), and 3 months (-0.8 vs 0.0, p = 0.037) after aSAH. Patients with DCI were more likely to experience a decline of ≥ 2 points in MoCA score at 14 days after aSAH (adjusted OR [aOR] 3.02, 95% CI 1.07-8.54; p = 0.037), but the likelihood was similar to that in patients without DCI at 3 months after aSAH (aOR 1.58, 95% CI 0.28-8.89; p = 0.606). CONCLUSIONS Aneurysmal SAH patients experiencing DCI have worse neuropsychological function before and until 3 months after the DCI period. DCI itself is responsible for a temporary and clinically meaningful decline in neuropsychological function, but its effect on the MoCA score could not be measured at the time of the 3-month follow-up in patients with low-grade aSAH with little or no impairment of consciousness. Whether these findings can be extrapolated to patients with high-grade aSAH remains unclear. Clinical trial registration no.: NCT03032471 (ClinicalTrials.gov).
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | - Noemi Dannecker
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Julia Velz
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 4Department of Neurosurgery, University Hospital Geneva
| | | | | | - Karl Schaller
- 4Department of Neurosurgery, University Hospital Geneva
| | | | - Rodolfo Maduri
- 6Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier
| | - Valérie Beaud
- 7Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | - Khalid Al-Taha
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | - Roy Thomas Daniel
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | | | - Stefania Rossi
- 10Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Johannes Goldberg
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 11Department of Neurosurgery, University Hospital Berne, Switzerland.,12Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | | | - Klemens Gutbrod
- 13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | | | | | - Severin Früh
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Marc Schwind
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,14Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Peter Brugger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich.,16Neuropsychology Unit, Rehabilitation Clinic Valens; and
| | - Emanuela Keller
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Angelina Marr
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sébastien Roux
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
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17
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Singh A, Broad J, Brenna CTA, Kaustov L, Choi S. The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. ANNALS OF SURGERY OPEN 2022; 3:e130. [PMID: 37600088 PMCID: PMC10431438 DOI: 10.1097/as9.0000000000000130] [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: 06/21/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this review is to examine the effect of dexmedetomidine on delayed neurocognitive recovery (dNCR; cognitive dysfunction ≥1 week postoperative) after major noncardiac surgery. Background Dexmedetomidine (DEX) effectively reduces delirium in the intensive care unit and reportedly attenuates cognitive decline following major noncardiac surgery. Ascertaining the true effect on postoperative cognition is difficult because studies are limited by suboptimal selection of cognitive assessment tools, timing of testing, and criteria for defining significant cognitive decline. Methods Prospective randomized trials comparing perioperative DEX to placebo for major noncardiac surgery assessing cognitive function ≥1 week postoperative were included. Pediatric, nonhuman, and non-English trials, and those where executive function was not assessed were excluded. Data were abstracted by 3 reviewers independently and in parallel according to PRISMA guidelines. The a priori binary primary outcome is dNCR defined as cognitive function declining by the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index ≥1.96). Bias was assessed with the Cochrane Collaboration tool. Data were pooled using a random effects model. Results Among 287 citations identified, 26 (9%) met criteria for full-text retrieval. Eleven randomized trials (1233 participants) were included for qualitative analysis, and 7 trials (616 participants) were included for meta-analysis of dNCR. Dexmedetomidine did not reduce the incidence of dNCR significantly (OR 0.57, 95% CI 0.30-1.10, P = 0.09) compared with placebo. There was no difference in the incidence of delirium (OR 0.94, 95% CI 0.55-1.63, P = 0.83) and a higher incidence of hemodynamic instability (OR 2.11, 95% CI 1.22-3.65, P = 0.008). Conclusions Dexmedetomidine does not reduce dNCR 1 week after major noncardiac surgery. This meta-analysis does not yet support the use of perioperative DEX to improve short term cognitive outcomes at this time; trials underway may yet change this conclusion while larger trials are needed to refine the point estimate of effect and examine long-term cognitive outcomes.
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Affiliation(s)
- Amara Singh
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jeremy Broad
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Connor T. A. Brenna
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Lilia Kaustov
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Stephen Choi
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
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18
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Hashizume S, Nakano M, Kubota K, Sato S, Himuro N, Kobayashi E, Takaoka A, Fujimiya M. Mindfulness intervention improves cognitive function in older adults by enhancing the level of miRNA-29c in neuron-derived extracellular vesicles. Sci Rep 2021; 11:21848. [PMID: 34750393 PMCID: PMC8575875 DOI: 10.1038/s41598-021-01318-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
Although mindfulness-based stress reduction (MBSR) improves cognitive function, the mechanism is not clear. In this study, people aged 65 years and older were recruited from elderly communities in Chitose City, Japan, and assigned to a non-MBSR group or a MBSR group. Before and after the intervention, the Japanese version of the Montreal Cognitive Assessment (MoCA-J) was administered, and blood samples were collected. Then, neuron-derived extracellular vesicles (NDEVs) were isolated from blood samples, and microRNAs, as well as the target mRNAs, were evaluated in NDEVs. A linear mixed model analysis showed significant effects of the MBSR x time interaction on the MoCA-J scores, the expression of miRNA(miR)-29c, DNA methyltransferase 3 alpha (DNMT3A), and DNMT3B in NDEVs. These results indicate that MBSR can improve cognitive function by increasing the expression of miR-29c and decreasing the expression of DNMT3A, as well as DNMT3B, in neurons. It was also found that intracerebroventricular injection of miR-29c mimic into 5xFAD mice prevented cognitive decline, as well as neuronal loss in the subiculum area, by down-regulating Dnmt3a and Dnmt3b in the hippocampus. The present study suggests that MBSR can prevent neuronal loss and cognitive impairment by increasing the neuronal expression of miR-29c.
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Affiliation(s)
- Shin Hashizume
- Department of Anatomy, Sapporo Medical University School of Medicine, W17, S1, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Masako Nakano
- Department of Anatomy, Sapporo Medical University School of Medicine, W17, S1, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan.
| | - Kenta Kubota
- Department of Anatomy, Sapporo Medical University School of Medicine, W17, S1, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
- Department of Physical Therapy, Hokkaido Chitose Rehabilitation College, Chitose, Hokkaido, Japan
| | - Seiichi Sato
- Division of Signaling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuaki Himuro
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Eiji Kobayashi
- Department of Anatomy, Sapporo Medical University School of Medicine, W17, S1, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
- Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, Eniwa, Hokkaido, Japan
| | - Akinori Takaoka
- Division of Signaling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, W17, S1, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
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19
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 869] [Impact Index Per Article: 289.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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Abstract
This study investigated the effects of vortioxetine on cognitive function in adults with mild cognitive impairment (MCI). This single-arm, open-label, phase II study enrolled 111 adults with MCI without depressive symptoms to receive 5-10 mg/day vortioxetine for 6 months. Main outcomes assessed: cognitive function [Montreal Cognitive Assessment (MoCA); Digit Symbol Substitution Test (DSST)], disease severity [Clinical Dementia Rating (CDR)], clinician-assessed improvement and safety. Mean MoCA score increased from 24.2 points (baseline) to 29.7 points (month 6), placing most subjects within the cognitively normal range (≥26 points). Compared with baseline, MoCA and DSST scores were significantly improved at months 1, 3 and 6 (P < 0.001 for all). Global CDR scores significantly improved from baseline to month 6 (mean change -0.37 points; P < 0.001), representing an improvement from very mild impairment (0.50 points) to cognitively normal status (0.13 points), mainly in CDR memory scores. At month 6, 89.6% of subjects had improved disease severity. Adverse events and adverse drug reactions were reported in 9.9% (n = 11) and 2.7% (n = 3) of subjects, respectively. Vortioxetine treatment was associated with significant improvement in cognitive function and a favorable safety profile in community-dwelling older adults with MCI. Given the lack of evidence for efficacious pharmacologic interventions for MCI, our results are encouraging and warrant further investigation.
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Affiliation(s)
- Sheng Neng Tan
- The Good Life Medical Center, Mount Alvernia Hospital, Singapore, Singapore
| | - Carol Tan
- The Good Life Medical Center, Mount Alvernia Hospital, Singapore, Singapore
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21
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1400] [Impact Index Per Article: 466.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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22
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Assonov D. Two-Step Resilience-Oriented Intervention for Veterans with Traumatic Brain Injury: A Pilot Randomized Controlled Trial. CLINICAL NEUROPSYCHIATRY 2021; 18:247-259. [PMID: 34984068 PMCID: PMC8696289 DOI: 10.36131/cnfioritieditore20210503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present randomized parallel two-arm pilot study aimed to compare the efficacy of two-step resilience-oriented intervention with treatment as usual in veterans with mild to moderate traumatic brain injury. METHOD Two-step Resilience-Oriented Intervention (TROI) is a brief psychological intervention that targets cognitive (step 1) and emotional (step 2) factors of resilience and consists of six 1-hour sessions. Overall, 70 Ukrainian veterans serviced in Anti-Terrorist Operation / Joint Forces Operation were randomly assigned to an intervention group (TROI group) or a control group that underwent treatment as usual (TAU group). For pre- (T1) and post-treatment (T2) assessment the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA), Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Chaban Quality of Life Scale (CQLS), Positive and Negative Affect Scale (PANAS) were used. RESULTS Multivariable linear regression with the treatment group, gender, baseline cognitive performance level and TBI severity as the independent variables revealed statistically significant improvements in the TROI group in resilience (CD-RISC), cognitive performance (MoCA), postconcussive symptoms (NSI), posttraumatic symptoms (PCL-5), positive affect (PANAS) and quality of life (CQLS) comparing to such in TAU group. We found no statistically significant differences between groups in depression, anxiety (HADS) and negative affect (PANAS) outcomes. Additionally, Wilcoxon signed-rank test revealed that participants who completed two-step resilience-oriented intervention had significantly improved scores for all outcomes compared to the baseline (p < 0.05). CONCLUSIONS In summary, we can tentatively conclude that adding TROI to the standard treatment measures may improve the resilience and sustainable symptoms in veterans with TBI when compared with standard treatment. Targeting cognitive and emotional factors like problem-solving, decision-making, positive thinking can promote resilience in veterans with TBI and be useful in facilitating recovery from injury. Results of this pilot study are promising, but the intervention needs to be studied in a larger trial.
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Affiliation(s)
- Dmytro Assonov
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine,Corresponding author Dmytro Assonov, E-mail:
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23
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Mahdavi KD, Jordan SE, Barrows HR, Pravdic M, Habelhah B, Evans NE, Blades RB, Iovine JJ, Becerra SA, Steiner RA, Chang M, Kesari S, Bystritsky A, O'Connor E, Gross H, Pereles FS, Whitney M, Kuhn T. Treatment of Dementia With Bosutinib: An Open-Label Study of a Tyrosine Kinase Inhibitor. Neurol Clin Pract 2021; 11:e294-e302. [PMID: 34484904 PMCID: PMC8382351 DOI: 10.1212/cpj.0000000000000918] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The pursuit of an effective therapeutic intervention for dementia has inspired interest in the class of medications known as tyrosine kinase inhibitors such as bosutinib. METHODS Thirty-one patients with probable Alzheimer dementia or Parkinson spectrum disorder with dementia completed 12 months of bosutinib therapy and an additional 12 months of follow-up. The Clinical Dementia Rating scale (as estimated by the Quick Dementia Rating System [QDRS]) was the primary cognitive status outcome measure. Secondary outcome measures included the Repeatable Battery Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment. Cox regression methods were used to compare results with population-based estimates of cognitive decline. RESULTS The present article reports on cognitive outcomes obtained at 12 months for 31 participants and up to 24 months for a 16-participant subset. Safety and tolerability of bosutinib were confirmed among the study population (Mage = 73.7 years, SDage = 14 years). Bosutinib was associated with less worsening in Clinical Dementia Rating (CDR) scores (hazard ratio = -0.62, p < 0.001, 95% confidence interval [CI]: -1.02 to -0.30) and less decline in RBANS performance (hazard ratio = -3.42, p < 0.001, 95% CI: -3.59 to -3.72) during the year of treatment than population-based estimates of decline. In the 24-month follow-up, wherein 16 patients were observed after 1 year postintervention, 31.2% of participants exhibited worsened CDR levels compared with their 12-month performances. CONCLUSIONS Results support an overall positive outcome after 1 year of bosutinib. Future studies should explore the relationship between tyrosine kinases and neurodegenerative pathology as well as related avenues of treatment.
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Affiliation(s)
- Kennedy D Mahdavi
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Sheldon E Jordan
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Hannah R Barrows
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Maša Pravdic
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Barshen Habelhah
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Natalie E Evans
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Robin B Blades
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Jessica J Iovine
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Sergio A Becerra
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Rachel A Steiner
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Marisa Chang
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Santosh Kesari
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Alexander Bystritsky
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Ed O'Connor
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Hyman Gross
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - F Scott Pereles
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Mike Whitney
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
| | - Taylor Kuhn
- Neurological Associates - The Interventional Group (KDM, MP, BH, NEE, RBB, JJI, RAS, MC), Santa Monica, CA; Department of Neurology (SEJ), University of California, Los Angeles; Neurological Associates of West Los Angeles (HRB, EOC), Santa Monica, CA; Synaptec Network (SAB), Santa Monica, CA; Pacific Neuroscience Institute (SK), Santa Monica, CA; Department of Psychiatry and Biobehavioral Sciences (AB, TK) University of California, Los Angeles; Department of Neurology (HG), University of Southern California, Los Angeles; and Rad Alliance, Inc. (FSP, MW), Los Angeles, CA
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24
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Chau PH, Kwok YYJ, Chan MKM, Kwan KYD, Wong KL, Tang YH, Chau KLP, Lau SWM, Yiu YYY, Kwong MYF, Lai WTT, Leung MK. Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study. J Med Internet Res 2021; 23:e27640. [PMID: 33944795 PMCID: PMC8132975 DOI: 10.2196/27640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. OBJECTIVE This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. METHODS A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. RESULTS A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. CONCLUSIONS A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients.
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Affiliation(s)
- Pui Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | | | | | | | | | | | | | | | | | - Wai Ting Thomas Lai
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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25
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Rodriguez-Larrad A, Arrieta H, Rezola-Pardo C, Esain I, Mendia-Oria P, Irazusta J. Loss of benefits after cessation of exercise interventions in nursing home residents: randomized controlled trial follow-up. Geriatr Nurs 2021; 42:621-627. [PMID: 33823419 DOI: 10.1016/j.gerinurse.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
Exercise interventions improve physical fitness, cognitive and affective function, and quality of life among nursing home residents. However, little is known regarding the consequences of cessation of activity, or detraining. We analyzed physical fitness, physical activity level, cognitive function, quality of life, and loneliness during a 6-month observational follow-up after a 6-month randomized controlled trial in which nursing home residents performed either routine activities (control group) or group-based exercise (intervention group). The intervention group showed an important decline in most physical fitness and cognitive function parameters after a 6-month detraining period. These results highlight the importance of recreation as part of residents' care needs, and exercise should therefore be implemented continuously.
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Affiliation(s)
- Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, E-48940 Leioa (Bizkaia), Spain
| | - Haritz Arrieta
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Begiristain Doktorea Pasealekua 105, E-20014 Donostia (Gipuzkoa), Spain.
| | - Chloe Rezola-Pardo
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, E-48940 Leioa (Bizkaia), Spain
| | - Izaro Esain
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, E-48940 Leioa (Bizkaia), Spain
| | - Pablo Mendia-Oria
- Lamourous (Matia Fundazioa), Joseba Zubimendi 1, E-20015 Donostia (Gipuzkoa), Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, E-48940 Leioa (Bizkaia), Spain
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26
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Nussbaum ES, Mikoff N, Paranjape GS. Cognitive deficits among patients surviving aneurysmal subarachnoid hemorrhage. A contemporary systematic review. Br J Neurosurg 2020; 35:384-401. [PMID: 33345644 DOI: 10.1080/02688697.2020.1859462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is associated with high rates of morbidity, including neurological and cognitive deficits that may be difficult to identify and quantify. This review provides an update on the cognitive deficits that may result from spontaneous aneurysmal SAH (aSAH) and identifies factors that may help predict and manage these deficits at discharge and thereafter. MATERIALS AND METHODS We conducted a systematic review of PubMed and Google Scholar to identify studies published between 2010 and 2019 that assessed cognitive deficits at discharge and during follow-up in patients with aSAH. Full-text articles were assessed for information regarding cognitive testing and factors that may be associated with functional outcomes in this population. RESULTS We reviewed 65 studies published since 2010 that described the cognitive deficits associated with non-traumatic aSAH. Such deficits may impact functional outcomes, quality of life, and return to work and may result in cognitive impairments, such as memory difficulties, speech problems, and psychiatric disorders. CONCLUSIONS Patients with aSAH, even those that appear normal at the time of hospital discharge, may harbor cognitive deficits that are difficult to detect, yet can interfere with daily functioning. Further research is needed to provide additional information and to identify stronger correlations to be used in the identification, treatment, and amelioration of long-term cognitive deficits in aSAH patients, including those who are discharged with good clinical outcomes scores.
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Affiliation(s)
- Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, Twin Cities, MN, USA
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27
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Zhou L, Wang Y, Qiao J, Wang QM, Luo X. Acupuncture for Improving Cognitive Impairment After Stroke: A Meta-Analysis of Randomized Controlled Trials. Front Psychol 2020; 11:549265. [PMID: 33424671 PMCID: PMC7793937 DOI: 10.3389/fpsyg.2020.549265] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This meta-analysis evaluated the efficacy of acupuncture in improving cognitive impairment of post-stroke patients. Design: Randomized controlled trials (RCTs) investigating the effects of acupuncture compared with no treatment or sham acupuncture on post-stroke cognitive impairment (PSCI) before December 2019 were identified from databases (PubMed, EMBASE, Ovid library, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wanfang Database, and SinoMed). The literature searching and data extracting were independently performed by two investigators. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed for the eligible RCTs with Revman 5.3 software. Results: Thirty-seven RCTs (2,869 patients) were included in this meta-analysis. Merged Random-effects estimates of the gain of MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment) were calculated for the comparison of acupuncture with no acupuncture or sham acupuncture. Following 2-8 weeks of intervention with acupuncture, pooled results demonstrated significant effects of acupuncture in improving PSCI assessed by MMSE (MD [95% CI] = 2.88 [2.09, 3.66], p < 0.00001) or MoCA (MD [95% CI] = 2.66 [1.95, 3.37], p < 0.00001). Conclusion: The results suggest that acupuncture was effective in improving PSCI and supported the needs of more rigorous design with large-scale randomized clinical trials to determine its therapeutic benefits.
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Affiliation(s)
- Liang Zhou
- Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yao Wang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Jun Qiao
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, The Teaching Affiliate of Harvard Medical School, Boston, MA, United States
| | - Xun Luo
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, China.,Kerry Rehabilitation Medicine Research Institute, Shenzhen, China
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28
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Cognitive function following pulmonary rehabilitation and post-discharge recovery from exacerbation in people with COPD. Respir Med 2020; 176:106249. [PMID: 33253973 DOI: 10.1016/j.rmed.2020.106249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Cognitive impairment (CI) is prevalent in COPD and is associated with poor health-related quality of life. Recovery of cognition following an acute exacerbation of COPD (AECOPD), the impact of CI on pulmonary rehabilitation (PR) uptake and the effect of PR on CI are not fully understood. METHODS This 6-week prospective study analysed 67 people with stable COPD symptoms who completed PR (PR group) and the recovery of 45 people admitted for AECOPD (AECOPD group). All participants were assessed for cognitive function (Montreal Cognitive Assessment [MoCA]), health status (COPD Assessment Test, Chronic Respiratory Questionnaire), lower extremity function (Short Physical Performance Battery), and psychological well-being (Hospital Anxiety and Depression Score). Follow up assessments were carried out after a 6-week recovery post-discharge in AECOPD group and after PR in the PR group. RESULTS AECOPD group showed no improvement in MoCA following a 6-week recovery post-discharge (Δ-0.8 ± 3.2, p = 0.205), despite improvements in all other clinical outcomes. PR uptake among the AECOPD group was not associated with the presence of CI (p = 0.325). Participants in the PR group with CI at baseline showed a significant improvement in MoCA score following PR (Δ1.6 ± 2.4, p = 0.004). CONCLUSIONS Cognition does not improve following 6-week recovery post-AECOPD, and CI may influence patients' response to PR referral as an inpatient. PR improves cognition in people with stable COPD symptoms and CI. People with AECOPD should be actively encouraged to attend PR irrespective of mild-moderate cognition but may require additional support or opportunities to take part.
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29
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Schupper AJ, Eagles ME, Neifert SN, Mocco J, Macdonald RL. Lessons from the CONSCIOUS-1 Study. J Clin Med 2020; 9:jcm9092970. [PMID: 32937959 PMCID: PMC7564635 DOI: 10.3390/jcm9092970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/25/2022] Open
Abstract
After years of research on treatment of aneurysmal subarachnoid hemorrhage (aSAH), including randomized clinical trials, few treatments have been shown to be efficacious. Nevertheless, reductions in morbidity and mortality have occurred over the last decades. Reasons for the improved outcomes remain unclear. One randomized clinical trial that has been examined in detail with these questions in mind is Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1). This was a phase-2 trial testing the effect of clazosentan on angiographic vasospasm (aVSP) in patients with aSAH. Clazosentan decreased moderate to severe aVSP. There was no statistically significant effect on the extended Glasgow outcome score (GOS), although the study was not powered for this endpoint. Data from the approximately 400 patients in the study were detailed, rigorously collected and documented and were generously made available to one investigator. Post-hoc analyses were conducted which have expanded our knowledge of the management of aSAH. We review those analyses here.
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Affiliation(s)
- Alexander J. Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.J.S.); (S.N.N.); (J.M)
| | - Matthew E. Eagles
- Department of Clinical Neurosciences, Division of Neurosurgery, Alberta Children’s Hospital, University of Calgary, Alberta, AB T3B 6A8, Canada;
| | - Sean N. Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.J.S.); (S.N.N.); (J.M)
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.J.S.); (S.N.N.); (J.M)
| | - R. Loch Macdonald
- Department of Neurological Surgery, UCSF Fresno, Fresno, CA 93701, USA
- Correspondence: ; Tel.: +1 (559) 459-3705
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30
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Jackson JM, Bay AA, Barter JD, Ni L, Caudle WM, Serra MC, Wharton W, Hackney ME. The Role of Nutrition and Inflammation on Cognition in a High-Risk Group for Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:345-352. [PMID: 33024941 PMCID: PMC7504978 DOI: 10.3233/adr-200224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Alzheimer’s disease (AD) is a prevalent neurodegenerative disease. Treatments are necessary to target people at high risk for AD. Inflammation, particularly tumor necrosis factor alpha (TNFα), appears to be an important marker associated with the development of AD pathophysiology. Consuming a high-fat diet induces tissue expression of TNFα. Objective: This study investigates the relationship between nutrition, circulating inflammation, and cognition in African American women (age: M = 59.5 (±8.20) [42–73] years) at risk for developing AD. Methods: Participants were split into high-fat and low-fat groups based on total dietary fat consumption self-reported on the Lower Mississippi Delta Nutrition Intervention Research Initiative Food Frequency Questionnaire (Delta NIRI FFQ). Results: A high-fat diet was associated with increased blood serum TNFα (p = 0.02) compared to the low-fat diet. In addition, global cognition scores were 9.0% better in those who consumed a higher fat diet (p = 0.04). No significant differences across groups were noted for executive function, dual-tasking, and visuospatial performance. Conclusion: These results indicate that there may be multiple biological pathways involved in AD development, suggesting the need for more holistic approaches to mitigate AD-development risk.
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Affiliation(s)
- Jordan M Jackson
- Emory University's Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, GA, USA
| | - Allison A Bay
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - Jolie Denise Barter
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - Liang Ni
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - William Michael Caudle
- Emory University's Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, GA, USA.,Emory Center for Neurodegenerative Disease, Atlanta, GA, USA
| | - Monica C Serra
- Division of Geriatrics, Gerontology & Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,San Antonio Geriatrics Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Madeleine E Hackney
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA
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31
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Faria AL, Pinho MS, Bermúdez I Badia S. A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients. J Neuroeng Rehabil 2020; 17:78. [PMID: 32546251 PMCID: PMC7298954 DOI: 10.1186/s12984-020-00691-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL's. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL's simulation. METHODS We have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains. RESULTS A within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA. CONCLUSIONS The Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT02857803. Registered 5 August 2016, .
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Affiliation(s)
- Ana Lúcia Faria
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal.
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal.
- NOVA-LINCS, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Maria Salomé Pinho
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
- Laboratório de Memória, Linguagem e Funções Executivas, Coimbra, Portugal
| | - Sergi Bermúdez I Badia
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA-LINCS, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
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Stienen MN, Fung C, Bijlenga P, Zumofen DW, Maduri R, Robert T, Seule MA, Marbacher S, Geisseler O, Brugger P, Gutbrod K, Chicherio C, Monsch AU, Beaud V, Rossi S, Früh S, Schmid N, Smoll NR, Keller E, Regli L. Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study). Neurosurgery 2020; 84:1124-1132. [PMID: 29762759 DOI: 10.1093/neuros/nyy155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The exact relationship between delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) and neuropsychological impairment remains unknown, as previous studies lacked a baseline examination after aneurysm occlusion but before the DCI-period. Neuropsychological evaluation of acutely ill patients is often applied in a busy intensive care unit (ICU), where distraction represents a bias to the obtained results. OBJECTIVE To evaluate the relationship between DCI and neuropsychological outcome after aSAH by comparing the Montreal Cognitive Assessment (MoCA) results in aSAH patients with and without DCI at 3 mo with a baseline examination before the DCI-period (part 1). To determine the reliability of the MoCA, when applied in an ICU setting (part 2). METHODS Prospective, multicenter, and observational study performed at all Swiss neurovascular centers. For part 1, n = 240 consecutive aSAH patients and for part 2, n = 50 patients with acute brain injury are recruited. EXPECTED OUTCOMES Part 1: Effect size of the relationship between DCI and neuropsychological outcome (MoCA). Part 2: Reliability measures for the MoCA. DISCUSSION The institutional review boards approved this study on July 4, 2017 under case number BASEC 2017-00103. After completion, the results will be offered to an international scientific journal for peer-reviewed publication. This study determines the exact impact of DCI on the neuropsychological outcome after aSAH, unbiased by confounding factors such as early brain injury or patient-specific characteristics. The study provides unique insights in the neuropsychological state of patients in the early period after aSAH.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Christian Fung
- Department of Neurosurgery, University Hospital Berne, Berne, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Olivia Geisseler
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Klemens Gutbrod
- Neuropsychology Unit, Department of Neurology, University Hospital Berne, Berne, Switzerland
| | - Christian Chicherio
- Neuropsychology Unit, Department of Neurology, University Hospital Geneva, Geneva, Switzerland
| | - Andreas U Monsch
- Neuropsychology Unit, Department of Neurology, Memory Clinic Basel, Basel, Switzerland
| | - Valérie Beaud
- Neuropsychology Unit, Department of Neurology, University Hospital Lausanne, Lausanne, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Severin Früh
- Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nicole Schmid
- Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolas R Smoll
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Emanuela Keller
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
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Lilja G, Nielsen N, Ullén S, Blennow Nordstrom E, Dankiewicz J, Friberg H, Heimburg K, Jakobsen JC, Levin H, Callaway C, Cariou A, Eastwood GM, Helbok R, Hovdenes J, Kirkegaard H, Leithner C, Morgan MPG, Nordberg P, Oddo M, Pelosi P, Rylander C, Saxena M, Taccone FS, Siranec M, Wise MP, Young PJ, Cronberg T. Protocol for outcome reporting and follow-up in the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2). Resuscitation 2020; 150:104-112. [PMID: 32205155 DOI: 10.1016/j.resuscitation.2020.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/12/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023]
Abstract
AIMS The TTM2-trial is a multi-centre randomised clinical trial where targeted temperature management (TTM) at 33 °C will be compared with normothermia and early treatment of fever (≥37.8 °C) after Out-of-Hospital Cardiac Arrest (OHCA). This paper presents the design and rationale of the TTM2-trial follow-up, where information on secondary and exploratory outcomes will be collected. We also present the explorative outcome analyses which will focus on neurocognitive function and societal participation in OHCA-survivors. METHODS Blinded outcome-assessors will perform follow-up at 30-days after the OHCA with a telephone interview, including the modified Rankin Scale (mRS) and the Glasgow Outcome Scale Extended (GOSE). Face-to-face meetings will be performed at 6 and 24-months, and include reports on outcome from several sources of information: clinician-reported: mRS, GOSE; patient-reported: EuroQol-5 Dimensions-5 Level responses version (EQ-5D-5L), Life satisfaction, Two Simple Questions; observer-reported: Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest version (IQCODE-CA) and neurocognitive performance measures: Montreal Cognitive Assessment, (MoCA), Symbol Digit Modalities Test (SDMT). Exploratory analyses will be performed with an emphasis on brain injury in the survivors, where the two intervention groups will be compared for potential differences in neuro-cognitive function (MoCA, SDMT) and societal participation (GOSE). Strategies to increase inter-rater reliability and decrease missing data are described. DISCUSSION The TTM2-trial follow-up is a pragmatic yet detailed pre-planned and standardised assessment of patient's outcome designed to ensure data-quality, decrease missing data and provide optimal conditions to investigate clinically relevant effects of TTM, including OHCA-survivors' neurocognitive function and societal participation.
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Affiliation(s)
- Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Helsingborg, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
| | - Erik Blennow Nordstrom
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Josef Dankiewicz
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Cardiology, Lund, Sweden
| | - Hans Friberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Malmö, Sweden
| | - Katarina Heimburg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Copenhagen, Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Department of Cardiology, Holbæk Hospital, Copenhagen, Denmark
| | - Helena Levin
- Lund University, Skane University Hospital, Department of Clinical Sciences, Research and Education, Lund, Sweden
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - Glenn M Eastwood
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raimund Helbok
- Department of Neurology, Neurological Intensive Care Unit, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hovdenes
- Department of Anesthesiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | - Matt P G Morgan
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Per Nordberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Mauro Oddo
- Department of Intensive Care Medicine, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Manoj Saxena
- Bankstown Hospital, South Western Sydney Local Health District, Sydney, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Fabio Silvio Taccone
- Erasme Hospital, Université Libre de Bruxelles, Department of Intensive Care, Brussels, Belgium
| | - Michal Siranec
- Department of Medicine - Department of Cardiovascular Medicine, Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Tobias Cronberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
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Arrieta H, Rezola-Pardo C, Kortajarena M, Hervás G, Gil J, Yanguas JJ, Iturburu M, Gil SM, Irazusta J, Rodriguez-Larrad A. The impact of physical exercise on cognitive and affective functions and serum levels of brain-derived neurotrophic factor in nursing home residents: A randomized controlled trial. Maturitas 2020; 131:72-77. [DOI: 10.1016/j.maturitas.2019.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/20/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022]
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Stienen MN, Geisseler O, Velz J, Maldaner N, Sebök M, Dannecker N, Rothacher Y, Schlosser L, Smoll NR, Keller E, Brugger P, Regli L. Influence of the Intensive Care Unit Environment on the Reliability of the Montreal Cognitive Assessment. Front Neurol 2019; 10:734. [PMID: 31333576 PMCID: PMC6617738 DOI: 10.3389/fneur.2019.00734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Neuropsychological screening becomes increasingly important for the evaluation of subarachnoid hemorrhage (SAH) and stroke patients. It is often performed during the surveillance period on the intensive (ICU), while it remains unknown, whether the distraction in this environment influences the results. We aimed to study the reliability of the Montreal Cognitive Assessment (MoCA) in the ICU environment. Methods: Consecutive stable patients with recent brain injury (tumor, trauma, stroke, etc.) were evaluated twice within 36 h using official parallel versions of the MoCA (ΔMoCA). The sequence of assessment was randomized into (a) busy ICU first or (b) quiet office first with subsequent crossover. For repeated MoCA, we determined sequence, period, location effects, and the intraclass correlation coefficient (ICC). Results: N = 50 patients were studied [n = 30 (60%) male], with a mean age of 57 years. The assessment's sequence ["ICU first" mean ΔMoCA -1.14 (SD 2.34) vs. "Office first" -0.73 (SD 1.52)] did not influence the MoCA (p = 0.47). On the 2nd period, participants scored 0.96 points worse (SD 2.01; p = 0.001), indicating no MoCA learning effect but a possible difference in parallel versions. There was no location effect (p = 0.31) with ΔMoCA between locations (Office minus ICU) of -0.32 (SD 2.21). The ICC for repeated MoCA was 0.87 (95% CI 0.79-0.92). Conclusions: The reliability of the MoCA was excellent, independent from the testing environment being ICU or office. This finding is helpful for patient care and studies investigating the effect of a therapeutic intervention on the neuropsychological outcome after SAH, stroke or traumatic brain injury.
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Affiliation(s)
- Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivia Geisseler
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Noemi Dannecker
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yannick Rothacher
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ladina Schlosser
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emanuela Keller
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Brugger
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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36
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Dong L, Hyde AJ, Zhang AL, Xue CC, May BH. Chinese Herbal Medicine for Mild Cognitive Impairment Using Montreal Cognitive Assessment: A Systematic Review. J Altern Complement Med 2019; 25:578-592. [PMID: 30920303 DOI: 10.1089/acm.2018.0346] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Mild cognitive impairment (MCI) prevalence is estimated at 6%-12% of the population. It is possible that early treatment at the MCI stage could reduce progression to more severe cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a sensitive measure used to assess changes in cognitive function. Various Chinese herbal medicines (CHMs) have been tested for effects on MCI using MoCA. Objectives: To evaluate the clinical evidence for CHMs on MoCA scores in MCI. Design: Five biomedical databases in English and Chinese language were searched for randomized controlled trials that compared orally administered CHMs with a control group and assessed changes in cognition using MoCA. Analyses were based on the comparison, control intervention, and study duration. Mean differences and 95% confidence intervals were calculated to evaluate treatment effects. For each study, risk of bias was assessed according to the Cochrane tool. Results: Nineteen studies were included with 16 contributing to the data analyses. Three studies were placebo controlled. Nine compared a CHM with a pharmacotherapy, three combined a CHM with a pharmacotherapy, and one combined CHM with cognitive training. In the two placebo-controlled studies of 24-week duration, results favored the CHMs at end of treatment. Conclusions: The systematic review suggests that the oral application of certain CHMs improved scores on MoCA by 1.76-2.34 points compared with placebo in people with MCI after 24 weeks of treatment. However, these two studies used different CHM formulations. Two studies that tested the same CHM formulation, Bu Yang Huan Wu Tang, in combination with donepezil, reported improvement in the integrative groups, but the studies were not blind and the durations were only 8-12 weeks. Overall, methodological weaknesses limited the strength of the evidence. The herbal formulae included ingredients that have received considerable research attention for their effects on memory and cognition. PROSPERO international prospective register of systematic reviews protocol registration number: CRD42018099650.
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Affiliation(s)
- Lin Dong
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Anna J Hyde
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Brian H May
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Subramaniam B, Shankar P, Shaefi S, Mueller A, O’Gara B, Banner-Goodspeed V, Gallagher J, Gasangwa D, Patxot M, Packiasabapathy S, Mathur P, Eikermann M, Talmor D, Marcantonio ER. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA 2019; 321:686-696. [PMID: 30778597 PMCID: PMC6439609 DOI: 10.1001/jama.2019.0234] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/16/2019] [Indexed: 01/04/2023]
Abstract
Importance Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative. Objective To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older patients undergoing cardiac surgery. Design, Setting, and Participants Randomized, placebo-controlled, factorial clinical trial among 120 patients aged 60 years or older undergoing on-pump coronary artery bypass graft (CABG) surgery or combined CABG/valve surgeries at a US center. Enrollment was September 2015 to April 2018, with follow-up ending in April 2019. Interventions Patients were randomized to 1 of 4 groups receiving postoperative analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and postoperative sedation with dexmedetomidine or propofol starting at chest closure and continued for up to 6 hours (acetaminophen and dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30; acetaminophen and propofol: n = 31; placebo and propofol: n = 30). Main Outcomes and Measures The primary outcome was incidence of postoperative in-hospital delirium by the Confusion Assessment Method. Secondary outcomes included delirium duration, cognitive decline, breakthrough analgesia within the first 48 hours, and ICU and hospital length of stay. Results Among 121 patients randomized (median age, 69 years; 19 women [15.8%]), 120 completed the trial. Patients treated with IV acetaminophen had a significant reduction in delirium (10% vs 28% placebo; difference, -18% [95% CI, -32% to -5%]; P = .01; HR, 2.8 [95% CI, 1.1-7.8]). Patients receiving dexmedetomidine vs propofol had no significant difference in delirium (17% vs 21%; difference, -4% [95% CI, -18% to 10%]; P = .54; HR, 0.8 [95% CI, 0.4-1.9]). There were significant differences favoring acetaminophen vs placebo for 3 prespecified secondary outcomes: delirium duration (median, 1 vs 2 days; difference, -1 [95% CI, -2 to 0]), ICU length of stay (median, 29.5 vs 46.7 hours; difference, -16.7 [95% CI, -20.3 to -0.8]), and breakthrough analgesia (median, 322.5 vs 405.3 µg morphine equivalents; difference, -83 [95% CI, -154 to -14]). For dexmedetomidine vs propofol, only breakthrough analgesia was significantly different (median, 328.8 vs 397.5 µg; difference, -69 [95% CI, -155 to -4]; P = .04). Fourteen patients in both the placebo-dexmedetomidine and acetaminophen-propofol groups (46% and 45%) and 7 in the acetaminophen-dexmedetomidine and placebo-propofol groups (24% and 23%) had hypotension. Conclusions and Relevance Among older patients undergoing cardiac surgery, postoperative scheduled IV acetaminophen, combined with IV propofol or dexmedetomidine, reduced in-hospital delirium vs placebo. Additional research, including comparison of IV vs oral acetaminophen and other potentially opioid-sparing analgesics, on the incidence of postoperative delirium is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02546765.
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Affiliation(s)
- Balachundhar Subramaniam
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Puja Shankar
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ariel Mueller
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian O’Gara
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jackie Gallagher
- Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Doris Gasangwa
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Melissa Patxot
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Senthil Packiasabapathy
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Pooja Mathur
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward R. Marcantonio
- Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Zaki Ghali MG, Srinivasan VM, Wagner K, Rao C, Chen SR, Johnson JN, Kan P. Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment. World Neurosurg 2018; 120:537-549. [PMID: 29966787 DOI: 10.1016/j.wneu.2018.06.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive sequelae frequently follow subarachnoid hemorrhage (SAH) and include deficits across multiple domains of executive function. This factor affects overall functional outcomes negatively, especially in younger patients. Several clinical correlates predict development and severity of cognitive dysfunction after SAH. Hypothetical mechanisms of cognitive dysfunction in the absence of radiographic lesion include cerebral hypoperfusion and blood breakdown products, resulting in perturbed interneuronal communication and network synchrony, excitotoxicity, and altered microRNA expression. METHODS The PubMed database was searched for articles discussing cognitive outcomes in patients with unruptured and ruptured intracranial aneurysmal disease, sequelae of treatment, and modalities for neuropsychologic testing. RESULTS Treatment of unruptured intracranial aneurysms, although capable of preventing SAH, comes with its own set of complications and may also affect cognitive function. Neuropsychological tests such as the Montreal Cognitive Assessment, Mini-Mental Status Examination, and others have proved useful in evaluating cognitive decline. Studies using functional neurologic imaging modalities have identified regions with altered activation patterns during various cognitive tasks. The sum of research efforts in this field has provided useful insights and an initial understanding of cognitive dysfunction after aneurysm treatment and SAH that should prove useful in guiding and rendering future investigations more fruitful. CONCLUSIONS Development of finer and more sensitive neuropsychological tests in evaluating the different domains of cognitive function after aneurysm treatment and SAH in general will be useful in accurately determining outcomes after ictus and comparing efficacy of different therapeutic strategies.
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Affiliation(s)
| | | | - Kathryn Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Chethan Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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