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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. Longitudinal Trajectories of Quality of Life Among People With Mild-to-Moderate Dementia: A Latent Growth Model Approach With IDEAL Cohort Study Data. J Gerontol B Psychol Sci Soc Sci 2022; 77:1037-1050. [PMID: 35134935 PMCID: PMC9159063 DOI: 10.1093/geronb/gbac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories. METHODS We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories. RESULTS Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores. DISCUSSION Understanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Banning LCP, Janssen EPCJ, Hamel REG, de Vugt M, Köhler S, Wolfs CAG, Oosterveld SM, Melis RJF, Olde Rikkert MGM, Kessels RPC, Pijnenburg YAL, Koene T, van der Flier WM, Scheltens P, Visser PJ, Verhey FRJ, Aalten P, Ramakers IHGB. Determinants of Cross-Sectional and Longitudinal Health-Related Quality of Life in Memory Clinic Patients Without Dementia. J Geriatr Psychiatry Neurol 2020; 33:256-264. [PMID: 31645191 PMCID: PMC7361660 DOI: 10.1177/0891988719882104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify determinants within 3 different domains (ie, somatic comorbidities, cognitive functioning, and neuropsychiatric symptoms [NPS]) of health-related quality of life (HRQoL) over time in memory clinic patients without dementia. METHODS This longitudinal multicenter cohort study with a 3-year observation period recruited 315 individuals (age: 69.8 ± 8.6, 64.4% males, Mini-Mental State Examination score 26.9 ± 2.6). A multivariable explanatory model was built using linear mixed effects models (forward selection per domain) to select determinants for self-perceived HRQoL over time, as measured by the EuroQoL-5D visual analogue scale (EQ VAS). RESULTS Mean HRQoL at study entry was 69.4 ± 15.6. The presence of agitation, appetite and eating abnormalities, and eyes/ears/nose (ie, sensory impairment) comorbidities were associated with a change in HRQoL over time. Agitation was most strongly associated with HRQoL over time. CONCLUSIONS The association of somatic comorbidities and NPS in memory clinic patients with course of HRQoL shows that these should receive more awareness, detection, and monitoring by clinicians.
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Affiliation(s)
- Leonie C. P. Banning
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eveline P. C. J. Janssen
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands,Mondriaan Department of Old Age Psychiatry, Heerlen, the Netherlands
| | | | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Claire A. G. Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Saskia M. Oosterveld
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rene J. F. Melis
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Ted Koene
- Department of Medical Psychology and Neuroscience Campus Amsterdam, VUmc Alzheimer Center, VUmc Medical Center, Amsterdam, the Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands,Department of Epidemiology & Biostatistics, VUmc Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Inez H. G. B. Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Inez H. G. B. Ramakers, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Rossi Daré L, Garcia A, Neves BH, Mello-Carpes PB. One physical exercise session promotes recognition learning in rats with cognitive deficits related to amyloid beta neurotoxicity. Brain Res 2020; 1744:146918. [PMID: 32485172 DOI: 10.1016/j.brainres.2020.146918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022]
Abstract
Alzheimer's disease is a progressive neurodegenerative pathological process that causes memory loss and cognitive impairment. One of the pathological characteristics of Alzheimer's disease is the amyloid-β protein aggregation on the brain. The regular practice of physical exercise is a consolidated strategy on the prevention of cognitive deficits; however, little is known about the effects of acute exercise on memory. We hypothesize that one physical exercise session could act as a modulator of learning. Here we investigated the effects of one single session of running (aerobic) or strength (anaerobic) exercise on memory deficits related to neurotoxicity induced by amyloid-β. Male Wistar rats were submitted to stereotaxic surgery to intrahippocampal infusion of amyloid-β protein or saline (control). Ten days after the surgery the rats were submitted to the object recognition (OR) memory task. Immediately after the OR learning session, some rats were submitted to one treadmill running or strength exercise session. Then, the animals were submitted to memory tests 24 h, 7, and 14 days after the OR learning. We demonstrated that one physical exercise session, both aerobic as anaerobic, performed after learning improves learning and memory, promoting memory persistence in control rats and memory consolidation in rats submitted to amyloid-β neurotoxicity model. Notably, the effects of the aerobic exercise session seem to be more prominent, since they also reflect in an improvement of object discrimination index for 7 days in control animals. We verified that the mechanisms involved in the effects of aerobic exercise include the dopaminergic system activation. The mechanisms involved in the anaerobic exercise effects seem to be others since no alterations on hippocampal dopamine or noradrenaline levels were detected.
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Affiliation(s)
- Leticia Rossi Daré
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Alexandre Garcia
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Ben-Hur Neves
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Pâmela B Mello-Carpes
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil.
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Ajtahed SS, Rezapour T, Etemadi S, Moradi H, Habibi Asgarabad M, Ekhtiari H. Efficacy of Neurocognitive Rehabilitation After Coronary Artery Bypass Graft Surgery in Improving Quality of Life: An Interventional Trial. Front Psychol 2019; 10:1759. [PMID: 31440180 PMCID: PMC6694840 DOI: 10.3389/fpsyg.2019.01759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/15/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Cognitive deficits are frequent after coronary artery bypass graft (CABG) surgery and consequently could lead to a decrease in quality of life. This is the first study that has been conducted with the aim of examining the efficacy of a computerized cognitive rehabilitation therapy (CCRT) in improving quality of life in patients after CABG surgery. Methods In this study, an interventional trial with pre-, post-, and follow-up assessments in active (CCRT), active control and control groups was conducted. Seventy-five patients after CABG surgery were selected and assigned to the groups (n = 25 for each group). CCRT consists of four modules of attention, working memory, response inhibition and processing speed training with graded schedule in 20-min sessions three times per week within 8 weeks. Cognitive functions (attention and working memory) were assessed by the tests of continuous performance, Flanker, useful field of view and digit span at three time points: pre- and post-intervention (T0 and T1) and 6-month follow-up (T2). Quality of life was assessed by the SF-36 questionnaire at the same time points. The CCRT group received the cognitive rehabilitation for 2 months, active control group received a sham version of CCRT in an equal time duration and control group did not receive any cognitive intervention. Results Repeated measures analysis of variance (ANOVA) revealed a time by group interaction on cognitive functions, with CCRT producing a significant improvement at T1 (p < 0.01) and these improvements were maintained at T2. Moreover, in CCRT and active control groups, quality of life (QoL) improved at T1 and these improvements remained stable throughout follow-up (T2). However, improvement of QoL in CCRT group was greater than improvement of QoL in the other two groups at T1. Pearson’s correlation analysis shows a positive correlation between QoL improvement and sustained attention and working memory enhancement (p < 0.05). Conclusion Cognitive rehabilitation can lead to a significant improvement in the cognitive functions that have been trained in patients receiving CABG. Interestingly enough, cognitive rehabilitation can also improve quality of life in patients after CABG surgery and this improvement is maintained for at least 6 months.
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Affiliation(s)
| | - Tara Rezapour
- Department of Psychology, University of Tehran, Tehran, Iran
| | | | - Hadi Moradi
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Mojtaba Habibi Asgarabad
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Ekhtiari
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran.,Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
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Kaushal N, Desjardins-Crépeau L, Langlois F, Bherer L. The Effects of Multi-Component Exercise Training on Cognitive Functioning and Health-Related Quality of Life in Older Adults. Int J Behav Med 2019; 25:617-625. [PMID: 29926316 DOI: 10.1007/s12529-018-9733-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Exercise has been shown to have various proximal and distal benefits among older adults such as improving physical fitness, cognitive functioning, and health-related quality of life (HR-QOL). Despite this evidence, limited research has investigated pathway change of these outcomes. The primary purpose of this study was to test if older adults who improved in physical fitness measures from engaging in multicomponent exercise training for 12 weeks predicted change in proximal (cognitive functioning) and distal (HR-QOL) outcomes, respectively. METHODS Participants (n = 110) were healthy, older adults (M = 72, SD = 7.24) that comprised an exercise-intervention and control group. The intervention consisted of exercising in a supervised laboratory setting for 12 weeks. RESULTS Structural equation modeling revealed group type to predict change in physical performance and the maximum walking test with comparable effect sizes. Physical performance in turn predicted improvement in processing speed (β = 0.23, p = 0.013) executive functioning (β = 0.26, p = 0.006), and HR-QOL (β = 0.13, p = 0.031). However, only executive functioning was found to significantly predict HR-QOL (β = 0.49, p < 0.001) over processing speed (p > 0.05). CONCLUSIONS Between two fitness measures, the physical performance test demonstrated better predictive validity in proximal and distal health outcomes. In addition to physical fitness, older adults who engage in multi-component exercise sessions regularly can improve their executive functioning, which in turn enhances their HR-QOL.
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Affiliation(s)
- Navin Kaushal
- Department of Medicine, University of Montreal, Montréal, Québec, Canada.
- Montreal Heart Institute, Montréal, Québec, Canada.
| | - Laurence Desjardins-Crépeau
- Department of Medicine, University of Montreal, Montréal, Québec, Canada
- Montreal Heart Institute, Montréal, Québec, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Francis Langlois
- CSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Montréal, Québec, Canada
| | - Louis Bherer
- Department of Medicine, University of Montreal, Montréal, Québec, Canada
- Montreal Heart Institute, Montréal, Québec, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
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Abstract
UNLABELLED ABSTRACTObjective:To study longitudinal changes in the quality of life (QoL) in persons with and without dementia, and explore the factors associated with baseline QoL and changes of QoL over the follow-up period. DESIGN Prospective longitudinal study. SETTING Data were collected from 17 municipalities in Norway in the period from January 2009 to August 2012. A total of 412 persons were included, 254 (61.7 %) persons without dementia and 158 (38.3 %) with dementia at baseline. SUBJECTS Persons 70 years of age or older, receiving municipal care services. Main outcome measures include the following: self-rated and proxy-rated QoL over a period of 18 months, cognitive status, functional status, neuropsychiatric symptoms, and demographics. RESULTS Longitudinal changes in QoL were small, despite changes in clinical variables. Proxy ratings of patients QoL were lower than the patients' own ratings. Belonging to a group with low QoL trajectory was associated with symptoms of depression, reduced physical and instrumental functioning, and more severe dementia. CONCLUSION Patients and proxies evaluated the patients' QoL differently and QoL did not necessarily correspond with deterioration in clinical parameters. To prevent impaired QoL, we need to address identified factors and keep an approach open to the individual perceptions of QoL.
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Dewitte L, Vandenbulcke M, Dezutter J. Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff. Int J Geriatr Psychiatry 2018; 33:1074-1081. [PMID: 29869400 DOI: 10.1002/gps.4895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self-ratings. However, cognition-related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, 2 issues we addressed in the current study. METHODS We collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self-report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini-Mental State Examination and a battery of specific cognitive measures. RESULTS Intraclass correlations and a paired sample t test confirmed a discrepancy between self-rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini-Mental State Examination score remained a significant predictor of staff ratings but not self-ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff-rated QOL. CONCLUSIONS Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease.
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Affiliation(s)
- Laura Dewitte
- KU Leuven-University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven-University of Leuven, Leuven, Belgium.,University Psychiatric Centre KU Leuven, Leuven, Belgium
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Abstract
OBJECTIVE Existing evidence indicates that a younger subjective age is a marker of successful aging, including better health and cognition. Building upon this evidence, it is likely that individuals with dementia might feel older. However, subjective evaluation of age might not be affected by dementia because these individuals tend to be anosognosic and report positive health-related quality of life. METHODS Data from two cross-sectional samples from France and the United States were used to compare the subjective age ratings of individuals with and without dementia. RESULTS Results from both samples revealed that individuals with dementia felt younger than their age but did not differ from the controls, even after controlling for sex, chronological age, education, and self-rated health. CONCLUSION The present study suggests that there are no large differences in the subjective experience of age between healthy individuals and those with dementia.
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Affiliation(s)
| | - Antonio Terracciano
- b Florida State University College of Medicine , Tallahassee , Florida , USA
| | - Angelina R Sutin
- b Florida State University College of Medicine , Tallahassee , Florida , USA
| | | | - Stéphane Raffard
- c University of Montpellier , Montpellier , France.,d University Department of Adult Psychiatry , La Colombière Hospital , CHRU Montpellier, Montpellier , France
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