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Lin P, Kamdar N, Rodriguez GM, Cigolle C, Tate D, Mahmoudi E. Incident traumatic spinal cord injury and risk of Alzheimer's disease and related dementia: longitudinal case and control cohort study. Spinal Cord 2024; 62:479-485. [PMID: 38937544 DOI: 10.1038/s41393-024-01009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
STUDY DESIGN Retrospective case/control longitudinal cohort study OBJECTIVES: Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer's disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. SETTING Using 2010-2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). METHODS We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. RESULTS Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01-1.67). People aged 45-64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27-11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92-1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45-64 years of age compared with the matched controls. CONCLUSIONS TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.
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Affiliation(s)
- Paul Lin
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christine Cigolle
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Denise Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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De Vito AN, Emrani S, Correia S, Coutinho MT, Lee A. Compensatory strategy use in diverse older adults with subjective cognitive complaints. Aging Ment Health 2024:1-8. [PMID: 38952264 DOI: 10.1080/13607863.2024.2367060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The current study aimed to evaluate the relationship between subjective cognitive complaints (SCC) and compensatory strategy (CS) use in a diverse sample of non-Latinx White (NLW), Black, and Latinx American older adults. METHOD 807 older adults (Mage = 65.38, 62.7% female) were recruited through Amazon's Mechanical Turk (MTurk) and Qualtrics Panel to complete questionnaires on SCC and CS use. Kruskall-Wallis tests were used to evaluate differences in SCC across groups given non-normal distributions. Analysis of variance (ANOVA) was used to evaluate group differences in CS use. The PROCESS macro for SPSS was used to examine whether demographic factors moderated the relationship between SCC and CS use. RESULTS NLWs reported higher levels of SCC and greater overall use of CS in comparison to Latinx and Black individuals. Several demographic and psychosocial factors including age, ethno-racial group, education, and anxiety level were found to be associated with CS use. Education was found to moderate the association between SCC and CS use. CONCLUSION Inconsistent with prior studies, our study found that NLWs reported the highest levels of SCC. CS were used across all racial/ethnic groups, but the frequency of CS use may be impacted by education level. While all education groups increased their CS in response to higher levels of SCC, this increase was more substantial for those with lower levels of education. Future work should consider individuals' cultural and educational background when examining SCC and/or developing CS-based intervention for the aging population.
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Affiliation(s)
- Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital Memory and Aging Program, Providence, RI, USA
| | - Sheina Emrani
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital Memory and Aging Program, Providence, RI, USA
| | - Stephen Correia
- Institute of Gerontology, University of Georgia, Athens, GA, USA
| | - Maria Teresa Coutinho
- Department of Counseling Psychology and Applied Human Development, Boston University, Boston, MA, USA
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital Memory and Aging Program, Providence, RI, USA
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Döhring J, Williamson M, Brettschneider C, Fankhänel T, Luppa M, Pabst A, Weißenborn M, Zöllinger I, Czock D, Frese T, Gensichen J, Hoffmann W, König HH, Thyrian JR, Wiese B, Riedel-Heller S, Kaduszkiewicz H. Quality of life in a high-risk group of elderly primary care patients: characteristics and potential for improvement. Qual Life Res 2024; 33:1841-1851. [PMID: 38740640 PMCID: PMC11176227 DOI: 10.1007/s11136-024-03647-7] [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] [Accepted: 03/08/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Quality of Life (QoL) is associated with a bandwidth of lifestyle factors that can be subdivided into fixed and potentially modifiable ones. We know too little about the role of potentially modifiable factors in comparison to fixed ones. This study examines four aspects of QoL and its associations with 15 factors in a sample of elderly primary care patients with a high risk of dementia. The main objectives are (a) to determine the role of the factors in this particular group and (b) to assess the proportion of fixed and potentially modifiable factors. METHOD A high-risk group of 1030 primary care patients aged between 60 and 77 years (52.1% females) were enrolled in "AgeWell.de," a cluster-randomized, controlled trial. This paper refers to the baseline data. The multi-component intervention targets to decrease the risk of dementia by optimization of associated lifestyle factors. 8 fixed and 7 modifiable factors potentially influencing QoL served as predictors in multiple linear regressions. RESULTS The highest proportion of explained variance was found in psychological health and age-specific QoL. In comparison to health-related QoL and physical health, the modifiable predictors played a major role (corr. R2: 0.35/0.33 vs. 0.18), suggesting that they hold a greater potential for improving QoL. CONCLUSION Social engagement, body weight, instrumental activities of daily living, and self-efficacy beliefs appeared as lifestyle factors eligible to be addressed in an intervention program for improving QoL. TRIAL REGISTRATION German Clinical Trials Register, reference number: DRKS00013555. Date of registration: 07.12.2017.
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Affiliation(s)
- Juliane Döhring
- Institute of General Practice, University of Kiel, 24105, Kiel, Germany.
| | - Martin Williamson
- Institute of General Practice, University of Kiel, 24105, Kiel, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Thomas Fankhänel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336, Munich, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336, Munich, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17489, Greifswald, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald, 17489, Greifswald, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), 17489, Greifswald, Germany
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Institute for General Practice, 30625, Hannover, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany
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Yang D, Lee JM, Yang SH, Cho KH, Kim J. Socioeconomic status and physical activity disparities in older adults: Implications for COVID-19 related diabetes cognitive dysfunction. Prev Med Rep 2024; 43:102772. [PMID: 38952432 PMCID: PMC11216005 DOI: 10.1016/j.pmedr.2024.102772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives This study aims to investigate the influence of socioeconomic status (SES) on variations in physical activity (PA) levels and diabetes-related cognitive dysfunction and impairment amidst disruptions caused by the COVID-19 pandemic. Methods With the sample of old population, comprising about 20 thousand from the Fact-Finding Survey on the Status of Senior Citizens (FSSSC) released by Ministry of Health and Welfare of South Korea in 2017 and 2020, we empirically tested the direct and indirect effects of SES on cognitive dysfunction using structural equation modeling (SEM). Two SEMs provided the comparison on the effects of COVID-19. Results Household income had a negative impact on the likelihood of dementia diagnosis via PA related diabetes during the pandemic (p < 0.001), whereas no effects of household income on dementia diagnosis were found in 2017, due to no direct effect of PA on diabetes confirmation in 2017. The disparity in PA based on SES becomes more prominent among the older individuals during the pandemic (z = 11.7) than 2017 (z = 6.0), emphasizing the significance of PA in mitigating diabetes-induced cognitive dysfunction during the pandemic. SES affects access to PA, contributing to diabetes-induced cognitive dysfunctions in the older population with lower SES during the pandemic. Conclusion PA may serve as a preventive measure against diabetes-induced cognitive dysfunction and dementia in the older population. Thorough investigation of these mechanisms is imperative to establish the role of PA in preventing diabetes-induced cognitive impairment, particularly among the older population with lower SES.
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Affiliation(s)
- Dongwoo Yang
- Center for Regional Development, Chonnam National University, Gwangju, South Korea
| | - Jung-Min Lee
- Department of Physical Education, Kyung-Hee University, Yongin, South Korea
| | - Seo-Hyung Yang
- School of Global Sports Studies, Korea University, Sejong, South Korea
| | - Kyung-Hun Cho
- Department of Physical Education, Kyung-Hee University, Yongin, South Korea
| | - Jahyun Kim
- Department of Kinesiology, California State University Bakersfield, Bakersfield, CA, USA
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5
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Fauzi NBM, Huang X, Cheng LJ, Luo N, Hilal S. Association of a healthy ageing index with health-related outcomes in a multi-ethnic cohort from Singapore. BMC Geriatr 2024; 24:508. [PMID: 38862903 PMCID: PMC11165847 DOI: 10.1186/s12877-024-05099-7] [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: 12/05/2023] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The global population is ageing rapidly and it is important to promote healthy ageing. The Healthy Ageing Index (HAI) is a comprehensive measure of health, but there is limited research on its association with other age-related outcomes. The management of an aging population necessitates considerations even among generally healthy adults, as age-related diseases often remain unaccounted for until later stages of life. This study explores the association of risk factors with HAI and its association with peripheral artery disease (PAD), muscle strength, health-related quality of life (HRQoL), and psychological distress in the Singapore Multi-Ethnic Cohort study. METHODS This cross-sectional study involved 1909 participants (median (Q1, Q3) age: 53 (48, 60) years and 59.3% females) from Singapore Multi-Ethnic Cohort study. The risk factors of HAI included age, gender, ethnicity, education level, smoking, alcohol consumption, employment, BMI and past medical histories. PAD was assessed using ankle-brachial index (ABI), handgrip strength (HGS), HRQoL with the EQ-5D-5 L questionnaire and psychological distress via the Kessler Psychological Distress Scale (K10). HAI components were assessed using relevant marker tests. RESULTS Older age, Malay and Indian ethnicities, unemployment, high BMI and histories of CHD, hypercholesterolaemia, tumours and TIA/stroke were associated with lower HAI scores indicative of poorer health. Higher HAI scores were associated with females and higher education levels. Lower HAI scores were significantly associated with low ABI, high K10 scores, mobility and anxiety/depression dimensions of EQ-5D-5 L. CONCLUSION The most important factors associated with HAI were age, sex, ethnicity, education, unemployment, BMI and a history of health conditions. Lower HAI scores were significantly associated with PAD, lower HRQoL and psychological distress. Thus, the HAI demonstrates promise as an evaluation method for assessing PAD, overall muscle strength and HRQoL in a population-based setting.
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Affiliation(s)
- Nazira Binte Muhammad Fauzi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore.
- Department of Pharmacology, National University of Singapore, Singapore, Singapore.
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Martins VF, Peyré-Tartaruga LA, Haas AN, Kanitz AC, Martinez FG, Gonçalves AK. Observational evidence of the association between physical and psychological determinants of aging with cognition in older adults. Sci Rep 2024; 14:12574. [PMID: 38821915 PMCID: PMC11143211 DOI: 10.1038/s41598-024-58497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/29/2024] [Indexed: 06/02/2024] Open
Abstract
Aging involves physical and cognitive deterioration in older adults. Detecting predictors of dementia early is crucial to identify its onset. This study aimed to associate physical and psychological determinants with cognitive performance in older adults. Observational study with 221 older adults, classified according to cognitive impairment. We evaluated cognitive function by Mini-Mental State Examination. Physical determinants encompassed muscle strength, functional mobility, and cardiorespiratory fitness, while psychological consisted of quality of life and activities of daily living. Multiple linear regression was performed to investigate this relationship. Physical and psychological determinants were significantly linked to cognitive impairment, including lower muscle strength, reduced functional mobility and of cardiorespiratory fitness. The influence of environment, autonomy, and engagement in daily activities on cognitive impairment was also observed. The analysis of physical and psychological determinants could help to aid in distinguishing individuals with cognitive impairment.
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Affiliation(s)
- Valéria Feijó Martins
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Alexandre Peyré-Tartaruga
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Human Locomotion Laboratory (LocoLab), Department of Public Health, Experimental Medicine and Forensic Sciences, University of Pavia, Pavia, Italy.
| | - Aline Nogueira Haas
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Global Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Ana Carolina Kanitz
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréa Kruger Gonçalves
- Programa de Pós-Graduação em Ciências do Movimento Humano, Laboratório de Biodinâmica, Centro de Referência do Envelhecimento e Movimento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Shetty A, Saab EG, Choi G. Social Impact of Hepatic Encephalopathy. Clin Liver Dis 2024; 28:273-285. [PMID: 38548439 DOI: 10.1016/j.cld.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Hepatic encephalopathy is a medical condition that stems from liver dysfunction, leading to the accumulation of toxins in the bloodstream. This can result in cognitive impairments, mood changes, and motor dysfunction. Its social impact includes challenges in employment, relationships, and daily functioning for affected individuals. Stigma and misunderstanding around the condition can further exacerbate the difficulties faced by both patients and their caregivers. Efforts to raise awareness, improve medical management, and provide support systems can help mitigate the social impact of hepatic encephalopathy.
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Affiliation(s)
- Akshay Shetty
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Elena G Saab
- School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Gina Choi
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
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Sutin AR, Gamaldo AA, Terracciano A, Evans MK, Zonderman AB. Personality and cognitive errors in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. JOURNAL OF RESEARCH IN PERSONALITY 2024; 109:104449. [PMID: 38312326 PMCID: PMC10836197 DOI: 10.1016/j.jrp.2023.104449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
This study examines the association between personality and cognitive errors in the Healthy Aging in Neighborhoods of Diversity across the Life Span study, a sample diverse across race (Black, White) and SES (above, below 125% of the federal poverty line). Participants (N=1,062) completed a comprehensive personality questionnaire and were administered a brief mental status screener of cognitive errors. Higher neuroticism was associated with more cognitive errors, whereas higher openness and conscientiousness were associated with fewer errors. These associations were independent of age, sex, race, poverty status, and education and were generally not moderated by these factors. These findings support the associations between personality and cognition across race and SES.
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Affiliation(s)
| | - Alyssa A. Gamaldo
- Human Development and Family Studies, The Pennsylvania State University
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9
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Ware OD, Baik S, Becker TD, Neukrug H, Zimmerman S. Substance use problems and disorders among adults 50 years and older receiving mental health treatment for a primary neurocognitive disorder. Aging Ment Health 2024:1-6. [PMID: 38533723 DOI: 10.1080/13607863.2024.2335396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES This study sought to (1) identify the percentage of high-risk substance use or substance use disorder (SUD) and (2) examine the factors associated with high-risk substance use or SUD in adults aged 50 years and older receiving mental health treatment with a primary delirium or dementia diagnosis. METHOD This study used 7 years (2013-2019) of national administrative data on community mental health center patients aged 50 years and older with a primary delirium or dementia diagnosis receiving treatment in the United States (U.S.). To examine factors associated with the dependent variable (high-risk substance use or SUD), a multivariable binary logistic regression model was utilized. RESULTS The sample included 77,509 individuals who were mostly aged 65 years and older (69.7%), and did not have co-occurring high-risk substance use or SUD (90.1%). Receiving treatment in a U.S. region other than the Northeast, being younger, male, not non-Hispanic White, and having multiple mental health diagnoses had greater odds of co-occurring high-risk substance use or SUD. CONCLUSION One in ten persons in this sample having high-risk substance use or SUD highlights the clinical necessity for screening and subsequent treatment for co-occurring high-risk substance use among persons receiving treatment for a neurocognitive disorder.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sol Baik
- Weldon Cooper Center for Public Service, University of Virginia, Charlottesville, VA, USA
| | - Todd D Becker
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Hannah Neukrug
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chan DC, Kim C, Kang RY, Kuhn MK, Beidler LM, Zhang N, Proctor EA. Cytokine expression patterns predict suppression of vulnerable neural circuits in a mouse model of Alzheimer's disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.17.585383. [PMID: 38559177 PMCID: PMC10979954 DOI: 10.1101/2024.03.17.585383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Alzheimer's disease is a neurodegenerative disorder characterized by progressive amyloid plaque accumulation, tau tangle formation, neuroimmune dysregulation, synapse an neuron loss, and changes in neural circuit activation that lead to cognitive decline and dementia. Early molecular and cellular disease-instigating events occur 20 or more years prior to presentation of symptoms, making them difficult to study, and for many years amyloid-β, the aggregating peptide seeding amyloid plaques, was thought to be the toxic factor responsible for cognitive deficit. However, strategies targeting amyloid-β aggregation and deposition have largely failed to produce safe and effective therapies, and amyloid plaque levels poorly correlate with cognitive outcomes. However, a role still exists for amyloid-β in the variation in an individual's immune response to early, soluble forms of aggregates, and the downstream consequences of this immune response for aberrant cellular behaviors and creation of a detrimental tissue environment that harms neuron health and causes changes in neural circuit activation. Here, we perform functional magnetic resonance imaging of awake, unanesthetized Alzheimer's disease mice to map changes in functional connectivity over the course of disease progression, in comparison to wild-type littermates. In these same individual animals, we spatiotemporally profile the immune milieu by measuring cytokines, chemokines, and growth factors across various brain regions and over the course of disease progression from pre-pathology through established cognitive deficit. We identify specific signatures of immune activation predicting hyperactivity followed by suppression of intra- and then inter-regional functional connectivity in multiple disease-relevant brain regions, following the pattern of spread of amyloid pathology.
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Affiliation(s)
- Dennis C Chan
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neurotechnology in Mental Health Research, Pennsylvania State University, University Park, PA, USA
| | - ChaeMin Kim
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Rachel Y Kang
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Madison K Kuhn
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, USA
| | - Lynne M Beidler
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Nanyin Zhang
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neurotechnology in Mental Health Research, Pennsylvania State University, University Park, PA, USA
| | - Elizabeth A Proctor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, USA
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA, USA
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11
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Diedrich L, Kolhoff HI, Chakalov I, Vékony T, Németh D, Antal A. Prefrontal theta-gamma transcranial alternating current stimulation improves non-declarative visuomotor learning in older adults. Sci Rep 2024; 14:4955. [PMID: 38418511 PMCID: PMC10901881 DOI: 10.1038/s41598-024-55125-2] [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: 08/29/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
The rise in the global population of older adults underscores the significance to investigate age-related cognitive disorders and develop early treatment modalities. Previous research suggests that non-invasive transcranial Alternating Current Stimulation (tACS) can moderately improve cognitive decline in older adults. However, non-declarative cognition has received relatively less attention. This study investigates whether repeated (16-day) bilateral theta-gamma cross-frequency tACS targeting the Dorsolateral Prefrontal Cortex (DLPFC) enhances non-declarative memory. Computerized cognitive training was applied alongside stimulation to control for the state-of-the-brain. The Alternating Serial Reaction Time (ASRT) task was employed to assess non-declarative functions such as visuomotor skill and probabilistic sequence learning. Results from 35 participants aged 55-82 indicated that active tACS led to more substantial improvements in visuomotor skills immediately after treatment, which persisted 3 months later, compared to sham tACS. Treatment benefit was more pronounced in older adults of younger age and those with pre-existing cognitive decline. However, neither intervention group exhibited modulation of probabilistic sequence learning. These results suggest that repeated theta-gamma tACS can selectively improve distinct non-declarative cognitive aspects when targeting the DLPFC. Our findings highlight the therapeutic potential of tACS in addressing deficits in learning and retaining general skills, which could have a positive impact on the quality of life for cognitively impaired older individuals by preserving independence in daily activities.
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Affiliation(s)
- Lukas Diedrich
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Hannah I Kolhoff
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ivan Chakalov
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Teodóra Vékony
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, Bron, France
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, Las Palmas de Gran Canaria, Spain
| | - Dezső Németh
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, Bron, France
- BML-NAP Research Group, Institute of Psychology, Eötvös Loránd University and Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, Las Palmas de Gran Canaria, Spain
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
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12
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Franco-Rocha OY, Lewis KA, Kesler SR, Henneghan AM. An Exploratory Analysis of Contributors to Cognitive Functioning Among Sexual and Gender Minority Individuals Who Had COVID-19. JOURNAL OF HOMOSEXUALITY 2024:1-16. [PMID: 38305820 PMCID: PMC11294494 DOI: 10.1080/00918369.2024.2309497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sexual and gender minority (SGM) individuals face mental health disparities. However, research analyzing SGM people's mental health after a COVID-19 diagnosis is scarce. In this secondary analysis of a remote study, we 1) examined associations between cognitive and psychosocial health and 2) explored differences between these health outcomes among SGM (n = 14) and heterosexual cisgender (n = 64) U.S. adults who had COVID-19. We used the Patient Reported Outcome Measures Information System (PROMIS) v2.0 to assess subjective cognition and the BrainCheck cognitive test to analyze objective cognition. We administered the Perceived Stress Scale and PROMIS 57 Profile V.2.0 to measure psychosocial health. SGM COVID-19 survivors had worse scores in depression, anxiety, sleep disturbance, pain, stress, and objective cognition than heterosexual cisgender participants (p-values < .05). Objective cognition was associated with age, SGM classification, racial or ethnic minority classification, income, comorbidities, COVID-19 severity, number of symptoms, and pain (|0.137| < r < |0.373|, p-values < .05). Subjective cognition was associated with comorbidities, number of symptoms, depression, anxiety, sleep disturbance, pain, and stress (|0.158| < r < |0.537|, p-values < .05). Additional studies are needed to expand what is known about post-COVID-19 health disparities and to guide policies and interventions that promote cognitive functioning.
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Affiliation(s)
- Oscar Y. Franco-Rocha
- School of Nursing, University of Texas at Austin. 1710 Red River St. Austin, TX, 78712. U.S
| | - Kimberly A. Lewis
- School of Nursing, University of Texas at Austin. 1710 Red River St. Austin, TX, 78712. U.S
- Postdoctoral Scholar, Department of Physiological Nursing, School of Nursing, University of California, San Francisco. San Francisco, CA, U.S
| | - Shelli R. Kesler
- School of Nursing, University of Texas at Austin. 1710 Red River St. Austin, TX, 78712. U.S
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin. 1501 Red River St. Austin, TX, 78712. U.S
| | - Ashley M. Henneghan
- School of Nursing, University of Texas at Austin. 1710 Red River St. Austin, TX, 78712. U.S
- Department of Oncology, Dell Medical School, The University of Texas at Austin. 1501 Red River St. Austin, TX, 78712. U.S
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13
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Krämer C, Stumme J, da Costa Campos L, Dellani P, Rubbert C, Caspers J, Caspers S, Jockwitz C. Prediction of cognitive performance differences in older age from multimodal neuroimaging data. GeroScience 2024; 46:283-308. [PMID: 37308769 PMCID: PMC10828156 DOI: 10.1007/s11357-023-00831-4] [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: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023] Open
Abstract
Differences in brain structure and functional and structural network architecture have been found to partly explain cognitive performance differences in older ages. Thus, they may serve as potential markers for these differences. Initial unimodal studies, however, have reported mixed prediction results of selective cognitive variables based on these brain features using machine learning (ML). Thus, the aim of the current study was to investigate the general validity of cognitive performance prediction from imaging data in healthy older adults. In particular, the focus was with examining whether (1) multimodal information, i.e., region-wise grey matter volume (GMV), resting-state functional connectivity (RSFC), and structural connectivity (SC) estimates, may improve predictability of cognitive targets, (2) predictability differences arise for global cognition and distinct cognitive profiles, and (3) results generalize across different ML approaches in 594 healthy older adults (age range: 55-85 years) from the 1000BRAINS study. Prediction potential was examined for each modality and all multimodal combinations, with and without confound (i.e., age, education, and sex) regression across different analytic options, i.e., variations in algorithms, feature sets, and multimodal approaches (i.e., concatenation vs. stacking). Results showed that prediction performance differed considerably between deconfounding strategies. In the absence of demographic confounder control, successful prediction of cognitive performance could be observed across analytic choices. Combination of different modalities tended to marginally improve predictability of cognitive performance compared to single modalities. Importantly, all previously described effects vanished in the strict confounder control condition. Despite a small trend for a multimodal benefit, developing a biomarker for cognitive aging remains challenging.
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Affiliation(s)
- Camilla Krämer
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johanna Stumme
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lucas da Costa Campos
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Paulo Dellani
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christiane Jockwitz
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany.
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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14
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Chang YK, Etnier JL, Li RH, Ren FF, Ai JY, Chu CH. Acute Exercise Effect on Neurocognitive Function Among Cognitively Normal Late-Middle-Aged Adults With/Without Genetic Risk of AD: The Moderating Role of Exercise Volume and APOE Genotype. J Gerontol A Biol Sci Med Sci 2024; 79:glad179. [PMID: 37526237 DOI: 10.1093/gerona/glad179] [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: 02/27/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Acute exercise is a behavior that benefits cognitive function; however, its effect on populations with different risks for Alzheimer's disease (AD) and the role of exercise variance and Apolipoprotein E (APOE) genotype on this effect remains unknown. This study explores the acute exercise effect on behavioral and neurocognitive function, and its potential moderation by exercise intensity and duration and APOE genetic risk. METHODS Fifty-one cognitively normal adults (~36% APOE ε4 carriers) performed the Stroop task under a rest condition and 3 exercise conditions while electroencephalographic activity was assessed. RESULTS Acute exercise improved cognitive performance assessed through both behavioral and neuroelectrical indices. These benefits were observed regardless of adjustments of intensity and duration at a predetermined exercise volume as well as being evident irrespective of APOE ɛ4 carrier status. CONCLUSIONS Acute exercise could be proposed as a lifestyle intervention to benefit neurocognitive function in populations with and without genetic risk of AD. Future exploration should further the precise exercise prescription and also the mechanisms underlying the beneficial effects of acute exercise for neurocognitive function. CLINICAL TRIALS REGISTRATION NUMBER NCT05591313.
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Affiliation(s)
- Yu-Kai Chang
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan
- Social Emotional Education and Development Center, National Taiwan Normal University, Taipei, Taiwan
| | - Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Ruei-Hong Li
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Fei-Fei Ren
- Department of Physical Education, Beijing Language and Culture University, Beijing, China
| | - Jing-Yi Ai
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Chien-Heng Chu
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
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15
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DAmico D, Yusupov I, Zhu L, Lass JW, Plunkett C, Levine B, Troyer AK, Vandermorris S. Feasibility, Acceptability, and Impact of a self-guided e-learning Memory and Brain Health Promotion Program for Healthy Older Adults. Clin Gerontol 2024; 47:4-16. [PMID: 35713408 DOI: 10.1080/07317115.2022.2088325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the feasibility (e.g., completion rate), acceptability (e.g., satisfaction), and participant-reported impact (e.g., memory concerns, behavior change, goal attainment) of a self-guided, e-learning adaptation of a validated, facilitator-guided, in-person memory intervention for older adults. METHODS Participants were 139 healthy older adults (mean age: 73 ± 7, 73% women). Participation tracking and pre/post questionnaires embedded within the e-learning program were used to assess feasibility, acceptability, and impact. RESULTS Sixty-eight percent of participants completed the program. Anonymous feedback data indicated a high level of satisfaction with the program, the pace and clarity of the learning modules, and the user interface. Suggested improvements included offering more interaction with others and addressing minor platform glitches. There was a 41% decrease in the prevalence of concern about memory changes from baseline to posttest. The majority of participants reported an increase in use of memory strategies and uptake of health-promoting lifestyle behaviors. All participants reported moderate-to-high satisfaction with personal goal attainment. CONCLUSIONS The program demonstrated good feasibility, acceptability, and lead to reduction in age-related memory concerns. CLINICAL IMPLICATIONS Self-guided, e-learning programming shows promise for fostering positive adaptation to age-related memory changes and improving the uptake of evidence-based strategies to promote brain health among older adults.
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Affiliation(s)
- Danielle DAmico
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Iris Yusupov
- Department of Psychology, York University, Toronto, Ontario, Canada
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Ontario, Canada
| | - Lynn Zhu
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Jordan W Lass
- Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Baycrest, Toronto, Ontario, Canada
| | - Cindy Plunkett
- Centre for Aging and Brain Health Innovation (CABHI), Baycrest, Toronto, Ontario, Canada
| | - Brian Levine
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Susan Vandermorris
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Ontario, Canada
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16
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Stites SD, Lee BN, Rubright JD, Harkins K, Mechanic-Hamilton D. Cognitive Complaint Types Can Correlate With Cognitive Testing, Perceived Stress, and Symptom Distress in Older Adults With Normal Cognition and Dementia. Alzheimer Dis Assoc Disord 2024; 38:34-41. [PMID: 38133963 PMCID: PMC10922433 DOI: 10.1097/wad.0000000000000595] [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: 05/24/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE We examined how cognitive complaint types (CCTs) correlate with cognitive testing, perceived stress, and symptom distress in older adults with normal cognition and dementia. METHODS Older adults (n = 259) with normal cognition, mild cognitive impairment, or mild-stage Alzheimer disease completed cognitive testing and self-report measures (Cognitive Difficulties Scale, Global Distress Index, Perceived Stress Scale). Cross-sectional analyses examined: (1) CCT composition by classification method,( 2) CCTs by diagnostic group, (3) correlations of CCTs with cognitive testing scores, and (4) correlations of CCTs with perceived stress and symptom distress. RESULTS CCTs derived from 2 classification approaches loaded onto 4 factors: memory, attention-concentration (AC), temporal orientation, and praxis. Memory contained complaints about both memory and executive functioning. AC contained both classifications of AC complaints. Complaints about AC (AC1 and AC2) differed by diagnostic group (all P < 0.05). One of 2 classifications of AC (AC1) complaints discerned between impaired and unimpaired long-delay memory scores (both P < 0.05). In multivariable analyses, that same classification of AC (AC1) complaints correlated with higher perceived stress (both P < 0.001) but not symptom distress (both P > 0.05). CONCLUSION CCTs showed a factor structure that was mostly robust between classification methods; however, some content-divergent CCTs shared factors, suggesting construct overlap. Relatively slight variations in content altered how CCTs correlated with diagnostic groups, perceived stress, and symptom distress. Most CCTs did not discern between impaired and unimpaired cognitive test scores. Research is needed to better understand CCTs as clinical markers and targets of clinical interventions.
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Affiliation(s)
- Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Brian N Lee
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | | | - Kristin Harkins
- Department of Medicine, Penn Memory Center, University of Pennsylvania, Philadelphia, PA
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17
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Okumura E, Hoshi H, Morise H, Okumura N, Fukasawa K, Ichikawa S, Asakawa T, Shigihara Y. Reliability of Spectral Features of Resting-State Brain Activity: A Magnetoencephalography Study. Cureus 2024; 16:e52637. [PMID: 38249648 PMCID: PMC10799710 DOI: 10.7759/cureus.52637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 01/23/2024] Open
Abstract
Background Cognition is a vital sign and its deterioration is a major concern in clinical medicine. It is usually evaluated using neuropsychological assessments, which have innate limitations such as the practice effect. To compensate for these assessments, the oscillatory power of resting-state brain activity has recently become available. The power is obtained noninvasively using magnetoencephalography and is summarized by spectral parameters such as the median frequency (MF), individual alpha frequency (IAF), spectral edge frequency 95 (SEF95), and Shannon's spectral entropy (SSE). As these parameters are less sensitive to practice effects, they are suitable for longitudinal studies. However, their reliability remains unestablished, hindering their proactive use in clinical practice. Therefore, we aimed to quantify the within-participant reliability of these parameters using repeated measurements of healthy participants to facilitate their clinical use and to evaluate the observed changes/differences in these parameters reported in previous studies. Methodology Resting-state brain activity with eyes closed was recorded using magnetoencephalography for five minutes from 15 healthy individuals (29.3 ± 4.6 years old: ranging from 23 to 28 years old). The following four spectral parameters were calculated: MF, IAF, SEF95, and SSE. To quantify reliability, the minimal detectable change (MDC) and intraclass correlation coefficient (ICC) were computed for each parameter. In addition, we used MDCs to evaluate the changes and differences in the spectral parameters reported in previous longitudinal and cross-sectional studies. Results The MDC at 95% confidence interval (MDC95) of MF, IAF, SEF95, and SSE were 0.61 Hz, 0.44 Hz, 2.91 Hz, and 0.028, respectively. The ICCs of these parameters were 0.96, 0.92, 0.94, and 0.83, respectively. The MDC95 of these parameters was smaller than the mean difference in the parameters between cognitively healthy individuals and patients with dementia, as reported in previous studies. Conclusions The spectral parameter changes/differences observed in prior studies were not attributed to measurement errors but rather reflected genuine effects. Furthermore, all spectral parameters exhibited high ICCs (>0.8), underscoring their robust within-participant reliability. Our results support the clinical use of these parameters, especially in the longitudinal monitoring and evaluation of the outcomes of interventions.
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Affiliation(s)
- Eiichi Okumura
- Medical Imaging Business Center, Ricoh Company, Ltd., Kanazawa, JPN
| | - Hideyuki Hoshi
- Medical Imaging Business Center, Ricoh Company, Ltd., Kanazawa, JPN
- Precision Medicine Centre, Hokuto Hospital, Obihiro, JPN
| | - Hirofumi Morise
- Medical Imaging Business Center, Ricoh Company, Ltd., Kanazawa, JPN
| | - Naohiro Okumura
- Medical Imaging Business Center, Ricoh Company, Ltd., Kanazawa, JPN
| | - Keisuke Fukasawa
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, JPN
| | - Sayuri Ichikawa
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, JPN
| | - Takashi Asakawa
- Medical Imaging Business Center, Ricoh Company, Ltd., Kanazawa, JPN
| | - Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, JPN
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, JPN
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18
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Hao Z, Tran JYS, Bat BKK, Yiu KKL, Chan JYC, Tsoi KKF. Rhythmic musical intervention improves response time of memory tests: A pilot study on the application of a digital cognitive assessment. Digit Health 2024; 10:20552076241271875. [PMID: 39119553 PMCID: PMC11307344 DOI: 10.1177/20552076241271875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
Background Memory complaints are the early symptoms of cognitive impairment, and they usually bring anxiety about cognitive deterioration among the elderly population. Musical interventions were demonstrated to relieve dementia symptoms. This pilot study investigated the potential benefits of rhythmic musical intervention, African drumming, on cognitive function and mood status with traditional and digital assessments for elderly participants. Method Participants were recruited through social media. The musical intervention was arranged by drumming instructors certified by the Hong Kong Association of African Drumming. Participants joined regular training classes with eight lessons, which covered rhythmic clapping and drumming, power control, and overall performance with songs. The inclusion criteria included the following: (1) age over 50; (2) self-reported complaints of memory loss; (3) the ability to use digital devices, such as a smartphone; and (4) can understand the content of questionnaires and follow the intervention schedules. Those with hearing impairment, failure to use Chinese, and active psychosis or dementia were excluded. Cognitive function was measured by the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA) and a digital platform, ScreenMat. Anxiety and depression levels were assessed by the State-Trait Anxiety Inventory (STAI) and Geriatric Depression Scale (GDS-15). All assessments were performed before and after the drumming classes. The outcomes were compared using the Wilcoxon signed rank test with 0.05 as the significance level. Result Twenty-two participants joined this study with an attendance rate of 90%. The overall cognitive function of the participants was good with an average score of 27 for HK-MoCA. After eight sessions of African drum intervention, the cognitive function did not show a significant improvement, but the response time of answering the digital cognitive questions was significantly faster than before the intervention (-39.9 s, p = 0.03). The response time for the short-term memory function was most significantly reduced (-13.5 s, p = 0.017). The anxiety and depression scores (i.e. STAI and GDS) also significantly improved (p < 0.001) after the intervention. Conclusion Rhythmic musical intervention is not only effective in improving emotional status, but also potentially good for improving cognitive symptoms, including the response time of the memory test. Digital behavioral analysis may bring new insights for future research on cognitive assessment.
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Affiliation(s)
- Ziyu Hao
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joshua YS Tran
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Baker KK Bat
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Karen KL Yiu
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce YC Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin KF Tsoi
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China
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19
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Buchwald D, Schmidt C, Buchwald D, Winter KI, Nielsen IB, Klostergaard K, Melgaard D, Fagerberg SK, Leutscher PDC. Impact of Low-Dose Dronabinol Therapy on Cognitive Function in Cancer Patients Receiving Palliative Care: A Case-Series Intervention Study. Palliat Med Rep 2023; 4:326-333. [PMID: 38098857 PMCID: PMC10719641 DOI: 10.1089/pmr.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Background Cannabis may offer therapeutic benefits to patients with advanced cancer not responding adequately to conventional palliative treatment. However, tolerability is a major concern. Cognitive function is a potential adverse reaction to tetrahydrocannabinol containing regimens. The aim of this study was to test cognitive function in patients being prescribed dronabinol as an adjuvant palliative therapy. Methods Adult patients with advanced cancer and severe related pain refractory to conventional palliative treatment were included in this case-series study. Patients were examined at baseline in conjunction with initiation of dronabinol therapy and at a two-week follow-up using three selected Wechsler's adult intelligence scale III neurocognitive tests: Processing Speed Index (PSI), Perceptual Organization Index (POI), and Working Memory Index (WMI). Patients were also assessed using pain visual analog scale, Major Depression Inventory, and Brief Fatigue Inventory. Results Eight patients consented to take part in the study. Two patients discontinued dronabinol therapy, one due to a complaint of dizziness and another critical progression of cancer disease, respectively. The remaining six patients were successfully treated with a daily dosage of 12.5 mg dronabinol (p = 0.039). PSI (p = 0.020), POI (p = 0.034.), and WMI (p = 0.039). Conclusions Cognitive function improved in this group of patients with advanced cancer in conjunction with low-dose dronabinol therapy. The cause is likely multifactorial including reported relief of cancer-associated symptoms. Further clinical investigation is required.
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Affiliation(s)
- Ditte Buchwald
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Dorte Buchwald
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Palliative Care Team, Department of Gerontology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Kristina Iris Winter
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Palliative Care Team, Department of Gerontology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Ivan Bo Nielsen
- Palliative Care Team, Department of Gerontology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Kirsten Klostergaard
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Steen K. Fagerberg
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Palliative Care Team, Department of Gerontology, North Denmark Regional Hospital, Hjørring, Denmark
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20
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Hoshi H, Kobayashi M, Hirata Y, Fukasawa K, Ichikawa S, Shigihara Y. Decreased beta-band activity in left supramarginal gyrus reflects cognitive decline: Evidence from a large clinical dataset in patients with dementia. Hum Brain Mapp 2023; 44:6214-6226. [PMID: 37791985 PMCID: PMC10619364 DOI: 10.1002/hbm.26507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/03/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
Cognitive impairment is a major concern in clinical medicine. It is usually evaluated with neuropsychological assessments, which have inherent limitations. To compensate for them, magnetoencephalography has already come into clinical use to evaluate the level of cognitive impairment. It evaluates global changes in the frequency of resting-state brain activity, which are associated with cognitive status. However, it remains unclear what neural mechanism causes the frequency changes. To understand this, it is important to identify cortical regions that mainly contribute to these changes. We retrospectively analysed the clinical records from 310 individuals with cognitive impairment who visited the outpatient department at our hospital. The analysis included resting-state magnetoencephalography, neuropsychological assessment, and clinical diagnosis data. Regional oscillatory intensities were estimated from the magnetoencephalography data, which were statistically analysed, along with neuropsychological assessment scores, and the severity of cognitive impairment associated with clinical diagnosis. The regional oscillatory intensity covering a wide range of regions and frequencies was significantly associated with neuropsychological assessment scores and differed between healthy individuals and patients with cognitive impairment. However, these associations and differences in all conditions were overlapped by a single change in beta frequency in the left supramarginal gyrus. High frequency oscillatory intensity in the left supramarginal gyrus is associated with cognitive impairment levels among patients who were concerned about dementia. It provides new insights into cognitive status measurements using magnetoencephalography, which is expected to develop as an objective index to be used alongside traditional neuropsychological assessments.
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Affiliation(s)
- Hideyuki Hoshi
- Precision Medicine CentreHokuto HospitalObihiro CityHokkaidoJapan
| | - Momoko Kobayashi
- Precision Medicine CentreKumagaya General HospitalKumagaya CitySaitamaJapan
| | - Yoko Hirata
- Department of NeurosurgeryKumagaya General HospitalKumagaya CitySaitamaJapan
| | - Keisuke Fukasawa
- Clinical LaboratoryKumagaya General HospitalKumagaya CitySaitamaJapan
| | - Sayuri Ichikawa
- Clinical LaboratoryKumagaya General HospitalKumagaya CitySaitamaJapan
| | - Yoshihito Shigihara
- Precision Medicine CentreHokuto HospitalObihiro CityHokkaidoJapan
- Precision Medicine CentreKumagaya General HospitalKumagaya CitySaitamaJapan
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21
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Min SH, Topaz M, Lee C, Schnall R. Racial Differences in Older Adult's Mental Health and Cognitive Symptomatology: Identifying Subgroups Using Multiple-Group Latent Class Analysis. J Aging Health 2023:8982643231212547. [PMID: 37907211 PMCID: PMC11139013 DOI: 10.1177/08982643231212547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Little is known on the potential racial differences in latent subgroup membership based on mental health and cognitive symptomatology among older adults. METHODS This is a secondary data analysis of Wave 2 data from the National Social Life, Health, and Aging Project (N = 1819). Symptoms were depression, anxiety, loneliness, happiness, and cognition. Multiple-group latent class analysis was conducted to identify latent subgroups based on mental health and cognitive symptoms and to compare these differences between race. RESULTS Class 1: "Severe Cognition & Mild-Moderate Mood Impaired," Class 2: "Moderate Cognition & Mood Impaired," and Class 3: "Mild Cognition Impaired & Healthy Mood" were identified. Black older adults were more likely to be in Class 1 while White older adults were more likely to be in Class 2 and Class 3. DISCUSSION Clinicians need to provide culturally-sensitive care when assessing and treating symptoms across different racial groups.
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Affiliation(s)
- Se Hee Min
- School of Nursing, Columbia University, New York, NY, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY, USA
| | - Chiyoung Lee
- Bothell School of Nursing & Health Studies, University of Washington, Bothell, WA, USA
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22
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López C, Altuna M. New Community and Sociohealth Challenges Arising from the Early Diagnosis of Mild Cognitive Impairment (MCI). J Pers Med 2023; 13:1410. [PMID: 37763177 PMCID: PMC10532951 DOI: 10.3390/jpm13091410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Population aging increases the risk of developing neurodegenerative diseases that cause cognitive impairment. Advances in clinical practice and greater social awareness of the importance of cognitive impairment have led to an increase in the number of people with early diagnosis, predementia. Increasing access to biomarkers to assess whether Alzheimer's disease (AD) is the underlying cause of mild cognitive impairment (MCI) has undoubted clinical benefits (access to potentially disease-modifying treatments, among others) but is also responsible for new social-health care challenges. Understanding the psychosocial impact of a diagnosis of MCI due to AD or another neurodegenerative disease is essential to create future strategies to reduce the emotional overload of patients, their risk of discrimination and stigmatization, and to favor their social inclusion. We present a narrative review of the diagnostic process of mild cognitive impairment in clinical practice, with a holistic person-centered approach, and discuss the implications of such diagnosis (benefits and risks) and strategies on how to address them.
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Affiliation(s)
- Carolina López
- Fundación CITA-Alzheimer Fundazioa, 20009 Gipuzkoa, Spain
| | - Miren Altuna
- Fundación CITA-Alzheimer Fundazioa, 20009 Gipuzkoa, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI), 20690 Gipuzkoa, Spain
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23
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Bampa G, Tsolaki M, Moraitou D, Metallidou P, Masoura E, Mintziviri M, Paparis K, Tsourou D, Papantoniou G, Sofologi M, Papaliagkas V, Kougioumtzis G, Papatzikis E. Metacognitive Differences in Amnestic Mild Cognitive Impairment and Healthy Cognition: A Cross-Sectional Study Employing Online Measures. J Intell 2023; 11:184. [PMID: 37754914 PMCID: PMC10532837 DOI: 10.3390/jintelligence11090184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
This study aimed to examine metacognitive abilities in individuals diagnosed with amnestic mild cognitive impairment (aMCI) by using online metacognitive measures during cognitive tasks. A total of 100 participants were enrolled, all aged 50 or older (mean age = 61.98; SD = 6.27), and with a minimum of six years of education (mean = 14.95; SD = 2.94). The sample included 50 individuals with aMCI (34 females) and 50 healthy controls (HC) (33 females). Both groups underwent metacognitive versions of memory tasks (Doors and People) and executive functions tasks (Wisconsin Card Sorting Test). Metacognition was assessed through confidence ratings given after each answer (referred to as metacognitive monitoring) and the accuracy of the participants' decisions to include or exclude answers from their final scores (known as metacognitive control). The results showed that although individuals with aMCI were aware of their cognitive limitations-evidenced by their lower confidence ratings across all tasks-they still exhibited overconfidence relative to their actual performance. Moreover, they included a greater number of incorrect answers in their final scores compared to the healthy control group. These findings suggest that while individuals with aMCI retain some level of awareness, their self-evaluations appear to lack precision. This observation was consistent across both types of cognitive tasks. The results underscore the need for additional research to better understand metacognition in MCI as well as the interplay between metacognitive monitoring and control.
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Affiliation(s)
- Grigoria Bampa
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.M.); (P.M.); (E.M.)
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI–AUTH), Balcan Center, Buildings A & B, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece;
| | - Magdalini Tsolaki
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI–AUTH), Balcan Center, Buildings A & B, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece;
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.M.); (P.M.); (E.M.)
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI–AUTH), Balcan Center, Buildings A & B, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece;
| | - Panagiota Metallidou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.M.); (P.M.); (E.M.)
| | - Elvira Masoura
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.M.); (P.M.); (E.M.)
| | - Maria Mintziviri
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Paparis
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dorothea Tsourou
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgia Papantoniou
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, 45110 Ioannina, Greece; (G.P.); (M.S.)
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina (URCI), 45110 Ioannina, Greece
| | - Maria Sofologi
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, 45110 Ioannina, Greece; (G.P.); (M.S.)
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina (URCI), 45110 Ioannina, Greece
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Georgios Kougioumtzis
- Department of Turkish and Modern Asian Studies, National and Kapodistrian University of Athens, 15772 Athens, Greece;
- Department of Psychology, Neapolis University Pafos, Pafos 8042, Cyprus
| | - Efthymios Papatzikis
- Department of Early Childhood Education and Care, Oslo Metropolitan University, 0167 Oslo, Norway
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 127788, United Arab Emirates
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24
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Uemura T, Matsunaga M, Yokota Y, Takao K, Furuchi T. Inhibition of Polyamine Catabolism Reduces Cellular Senescence. Int J Mol Sci 2023; 24:13397. [PMID: 37686212 PMCID: PMC10488189 DOI: 10.3390/ijms241713397] [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: 08/02/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The aging of the global population has necessitated the identification of effective anti-aging technologies based on scientific evidence. Polyamines (putrescine, spermidine, and spermine) are essential for cell growth and function. Age-related reductions in polyamine levels have been shown to be associated with reduced cognitive and physical functions. We have previously found that the expression of spermine oxidase (SMOX) increases with age; however, the relationship between SMOX expression and cellular senescence remains unclear. Therefore, we investigated the relationship between increased SMOX expression and cellular senescence using human-liver-derived HepG2 cells. Intracellular spermine levels decreased and spermidine levels increased with the serial passaging of cells (aged cells), and aged cells showed increased expression of SMOX. The levels of acrolein-conjugated protein, which is produced during spermine degradation, also increases. Senescence-associated β-gal activity was increased in aged cells, and the increase was suppressed by MDL72527, an inhibitor of acetylpolyamine oxidase (AcPAO) and SMOX, both of which are enzymes that catalyze polyamine degradation. DNA damage accumulated in aged cells and MDL72527 reduced DNA damage. These results suggest that the SMOX-mediated degradation of spermine plays an important role in cellular senescence. Our results demonstrate that cellular senescence can be controlled by inhibiting spermine degradation using a polyamine-catabolizing enzyme inhibitor.
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Affiliation(s)
- Takeshi Uemura
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado 350-0295, Saitama, Japan (K.T.); (T.F.)
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25
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Llaurador-Coll M, Rios S, García-Gavilán JF, Babio N, Vilella E, Salas-Salvadó J. Plasma levels of neurology-related proteins are associated with cognitive performance in an older population with overweight/obesity and metabolic syndrome. GeroScience 2023; 45:2457-2470. [PMID: 36964401 PMCID: PMC10651568 DOI: 10.1007/s11357-023-00764-y] [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: 10/04/2022] [Accepted: 01/17/2023] [Indexed: 03/26/2023] Open
Abstract
Cognitive impairment is present in a broad spectrum of medical conditions and in aging. Here, we aimed to identify plasma proteins related to cognitive function in a sample of older adults with overweight/obesity and metabolic syndrome. A total of 129 subjects (mean age 64.7 years; 36% females) were grouped according to low (l-GCF, N=65) or high (h-GCF, N=64) global cognitive function and matched according to education, sex, age, and body mass index. Cognitive performance was assessed using neuropsychological tests. Plasma levels of 92 neurology-related proteins were assessed using a proximity extension assay. An elastic net regression analysis was used to identify proteins more associated with cognitive performance. Additionally, the protein expression levels were compared between the two groups by means of a t-test with false discovery rate correction. Pearson correlations were used to assess associations between the protein levels and scores from the neurocognitive tests. Six proteins (alpha-2-MRAP, HAGH, Siglec-9, MDGA1, IL12, and EDA2R) were identified as potential contributors to cognitive performance, remaining significantly increased in l-GCF compared to h-GCF participants after correction for multiple testing. Negative correlations (r= -0.23 to -0.18, i.e., lower protein levels, higher cognitive function) were found between global cognitive function and Siglec-9, NMNAT1, HAGH, LXN, gal-8, alpha-2-MRAP, IL12, PDGF-R-alpha, NAAA, EDA2R, CLEC1B, and LAT. Mini-mental state examination z scores showed the strongest correlations with protein levels, specifically negative correlations with CLEC1b, LXN, LAT, PLXNB3, NMNAT1, gal-8, HAGH, NAAA, CTSS, EZR, KYNU, MANF (r=-0.38 to -0.26) and a positive correlation with ADAM23 (r= 0.26). In summary, we identified several plasma proteins that were significantly associated with cognitive performance in older adults with obesity and metabolic syndrome, although further research is needed to replicate the results in larger samples and to include a predictive perspective.
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Affiliation(s)
- Martí Llaurador-Coll
- Universitat Rovira i Virgili, Departament de Medicina i Cirurgia, Reus, Spain
- Hospital Universitari Institut Pere Mata, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
| | - Santiago Rios
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesus F García-Gavilán
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Nancy Babio
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Vilella
- Universitat Rovira i Virgili, Departament de Medicina i Cirurgia, Reus, Spain.
- Hospital Universitari Institut Pere Mata, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Salas-Salvadó
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain.
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
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26
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Jackson-Cowan L, Silverberg JI. Longitudinal course of cognitive impairment in patients with atopic dermatitis. Arch Dermatol Res 2023; 315:1553-1560. [PMID: 36708375 DOI: 10.1007/s00403-023-02536-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/29/2023]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease. Cognitive dysfunction was recently demonstrated to be increased in adults and children with AD. However, little is known about the longitudinal course of cognitive impairment in AD and its relationship with pruritus. To investigate the longitudinal course and predictors of cognitive impairment in AD a prospective dermatology practice-based study was performed using questionnaires and evaluation by a dermatologist (n = 210). Patients with ≥ 2 visits were included (mean follow-up time: 318 days). Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function 8-item Short-Form. At baseline, 20.85% of patients had PROMIS T scores ≤ 45, indicating cognitive impairment (CI). Among patients with CI at baseline, 34.09% had persistent CI, 47.72% had a fluctuating course, and 18.18% had sustained improvement of cognitive function. In repeated-measures regression models, cognitive function scores declined overtime in patients with worse AD severity [SCORing Atopic Dermatitis (SCORAD): p = 0.01, Atopic Dermatitis Severity Index: p = 0.001], increased itch (p = 0.01), skin pain (p = 0.001), and sleep disturbance (p = 0.001). In multivariable logistic regression models, persistent CI was associated with female gender and depressive symptoms [moderate-to-severe Patient Health Questionnaire-9 score (PHQ9)]. Latent class analysis identified two classes of cognitive dysfunction: normal cognition (77.23%), moderate dysfunction (16.21%) and severe impairment (6.55%). Black/African-American race (p = 0.02), moderate-to-severe SCORAD (p = 0.03), dermatology life quality index (p < 0.0001), PHQ9 (p < 0.0001), itch (p = 0.02) and skin pain (p < 0.0001) were more likely to experience moderate dysfunction or severe cognitive impairment. AD is associated with a heterogeneous longitudinal course of cognitive function in adults, with some patients experiencing persistent CI over time.
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Affiliation(s)
- Ladonya Jackson-Cowan
- AU/UGA Medical Partnership, The Medical College of Georgia at Augusta University, Athens, GA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA.
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA.
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27
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McNett SD, Vyshedskiy A, Savchenko A, Durakovic D, Heredia G, Cahn R, Kogan M. A Feasibility Study of AlzLife 40 Hz Sensory Therapy in Patients with MCI and Early AD. Healthcare (Basel) 2023; 11:2040. [PMID: 37510481 PMCID: PMC10379682 DOI: 10.3390/healthcare11142040] [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: 03/27/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) are debilitating diseases that affect millions of individuals and have notoriously limited treatment options. One emerging therapy, non-invasive 40 Hz sensory therapy delivered through light and sound has previously shown promise in improving cognition in Alzheimer Disease (AD) rodent models. Small studies in humans have proven safe and tolerable, however exploration of feasibility and utility is limited. The purpose of this study is to examine the feasibility of this treatment in a human population through a smart tablet application that emits light and sound waves at 40 Hz to the user over the span of 1 h a day. Confirmation of entrainment of 40 Hz stimulation in the cerebral cortex was performed via EEG. 27 preliminary subjects with subjective cognitive complaints, Mild Cognitive Impairment, or AD were enrolled in the study; 11 participants completed 6 months of therapy. Of those that discontinued treatment, other health issues and difficulties with compliance were the most common causes. Participants were followed with Montreal Cognitive Assessment (MOCA) and Boston Cognitive Assessment (BOCA). For participants with subjective cognitive complaints, 2 of the 4 had improved MOCA score and 1 of 4 had improved BOCA score. For the participant with MCI, his MOCA score improved. For AD participants, 2 out of 6 had improved MOCA score and 3 of the 6 stayed stable, while 3 of 6 BOCA score improved. 4 of 11 participants specifically increased their MOCA scores in the Memory Index section. Of the 8 participants/caregivers able to speak to perceived usefulness of the study, 6 spoke to at least some level of benefit. Of these 6, 2 enrolled with subjective cognitive complaint, 1 had MCI, and 3 had AD. The therapy did not have reported side effects. However, those who did not finish the study experienced issues obtaining and operating a smart tablet independently as well as complying with the therapy. Overall, further exploration of this treatment modalities efficacy is warranted.
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Affiliation(s)
- Sienna D McNett
- Center for Integrative Medicine, George Washington University, Washington, DC 20052, USA
| | - Andrey Vyshedskiy
- MET, Boston University, Boston, MA 02215, USA
- Alzheimer's Light, Miami, FL 33626, USA
| | | | | | - George Heredia
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA 90007, USA
| | - Rael Cahn
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA 90007, USA
| | - Mikhail Kogan
- Center for Integrative Medicine, George Washington University, Washington, DC 20052, USA
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28
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Degraff Z, Souza GS, Santos NA, Shoshina II, Felisberti FM, Fernandes TP, Sigurdsson G. Brain atrophy and cognitive decline in bipolar disorder: Influence of medication use, symptomatology and illness duration. J Psychiatr Res 2023; 163:421-429. [PMID: 37276646 DOI: 10.1016/j.jpsychires.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
Bipolar disorder (BPD) is a chronic condition characterized by recurrent episodes of mania and depression. To date, the association of biological and psychopathological processes in BPD has not been extensively studied on a cognitive and cortical basis at the same time. We investigated whether brain atrophy (in prefrontal, temporal and occipital cortices) was associated with cognitive, biological and clinical processes in patients with BPD and healthy controls (HCs). A total of 104 participants (56 with BPD) completed tasks that measured attention, memory, information processing speed, inhibitory control, visuospatial working memory and cognitive flexibility. In addition, structural brain scans were obtained using high-resolution MRI. Outcomes of the measurements were examined using robust multiple mediation analyses. BPD patients showed greater cortical atrophy across all regions of interest when compared to HCs, linked to cognitive decline. BPD patients had slower reaction times and markedly increased errors of commission on the tasks. The outcomes were significantly influenced by medication use, symptomatology and illness duration. The findings showcase the complexity of brain structures and networks as well as the physiological mechanisms underlying diverse BPD symptomatology and endophenotypes. These differences were pronounced in patients with BPD, motivating further investigations of pathophysiological mechanisms involved in brain atrophy and cognitive decline.
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Affiliation(s)
- Zeke Degraff
- Svenskagier Neurologie, Stockholm, Sweden; Institute of Neurology, Belgium.
| | | | | | | | | | - Thiago P Fernandes
- Federal University of Para, Para, Brazil; Federal University of Paraiba, Paraiba, Brazil
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29
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Sharifi S, Babaei Khorzoughi K, Khaledi-Paveh B, Rahmati M. Association of intergenerational relationship and supports with cognitive performance in older adults: A systematic review. Geriatr Nurs 2023; 52:146-151. [PMID: 37307634 DOI: 10.1016/j.gerinurse.2023.05.014] [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: 05/04/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE As individuals age, cognitive decline can significantly impact their quality of life. This systematic review aims to investigate the potential association between parent-child relationships among older adults in Eastern Asian countries and their cognitive performance. METHODS For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine, up to March 2023. RESULTS Out of 418 articles, 6 were eligible for inclusion in the study. The findings suggest that intergenerational relationships, particularly emotional support and two-way financial communications, are associated with maintaining cognitive health in older adults. CONCLUSIONS Intergenerational relationships affect cognitive health in older adults, with implications for healthcare, social welfare, and the economy. Further research is required to investigate the effects of children's visits on cognitive health and explore the complexities of intergenerational relationships on cognitive health in aging populations.
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Affiliation(s)
- Sina Sharifi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kimia Babaei Khorzoughi
- Faculty of Education and Psychology, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Behnam Khaledi-Paveh
- Department of Geriatric and Psychiatric Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mahmoud Rahmati
- Department of Geriatric and Psychiatric Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
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30
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Zhang J, Zheng X, Zhao Z. A systematic review and meta-analysis on the efficacy outcomes of selective serotonin reuptake inhibitors in depression in Alzheimer's disease. BMC Neurol 2023; 23:210. [PMID: 37259037 DOI: 10.1186/s12883-023-03191-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Depressive symptoms are the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). However, despite being common, no definite consensus recommendations exist for the management of depression in AD. OBJECTIVE To assess the effects of selective serotonin reuptake inhibitors (SSRIs) on the alleviation of depressive symptoms in patients with AD. MATERIAL AND METHODS Medline, Scopus, Web of Science, Google Scholar, and PsychINFO were electronically searched from inception until October 2022. Response to therapy and mean depression scores between the treatment (or before) and placebo (or after) groups were the primary outcomes. For depression scores, the standard mean deviation and accompanying 95% confidence interval were determined. The risk of bias was determined using the funnel plot, trim and fill, Egger's and Begg's analyses. RESULTS SSRIs attenuated depressive symptoms in patients with AD (0.905 SMD, 95%CI, 0.689 to 1.121, p < 0.000). At individual SSRI level, escitalopram, paroxetine, and sertraline significantly alleviated depressive symptoms in AD patients (0.813 SMD, 95%CI, 0.207 to 1.419, p = 0.009, 1.244 SMD, 95%CI, 0.939 to 1.548, p < 0.000, and 0.818 SMD, 95%CI, 0.274 to 1.362, p < 0.000). The funnel plot, trim and fill, Begg's test (p = 0.052), and Egger's test (p = 0.148), showed no significant risk of publication bias. CONCLUSION Our meta-analysis supports the use of SSRIs for the alleviation of depression in patients with AD. However, we recommend larger randomized clinical trials that would compare the efficacy of different SSRIs in AD patients with depression.
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Affiliation(s)
- Jinli Zhang
- Department of Pharmacy, Tianjin Second People's Hospital, Tianjin, China
| | - Xiaohui Zheng
- Department of Pharmacy, Tianjin Union Medical Center, Tianjin, China
| | - Zhenying Zhao
- Department of Pharmacy, Tianjin Union Medical Center, Tianjin, China.
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Munawar K, Fadzil Z, Choudhry FR, Kausar R. Cognitive Functioning, Dependency, and Quality of Life Among Older Adults. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2193786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Vints WA, Kušleikienė S, Sheoran S, Valatkevičienė K, Gleiznienė R, Himmelreich U, Pääsuke M, Česnaitienė VJ, Levin O, Verbunt J, Masiulis N. Body fat and components of sarcopenia relate to inflammation, brain volume and neurometabolism in older adults. Neurobiol Aging 2023; 127:1-11. [PMID: 37004309 DOI: 10.1016/j.neurobiolaging.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/27/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Obesity and sarcopenia are associated with cognitive impairments at older age. Current research suggests that blood biomarkers may mediate this body-brain crosstalk, altering neurometabolism and brain structure eventually resulting in cognitive performance changes. Seventy-four older adults (60-85 years old) underwent bio-impedance body composition analysis, handgrip strength measurements, 8-Foot Up-and-Go (8UG) test, Montreal Cognitive Assessment (MoCA), blood analysis of interleukin-6 (IL-6), kynurenine, and insulin-like growth factor-1 (IGF-1), as well as brain magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), estimating neurodegeneration and neuroinflammation. Normal fat% or overweight was associated with larger total gray matter volume compared to underweight or obesity in older adults and obesity was associated with higher N-acetylaspartate/Creatine levels in the sensorimotor and dorsolateral prefrontal cortex. Muscle strength, not muscle mass/physical performance, corresponded to lower kynurenine and higher N-acetylaspartate/Creatine levels in the dorsal posterior cingulate and dorsolateral prefrontal cortex. The inflammatory and neurotrophic blood biomarkers did not significantly mediate these body-brain associations. This study used a multimodal approach to comprehensively assess the proposed mechanism of body-brain crosstalk.
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Königsberg A, Belau MH, Ascone L, Gallinat J, Kühn S, Jensen M, Gerloff C, Cheng B, Thomalla G. Subjective Cognitive Decline Is Associated with Health-Related Quality of Life in the Middle-Aged to Elderly Population. J Alzheimers Dis 2023; 91:427-436. [PMID: 36442192 DOI: 10.3233/jad-220659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is considered to be a preliminary stage of dementia, and its prevalence is increasing with age. OBJECTIVE We aimed to study the association of SCD with health-related quality of life (HRQoL) in a large population-based sample. METHODS We analyzed data of the first 10,000 participants from the Hamburg City Health Study in Germany, a single center prospective cohort study, aged between 45 and 74 years that scored higher than 25 points in the Mini-Mental State Examination and had no known pre-existing dementia. HRQoL was assessed by the EQ-5D-5 L index, as well as the mental (MCS) and physical component summary (PCS) score of the Short Form-8. We computed linear regression analyses with 99% bias-corrected and accelerated (BCa) confidence intervals (CI) from 10,000 bootstrap samples to investigate the association between SCD and different indicators of HRQoL, while controlling for depression (PHQ-9), age, sex, and education as potential confounders. RESULTS Of 7,799 eligible participants (mean (SD) age 62.01 (8.41) years, 51.1% female), 3,708 (47.5%) reported SCD. Participants with SCD were older (62.7 versus 61.4 years) and more frequently female (54.2% versus 48.2%). SCD was independently associated with a lower EQ-5D-5 L index (β=-0.01, 99% BCa CI = [-0.020, -0.003], p < 0.001) and PCS (β=-1.00, 99% BCa CI = [-1.48, -0.51], p < 0.001) but not with MCS score. CONCLUSION In a population of middle-aged to elderly participants, there is a significant negative association between SCD and HRQoL across different instruments of HRQoL measurement independent of depression, demographics, and education.
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Affiliation(s)
- Alina Königsberg
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias H Belau
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leonie Ascone
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Jürgen Gallinat
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Simone Kühn
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Chae HJ, Lee SH. Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2023; 38:e5853. [PMID: 36468299 PMCID: PMC10107881 DOI: 10.1002/gps.5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients. OBJECTIVES This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia. METHODS A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia. RESULTS Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group. CONCLUSIONS ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.
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Affiliation(s)
- Hee Jae Chae
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
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Alford K, Banerjee S, Daley S, Hamlyn E, Trotman D, Vera JH. Health-Related Quality of Life in People Living With HIV With Cognitive Symptoms: Assessing Relevant Domains and Associations. J Int Assoc Provid AIDS Care 2023; 22:23259582231164241. [PMID: 36945871 PMCID: PMC10034276 DOI: 10.1177/23259582231164241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This study aimed to validate and assess a comprehensive set of illness-specific health-related quality of life (HRQL) domains in people living with HIV (PLWH) with cognitive symptoms. One hundred and three HIV patients with cognitive symptoms (n = 93 male, 90.3%) were identified from two UK HIV clinics and complete a series of validated scales measuring seven HRQL domains identified as important to HRQL by PLWH with cognitive impairment. These included: physical functioning, cognition, social connectedness, self-concept, HIV stigma, acceptance of and perceived control over cognitive health, and physical and mental health and wellbeing. Exploratory factor analysis confirmed that domain total scores loaded onto one main factor, representing HRQL. Scale cut-off scores revealed a significant proportion of patients scored outside the normal range on single domains (between 26.2% and 79.6%), and many patients on multiple domains (40.8% on 4 or more domains). We found evidence of poor HRQL across domains in the majority of PLWH with cognitive symptoms and identified domains driving these experiences. This provides targets for intervention development and clinical action to maintain or improve HRQL in PLWH with cognitive symptoms or impairment.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, 12190Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Faculty of Health, 6633University of Plymouth, Plymouth, UK
| | - Stephanie Daley
- Centre for Dementia Studies, 12190Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Hamlyn
- 111990HIV and Sexual Health Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Trotman
- 111990HIV and Sexual Health Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, 12190Brighton and Sussex Medical School, Brighton, UK
- 8721HIV and Sexual Health Service, University Hospitals Sussex NHS Trust, Brighton, UK
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36
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Divers R, Robinson A, Miller L, De Vito AN, Pugh E, Calamia M. Beyond depression: examining the role of anxiety and anxiety sensitivity on subjective cognition and functioning in older adults. Aging Ment Health 2022; 26:2300-2306. [PMID: 34424804 DOI: 10.1080/13607863.2021.1966747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Subjective cognitive difficulties in the elderly may serve as potential risk-factors for future, objective decline and conversion to neurodegenerative disorders (e.g., mild cognitive impairment [MCI] and dementia). Though these subjective declines have been associated with depression, and to a lesser extent, anxiety, it is unknown if related constructs (e.g. anxiety sensitivity) and specific kinds of worries (e.g. worry about developing dementia, health anxiety) are related to subjective declines. The current study sought to examine if cognitive concerns related to anxiety sensitivity, dementia worry, and health anxiety added incremental validity beyond general symptoms of anxiety and depression in predicting subjective cognition and functioning in a sample of older adults. METHODS Participants were 429 older adults who were at least 60 years old. Participants completed questionnaires on subjective cognition, subjective everyday function, anxiety, depression, anxiety sensitivity, dementia worry, and health anxiety via Qualtrics Panels. Hierarchical multiple regressions were conducted. RESULTS Our variables of interest (anxiety sensitivity, dementia worry, and health anxiety) added significant variance in predicting subjective cognition and everyday function. Specifically, anxiety sensitivity was related to subjective cognition and functioning, while dementia worry and health anxiety were variably associated. CONCLUSION Our results suggest that constructs related to anxiety and worry have a significant relationship with subjective cognition and function in older adults beyond general symptoms of depression and anxiety. Future work should examine if interventions and education may help to decrease anxiety sensitivity and worry about dementia respectively in older adults, which may in tern protect against future subjective declines.
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Affiliation(s)
- Ross Divers
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Luke Miller
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Alyssa N De Vito
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Erika Pugh
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Lahbairi N, Laniepce A, Segobin S, Cabé N, Boudehent C, Vabret F, Rauchs G, Pitel AL. Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder. Health Qual Life Outcomes 2022; 20:149. [PMID: 36310156 PMCID: PMC9620657 DOI: 10.1186/s12955-022-02058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors. Methods 53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD. Results sAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance. Conclusion Anxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes.
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Affiliation(s)
- Najlaa Lahbairi
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France
| | - Alice Laniepce
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.460771.30000 0004 1785 9671Normandie Univ, UNIROUEN, CRFDP (EA 7475), 76000 Rouen, France
| | - Shailendra Segobin
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France
| | - Nicolas Cabé
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.411149.80000 0004 0472 0160Service d’Addictologie, Centre Hospitalier Universitaire de Caen, 14000 Caen, France ,grid.417831.80000 0004 0640 679XNormandie Univ, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), Cyceron, 14000 Caen, France
| | - Céline Boudehent
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.411149.80000 0004 0472 0160Service d’Addictologie, Centre Hospitalier Universitaire de Caen, 14000 Caen, France ,grid.417831.80000 0004 0640 679XNormandie Univ, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), Cyceron, 14000 Caen, France
| | - François Vabret
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.411149.80000 0004 0472 0160Service d’Addictologie, Centre Hospitalier Universitaire de Caen, 14000 Caen, France ,grid.417831.80000 0004 0640 679XNormandie Univ, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), Cyceron, 14000 Caen, France
| | - Géraldine Rauchs
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.417831.80000 0004 0640 679XNormandie Univ, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), Cyceron, 14000 Caen, France
| | - Anne-Lise Pitel
- grid.412043.00000 0001 2186 4076Neuropsychologie et Imagerie de la Mémoire Humaine, Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, 14000 Caen, France ,grid.417831.80000 0004 0640 679XNormandie Univ, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), Cyceron, 14000 Caen, France
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Poitras M, Narvaez Linares NF, Lambert M, Browndyke JN, Plamondon H. Women with Myocardial Infarction Present Subtle Cognitive Difficulties on a Neuropsychological Battery After Exposure to a Social Stressor. Psychol Res Behav Manag 2022; 15:2761-2771. [PMID: 36176378 PMCID: PMC9514296 DOI: 10.2147/prbm.s379381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Myocardial infarction (MI) is the primary cause of mortality and morbidity in women, but its sequelae remain largely understudied. Given the heart-brain relationship, our study aimed to further understand stress's impact on regulating cognitive function post-MI. Specifically, our study evaluated the effect of stress induced using the Trier Social Stress Test (TSST), on neuropsychological function in women who have or have not experienced MI. Methodology To do so, women (mean age = 59.41 yrs) with (WHxMI = 13) or without () a history of MI were exposed to the TSST prior to completion of a series of standardized neuropsychological tests: the Montreal Cognitive Assessment (MoCA), Control Oral Word Association (COWA), Rey Complex Figure and Recognition (RCFT), Trail Making Test (TMT), and Auditory Consonant Triagrams (ACT). Results Our findings support MI to be associated with impairments in working memory affecting immediate recall of ACT, as well as visuospatial impairments in the RCFT copy trial, marked by poorer drawing accuracy and incorrect placement of figure elements. Overall, WHxMI required more time to complete the neuropsychological assessment (WHxMI 166.57 ± 12, 155.00 ± 6.57; p < 0.01). Conclusion Together, these findings support cognitive impairments noted following a social stressor to remain subtle in WHxMI. Our study highlights the need for the development of more sensitive tools to screen for neuropsychological impairments in women with MI and the importance of assessing performance in a variety of testing conditions.
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Affiliation(s)
- Marilou Poitras
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Maude Lambert
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey N Browndyke
- Department of Psychiatry and Behavioural Medicine, Division of Behavioral Medicine & Neurosciences, Duke University Medical Centre, Durham, NC, USA
| | - Hélène Plamondon
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Vega-Ávila GC, Afanador-Restrepo DF, Rivas-Campo Y, García-Garro PA, Hita-Contreras F, Carcelén-Fraile MDC, Castellote-Caballero Y, Aibar-Almazán A. Rhythmic Physical Activity and Global Cognition in Older Adults with and without Mild Cognitive Impairment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912230. [PMID: 36231532 PMCID: PMC9566681 DOI: 10.3390/ijerph191912230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 05/05/2023]
Abstract
Growing evidence suggests that rhythmic physical activity (PA) improves cognitive function in both persons with normal brain aging and with cognitive impairment. This study aims to conduct a systematic review of randomized controlled trials assessing the effects of rhythmic PA over global cognition in older adults with and without mild cognitive impairment. Different keywords related to the topic and Boolean operators were used in the Web of Science, PubMed, and Scopus databases. A total of 11 articles that met the inclusion criteria were analyzed; all of them assessed global cognition using either the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) or the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Five studies showed beneficial effects over global cognition. All studies had at least one experimental group with rhythmic training, and the interventions evidenced a great diversity of rhythmic stimuli, as well as a varied frequency, duration and type of activities. The heterogeneity of the protocols could be the reason for the mixed findings. Future studies with more precise exercise prescriptions are needed to establish whether rhythmic PA has beneficial effects on global cognition.
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Affiliation(s)
- Gloria Cecilia Vega-Ávila
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
| | - Diego Fernando Afanador-Restrepo
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
- Faculty of Health Sciences, University Foundation of the Área Andina—Pereira, Pereira 660004, Colombia
| | - Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura—Cali, Santiago de Cali 760016, Colombia
| | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Correspondence:
| | | | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
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Villarejo-Galende A, García-Arcelay E, Piñol-Ripoll G, del Olmo-Rodríguez A, Viñuela F, Boada M, Franco-Macías E, Ibañez de la Peña A, Riverol M, Puig-Pijoan A, Abizanda-Soler P, Arroyo R, Baquero-Toledo M, Feria-Vilar I, Balasa M, Berbel Á, Rodríguez-Rodríguez E, Vieira-Campos A, García-Ribas G, Rodrigo-Herrero S, Terrancle Á, Prefasi D, Lleó A, Maurino J. Quality of Life and the Experience of Living with Early-Stage Alzheimer’s Disease. J Alzheimers Dis 2022; 90:719-726. [DOI: 10.3233/jad-220696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: There is a need to better understand the experience of patients living with Alzheimer's disease (AD) in the early stages. Objective: The aim of the study was to evaluate the perception of quality of life in patients with early-stage AD. Methods: A multicenter, non-interventional study was conducted including patients of 50–90 years of age with prodromal or mild AD, a Mini-Mental State Examination (MMSE) score ≥22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5.–1.0. The Quality of Life in Alzheimer ’s Disease (QoL-AD) questionnaire was used to assess health-related quality of life. A battery of self-report instruments was used to evaluate different psychological and behavioral domains. Associations between the QoL-AD and other outcome measures were analyzed using Spearman’s rank correlations. Results: A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years and mean disease duration was 1.4 (1.8) years. Mean MMSE score was 24.6 (2.1). The mean QoL-AD score was 37.9 (4.5). Eighty-three percent (n = 124) of patients had moderate-to-severe hopelessness, 22.1% (n = 33) had depressive symptoms, and 36.9% (n = 55) felt stigmatized. The quality of life showed a significant positive correlation with self-efficacy and negative correlations with depression, emotional and practical consequences, stigma, and hopelessness. Conclusion: Stigma, depressive symptoms, and hopelessness are frequent scenarios in AD negatively impacting quality of life, even in a population with short disease duration and minimal cognitive impairment.
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Affiliation(s)
- Alberto Villarejo-Galende
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gerard Piñol-Ripoll
- Cognitive Disorders Unit, Hospital Universitari Santa Maria de Lleida, Institut de Recerca Biomédica de Lleida (IRBLLeida), Lleida, Spain
| | | | - Félix Viñuela
- Instituto Neurológico Andaluz, Hospital Victoria Eugenia, Unidad Deterioro Cognitivo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercè Boada
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Emilio Franco-Macías
- Dementia Unit, Department of Neurology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | | | - Mario Riverol
- Department of Neurology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Albert Puig-Pijoan
- Cognitive Impairment and Movement Disorders Unit, Department of Neurology, Hospital del Mar, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Pedro Abizanda-Soler
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Rafael Arroyo
- Department of Neurology, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Miquel Baquero-Toledo
- Grup d’Investigació en Malaltia d’Alzheimer, Department of Neurology, Hospital Universitari i Politècnic La Fe, Institut d’Investigació Sanitaria La Fe, Valencia, Spain
| | - Inmaculada Feria-Vilar
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mircea Balasa
- Alzheimer’s Disease and other Cognitive Disorders Unit, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ángel Berbel
- Department of Neurology, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Department of Neurology, Hospital Universitario de Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Alba Vieira-Campos
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo García-Ribas
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
| | - Silvia Rodrigo-Herrero
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
| | | | | | - Alberto Lleó
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
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Frailty as a Predictor of Hospitalization and Low Quality of Life in Geriatric Patients at an Internal Medicine Outpatient Clinic: A Cross-Sectional Study. Geriatrics (Basel) 2022; 7:geriatrics7050089. [PMID: 36136798 PMCID: PMC9498513 DOI: 10.3390/geriatrics7050089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/15/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Frailty is an aging-associated state that increases patients’ vulnerability to disease, and can lead to various adverse outcomes. It is classified as either physical frailty alone or physical frailty in combination with cognitive impairment (cognitive frailty). There are currently limited data available regarding the prevalence and adverse outcomes of frailty in Thailand. This was a cross-sectional study aimed at determining the prevalence of physical and cognitive frailty and their effects on hospitalization and quality of life. Participants were older patients who attended an internal medicine outpatient clinic. Frailty was diagnosed using the Thai Frailty Index. The Thai version of the MoCA was used to evaluate cognitive status. Univariate and multivariate analyses were performed to compare adverse outcomes in terms of poor quality of life and history of admission to hospital between patients with frailty and non-frail patients, and among patients with physical frailty, cognitive frailty, cognitive impairment, and robust (non-frail and non-cognitively impaired) patients. We enrolled 198 participants. The prevalence of physical and cognitive frailty was 28.78% and 20.70%, respectively. When compared with non-frail patients, frailty was associated with hospitalization (adjusted OR 3.01, p = 0.002) but was not significantly related to quality of life (adjusted OR = 1.98, p = 0.09). However, physical and cognitive frailty were associated with fair quality of life when compared with normal patients (adjusted OR = 4.34, p = 0.04 and adjusted OR = 4.28, p = 0.03, respectively). The prevalence of frailty—particularly cognitive frailty—was high. Frailty was associated with adverse outcomes in terms of hospitalization and quality of life.
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42
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Pike K, Moller CI, Bryant C, Farrow M, Dao DP, Ellis KA. Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults: Results from a Single-Arm Pre-Post Trial (Preprint). J Med Internet Res 2022; 25:e41712. [PMID: 37079356 PMCID: PMC10160943 DOI: 10.2196/41712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. OBJECTIVE We report on OPTIMiSE's feasibility, acceptability, and efficacy. METHODS Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. RESULTS OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. CONCLUSIONS This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3233/ADR-200251.
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Affiliation(s)
- Kerryn Pike
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Australia
- School of Applied Psychology, Griffith Centre for Mental Health & Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Carl I Moller
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Duy P Dao
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn A Ellis
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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43
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The Effect of Music-Based Intervention on General Cognitive and Executive Functions, and Episodic Memory in People with Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials. Healthcare (Basel) 2022; 10:healthcare10081462. [PMID: 36011119 PMCID: PMC9408548 DOI: 10.3390/healthcare10081462] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Music-based intervention has been used as first-line non-pharmacological treatment to improve cognitive function for people with mild cognitive impairment (MCI) or dementia in clinical practice. However, evidence regarding the effect of music-based intervention on general cognitive function as well as subdomains of cognitive functions in these individuals is scarce. Objective: To evaluate the efficacy of music-based interventions on a wide range of cognitive functions in people with MCI or dementia. Method: We searched the effect of various music therapies using randomized controlled trials on cognitive function using several databases. Studies based on any type of dementia or MCI were combined. The effects of music-based intervention on each cognitive function were pooled by meta-analysis. Results: A total of 19 studies involving n = 1024 participants (mean age ranged from 60 to 87 years old) were included. We found statistically significant improvements in MMSE (general cognitive function), the Frontal Assessment Battery (executive function), and the Auditory Verbal Learning Test (episodic memory). Conclusions: This study provides positive evidence to support music-based interventions for improving a wide range of cognitive functions in older adults with MCI and dementia. Therefore, we recommend increased use of music in people’s homes, day care centers and nursing homes. This study was registered with PROSPERO, number 250383.
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44
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Han A. Mindfulness-Based Interventions for Older Adults with Dementia or Mild Cognitive Impairment: A Meta-Analysis. Clin Gerontol 2022; 45:763-776. [PMID: 34693892 DOI: 10.1080/07317115.2021.1995561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis examined the effects of mindfulness-based interventions (MBIs) on psychological symptoms, cognitive functions, and quality of life in older adults with dementia or mild cognitive impairment (MCI). METHODS A comprehensive search was conducted within four databases to identify relevant randomized controlled trials (RCTs). Heterogeneity was assessed using the I2 statistic. Depending on I2 statistic values, either a random effects model or fixed effects model was used. RESULTS 10 RCTs published in 11 articles met the eligibility criteria. The present meta-analysis study found no significant effect of MBIs on depressive symptoms, anxiety, quality of life, memory, and overall cognitive functions compared to control groups. CONCLUSIONS Future high-quality studies involving different types of MBIs are needed to better understand the effects of MBIs on psychological symptoms, quality of life, and cognitive functions in older adults with MCI and dementia and examine effective intervention features. CLINICAL IMPLICATIONS There is insufficient evidence to determine whether or not practitioners should be routinely providing MBIs to older adults with MCI and dementia due to the lack of studies currently.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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45
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Etholén A, Pietiläinen O, Kouvonen A, Hänninen M, Rahkonen O, Lallukka T. Trajectories of Insomnia Symptoms Among Aging Employees and Their Associations With Memory, Learning Ability, and Concentration After Retirement - A Prospective Cohort Study (2000-2017). J Aging Health 2022; 34:916-928. [PMID: 35482013 PMCID: PMC9483690 DOI: 10.1177/08982643221078740] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives We applied a person-oriented approach and used latent class linear mixed
models to identify sleep trajectories that explain memory, concentration,
and learning ability problems after retirement. Methods Data consist of prospective surveys from four phases of the Helsinki Health
Study between 2000–2017 (n = 3748, aged 55–77 years, 80% women). Multinomial
regression was used to examine the associations between sleep trajectories
and cognitive function, adjusting for sociodemographic, health-related
behavior, and health factor covariates. Results Among statutory retirees, three latent group trajectories of insomnia-related
symptoms were identified: stable low, decreasing, and increasing. Among
those who had retired for disability reasons, we identified one additional
latent group trajectory: stable high. Insomnia symptoms were associated with
worse cognitive function. Discussion Early detection of insomnia symptoms would be a potential intervention point
to improve both sleep quality and prevent cognitive decline in later life.
However, intervention studies are needed.
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Affiliation(s)
- Antti Etholén
- Department of Public Health, 176449University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, 176449University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, 176449University of Helsinki, Helsinki, Finland.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mirja Hänninen
- Department of Public Health, 176449University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, 176449University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, 176449University of Helsinki, Helsinki, Finland
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Frias JR, Nogueira J, Gerardo B, Afonso RM, Freitas S. Cognitive decline complaints scale (CDCS): validation and normative studies for the adults and older adults Portuguese population. Aging Ment Health 2022; 27:721-728. [PMID: 35470707 DOI: 10.1080/13607863.2022.2068130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Subjective Cognitive Complaints, which result from the self-perception of Subjective Cognitive Decline, are frequently reported by older adults. The Cognitive Decline Complaints Scale (CDCS) assesses subjective complaints of cognitive decline in several cognitive domains through three levels of severity. This study aims to psychometrically validate this instrument considering the Classical Test Theory, and to establish preliminary normative data of the CDCS for adults and older adults of the Portuguese population. METHODS The community-based sample consisted of 199 cognitively healthy Portuguese participants, aged 50 years or older, stratified according to several sociodemographic variables. In addition to the CDCS, all participants responded to an extensive neuropsychological assessment protocol. RESULTS The psychometric characteristics of the CDCS were generally adequate for this community sample (e.g. Cronbach's alpha = .936). As for the sociodemographic variables analyzed, only the geographic region showed differences in the CDCS scores, which were more significant in the Azores. There were no significant correlations or differences between the CDCS scores and age and educational level and, therefore, normative data were explored considering the total sample. CONCLUSION As a scale, the CDCS allows for the detailed assessment of subjective cognitive complaints and the determination of whether or not such complaints are considered normative, which will facilitate an empirically based understanding of this dimension of psychological functioning and also provide indications as to the need for a more extensive neuropsychological assessment.
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Affiliation(s)
- Joana Rita Frias
- Department of Psychology and Education, University of Beira Interior, Covilhã, Portugal
| | - Joana Nogueira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal.,Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal
| | - Bianca Gerardo
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal.,Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal
| | - Rosa Marina Afonso
- Department of Psychology and Education, University of Beira Interior, Covilhã, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Sandra Freitas
- Department of Psychology and Education, University of Beira Interior, Covilhã, Portugal.,Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal.,Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), University of Coimbra, Coimbra, Portugal
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47
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Tahami Monfared AA, Byrnes MJ, White LA, Zhang Q. The Humanistic and Economic Burden of Alzheimer's Disease. Neurol Ther 2022; 11:525-551. [PMID: 35192176 PMCID: PMC9095804 DOI: 10.1007/s40120-022-00335-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in older individuals (aged ≥ 65 years) throughout the world. As a result of these progressive deficits in cognitive, emotional, and physical function, AD dementia can cause functional disability and loss of independence. To gain a deeper understanding of the recent literature on the burden of AD, including that of mild cognitive impairment (MCI) due to AD, we conducted a comprehensive targeted review of the PubMed-indexed literature (2014 to 2021) to examine the humanistic and economic burden of AD (including MCI) in North America, Europe, and Asia. Our literature review identified a range of factors associated with quality of life (QoL): some factors were positively associated with QoL, including caregiver relationship, religiosity, social engagement, and ability to engage in activities of daily living (ADL), whereas other factors such as neuropsychiatric symptoms were associated with poorer QoL. While patient- and proxy-rated QoL are highly correlated in patients with early AD dementia, proxy-rated QoL declines more substantially as severity worsens. The maintenance of self-reported QoL in patients with more severe AD dementia may be due to lack of awareness or to adaptation to circumstances. Compared to persons with normal cognition, MCI is associated with a greater cost burden, and individuals with MCI exhibit worse QoL. Key drivers of the societal economic burden of AD include disease severity, dependence level, institutionalization, and comorbidity burden. Evaluation of the impact of a hypothetical disease-modifying treatment delaying the progression from MCI to AD has suggested that such a treatment may result in cost savings.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, 200 Metro Blvd, Nutley, NJ, 07110, USA. .,McGill University, Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada.
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48
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Wittenberg GF, McKay MA, O’Connor M. Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211030468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.
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49
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Zhang XM, Wu XJ, Cao J, Jiao J, Chen W. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging 2022; 26:817-825. [PMID: 36156673 DOI: 10.1007/s12603-022-1833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome. RESULTS Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29-2.58), disability (3.17, 95%CI: 2.24-4.48), and hospitalization (1.78, 95%CI: 1.48-2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25-2.48), disability (pooled OR 1.82, 95%CI: 1.43-2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45-1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes. CONCLUSION Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.
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Affiliation(s)
- X M Zhang
- Xiao-Ming Zhang, Xin-Juan Wu, Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China, ,
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50
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Gómez-Soria I, Ferreira C, Oliván Blazquez B, Magallón Botaya RM, Calatayud E. Short-term memory, attention, and temporal orientation as predictors of the cognitive impairment in older adults: A cross-sectional observational study. PLoS One 2021; 16:e0261313. [PMID: 34928983 PMCID: PMC8687627 DOI: 10.1371/journal.pone.0261313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Late-life cognitive decline ranges from the mildest cases of normal, age-related change to mild cognitive impairment to severe cases of dementia. Dementia is the largest global burden for the 21st century welfare and healthcare systems. The aim of this study was to analyze the neuropsychological constructs (temporal orientation (TO), spatial orientation (SO), fixation memory (FM), attention (A), calculation (C), short-term memory (STM), language (L), and praxis (P)), semantic fluency, level of functionality, and mood that reveal the greatest deficit in the different stages ranging from normal cognition (NC) to cognitive impairment in older adults in a primary healthcare setting. The study included 337 participants (102 men, 235 women), having a mean age of 74 ± 6 years. According to their scores on the Spanish version of the Mini-Mental State Examination (MEC-35), subjects were divided into 4 groups: no deterioration (ND) (score 32-35), subtle cognitive impairment (SCI) (score 28-31), level deterioration (LD) (score 24-27) and moderate deterioration (MD) (score 20-23). The ND group revealed significant differences in TO, STM, C, A, L, P, and S-T as compared to the other groups. The MD group (in all the neuropsychological constructs) and the ND and SCI groups showed significant differences on the Yesavage geriatric depression scale (GDS-15). All except the FM neuropsychological construct were part of the MEC-35 prediction model and all of the regression coefficients were significant for these variables in the model. Furthermore, the highest average percentage of relative deterioration occurs between LD and MD and the greatest deterioration is observed in the STM for all groups, including A and TO for the LD and MD groups. Based on our findings, community programs have been implemented that use cognitive stimulation to prevent cognitive decline and to maintain the neuropsychological constructs.
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Affiliation(s)
- Isabel Gómez-Soria
- Faculty of Health Sciences, Department of Physiatry and Nursing,
University of Zaragoza, Zaragoza, Spain
- Institute of Health Research of Aragón (IIS Aragón), Zaragoza,
Spain
| | - Chelo Ferreira
- Faculty of Veterinary Sciences, Department of Applied Mathematics and
IUMA, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván Blazquez
- Institute of Health Research of Aragón (IIS Aragón), Zaragoza,
Spain
- Faculty of Social and Labor Sciences, Department of Psychology and
Sociology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Mª Magallón Botaya
- Institute of Health Research of Aragón (IIS Aragón), Zaragoza,
Spain
- Faculty of Medicine, Department of Medicine, Psychiatry and Dermatology,
University of Zaragoza, Zaragoza, Spain
| | - Estela Calatayud
- Faculty of Health Sciences, Department of Physiatry and Nursing,
University of Zaragoza, Zaragoza, Spain
- Institute of Health Research of Aragón (IIS Aragón), Zaragoza,
Spain
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