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Wiggins M, Arias F, Urman RD, Richman DC, Sweitzer BJ, Edwards AF, Armstrong MJ, Chopra A, Libon DJ, Price C. Common neurodegenerative disorders in the perioperative setting: Recommendations for screening from the Society for Perioperative Assessment and Quality Improvement (SPAQI). PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2020; 20:100092. [PMID: 32577538 PMCID: PMC7311090 DOI: 10.1016/j.pcorm.2020.100092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aging is associated with normal and abnormal brain and cognitive changes. Due to the expected increase in older adults requiring surgery, perioperative clinicians will be increasingly encountering patients with neurodegenerative disease. To help perioperative clinicians understand signs of abnormal behaviors that may mark an undiagnosed neurodegenerative disorder and alert additional patient monitoring, The Society for Perioperative Assessment and Quality Improvement (SPAQI) worked with experts in dementia, neuropsychology, geriatric medicine, neurology, and anesthesiology to provide a summary of cognitive and behavioral considerations for patients with common neurodegenerative disorders being evaluated at preoperative centers. Patients with neurodegenerative disorders are at high risk for delirium due to known neurochemical disruptions, medication interactions, associated frailty, or vascular risk profiles presenting risk for repeat strokes. We provide basic information on the expected cognitive changes with aging, most common neurodegenerative disorders, a list of behavioral features and considerations to help differentiate neurodegenerative disorders. Finally, we propose screening recommendations intended for a multidisciplinary team in the perioperative setting.
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Affiliation(s)
- Margaret Wiggins
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, Gainesville, FL 32610
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Deborah C Richman
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480
| | - Bobbie Jean Sweitzer
- Northwestern University Feinberg School of Medicine, 251 East Huron, Chicago, IL 60611
| | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Melissa J Armstrong
- Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 Williston Road, Gainesville, Florida 32608
- Neurology Department, University of Florida, 101 S Newell Drive, Gainesville, FL 32610
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
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Peven JC, Chen Y, Guo L, Zhan L, Boots EA, Dion C, Libon DJ, Heilman KM, Lamar M. The oblique effect: The relationship between profiles of visuospatial preference, cognition, and brain connectomics in older adults. Neuropsychologia 2019; 135:107236. [PMID: 31654648 DOI: 10.1016/j.neuropsychologia.2019.107236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 01/21/2023]
Abstract
The oblique effect (OE) describes the visuospatial advantage for identifying stimuli oriented horizontally or vertically rather than diagonally; little is known about brain aging and the OE. We investigated this relationship using the Judgment of Line Orientation (JLO) in 107 older adults (∼age = 67.8 ± 6.6; 51% female) together with neuropsychological tests of executive functioning (EF), attention/information processing (AIP), and neuroimaging. Only JLO lines falling between 36-54° or 126-144° were considered oblique. To quantify the oblique effect, we calculated z-scores for oblique errors (zOblique = #oblique errors/#oblique lines), and similarly, horizontal + vertical line errors (zHV), and a composite measure of oblique relative to HV errors (zOE). Composite z-scores of EF and AIP reflected domains associated with JLO performance. Graph theory analysis integrated T1-derived volumetry and diffusion MRI-derived white matter tractography into connectivity matrices analyzed for select network properties. Participants produced more zOblique than zHV errors (p < 0.001). Age was not associated with zOE adjusting for sex, education, and MMSE. Similarly adjusted linear regression models revealed that lower EF was associated with a larger oblique effect (p < 0.001). Modular analyses of neural connectivity revealed a differential patterns of network affiliation that varied by high versus low group status determined via median split of zOblique and zHV errors, separately. Older adults exhibit the oblique effect and it is associated with specific cognitive processes and regional brain networks that may facilitate future investigations of visuospatial preference in aging.
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Affiliation(s)
- Jamie C Peven
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Yurong Chen
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lei Guo
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Liang Zhan
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth A Boots
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, USA; Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, USA
| | - Kenneth M Heilman
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
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Sunderaraman P, Sokolov E, Cines S, Sullo E, Orly A, Lerer B, Karlawish J, Huey E, Cosentino S. Untimed Design Fluency in Aging and Alzheimer's Disease: Psychometrics and Normative Data. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 22:363-72. [PMID: 25679880 DOI: 10.1080/23279095.2014.940419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Design fluency tests, commonly used in both clinical and research contexts to evaluate nonverbal concept generation, have the potential to offer useful information in the differentiation of healthy versus pathological aging. Although normative data for older adults (OAs) are available for multiple timed versions of this test, similar data have been unavailable for a previously published untimed test, the Graphic Pattern Generation Test (GPG). Time constraints common to almost all of the available design fluency tests may cloud interpretation of higher-level executive abilities-for example, in individuals with slow processing speed. The current study examined the psychometric properties of the GPG and presents normative data in a sample of 167 healthy OAs and 110 individuals diagnosed with Alzheimer's disease (AD). Results suggest that a brief version of the GPG can be administered reliably and that this short form has high test-retest and interrater reliability. Number of perseverations was higher in individuals with AD as compared with OAs. A cutoff score of 4 or more perseverations showed a moderate degree of sensitivity (76%) and specificity (37%) in distinguishing individuals with AD and OAs. Finally, perseverations were associated with nonmemory indexes, thereby underscoring the nonverbal nature of this error in OAs and individuals with AD.
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Affiliation(s)
- Preeti Sunderaraman
- a Department of Psychology , Drexel University , Philadelphia , Pennsylvania
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Weakley A, Schmitter-Edgecombe M. Analysis of verbal fluency ability in Alzheimer's disease: the role of clustering, switching and semantic proximities. Arch Clin Neuropsychol 2014; 29:256-68. [PMID: 24687588 DOI: 10.1093/arclin/acu010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The underlying nature of verbal fluency deficits in Alzheimer's disease (AD) was investigated in this study. Participants were 48 individuals with AD and 48 cognitively healthy older adults. Fluency performance on letter and category tasks was analyzed across two 30-s intervals for total words produced, mean cluster size, and total switches. Compared with the control group, AD participants produced fewer words and switches on both fluency tasks and had a reduced category cluster size. The AD group was differentially impaired on category compared with letter fluency and produced more repetitive responses but fewer category exemplars than controls on the category task. A multidimensional scaling approach revealed that AD participants' semantic maps were similar to controls. Overall, the data suggest that executive abilities involving search and retrieval processes and a reduced availability of semantically related words contributed to the AD group's poorer performance despite similar temporal recall and organizational patterns.
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Affiliation(s)
- Alyssa Weakley
- Department of Psychology, Washington State University, Pullman, WA 99163, USA
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Kaiser NC, Melrose RJ, Liu C, Sultzer DL, Jimenez E, Su M, Monserratt L, Mendez MF. Neuropsychological and neuroimaging markers in early versus late-onset Alzheimer's disease. Am J Alzheimers Dis Other Demen 2012; 27:520-9. [PMID: 22990206 DOI: 10.1177/1533317512459798] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early-onset Alzheimer's disease (EOAD) has been overshadowed by the more common late-onset AD (LOAD). Yet, the literature indicates EOAD may have less hippocampal-memory presentations and more focal neocortical localization early in the disease. OBJECTIVE To evaluate these proposed differences between these 2 forms of AD and to explore what they inform about differences in AD pathophysiology. METHODS In all, 21 patients with EOAD and 24 patients with LOAD matched for disease progression and severity were compared on neurocognitive measures and resting state fluorodeoxy-glucose positron-emission tomography (FDG-PET). RESULTS Patients with EOAD had worse executive functions with greater hypometabolism in the parietal regions; whereas patients with LOAD had worse confrontation naming and verbal recognition memory with greater hypometabolism in inferior frontotemporal regions. CONCLUSIONS In addition to highlighting significant differences between EOAD and LOAD, these results reveal dissociation between executive deficits in AD and frontal hypometabolism, suggesting early disturbances of the parietal-frontal network in EOAD.
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Affiliation(s)
- Natalie C Kaiser
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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Romberg C, Mattson MP, Mughal MR, Bussey TJ, Saksida LM. Impaired attention in the 3xTgAD mouse model of Alzheimer's disease: rescue by donepezil (Aricept). J Neurosci 2011; 31:3500-7. [PMID: 21368062 PMCID: PMC3066152 DOI: 10.1523/jneurosci.5242-10.2011] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/09/2010] [Accepted: 01/06/2011] [Indexed: 01/11/2023] Open
Abstract
Several mouse models of Alzheimer's disease (AD) with abundant β-amyloid and/or aberrantly phosphorylated tau develop memory impairments. However, multiple non-mnemonic cognitive domains such as attention and executive control are also compromised early in AD individuals. Currently, it is unclear whether mutations in the β-amyloid precursor protein (APP) and tau are sufficient to cause similar, AD-like attention deficits in mouse models of the disease. To address this question, we tested 3xTgAD mice (which express APPswe, PS1M146V, and tauP301L mutations) and wild-type control mice on a newly developed touchscreen-based 5-choice serial reaction time test of attention and response control. The 3xTgAD mice attended less accurately to short, spatially unpredictable stimuli when the attentional demand of the task was high, and also showed a general tendency to make more perseverative responses than wild-type mice. The attentional impairment of 3xTgAD mice was comparable to that of AD patients in two aspects: first, although 3xTgAD mice initially responded as accurately as wild-type mice, they subsequently failed to sustain their attention over the duration of the task; second, the ability to sustain attention was enhanced by the cholinesterase inhibitor donepezil (Aricept). These findings demonstrate that familial AD mutations not only affect memory, but also cause significant impairments in attention, a cognitive domain supported by the prefrontal cortex and its afferents. Because attention deficits are likely to affect memory encoding and other cognitive abilities, our findings have important consequences for the assessment of disease mechanisms and therapeutics in animal models of AD.
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Affiliation(s)
- Carola Romberg
- Department of Experimental Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
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Lamar M, Price CC, Libon DJ, Penney DL, Kaplan E, Grossman M, Heilman KM. Alterations in working memory as a function of leukoaraiosis in dementia. Neuropsychologia 2006; 45:245-54. [PMID: 16950457 PMCID: PMC2911013 DOI: 10.1016/j.neuropsychologia.2006.07.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 06/14/2006] [Accepted: 07/08/2006] [Indexed: 11/24/2022]
Abstract
Dementia research suggests executive dysfunction is best understood within the context of disease-specific neuropathology. Leukoaraiosis (LA) results in executive dysfunction yet little is known about its impact on specific aspects of working memory (WM). This study aimed to investigate the relationship between MRI LA severity and WM in dementia. A visual rating scale was used to assign patients with dementia into groups with minimal-mild LA (Low LA; n=34) and moderate-severe LA (High LA; n=32). A modified Digit Span Backward Task consisting of 3-, 4-, and 5-span trials measured specific components of WM. Short-term storage and rehearsal in WM were assessed by the total number of digits reported regardless of recall order (ANY-ORDER; e.g., 47981 recalled '18943', score=4). Mental manipulation in the form of disengagement and temporal re-ordering was assessed by the total number of digits recalled in correct position (SERIAL-ORDER; e.g., 47981 recalled '18943', score=3). There was no difference between LA groups on ANY-ORDER comparisons. The High LA group obtained lower SERIAL-ORDER scores than the Low LA group. Stepwise regression analyses were conducted that first entered MMSE scores then composite z-scores reflecting executive functioning, language and memory. ANY-ORDER performance variance was explained solely by dementia severity. SERIAL-ORDER performance variance was further explained by executive dysfunction. Results suggest that high degrees of LA do not interfere with immediate (digit) recall but do interfere with disengagement and temporal re-ordering. LA may disconnect the frontal lobes from subcortical and cortical structures that form the neuronal networks critical for these WM functions.
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Affiliation(s)
- Melissa Lamar
- Institute of Psychiatry, King's College London, Department of Psychology, De Crespigny Park, London, UK.
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