1
|
Scharre DW, Vrettos NE, Nagaraja HN, Wexler RK, Clark AD, Nguyen CM. Self-administered gerocognitive examination (SAGE) aids early detection of cognitive impairment at primary care provider visits. Front Med (Lausanne) 2024; 11:1353104. [PMID: 38938387 PMCID: PMC11208700 DOI: 10.3389/fmed.2024.1353104] [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] [Received: 12/09/2023] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Current estimates indicate that up to 50-75% of dementia cases are undiagnosed at an early stage when treatments are most effective. Conducting robust accurate cognitive assessments can be time-consuming for providers and difficult to incorporate into a time-limited Primary Care Provider (PCP) visit. We wanted to compare PCP visits with and without using the self-administered SAGE to determine differences in identification rates of new cognitive disorders. Methods Three hundred patients aged 65-89 without diagnosed cognitive disorders completing a non-acute office visit were enrolled (ClinicalTrials.gov identifier: NCT04063371). Two PCP offices conducted routine visits for 100 consecutive eligible patients each. One office used the SAGE in an additional 100 subjects and asked available informants about cognitive changes over the previous year. Chart reviews were conducted 60 days later. One-way analysis of variance and Fisher exact tests were used to compare the groups and outcomes. Results When SAGE was utilized, the PCP documented the detection of new cognitive conditions/concerns six times (9% versus 1.5%) as often (p = 0.003). The detection rate was nearly 4-fold for those with cognitively impaired SAGE scores (p = 0.034). Patients having impaired SAGE score and informant concerns were 15-fold as likely to have new cognitive conditions/concerns documented (p = 0.0007). Among providers using SAGE, 86% would recommend SAGE to colleagues. Discussion SAGE was easily incorporated into PCP visits and significantly increased identification of new cognitive conditions/concerns leading to new diagnoses, treatment, or management changes. The detection rate increased 15-fold for those with impaired SAGE scores combined with informant reports.
Collapse
Affiliation(s)
- Douglas W. Scharre
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nicole E. Vrettos
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Randell K. Wexler
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aaron D. Clark
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Christopher M. Nguyen
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
2
|
Pujol A, Sanchis P, Tamayo MI, Nicolau J, Grases F, Espino A, Estremera A, Rigo E, Amengual GJ, Rodríguez M, Ribes JL, Gomila I, Simó-Servat O, Masmiquel L. Oral phytate supplementation on the progression of mild cognitive impairment, brain iron deposition and diabetic retinopathy in patients with type 2 diabetes: a concept paper for a randomized double blind placebo controlled trial (the PHYND trial). Front Endocrinol (Lausanne) 2024; 15:1332237. [PMID: 38872972 PMCID: PMC11169791 DOI: 10.3389/fendo.2024.1332237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Type 2 diabetes mellitus has a worldwide prevalence of 10.5% in the adult population (20-79 years), and by 2045, the prevalence is expected to keep rising to one in eight adults living with diabetes. Mild cognitive impairment has a global prevalence of 19.7% in adults aged 50 years. Both conditions have shown a concerning increase in prevalence rates over the past 10 years, highlighting a growing public health challenge. Future forecasts indicate that the prevalence of dementia (no estimations done for individuals with mild cognitive impairment) is expected to nearly triple by 2050. Type 2 diabetes mellitus is a risk factor for the development of cognitive impairment, and such impairment increase the likelihood of poor glycemic/metabolic control. High phytate intake has been shown to be a protective factor against the development of cognitive impairment in observational studies. Diary phytate intake might reduce the micro- and macrovascular complications of patients with type 2 diabetes mellitus through different mechanisms. We describe the protocol of the first trial (the PHYND trial) that evaluate the effect of daily phytate supplementation over 56 weeks with a two-arm double-blind placebo-controlled study on the progression of mild cognitive impairment, cerebral iron deposition, and retinal involvement in patients with type 2 diabetes mellitus. Our hypothesis proposes that phytate, by inhibiting advanced glycation end product formation and chelating transition metals, will improve cognitive function and attenuate the progression from Mild Cognitive Impairment to dementia in individuals with type 2 diabetes mellitus and mild cognitive impairment. Additionally, we predict that phytate will reduce iron accumulation in the central nervous system, mitigate neurodegenerative changes in both the central nervous system and retina, and induce alterations in biochemical markers associated with neurodegeneration.
Collapse
Affiliation(s)
- Antelm Pujol
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Pilar Sanchis
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Laboratory of Renal Lithiasis Research, University of Balearic Islands, Research Institute of Health Science (IUNICS) Health Research Institute of Balearic Islands, (IdISBa), Palma de Mallorca, Spain
| | - María I. Tamayo
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Joana Nicolau
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University of Balearic Islands, Research Institute of Health Science (IUNICS) Health Research Institute of Balearic Islands, (IdISBa), Palma de Mallorca, Spain
| | - Ana Espino
- Neurology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Ana Estremera
- Neuroradiology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Elena Rigo
- Neuroopthalmology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | | | - Manuel Rodríguez
- Neuroradiology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - José L. Ribes
- Biochemistry Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Isabel Gomila
- Biochemistry Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Masmiquel
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| |
Collapse
|
3
|
Dinh M, Lin CC, Whitfield C, Farhan Z, Meurer WJ, Bailey S, Skolarus LE. Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial. JMIR Form Res 2024; 8:e54010. [PMID: 38805251 PMCID: PMC11167316 DOI: 10.2196/54010] [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: 10/31/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. OBJECTIVE The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. METHODS Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). RESULTS Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. CONCLUSIONS Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.
Collapse
Affiliation(s)
- Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Chun Chieh Lin
- Division of Health Services Research, Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges into the Future, Flint, MI, United States
| | - Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
| |
Collapse
|
4
|
Ullal A, Tauseef M, Watkins A, Juckett L, Maxwell C, Tate J, Mion LC, Sarkar N. An Iterative Participatory Design Approach to Develop Collaborative Augmented Reality Activities for Older Adults in Long-Term Care Facilities. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:1009. [PMID: 39015130 PMCID: PMC11251005 DOI: 10.1145/3613904.3642595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Over four million older adults living in long-term care (LTC) communities experience loneliness, adversely impacting their health. Increased contact with friends and family is an evidence-based intervention to reduce loneliness, but in-person visits are not always possible. Augmented Reality (AR)-based telepresence activities can offer viable alternatives with increased immersion and presence compared to video calls. However, its feasibility as an interaction technology for older adults is not known. In this paper, we detail the design of two dyadic collaborative AR activities that accommodate diminished physical and cognitive abilities of older adults. The findings include a general design framework based on an iterative participatory design focusing on preferred activities, modes of interaction, and overall AR experience of eight older adults, two family members, and five LTC staff. Results demonstrate the potential of collaborative AR as an effective means of interaction for older adults with their family, if designed to cater to their needs.
Collapse
Affiliation(s)
| | | | | | | | | | - Judith Tate
- The Ohio State University, Columbus, Ohio, USA
| | | | | |
Collapse
|
5
|
Young A, Fechtner L, Kim C, Nayak N, Kellermeyer B, Ortega C, Rende S, Rosenberg S, Wazen J. Long-term cognition and speech recognition outcomes after cochlear implantation in the elderly. Am J Otolaryngol 2024; 45:104071. [PMID: 37793300 DOI: 10.1016/j.amjoto.2023.104071] [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: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. STUDY DESIGN This is a prospective study. SETTING This study was conducted at a single institution. METHODS Unilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). RESULTS Patients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. CONCLUSION Cognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.
Collapse
Affiliation(s)
- Allen Young
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA.
| | - Linnea Fechtner
- Grand Valley ENT and Facial Plastics Surgeon, 2373 G Road, Suite 270, Grand Junction, CO 81505, USA
| | - Christine Kim
- AMC Otolaryngology, 50 New Scotland Avenue, Albany, NY 12208, USA
| | - Neil Nayak
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Brian Kellermeyer
- West Virginia University Hospitals, 1 Medical Center DR, Morganton, WV 26505, USA
| | - Carmelo Ortega
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Sharon Rende
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Seth Rosenberg
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Jack Wazen
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| |
Collapse
|
6
|
Kawakami R, Wright KD, Scharre DW, Ning X. Detection of Cognitive Impairment From eSAGE Metadata Using Machine Learning. Alzheimer Dis Assoc Disord 2024; 38:22-27. [PMID: 38109352 DOI: 10.1097/wad.0000000000000593] [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: 04/20/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Using the metadata collected in the digital version of the Self-Administered Gerocognitive Examination (eSAGE), we aim to improve the prediction of mild cognitive impairment (MCI) and dementia (DM) by applying machine learning methods. PATIENTS AND METHODS A total of 66 patients had a diagnosis of normal cognition (NC), MCI, or DM, and eSAGE scores and metadata were used. eSAGE scores and metadata were obtained. Each eSAGE question was scored and behavioral features (metadata) such as the time spent on each test page, drawing speed, and average stroke length were extracted for each patient. Logistic regression (LR) and gradient boosting models were trained using these features to detect cognitive impairment (CI). Performance was evaluated using 10-fold cross-validation, with accuracy, precision, recall, F1 score, and receiver operating characteristic area under the curve (AUC) score as evaluation metrics. RESULTS LR with feature selection achieved an AUC of 89.51%, a recall of 87.56%, and an F1 of 85.07% using both behavioral and scoring. LR using scores and metadata also achieved an AUC of 84.00% in detecting MCI from NC, and an AUC of 98.12% in detecting DM from NC. Average stroke length was particularly useful for prediction and when combined with 4 other scoring features, LR achieved an even better AUC of 92.06% in detecting CI. The study shows that eSAGE scores and metadata are predictive of CI. CONCLUSIONS eSAGE scores and metadata are predictive of CI. With machine learning methods, the metadata could be combined with scores to enable more accurate detection of CI.
Collapse
Affiliation(s)
| | | | | | - Xia Ning
- Department of Computer Science and Engineering
- Department of Biomedical Informatics
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH
| |
Collapse
|
7
|
Fuchten D, Smit AL, Huenges Wajer IMC, Rhebergen KS, Stegeman I. Assessing the feasibility of a randomised controlled trial examining the effect of hearing aids on cognitive decline in elderly individuals: a study protocol. BMJ Open 2023; 13:e074176. [PMID: 38151274 PMCID: PMC10753785 DOI: 10.1136/bmjopen-2023-074176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Hearing loss is one of the leading potentially modifiable risk factors for dementia. There is growing evidence suggesting that treating hearing loss with hearing aids could be a relatively low-cost intervention in reducing cognitive decline and the risk of dementia in the long term. However, given the current constraints of the limited evidence, it is premature to draw definitive conclusions about the effect of hearing aids on cognitive functioning. More long-term randomised studies examining this effect would be recommended. Prior to embarking on large-scale lengthy randomised controlled trials (RCTs), it is imperative to determine the viability of such studies. Therefore, the purpose of the current study is to assess the feasibility of a RCT that investigates the effect of hearing aids on cognitive functioning in elderly hearing impaired individuals. METHODS AND ANALYSIS In this randomised controlled feasibility trial, 24 individuals aged 65 years or older with mild to moderate hearing loss (≥35-<50 dB pure tone average (0.5-4 kHz) unilateral or bilateral) will be included and randomised towards a hearing aid intervention or no intervention. At baseline and at 6-month follow-up, a test battery consisting of cognitive tests and questionnaires will be administered to both groups. The primary outcome of the study is the willingness of hearing impaired individuals to be randomised for hearing amplification in a study regarding cognition. The secondary outcomes are the feasibility of the test battery and the therapy compliance of hearing aid use. ETHICS AND DISSEMINATION This research protocol was approved by the Institutional Review Board of the University Medical Centre Utrecht (NL80594.041.22, V.3, January 2023). The trial results will be made accessible to the public in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN84550071.
Collapse
Affiliation(s)
- Denise Fuchten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Koen S Rhebergen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
Wagner AR, Kobel MJ, Merfeld DM. Increased roll tilt thresholds are associated with subclinical postural instability in asymptomatic adults aged 21 to 84 years. Front Aging Neurosci 2023; 15:1207711. [PMID: 37637958 PMCID: PMC10448770 DOI: 10.3389/fnagi.2023.1207711] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Balance assessments that intentionally alter the reliability of visual and proprioceptive feedback (e.g., standing on foam with eyes closed) have become a standard approach for identifying vestibular mediated balance dysfunction in older adults. However, such assessments cannot discern which specific element of the vestibular system (e.g., semicircular canal, otolith, or combined canal-otolith) underlies the observed age-related changes in balance performance. The present study was designed to determine the associations between specific sources of vestibular noise and quantitative measures of quiet stance postural control measured during standard "vestibular" balance conditions. Methods A group of 52 asymptomatic adults (53.21 ± 19.7, 21 to 84 years) without a history of vestibular or neurologic disorders volunteered for this study. We measured a battery of five vestibular perceptual thresholds that assay vestibular noise with predominant contributions from the vertical canals, lateral canals, utricles, saccules, and the centrally integrated canal-otolith signal. In addition, participants completed two standard balance assessments that were each designed to prioritize the use of vestibular cues for quiet stance postural control-eyes closed on foam (Condition 4 of the Modified Romberg Balance Test) and eyes closed, on a sway referenced support surface (Condition 5 of the Sensory Organization Test). Results In age adjusted models, we found strong positive associations between roll tilt vestibular thresholds, a measure of noise in the centrally integrated canal-otolith signal, and the root mean square distance (RMSD) of the anteroposterior and mediolateral center of pressure (CoP) captured during eyes closed stance on a sway referenced support surface. The strength of the association between roll tilt thresholds and the RMSD of the CoP was between 3-times and 30-times larger than the association between postural sway and each of the other vestibular thresholds measured. Conclusion We posit that noise in the centrally estimated canal-otolith "tilt" signal may be the primary driver of the subclinical postural instability experienced by older adults during the "vestibular" conditions of balance assessments. Additional testing in adults with clinical balance impairment are needed to identify if roll tilt thresholds may also serve as a surrogate metric by which to detect vestibular mediated balance dysfunction and/or fall risk.
Collapse
Affiliation(s)
- Andrew R. Wagner
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Megan J. Kobel
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, United States
| | - Daniel M. Merfeld
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
9
|
Tian BWCA, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, Bensard D, Sakakushev B, Galante J, Fraga GP, Koike K, Di Carlo I, Tebala GD, Leppaniemi A, Tan E, Damaskos D, De'Angelis N, Hecker A, Pisano M, Maier RV, De Simone B, Amico F, Ceresoli M, Pikoulis M, Weber DG, Biffl W, Beka SG, Abu-Zidan FM, Valentino M, Coccolini F, Kluger Y, Sartelli M, Agnoletti V, Chirica M, Bravi F, Sall I, Catena F. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg 2023; 18:38. [PMID: 37355698 DOI: 10.1186/s13017-023-00506-7] [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: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023] Open
Abstract
Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.
Collapse
Affiliation(s)
- Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Philip F Stahel
- Department of Orthopedic Surgery and Department of Neurosurgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Ernest Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Denis Bensard
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Boris Sakakushev
- Research Institute of Medical University Plovdiv/University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, SP, Brazil
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Giovanni D Tebala
- Oxford University Hospitals NHSFT John Radcliffe Hospital, Headley Way, HeadingtonOxford, OX3 9DU, UK
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicola De'Angelis
- Hôpital Henri Mondor, Université Paris Est, Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Créteil, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ron V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walt Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| |
Collapse
|
10
|
Totten DJ, Saltagi A, Libich K, Pisoni DB, Nelson RF. Cochlear Implantation in US Military Veterans: A Single Institution Study. OTO Open 2023; 7:e53. [PMID: 37187572 PMCID: PMC10181857 DOI: 10.1002/oto2.53] [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] [Received: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Objective Military veterans have high rates of noise-induced hearing loss (NIHL) which is associated with more significant spiral ganglion neuronal loss. This study explores the relationship between NIHL and cochlear implant (CI) outcomes in veterans. Study Design Retrospective case series of veterans who underwent CI between 2019 and 2021. Setting Veterans Health Administration hospital. Methods AzBio Sentence Test, Consonant-Nucleus-Consonant (CNC) scores, and Speech, Spatial, and Qualities of Hearing Scale (SSQ) were measured pre- and postoperatively. Linear regression assessed relationships between outcomes and noise exposure history, etiology of hearing loss, duration of hearing loss, and Self-Administered Gerocognitive Exam (SAGE) scores. Results Fifty-two male veterans were implanted at an average (standard deviation) age of 75.0 (9.2) years without major complications. The average duration of hearing loss was 36.0 (18.4) years. The average time of hearing aid use was 21.2 (15.4) years. Noise exposure was reported in 51.3% of patients. Objectively, AzBio and CNC scores 6 months postoperatively showed significant improvement of 48% and 39%, respectively. Subjectively, average 6-month SSQ scores showed significant improvement by 34 points (p < .0001). Younger age, SAGE score ≥17, and shorter duration of amplification were associated with higher postoperative AzBio scores. Greater improvement in AzBio and CNC scores was associated with lower preoperative scores. Noise exposure was not associated with any difference in CI performance. Conclusion Despite high levels of noise exposure and advanced age, veterans derive substantial benefits from cochlear implantation. SAGE score ≥17 may be predictive of overall CI outcomes. Noise exposure does not impact CI outcomes. Level of Evidence Level 4.
Collapse
Affiliation(s)
- Douglas J. Totten
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Abdul Saltagi
- College of Medicine, Indiana University School of MedicineIndianapolisIndianaUSA
| | - Karen Libich
- Department of AudiologyRoudebush Veterans' Administration Medical CenterIndianapolisIndianaUSA
| | - David B. Pisoni
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Rick F. Nelson
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Neurological SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| |
Collapse
|
11
|
Buckholz AP, Rosenblatt R. Remote monitoring of cognition in cirrhosis and encephalopathy: future opportunity and challenge. Metab Brain Dis 2022; 38:1737-1747. [PMID: 36507937 PMCID: PMC9743123 DOI: 10.1007/s11011-022-01134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Hepatic Encephalopathy (HE) is a critically important complication of chronic liver disease and portal hypertension, but especially in early covert stages remains underdiagnosed and a common cause of hospitalization and morbidity. Defined by often subtle neuropsychiatric changes, significant cognitive deficits have been extensively described. While traditional methods of assessment remain underutilized in practice and subject to significant confounding with other diseases, mobile technology has emerged as a potential future tool to provide simple and dynamic cognitive assessments. This review discusses the proliferation of cognitive assessment tools, describing possible applications in encephalopathy and the challenges such an implementation may face. There are significant potential advantages to assessing cognition in real time in order to aid early detection and intervention and provide a more realistic measurement of real-world function. Despite this, there are issues with reliability, privacy, applicability and more which must be addressed prior to wide proliferation and acceptance for clinical use. Regardless, the rapid uptake of mobile technology in healthcare is likely to have significant implications for the future management of encephalopathy and liver disease at large.
Collapse
Affiliation(s)
- Adam P Buckholz
- NewYork-Presbyterian/Weill Cornell Medical College Division of Gastroenterology and Hepatology, New York, NY, 10021, USA
| | - Russell Rosenblatt
- NewYork-Presbyterian/Weill Cornell Medical College Division of Gastroenterology and Hepatology, New York, NY, 10021, USA.
| |
Collapse
|
12
|
O'Caoimh R, Coghlan P, O'Donovan MR, Mohd Zaki N, Daly B, Gao Y, Molloy DW. Screening for Cognitive Impairment with the Quick Memory Check: Validation of a Caregiver Administered Cognitive Screen. J Alzheimers Dis 2022; 90:1417-1427. [PMID: 36057819 DOI: 10.3233/jad-220339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Self or home-administered cognitive screening instruments (CSIs) can reduce barriers to the early detection of mild cognitive impairment (MCI) and dementia. OBJECTIVE To examine the acceptability and diagnostic accuracy of a caregiver-administered CSI, the Quick Memory Check (QMC). METHODS Components of the Quick Mild Cognitive impairment (Qmci) screen (orientation, verbal fluency, and logical memory) were re-weighted to create the QMC, scored out of 100 points. Participants, attending a university hospital memory clinic, were provided administration instructions beforehand. Area under the curve (AUC) scores, adjusted for age and education, were compared with the Qmci screen and Montreal Cognitive Assessment (MoCA). Caregivers or family scored the QMC. RESULTS In all, 366 participants were recruited; 53 with subjective memory complaints (SMC), 74 with MCI, 193 with dementia, and 46 normal controls. Median QMC scores for controls were 70±13 versus 60±20 for SMC, 52±18 for MCI, and 31±21 for dementia. The QMC had excellent accuracy (AUC 0.97) for cognitive impairment (MCI/dementia from controls), similar to the Qmci screen (AUC 0.98, p = 0.17) and MoCA (AUC 0.95, p = 0.13). At a cut-off of <52/100, the QMC had 83% sensitivity and 100% specificity for cognitive impairment. The QMC had lower accuracy differentiating MCI from SMC (AUC 0.73), albeit similar to the MoCA (AUC 0.70). CONCLUSION The QMC, administered by caregivers in advance of clinic, compared favorably to established CSIs scored by trained raters. This caregiver, home-administered CSI is acceptable and can identify cognitive impairment, potentially improving efficiency by reducing testing time and patient stress in busy clinical settings.
Collapse
Affiliation(s)
- Rónán O'Caoimh
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland
| | - Patrick Coghlan
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland
| | - Mark R O'Donovan
- Health Research Board Clinical Research Facility, University College Cork, Cork City, Ireland
| | - Nurzakiah Mohd Zaki
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland
| | - Brian Daly
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland
| | - Yang Gao
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland
| | - D William Molloy
- Department of Gerontology and Rehabilitation, University College Cork, St Finbarr's hospital, Douglas road, Cork City, Ireland
| |
Collapse
|
13
|
Girolami S, Tardio M, Loredana S, Di Mattia N, Micheletti P, Di Napoli M. Sleep body position correlates with cognitive performance in middle-old obstructive sleep apnea subjects. Sleep Med X 2022; 4:100050. [PMID: 35784375 PMCID: PMC9241099 DOI: 10.1016/j.sleepx.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | | | | | - Mario Di Napoli
- Corresponding author. UOSD Neurologia, Ospedale S.S. Annunziata, Viale Mazzini, 100, 67039, Sulmona, L’Aquila, Italy.
| |
Collapse
|
14
|
Gold D, Stockwood J, Boulos K, Kasha S, Vyshedskiy A, deTorres L, Ostrovsky S, Durakovic D, Savchenko A, Piryatinsky I. The Boston cognitive assessment: Psychometric foundations of a self-administered measure of global cognition. Clin Neuropsychol 2022; 36:2313-2330. [PMID: 34075854 DOI: 10.1080/13854046.2021.1933190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The Boston Cognitive Assessment (BoCA) is a novel, computerized, self-administered assessment of global cognition. This work sought to establish the validity and reliability of the BoCA. Method: Two studies were conducted. The first study used a sample of 43 outpatients from a clinic in eastern Massachusetts to evaluate the content validity and internal consistency of the BoCA. The second study used a sample of 38 patients seen at an outpatient specialty neurological clinic to evaluate the BoCA's test-retest reliability after one week. Results: In the first study, participants without cognitive diagnoses scored significantly higher on both the BoCA and the Telephone Interview for Cognitive Status (TICS) compared to those with mild Neurocognitive Disorders. Correlational analyses revealed moderate correlations between several of the BoCA tasks and measures of related abilities. Exploratory factor analysis of the BoCA tasks revealed one robust factor accounting for a plurality (i.e., 42%) of variance in participant scores. The BoCA demonstrated good internal consistency (α = 0.79) and strong correlations (r = 0.80, p < 0.01) with the TICS. The second study revealed strong (r = 0.89, p < 0.001) test-retest reliability of the total BoCA score one week after participants' initial administration. Conclusions: This work provides evidence of the BoCA's psychometric properties as a self-administered screener of global cognition, and supports its implementation in clinical practice and future studies. Clinical implications, future directions, and limitations are discussed.
Collapse
Affiliation(s)
- Dov Gold
- Department of Clinical Psychology, William James College, Newton, MA, USA
| | - Jennifer Stockwood
- Department of Clinical Psychology, William James College, Newton, MA, USA
| | - Kirolos Boulos
- Department of Clinical Psychology, William James College, Newton, MA, USA
| | - Sabrina Kasha
- Department of Clinical Psychology, William James College, Newton, MA, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Vrankic M, Vlahinić S, Šverko Z, Markovinović I. EEG-Validated Photobiomodulation Treatment of Dementia-Case Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197555. [PMID: 36236654 PMCID: PMC9573554 DOI: 10.3390/s22197555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 05/15/2023]
Abstract
In this article, we perform a case study of the impact of photobiomodulation (PBM) on brain power spectrum and connectivity in an elderly person with a Self Administered Gerocognitive Exam (SAGE) score indicating probable memory and thinking disorder. First, we designed and realized the prototype of a near-infrared (NIR) device for PBM. Analysing the alpha band of the power spectrum, we found a positive long-term effect in nine out of sixteen electrodes in the eyes-open condition (OE) and in twelve out of sixteen electrodes in the eyes-closed condition (CE), while in the theta band, a positive long-term effect was found in nine out of sixteen electrodes for OE and seven out of sixteen electrodes for CE. When considering the theta-alpha ratio (TAR), the positive long-term effect is found on thirteen of sixteen electrodes for OE and on fourteen of sixteen electrodes for CE. A connectivity analysis using the imaginary component of the complex Pearson correlation coefficient (imCPCC) was also performed, and a global efficiency measure based on connectivity matrices with thresholds was calculated. The global efficiency calculated for the long-term effect was higher than before stimulation by a factor of 5.24 for the OE condition and by a factor of 1.25 for the CE condition. This case study suggests that PBM could have positive effects on improving desired brain activity, measured as improvement in power spectrum and connectivity measures in theta and alpha bands, for elderly people with memory and thinking disorders.
Collapse
|
16
|
Iversen WL, Monroe TB, Atalla S, Anderson AR, Cowan RL, Wright KD, Failla MD, Moss KO. Promoting successful participation of people living with Alzheimer's disease and related dementias in pain-related neuroimaging research studies. FRONTIERS IN PAIN RESEARCH 2022; 3:926459. [PMID: 36061416 PMCID: PMC9437430 DOI: 10.3389/fpain.2022.926459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Recruitment and retention of participants for pain-related neuroimaging research is challenging and becomes increasingly so when research participants have a diagnosis of Alzheimer's disease and related dementias (ADRD). This article shares the authors' recommendations from several years of successful recruitment and completion of pain-related neuroimaging studies of people living with ADRD and includes supportive literature. While not an exhaustive list, this review covers several topics related to recruitment and retention of participants living with ADRD, including community engagement, capacity to consent, dementia diagnostic criteria, pain medication and other study exclusion criteria, participant and caregiver burden, communication concerns, and relationships with neuroimaging facilities. Threaded throughout the paper are important cultural considerations. Additionally, we discuss implications of the coronavirus (COVID-19) pandemic for recruitment. Once tailored to specific research study protocols, these proven strategies may assist researchers with successfully recruiting and retaining participants living with ADRD for pain-related neuroimaging research studies toward improving overall health outcomes.
Collapse
Affiliation(s)
- Wm. Larkin Iversen
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Todd B. Monroe
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Sebastian Atalla
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison R. Anderson
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Ronald L. Cowan
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kathy D. Wright
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Michelle D. Failla
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Karen O. Moss
- College of Nursing, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
17
|
Prakash RS, Fountain-Zaragoza S, Fisher M, Gbadeyan O, Andridge R, Kiecolt-Glaser J, Manglani HR, Duraney EJ, Shankar A, McKenna MR, Teng J, Phansikar M, Canter R. Protocol for a randomized controlled trial of mindfulness-based stress reduction to improve attentional control in older adults (HealthyAgers trial). BMC Geriatr 2022; 22:666. [PMID: 35964000 PMCID: PMC9375078 DOI: 10.1186/s12877-022-03334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mindfulness meditation is a form of mind-body intervention that has increasing scientific support for its ability to reduce age-related declines in cognitive functioning, improve affective health, and strengthen the neural circuitry supporting improved cognitive and affective health. However, the majority of existent studies have been pilot investigations with small sample sizes, limited follow-up data, and a lack of attention to expectancy effects. Here, we present the study design of a Phase I/II, efficacy trial-HealthyAgers trial-that examines the benefits of a manualized mindfulness-based stress reduction program in improving attentional control and reducing mind-wandering in older adults. METHODS One hundred fifty older adults (ages 65-85 years) will be randomized into one of two groups: an eight-week mindfulness program or an eight-week, placebo-controlled, lifestyle education program. Behavioral and neuroimaging assessments are conducted before and after the training. Participants are then invited to booster sessions once every three months for a period of 12 months with post-intervention follow-up assessments conducted at 6-months and 12-months. The primary outcomes for the study are behavioral measures of attentional control and mind-wandering. Additional, secondary outcomes include network strength in an a priori defined neuromarker of attentional control, fluid and everyday cognition, emotion regulation strategy use, and markers of inflammation. DISCUSSION This study will establish the efficacy of a group-based, low-cost mind-body intervention for the inter-related facets of attentional control and mind-wandering in older adults. Strengths of this study include a well-designed, placebo-controlled comparison group, use of web/mobile application to track study adherence, and longitudinal follow-up. TRIAL REGISTRATION Clinicaltrials.gov (# NCT03626532 ). Registered August 4, 2018.
Collapse
Affiliation(s)
- Ruchika Shaurya Prakash
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA.
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA.
| | - Stephanie Fountain-Zaragoza
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Megan Fisher
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Oyetunde Gbadeyan
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- National Centre for Healthy Ageing, Peninsula Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Rebecca Andridge
- Department of Biostatistics, The Ohio State University, Columbus, OH, USA
| | | | - Heena R Manglani
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Elizabeth J Duraney
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Anita Shankar
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Michael R McKenna
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - James Teng
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Madhura Phansikar
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
| | - Rosie Canter
- Department of Psychology, The Ohio State University, 62 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
18
|
te Pas M, Olde Rikkert M, Bouwman A, Kessels R, Buise M. Screening for Mild Cognitive Impairment in the Preoperative Setting: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061112. [PMID: 35742163 PMCID: PMC9223065 DOI: 10.3390/healthcare10061112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
Cognitive impairment predisposes patients to the development of delirium and postoperative cognitive dysfunction. In particular, in older patients, the adverse sequelae of cognitive decline in the perioperative period may contribute to adverse outcomes after surgical procedures. Subtle signs of cognitive impairment are often not previously diagnosed. Therefore, the aim of this review is to describe the available cognitive screeners suitable for preoperative screening and their psychometric properties for identifying mild cognitive impairment, as preoperative workup may improve perioperative care for patients at risk for postoperative cognitive dysfunction. Electronic systematic and snowball searches of PubMed, PsycInfo, ClinicalKey, and ScienceDirect were conducted for the period 2015–2020. Major inclusion criteria for articles included those that discussed a screener that included the cognitive domain ‘memory’, that had a duration time of less than 15 min, and that reported sensitivity and specificity to detect mild cognitive impairment. Studies about informant-based screeners were excluded. We provided an overview of the characteristics of the cognitive screener, such as interrater and test-retest reliability correlations, sensitivity and specificity for mild cognitive impairment and cognitive impairment, and duration of the screener and cutoff points. Of the 4775 identified titles, 3222 were excluded from further analysis because they were published prior to 2015. One thousand four hundred and forty-eight titles did not fulfill the inclusion criteria. All abstracts of 52 studies on 45 screeners were examined of which 10 met the inclusion criteria. For these 10 screeners, a further snowball search was performed to obtain related studies, resulting in 20 articles. Screeners included in this review were the Mini-Cog, MoCA, O3DY, AD8, SAGE, SLUMS, TICS(-M), QMCI, MMSE2, and Mini-ACE. The sensitivity and specificity range to detect MCI in an older population is the highest for the MoCA, with a sensitivity range of 81–93% and a specificity range of 74–89%. The MoCA, with the highest combination of sensitivity and specificity, is a feasible and valid routine screening of pre-surgical cognitive function. This warrants further implementation and validation studies in surgical pathways with a large proportion of older patients.
Collapse
Affiliation(s)
- Mariska te Pas
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Correspondence: ; Tel.: +31-627624857
| | - Marcel Olde Rikkert
- Radboud University Medical Center, Department of Geriatric Medicine, 6500 GL Nijmegen, The Netherlands;
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Roy Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands;
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Marc Buise
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
| |
Collapse
|
19
|
Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum 2022; 65:473-488. [PMID: 35001046 DOI: 10.1097/dcr.0000000000002410] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole M Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Isacco Montroni
- Department of Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| |
Collapse
|
20
|
Scharre DW, Chang SI, Nagaraja HN, Wheeler NC, Kataki M. Self-Administered Gerocognitive Examination: longitudinal cohort testing for the early detection of dementia conversion. Alzheimers Res Ther 2021; 13:192. [PMID: 34872596 PMCID: PMC8650250 DOI: 10.1186/s13195-021-00930-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022]
Abstract
Background Significant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments. Use of brief, multi-domain, self-administered, objective cognitive assessment tools may remove some barriers in assessing and identifying cognitive changes. We compared longitudinal Self-Administered Gerocognitive Examination (SAGE) test scores to non-self-administered Mini-Mental State Examination (MMSE) scores in 5 different diagnostic subgroups. Methods A cohort study evaluating annual rates of change was performed on 665 consecutive patients from Ohio State University Memory Disorders Clinic. Patients with at least two visits 6 months apart evaluated with SAGE and MMSE and classified according to standard clinical criteria as subjective cognitive decline (SCD), mild cognitive impairment (MCI), or Alzheimer’s disease (AD) dementia were included. The pattern of change in SAGE scores was compared to MMSE. One way and repeated measures ANOVA and linear regression models were used. Results Four hundred twenty-four individuals (40 SCD, 94 MCI non-converters to dementia, 70 MCI converters to dementia (49 to AD dementia and 21 to non-AD dementia), 220 AD dementia) met inclusion criteria. SAGE and MMSE scores declined respectively at annual rates of 1.91 points/year (p < 0.0001) and 1.68 points/year (p < 0.0001) for MCI converters to AD dementia, and 1.82 points/year (p < 0.0001) and 2.38 points/year (p < 0.0001) for AD dementia subjects. SAGE and MMSE scores remained stable for SCD and MCI non-converters. Statistically significant decline from baseline scores in SAGE occurred at least 6 months earlier than MMSE for MCI converters to AD dementia (14.4 vs. 20.4 months), MCI converters to non-AD dementia (14.4 vs. 32.9 months), and AD dementia individuals (8.3 vs. 14.4 months). Conclusions SAGE detects MCI conversion to dementia at least 6 months sooner than MMSE. Being self-administered, SAGE also addresses a critical need of removing some barriers in performing cognitive assessments. Limitations of our single-site cohort study include potential referral and sampling biases. Repetitively administering SAGE and identifying stability or decline may provide clinicians with an objective cognitive biomarker impacting evaluation and management choices.
Collapse
Affiliation(s)
- Douglas W Scharre
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA.
| | - Shu Ing Chang
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA
| | - Haikady N Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Cunz Hall, Columbus, OH, 43210, USA
| | - Natalie C Wheeler
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA.,Present Address: Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Maria Kataki
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA
| |
Collapse
|
21
|
Skolarus LE, Dinh M, Kidwell KM, Farhan Z, Whitfield C, Levine DA, Meurer WJ. Supplement study update for Reach Out: a multi-arm randomized trial of behavioral interventions for hypertension initiated in the emergency department: Reach Out Cognition. Trials 2021; 22:836. [PMID: 34819115 PMCID: PMC8611628 DOI: 10.1186/s13063-021-05806-4] [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: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Reach Out is a factorial trial studying multicomponent behavioral interventions to reduce blood pressure in hypertensive emergency department patients. The original study protocol was published in June 2020. Here, we describe the updated protocol, including a supplemental study, Reach Out Cognition. Reach Out Cognition is a remote study that will assess the acceptability, feasibility, and satisfaction of digital, self-administered cognitive assessments and Bluetooth-enabled, self-measured blood pressure monitoring in the Reach Out population. We will also estimate the prevalence of mild cognitive impairment in Reach Out participants. Methods Reach Out Cognition includes remote enrollment and follow-up assessments. Reach Out Cognition extends Reach Out data collection past the current 12 months to 15 and 18 months. Participants will be Reach Out participants who complete their 12-month outcome assessments and opt to continue in the cohort study. Participants will continue to receive the Reach Out intervention, consisting of (1) daily healthy behavior text messaging and (2) weekly self-measured blood pressure monitoring. Blood pressure will be measured using Bluetooth-enabled self-measured blood pressure monitoring devices, and cognition will be measured using digital self-administered cognitive assessments at 12, 15, and 18 months. Discussion Reach Out Cognition will explore the potential of remote, digital, self-administered assessments of blood pressure and cognition among predominantly working-age Black Americans. Reach Out Cognition will inform future clinical trials and clinical remote monitoring of blood pressure and cognition that may lead to new approaches to treating and reducing hypertension and cognitive disparities. Trial registration ClinicalTrials.gov NCT03422718. The record was first available to the public on January 30, 2018, prior to the enrollment of patients on March 25, 2019.
Collapse
Affiliation(s)
- Lesli E Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA
| | - Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Deborah A Levine
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - William J Meurer
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.,Michigan Institute for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, USA
| |
Collapse
|
22
|
Qian Y, Chen X, Tang D, Kelley AS, Li J. Prevalence of Memory-Related Diagnoses Among U.S. Older Adults With Early Symptoms of Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2021; 76:1846-1853. [PMID: 33575783 DOI: 10.1093/gerona/glab043] [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: 07/31/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early diagnosis of cognitive impairment may confer important advantages. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. METHODS A retrospective, longitudinal cohort design using 2000-2014 Health and Retirement Survey-Medicare linked data. We leveraged within-individual variation to examine the relationship between incident cognitive impairment and receipt of diagnosis among 1225 individuals aged 66 or older. Receipt of a memory-related diagnosis was determined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Incident cognitive impairment was defined as the first assessment wherein the participant's modified Telephone Interview for Cognitive Status score was less than 12. RESULTS The unadjusted prevalence of memory-related diagnosis at cognitive impairment was 12.0%. Incident cognitive impairment was associated with a 7.3% (95% confidence interval [CI], 5.6% to 9.0%; p < .001) higher adjusted probability of any memory-related diagnosis overall, yielding 9.8% adjusted prevalence of diagnosis. The increase in likelihood of diagnosis associated with cognitive decline was significantly higher among non-Hispanic Whites than non-Hispanic Blacks (8.2% vs -0.7%), and among those with at least a college degree than those with a high school diploma or less (17.4% vs 6.8% vs 1.6%). Those who were younger, had below-median wealth, or without a partner had lower probability of diagnosis than their counterparts. CONCLUSIONS We found overall low prevalence of early diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-Whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations.
Collapse
Affiliation(s)
- Yuting Qian
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| | - Xi Chen
- Department of Health Policy and management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Diwen Tang
- Department of Health Economics, Shanghai Medical College, Fudan University, China
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai, New York, USA.,James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Jing Li
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| |
Collapse
|
23
|
Beversdorf DQ, Nagaraja HN, Bornstein RA, Scharre DW. The Effect of Donepezil on Problem-solving Ability in Individuals With Amnestic Mild Cognitive Impairment: A Pilot Study. Cogn Behav Neurol 2021; 34:182-187. [PMID: 34473669 PMCID: PMC8425600 DOI: 10.1097/wnn.0000000000000280] [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: 10/08/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical trials involving individuals with mild cognitive impairment (MCI) have reported mixed results for the effects of cholinesterase inhibitors on cognitive outcomes. Our previous work demonstrated that a visuospatial problem-solving task was sensitive to non-memory impairments in individuals with MCI. OBJECTIVE To determine whether the same task is also sensitive to the effects of cholinesterase inhibitors in individuals with amnestic MCI (aMCI). METHOD We gave 22 individuals with aMCI (clinical dementia rating of 0.5) and Mini-Mental State Examination (MMSE) scores of at least 24 the following measures at baseline and at follow-up 1 year later: Hopkins Verbal Learning Test, Boston Naming Test, Rey Complex Figures Test copying task, anagrams task, and visuospatial problem-solving task. The MMSE was also given at the 1-year follow-up. Twelve of the individuals were drug naïve, having never taken cholinesterase inhibitors before, and donepezil was initiated and titrated to 10 mg daily after baseline in an open-label manner. Ten of the individuals had already been taking donepezil, and there was no change in treatment. We compared the two groups for amount of performance change over 1 year. RESULTS Individuals for whom donepezil was initiated performed significantly better on the visuospatial problem-solving task after 1 year compared with individuals who had already been taking donepezil. No difference was observed for any of the other variables. CONCLUSION The visuospatial problem-solving task appeared to be more sensitive than memory measures to the effects of cholinesterase inhibitors in individuals with aMCI, perhaps due to the high attentional demand of the task.
Collapse
Affiliation(s)
- David Q. Beversdorf
- Departments of Radiology, Neurology, and Psychological Sciences, and the Thompson Center, University of Missouri, Columbia, Missouri
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | | | | |
Collapse
|
24
|
Paterson TSE, Sivajohan B, Gardner S, Binns MA, Stokes KA, Freedman M, Levine B, Troyer AK. Accuracy of a Self-Administered Online Cognitive Assessment in Detecting Amnestic Mild Cognitive Impairment. J Gerontol B Psychol Sci Soc Sci 2021; 77:341-350. [PMID: 34333629 PMCID: PMC8824689 DOI: 10.1093/geronb/gbab097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives Our aim was to validate the online Brain Health Assessment (BHA) for detection of amnestic mild cognitive impairment (aMCI) compared to gold-standard neuropsychological assessment. We compared the diagnostic accuracy of the BHA to the Montreal Cognitive Assessment (MoCA). Methods Using a cross-sectional design, community-dwelling older adults completed a neuropsychological assessment, were diagnosed as normal cognition (NC) or aMCI, and completed the BHA and MoCA. Both logistic regression (LR) and penalized logistic regression (PLR) analyses determined BHA and demographic variables predicting aMCI; MoCA variables were similarly modeled. Diagnostic accuracy was compared using area under the receiver operating characteristic curve (ROC AUC) analyses. Results Ninety-one participants met inclusion criteria (51 aMCI, 40 NC). PLR modeling for the BHA indicated Face–Name Association, Spatial Working Memory, and age-predicted aMCI (ROC AUC = 0.76; 95% confidence interval [CI]: 0.66–0.86). Optimal cut-points resulted in 21% classified as aMCI (positive), 23% negative, and 56% inconclusive. For the MoCA, digits, abstraction, delayed recall, orientation, and age predicted aMCI (ROC AUC = 0.71; 95% CI: 0.61–0.82). Optimal cut-points resulted in 22% classified positive, 8% negative, and 70% inconclusive (LR results presented within). The BHA model classified fewer participants into the inconclusive category and more as negative for aMCI, compared to the MoCA model (Stuart–Maxwell p = .004). Discussion The self-administered BHA provides similar detection of aMCI as a clinician-administered screener (MoCA), with fewer participants classified inconclusively. The BHA has the potential to save practitioners time and decrease unnecessary referrals for a comprehensive assessment to determine the presence of aMCI.
Collapse
Affiliation(s)
- Theone S E Paterson
- Baycrest Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychology, University of Victoria, British Columbia, Canada
| | | | - Sandra Gardner
- Baycrest Health Sciences Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Malcolm A Binns
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Rotman Research Institute, Toronto, Ontario, Canada
| | | | - Morris Freedman
- Baycrest Health Sciences Centre, Toronto, Ontario, Canada.,Rotman Research Institute, Toronto, Ontario, Canada
| | - Brian Levine
- Rotman Research Institute, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Ontario, Canada
| | - Angela K Troyer
- Baycrest Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Ontario, Canada
| |
Collapse
|
25
|
Liss JL, Seleri Assunção S, Cummings J, Atri A, Geldmacher DS, Candela SF, Devanand DP, Fillit HM, Susman J, Mintzer J, Bittner T, Brunton SA, Kerwin DR, Jackson WC, Small GW, Grossberg GT, Clevenger CK, Cotter V, Stefanacci R, Wise‐Brown A, Sabbagh MN. Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis. J Intern Med 2021; 290:310-334. [PMID: 33458891 PMCID: PMC8359937 DOI: 10.1111/joim.13244] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
The critical role of primary care clinicians (PCCs) in Alzheimer's disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: no longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stems from a focus on preventive interventions in midlife and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (i.e. MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (i.e. biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment and the role of biomarkers in the clinic.
Collapse
Affiliation(s)
| | - S. Seleri Assunção
- US Medical Affairs – Neuroscience, Genentech, A Member of the Roche GroupSouth San FranciscoCAUSA
| | - J. Cummings
- Chambers‐Grundy Center for Transformative NeuroscienceDepartment of Brain HealthSchool of Integrated Health SciencesUniversity of NevadaLas VegasNVUSA
- Lou Ruvo Center for Brain Health – Cleveland Clinic NevadaLas VegasNVUSA
| | - A. Atri
- Banner Sun Health Research InstituteSun CityAZUSA
- Center for Brain/Mind MedicineDepartment of NeurologyBrigham and Women’s HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - D. S. Geldmacher
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - S. F. Candela
- Health & Wellness Partners, LLCUpper Saddle RiverNJUSA
| | - D. P. Devanand
- Division of Geriatric PsychiatryNew York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNYUSA
| | - H. M. Fillit
- Departments of Geriatric Medicine, Medicine, and NeuroscienceIcahn School of Medicine and Mt. SinaiNew YorkNYUSA
- Alzheimer’s Drug Discovery FoundationNew YorkNYUSA
| | - J. Susman
- Department of Family and Community MedicineNortheast Ohio Medical UniversityRootstownOHUSA
| | - J. Mintzer
- Roper St Francis HealthcareCharlestonSCUSA
- Ralph H. Johnson VA Medical CenterCharlestonSCUSA
| | | | - S. A. Brunton
- Department of Family MedicineTouro UniversityVallejoCAUSA
| | - D. R. Kerwin
- Kerwin Medical CenterDallasTXUSA
- Department of Neurology and NeurotherapeuticsUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - W. C. Jackson
- Departments of Family Medicine and PsychiatryUniversity of Tennessee College of MedicineMemphisTNUSA
| | - G. W. Small
- Division of Geriatric PsychiatryUCLA Longevity CenterSemel Institute for Neuroscience & Human BehaviorUniversity of California – Los AngelesLos AngelesCAUSA
| | - G. T. Grossberg
- Division of Geriatric PsychiatrySt Louis University School of MedicineSt LouisMOUSA
| | - C. K. Clevenger
- Department of NeurologyNell Hodgson Woodruff School of NursingEmory UniversityAtlantaGAUSA
| | - V. Cotter
- Johns Hopkins School of NursingBaltimoreMDUSA
| | - R. Stefanacci
- Jefferson College of Population HealthThomas Jefferson UniversityPhiladelphiaPAUSA
| | - A. Wise‐Brown
- US Medical Affairs – Neuroscience, Genentech, A Member of the Roche GroupSouth San FranciscoCAUSA
| | - M. N. Sabbagh
- Lou Ruvo Center for Brain Health – Cleveland Clinic NevadaLas VegasNVUSA
| |
Collapse
|
26
|
Kasai M, Sugawara T, Takada J, Kumai K, Nakamura K, Meguro K. Self-Reported Cognitive Decline Based on the Ascertain Dementia 8 Questionnaire May Be Effective for Detecting Mild Cognitive Impairment and Dementia in the Community: The Wakuya Project. Dement Geriatr Cogn Dis Extra 2021; 11:45-50. [PMID: 33790940 PMCID: PMC7989666 DOI: 10.1159/000514324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction To assess cognitive impairment, self-awareness is an important issue. The Ascertain Dementia 8 questionnaire (AD8) is a brief observation checklist for detecting mild cognitive impairment (MCI) and dementia. After analyzing the reliability and validity of a self-reported Japanese version of the AD8 (AD8-J), we compared self- and informant-reported versions of the AD8-J. Methods A total of 93 community residents aged 75 years or older living in Wakuya, Northern Japan, agreed to participate in this study; 35 were rated as Clinical Dementia Rating (CDR) 0 (healthy), 46 as CDR 0.5 (defined herein as MCI), and 12 as CDR 1 or above (dementia, confirmed by the DSM-IV). We examined the reliability and validity using a receiver operating characteristic (ROC) curve. We analyzed the differences between self-reported and informant-reported AD8-J using a repeated measures ANOVA. Results The self-reported AD8-J showed a satisfactory reliability (i.e., Cronbach coefficient, α = 0.71; Guttman split half method coefficient = 0.60). For CDR 0 vs. CDR 0.5 or above, the area under the ROC curve was 0.74 and the cutoff score was 1/2, with a sensitivity of 70.7% and a specificity of 65.7%. Analysis of the subscores of AD8 suggested that, from the early stage of dementia, the subjects showed a subjective decline in memory and interest in hobbies/activities, as well as problems with judgment. Conclusion It is suggested that the self-reported AD8-J was effective in detecting MCI and dementia. We could use it for detecting MCI and dementia, including in those living alone, in the primary health checkup.
Collapse
Affiliation(s)
- Mari Kasai
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Tomohiro Sugawara
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Junko Takada
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Keiichi Kumai
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Kei Nakamura
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Kenichi Meguro
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan.,Cyclotron Radioisotope Center, Tohoku University, Sendai, Japan.,Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
27
|
Rose KM, Coop Gordon K, Schlegel EC, Mccall M, Gao Y, Ma M, Lenger KA, Ko E, Wright KD, Wang H, Stankovic J. Smarthealth technology study protocol to improve relationships between older adults with dementia and family caregivers. J Adv Nurs 2021; 77:2519-2529. [PMID: 33576064 DOI: 10.1111/jan.14714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study is to develop a Smarthealth system of monitoring, modelling, and interactive recommendation solutions (for caregivers) for in-home dementia patient care that focuses on caregiver-patient relationships. DESIGN This descriptive study employs a single-group, non-randomized trial to examine functionality, effectiveness, feasibility, and acceptability of the novel Smarthealth system. METHODS Thirty persons with Alzheimer's Disease or related dementia and their family caregivers (N = 30 dyads) will receive and install Smarthealth technology in their home. There will be a 1-month observation phase for collecting baseline mood states and a 2-month implementation phase when caregivers will receive stress management techniques for each detected, negative mood state. Caregivers will report technique implementation and usefulness, sent via Ecological Momentary Assessment system to the study-provided smartphone. Caregivers will provide daily, self-reported mood and health ratings. Instruments measuring caregiver assessment of disruptive behaviours and their effect on caregivers; caregiver depressive symptoms, anxiety and stress; caregiver strain; and family functioning will be completed at baseline and 3 months. The study received funding in 2018 and ethics board approval in 2019. DISCUSSION This study will develop and test novel in-home technology to improve family caregiving relationships. Results from this study will help develop and improve the Smarthealth recommendation system and determine its usefulness, feasibility, and acceptability for persons with dementia and their family caregiver. IMPACT The Smarthealth technology discussed will provide in-home stress reduction resources at a time when older adults may be experiencing increasingly high rates of isolation and anxiety and caregiver dyads may be experiencing high levels of relationship strain. TRIAL REGISTRATION This study was registered with Clinical Trials.gov (Identifier NCT04536701).
Collapse
Affiliation(s)
- Karen M Rose
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Emma C Schlegel
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Matthew Mccall
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Ye Gao
- School of Engineering and Applied Science, Computer Science, University of Virginia, Charlottesville, VA, USA
| | - Meiyi Ma
- School of Engineering and Applied Science, Computer Science, University of Virginia, Charlottesville, VA, USA
| | - Katherine A Lenger
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Eunjung Ko
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Kathy D Wright
- College of Nursing, The Ohio State University, Columbus, OH, USA.,Discovery Themes-Prevention and Treatment of Chronic Brain Injury Institute, The Ohio State University, Columbus, OH, USA
| | - Hongning Wang
- School of Engineering and Applied Science, Computer Science, University of Virginia, Charlottesville, VA, USA
| | - John Stankovic
- School of Engineering and Applied Science, Computer Science, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
28
|
Abstract
AbstractAgeing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p< 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p< 0.001), by primarily reducing fat mass (p= 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%,p⩽ 0.05 for all). Improvements were also observed in plasma glucose (p= 0.05), haemoglobin A1C (p= 0.06) and aldolase enzyme levels (p< 0.001). Scores for surveys on memory and sleep improved (p< 0.05). Improved QOL was associated with increased lean mass (r= −0.714,p= 0.002), decreased fat mass (r= −0.702,p= 0.003) and improved flexibility and balance (r= −0.627,p= 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.
Collapse
|
29
|
Garbóczy S, Magócs É, Szőllősi GJ, Harsányi S, Égerházi A, Kolozsvári LR. The use of the Hungarian Test Your Memory (TYM-HUN), MMSE, and ADAS-Cog tests for patients with mild cognitive impairment (MCI) in a Hungarian population: a cross-sectional study. BMC Psychiatry 2020; 20:571. [PMID: 33256672 PMCID: PMC7708165 DOI: 10.1186/s12888-020-02982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) often presages the development of Alzheimer's disease (AD). Accurate and early identification of cognitive impairment will substantially reduce the burden on the family and alleviate the costs for the whole society. There is a need for testing methods that are easy to perform even in a general practitioner's office, inexpensive and non-invasive, which could help the early recognition of mental decline. We have selected the Test Your Memory (TYM), which has proven to be reliable for detecting AD and MCI in several countries. Our study was designed to test the usability of the Hungarian version of the TYM (TYM-HUN) comparing with the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in MCI recognition in the Hungarian population. METHODS TYM test was translated and validated into Hungarian (TYM-HUN) in a previous study. The TYM-HUN test was used in conjunction with and compared with the MMSE and the ADAS-Cog. For our study, 50 subjects were selected: 25 MCI patients and 25 healthy controls (HC). Spearman's rank correlation was used to analyse the correlation between the scores of MMSE and ADAS-Cog with TYM-HUN and the receiver operating characteristic (ROC) curve was established. RESULTS MCI can be distinguished from normal aging using TYM-HUN. We established a 'cut-off' point of TYM-HUN (44/45points) where optimal sensitivity (80%) and specificity (96%) values were obtained to screen MCI. The total TYM-HUN scores significantly correlated with the MMSE scores (ρ = 0.626; p < 0.001) and ADAS-Cog scores (ρ = - 0.723; p < 0.001). CONCLUSIONS Our results showed that the TYM-HUN is a reliable, fast, self-administered questionnaire with the right low threshold regarding MCI and can be used for the early diagnosis of cognitive impairment.
Collapse
Affiliation(s)
- Szabolcs Garbóczy
- grid.7122.60000 0001 1088 8582Gyula Kenézy University Hospital, Department of Adult Psychiatry, University of Debrecen, Debrecen, Hungary
| | - Éva Magócs
- grid.7122.60000 0001 1088 8582Department of Psychiatry, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Gergő József Szőllősi
- grid.7122.60000 0001 1088 8582Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Postal Adress: Móricz Zs. krt. 22, Debrecen, 4032 Hungary
| | - Szilvia Harsányi
- grid.7122.60000 0001 1088 8582Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anikó Égerházi
- grid.7122.60000 0001 1088 8582Department of Psychiatry, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Postal Adress: Móricz Zs. krt. 22, Debrecen, 4032, Hungary.
| |
Collapse
|
30
|
Wright KD, Klatt MD, Adams IR, Nguyen CM, Mion LC, Tan A, Monroe TB, Rose KM, Scharre DW. Mindfulness in Motion and Dietary Approaches to Stop Hypertension (DASH) in Hypertensive African Americans. J Am Geriatr Soc 2020; 69:773-778. [PMID: 33227157 DOI: 10.1111/jgs.16947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Hypertension increases the risk of developing Alzheimer's disease or related dementias. This pilot study's purpose was to examine the feasibility and acceptability of a novel intervention, Mindfulness in Motion (MIM) and Dietary Approaches to Stop Hypertension DASH (MIM DASH), to improve diet, mindfulness, stress, and systolic blood pressure (BP) in older African Americans with mild cognitive impairment (MCI) and hypertension. DESIGN Cluster randomized controlled trial. SETTING Intergenerational community center in a large metropolitan area. PARTICIPANTS African Americans with MCI and hypertension. Participants were divided into six groups randomized 1:1:1 to the MIM DASH group, attention only (non-hypertensive education) group, or true control group. The MIM DASH and attention only interventions were delivered in 8-weekly 2 hour group sessions. MIM included mindful movements from chair/standing, breathing exercises, and guided meditation. The DASH component used a critical thinking approach of problem solving, goal setting, reflection, and self-efficacy. The true control group received a DASH pamphlet at the end. MEASUREMENTS Feasibility was tracked through enrollment and attendance records; acceptability was assessed through interviews. Blood pressure was measured using the Omron HEM-907XL Monitor. Dietary intake was measured by DASH-Q. Mindfulness was measured by the Cognitive and Affective Mindfulness Scale. Stress was measured by the Perceived Stress Scale. MCI was determined using the Self-Administered Gerocognitive Examination. Data were collected at baseline and 3-months. RESULTS Median session attendance was six for the MIM DASH group and six for the attention only group. There were no changes in diet, mindfulness, or stress. There was a clinically significant reduction in systolic BP in the MIM DASH group (-7.2 mmHg) relative to the attention only group (-.7), and no change between the MIM DASH and true control groups. CONCLUSION Results indicate that the MIM DASH intervention was feasible and culturally acceptable in African Americans with hypertension and MCI.
Collapse
Affiliation(s)
- Kathy D Wright
- College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University, Columbus, Ohio, USA
| | - Maryanna D Klatt
- Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ingrid Richards Adams
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Health & Rehabilitation Sciences, Medical Dietetics, College of Food, Agricultural, and Environmental Sciences, Columbus, Ohio, USA
| | - Christopher M Nguyen
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Psychiatry & Behavioral Health, Neurology, & Psychology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lorraine C Mion
- College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University, Columbus, Ohio, USA
| | - Alai Tan
- College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University, Columbus, Ohio, USA
| | - Todd B Monroe
- College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University, Columbus, Ohio, USA
| | - Karen M Rose
- College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University, Columbus, Ohio, USA
| | - Douglas W Scharre
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Neurology, Center for Cognitive and Memory Disorders, Center for Neuromodulation, Columbus, Ohio, USA
| |
Collapse
|
31
|
Galvin JE, Tolea MI, Chrisphonte S. Using a patient-reported outcome to improve detection of cognitive impairment and dementia: The patient version of the Quick Dementia Rating System (QDRS). PLoS One 2020; 15:e0240422. [PMID: 33057404 PMCID: PMC7561106 DOI: 10.1371/journal.pone.0240422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/27/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Community detection of mild cognitive impairment (MCI) and Alzheimer's disease and related disorders (ADRD) is a challenge. While Gold Standard assessments are commonly used in research centers, these methods are time consuming, require extensive training, and are not practical in most clinical settings or in community-based research projects. Many of these methods require an informant (e.g., spouse, adult child) to provide ratings of the patients' cognitive and functional abilities. A patient-reported outcome that captures the presence of cognitive impairment and corresponds to Gold Standard assessments could improve case ascertainment, clinical care, and recruitment into clinical research. We tested the patient version of the Quick Dementia Rating System (QDRS) as a patient-reported outcome to detect MCI and ADRD. METHODS The patient QDRS was validated in a sample of 261 consecutive patient-caregiver dyads compared with the informant version of the QDRS, the Clinical Dementia Rating (CDR), neuropsychological tests, and Gold Standard measures of function, behavior, and mood. Psychometric properties including item variability, floor and ceiling effects, construct, concurrent, and known-groups validity, and internal consistency were determined. RESULTS The patient QDRS strongly correlated with Gold Standard measures of cognition, function, mood, behavior, and global staging methods (p-values < .001) and had strong psychometric properties with excellent data quality and internal consistency (Cronbach alpha = 0.923, 95%CI:0.91-0.94). The patient QDRS had excellent agreement with the informant QDRS, the CDR and its sum of boxes (Intraclass Correlation Coefficients: 9.781-0.876). Receiver operator characteristic curves showed excellent discrimination between normal controls from CDR 0.5 (AUC:0.820;95% CI: 0.74-0.90) and for normal controls from any cognitive impairment (AUC:0.885;95% CI: 0.83-0.94). DISCUSSION The patient QDRS validly and reliably differentiates individuals with and without cognitive impairment and can be completed by patients through all stages of dementia. The patient QDRS is highly correlated with Gold Standard measures of cognitive, function, behavior, and global staging. The patient QDRS provides a rapid method to screen patients for MCI and ADRD in clinical practice, determine study eligibility, improve case ascertainment in community studies.
Collapse
Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| |
Collapse
|
32
|
Thabtah F, Peebles D, Retzler J, Hathurusingha C. Dementia medical screening using mobile applications: A systematic review with a new mapping model. J Biomed Inform 2020; 111:103573. [PMID: 32961306 DOI: 10.1016/j.jbi.2020.103573] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
Early detection is the key to successfully tackling dementia, a neurocognitive condition common among the elderly. Therefore, screening using technological platforms such as mobile applications (apps) may provide an important opportunity to speed up the diagnosis process and improve accessibility. Due to the lack of research into dementia diagnosis and screening tools based on mobile apps, this systematic review aims to identify the available mobile-based dementia and mild cognitive impairment (MCI) apps using specific inclusion and exclusion criteria. More importantly, we critically analyse these tools in terms of their comprehensiveness, validity, performance, and the use of artificial intelligence (AI) techniques. The research findings suggest diagnosticians in a clinical setting use dementia screening apps such as ALZ and CognitiveExams since they cover most of the domains for the diagnosis of neurocognitive disorders. Further, apps such as Cognity and ACE-Mobile have great potential as they use machine learning (ML) and AI techniques, thus improving the accuracy of the outcome and the efficiency of the screening process. Lastly, there was overlapping among the dementia screening apps in terms of activities and questions they contain therefore mapping these apps to the designated cognitive domains is a challenging task, which has been done in this research.
Collapse
Affiliation(s)
- Fadi Thabtah
- Digital Technologies, Manukau Institute of Technology, Auckland, New Zealand.
| | - David Peebles
- Department of Psychology, University of Huddersfield, Huddersfield, UK.
| | - Jenny Retzler
- Department of Psychology, University of Huddersfield, Huddersfield, UK.
| | | |
Collapse
|
33
|
Mansbach WE, Mace RA, Tanner MA, Simmons SP. A path to early diagnosis of mild cognitive impairment and dementia: validity and reliability of the myMemCheck® self-administered screening tool. Fam Pract 2020; 37:561-567. [PMID: 32077941 DOI: 10.1093/fampra/cmaa014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed at home to identify older adults that would benefit from a more comprehensive cognitive evaluation. OBJECTIVE Two prospective cross-sectional studies were conducted to examine the psychometric properties and clinical utility of myMemCheck®. METHODS In Study 1, participants were independent living residents referred to an outpatient memory clinic (N = 59); older adults in the community and post-acute nursing home residents (N = 357) comprised Study 2. RESULTS Psychometric analyses were performed on cognitive and psychological testing data, including myMemCheck®. myMemCheck® evidenced adequate reliability and strong construct validity. Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults at risk for MCI or dementia. myMemCheck® explained 25% of cognitive status beyond basic patient information. CONCLUSIONS myMemCheck® may help fast-track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in health care and prevent negative outcomes associated with undetected cognitive impairment.
Collapse
Affiliation(s)
| | - Ryan A Mace
- Mansbach Health Tools, LLC, Simpsonville, MD, USA.,Department of Psychology, Suffolk University, Boston, MA, USA
| | | | | |
Collapse
|
34
|
Efficacy of an 8-Week Resistance Training Program in Older Adults: A Randomized Controlled Trial. J Aging Phys Act 2020; 29:121-129. [PMID: 32788412 DOI: 10.1123/japa.2020-0078] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022]
Abstract
Older adults are challenged with aging-related declines in skeletal muscle mass and function. Although exercise interventions of longer duration typically yield larger changes, shorter-term interventions may kick-start positive effects, allowing participants to begin engaging in more activity. This study aimed to determine whether 8 weeks of a resistance training program (Stay Strong, Stay Healthy [SSSH]) improved dynamic muscle strength, balance, flexibility, and sleep. Inactive adults aged ≥60 years were randomized into SSSH (n = 15), walking (WALK; n = 17), or control (CON; n = 14) groups. The SSSH and WALK groups met 2 times per week for 60 min. The participants completed pre/post general health, activity, and sleep questionnaires; DXA scans; and functional tasks. One-way repeated-measures multivariate analysis of variance was used to determine interactions and decomposed using repeated-measures analysis of variance. SSSH improved sit-to-stand performance, back scratch distance, and sleep quality and reported more auxiliary physical activity than WALK or CON (p < .05). Resistance training interventions in sedentary older adults can improve physical function and encourage additional activity in 8 weeks.
Collapse
|
35
|
Lauraitis A, Maskeliūnas R, Damaševičius R, Krilavičius T. A Mobile Application for Smart Computer-Aided Self-Administered Testing of Cognition, Speech, and Motor Impairment. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3236. [PMID: 32517223 PMCID: PMC7309061 DOI: 10.3390/s20113236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022]
Abstract
We present a model for digital neural impairment screening and self-assessment, which can evaluate cognitive and motor deficits for patients with symptoms of central nervous system (CNS) disorders, such as mild cognitive impairment (MCI), Parkinson's disease (PD), Huntington's disease (HD), or dementia. The data was collected with an Android mobile application that can track cognitive, hand tremor, energy expenditure, and speech features of subjects. We extracted 238 features as the model inputs using 16 tasks, 12 of them were based on a self-administered cognitive testing (SAGE) methodology and others used finger tapping and voice features acquired from the sensors of a smart mobile device (smartphone or tablet). Fifteen subjects were involved in the investigation: 7 patients with neurological disorders (1 with Parkinson's disease, 3 with Huntington's disease, 1 with early dementia, 1 with cerebral palsy, 1 post-stroke) and 8 healthy subjects. The finger tapping, SAGE, energy expenditure, and speech analysis features were used for neural impairment evaluations. The best results were achieved using a fusion of 13 classifiers for combined finger tapping and SAGE features (96.12% accuracy), and using bidirectional long short-term memory (BiLSTM) (94.29% accuracy) for speech analysis features.
Collapse
Affiliation(s)
- Andrius Lauraitis
- Department of Multimedia Engineering, Kaunas University of Technology, 50186 Kaunas, Lithuania; (A.L.); (R.M.)
| | - Rytis Maskeliūnas
- Department of Multimedia Engineering, Kaunas University of Technology, 50186 Kaunas, Lithuania; (A.L.); (R.M.)
| | - Robertas Damaševičius
- Department of Applied Informatics, Vytautas Magnus University, 44404 Kaunas, Lithuania;
- Faculty of Applied Mathematics, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Tomas Krilavičius
- Department of Applied Informatics, Vytautas Magnus University, 44404 Kaunas, Lithuania;
- Baltic Institute of Advanced Technology, 01124 Vilnius, Lithuania
| |
Collapse
|
36
|
Thabtah F, Peebles D, Retzler J, Hathurusingha C. A review of dementia screening tools based on Mobile application. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00426-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
37
|
Saif N, Berkowitz C, Tripathi S, Scheyer O, Caesar E, Hristov H, Hackett K, Rahman A, Knowlton N, Sadek G, Lee P, McInnis M, Isaacson RS. Effectiveness of online education for recruitment to an Alzheimer's disease prevention clinical trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12006. [PMID: 32211509 PMCID: PMC7085257 DOI: 10.1002/trc2.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Low awareness of Alzheimer's disease (AD) clinical trials is a recruitment barrier. To assess whether online education may affect screening rates for AD prevention clinical trials, we conducted an initial prospective cohort study (n = 10,450) and subsequent randomized study (n = 351) using an online digital tool: AlzU.org. METHODS A total of 10,450 participants were enrolled in an initial cohort study and asked to complete a six-lesson course on AlzU.org, as well as a baseline and 6-month follow-up questionnaire. Participants were stratified into three groups based on lesson completion at 6 months: group 1 (zero to one lesson completed), group 2 (two to four lessons), and group 3 (five or more lessons). For the subsequent randomized-controlled trial (RCT), 351 new participants were enrolled in a six-lesson course (n = 180) versus a time-neutral control (n = 171). Screening and enrollment in the Anti-Amyloid Treatment in Asymptomatic AD (A4) clinical trial were reported via the 6-month questionnaire and are the primary outcomes. RESULTS Cohort: 3.9% of group 1, 5% of group 2, and 8.4% of group 3 screened for the A4 trial. Significant differences were found among the groups (P < 0.001). Post hoc analyses showed differences in A4 screening rates between groups 1 and 3 (P < 0.001) and groups 2 and 3 (P = 0.0194). There were no differences in enrollment among the three groups. RCT: 2.78% of the intervention group screened for A4 compared to 0% of controls (P = 0.0611). DISCUSSION Online education via the AlzU.org digital tool may serve as an effective strategy to supplement clinical trial recruitment.
Collapse
Affiliation(s)
- Nabeel Saif
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | - Cara Berkowitz
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | - Susmit Tripathi
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | - Olivia Scheyer
- School of LawUniversity of California Los AngelesLos AngelesCalifornia
| | | | - Hollie Hristov
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | | | - Aneela Rahman
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | | | - George Sadek
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| | - Paige Lee
- College of Letters and ScienceUniversity of California Los AngelesLos AngelesCalifornia
| | | | - Richard S. Isaacson
- Department of NeurologyWeill Cornell Medicine & New York‐PresbyterianNew YorkNew York
| |
Collapse
|
38
|
Charalambous AP, Pye A, Yeung WK, Leroi I, Neil M, Thodi C, Dawes P. Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation. J Med Internet Res 2020; 22:e14551. [PMID: 31951218 PMCID: PMC6996724 DOI: 10.2196/14551] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. OBJECTIVE The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. METHODS We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms "Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check." RESULTS We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms "(name of developer, if available)" AND "(the name of the tool)" to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. CONCLUSIONS The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation.
Collapse
Affiliation(s)
| | - Annie Pye
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| |
Collapse
|
39
|
Predicting Speech Outcomes After Cochlear Implantation in Older Adults Using the Self-administered Gerocognitive Examination Test. Otol Neurotol 2020; 41:e28-e35. [DOI: 10.1097/mao.0000000000002425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Boucher V, Lamontagne ME, Lee J, Carmichael PH, Déry J, Émond M. Acceptability of older patients' self-assessment in the Emergency Department (ACCEPTED)-a randomised cross-over pilot trial. Age Ageing 2019; 48:875-880. [PMID: 31297513 DOI: 10.1093/ageing/afz084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/19/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. OBJECTIVE to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. DESIGN randomised crossover pilot study. SETTING The Hôpital de l'Enfant-Jésus (CHU de Québec-Université Laval) (2018/05-2018/07). SUBJECTS (1) ED patients aged ≥65, (2) their caregiver, if present. METHODS participants' frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. RESULTS sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. CONCLUSIONS our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.
Collapse
Affiliation(s)
- Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Eve Lamontagne
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
| | | | - Julien Déry
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| |
Collapse
|
41
|
Steffens NK, LaRue CJ, Haslam C, Walter ZC, Cruwys T, Munt KA, Haslam SA, Jetten J, Tarrant M. Social identification-building interventions to improve health: a systematic review and meta-analysis. Health Psychol Rev 2019; 15:85-112. [PMID: 31530154 DOI: 10.1080/17437199.2019.1669481] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is growing evidence that social identity processes play an important role in a range of health outcomes. However, we know little about the nature and effectiveness of interventions that build social identification with the aim of promoting health. In the present research, we systematically review and meta-analyze interventions that build social identification to enhance health and wellbeing. A total of 27 intervention studies were identified (N = 2,230). Using a three-level meta-regression, results indicate that social identification-building interventions had a moderate-to-strong impact on health (Hedges g = 0.66; 95%CIs[0.34, 0.97]). Analyses revealed significant variation in intervention effectiveness as a function of its type: group-relevant decision making (g = 1.26), therapy programmes (g = 1.02), shared activities (g = 0.40), and reminiscence (g = -0.05). By contrast, there was much less variation across health outcomes: quality of life (g = 0.80), physical health (g = 0.76), self-esteem (g = 0.69), well-being (g = 0.66), (reduced) anxiety (g = 0.61), (reduced) depression (g = 0.58), cognitive health (g = 0.55), and (reduced) stress (g = 0.49). Finally, speaking to the mechanism of the interventions, interventions tended to be more effective to the extent that they succeeded in building participants' social identification with the intervention group. We discuss the theoretical and practical implications of social identification-building interventions to foster health and outline an agenda for future research and practical application.
Collapse
Affiliation(s)
- Niklas K Steffens
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Crystal J LaRue
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Zoe C Walter
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Katie A Munt
- School of Psychology, The University of Queensland, Brisbane, Australia
| | | | - Jolanda Jetten
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
42
|
Holden SK, Van Dok E, Pelak VS. Co-occurrence of Convergence Insufficiency and Cognitive Impairment in Parkinsonian Disorders: A Pilot Study. Front Neurol 2019; 10:864. [PMID: 31447772 PMCID: PMC6696607 DOI: 10.3389/fneur.2019.00864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Convergence insufficiency (CI) in parkinsonian conditions causes disabling visual symptoms during near tasks and usually manifests as double vision. Since double vision is more common in patients who report cognitive symptoms, we sought to determine if symptomatic CI, as opposed to asymptomatic CI, could serve as a marker of cognitive impairment in parkinsonian disorders. Methods: Twenty-four participants with parkinsonian disorders (18 Parkinson's disease, 5 progressive supranuclear palsy, 1 multiple system atrophy) and objective findings of convergence insufficiency on neuro-ophthalmologic examination were included. Subjective visual symptoms and cognitive complaints were recorded, and the Self-Administered Gerocognitive Examination was used as a global cognitive screening measure. Results: 54.1% of parkinsonian participants had cognitive impairment, but there were no significant differences in the degree of convergence insufficiency, measured by near point of convergence (NPC), or cognitive outcomes between those with symptomatic CI, and asymptomatic CI. However, NPC was greater for those with cognitive impairment (x = 18.4 cm), compared to those who were cognitively intact (x = 12.5 cm, p = 0.003). Conclusions: Cognitive impairment commonly co-occurs in parkinsonian disorders with convergence insufficiency and is associated with significantly greater NPC distances. Clinicians should have a high index of suspicion for cognitive impairment in patients with objective findings of convergence insufficiency, whether symptomatic or not. Further investigation of convergence insufficiency in relationship to cognitive impairment in parkinsonian disorders is warranted, as there may be a shared mechanism of dysfunction.
Collapse
Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Erin Van Dok
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
43
|
van Balkom TD, Berendse HW, van der Werf YD, Twisk JWR, Zijlstra I, Hagen RH, Berk T, Vriend C, van den Heuvel OA. COGTIPS: a double-blind randomized active controlled trial protocol to study the effect of home-based, online cognitive training on cognition and brain networks in Parkinson's disease. BMC Neurol 2019; 19:179. [PMID: 31366395 PMCID: PMC6668056 DOI: 10.1186/s12883-019-1403-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cognitive dysfunction is highly prevalent in Parkinson’s disease (PD) and a large proportion of patients eventually develops PD-related dementia. Currently, no effective treatment is available. Cognitive training is effective in relieving cognitive dysfunctions in several –neurodegenerative– diseases, and earlier small-scale trials have shown positive results for PD. In this randomized controlled trial, we assess the efficacy of online home-based cognitive training, its long-term effects, as well as the underlying neural correlates in a large group of PD patients. Methods In this double-blind randomized controlled trial we will include 140 non-demented patients with idiopathic PD that experience significant subjective cognitive complaints. Participants will be randomized into a cognitive training group and an active control group. In both groups, participants will individually perform an online home-based intervention for eight weeks, three times a week during 45 min. The cognitive training consists of thirteen games that focus on executive functions, attention and processing speed with an adaptive difficulty. The active control comprises three games that keep participants cognitively engaged without a training component. Participants will be subjected to extensive neuropsychological assessments at baseline and after the intervention, and at six months, one year and two years of follow-up. A subset of participants (40 in each treatment condition) will undergo structural and functional magnetic resonance imaging. The primary outcome of this study is the performance on the Tower of London task. Secondary outcomes are objective and subjective cognitive functioning, conversion to PD-related mild cognitive impairment or dementia, functional and structural connectivity and network topological indices measured with magnetic resonance imaging. None of the outcome measures are part of the cognitive training program. Data will be analyzed using multivariate mixed-model analyses and odds ratios. Discussion This study is a large-scale cognitive training study in PD patients that evaluates the efficacy in relieving cognitive dysfunction, and the underlying mechanisms. The strengths of this study are the large sample size, the long follow-up period and the use of neuroimaging in a large subsample. The study is expected to have a low attrition and a high compliance rate given the home-based and easily-accessible intervention in both conditions. Trial registration ClinicalTrials.gov ID NCT02920632. Registered September 30, 2016. Electronic supplementary material The online version of this article (10.1186/s12883-019-1403-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tim D van Balkom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Henk W Berendse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands
| | - Ysbrand D van der Werf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Iris Zijlstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands
| | - Rob H Hagen
- Dutch Parkinson's Disease Association, PO Box 46, Bunnik, 3980 CA, the Netherlands
| | - Tanja Berk
- Dutch Parkinson's Disease Association, PO Box 46, Bunnik, 3980 CA, the Netherlands
| | - Chris Vriend
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, Netherlands
| |
Collapse
|
44
|
Tarawneh R. Cerebrospinal Fluid Markers of Synaptic Injury and Functional Connectivity in Alzheimer Disease: Protocol for a Cross-Sectional Study. JMIR Res Protoc 2019; 8:e14302. [PMID: 31271547 PMCID: PMC6668296 DOI: 10.2196/14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/30/2022] Open
Abstract
Background Synaptic loss is the best surrogate for cognitive decline in Alzheimer disease (AD) and is more closely associated with cognitive function than amyloid or tau pathologies. Neurogranin (Ng) and synaptosome–associated protein-25 (SNAP-25) have demonstrated utility as cerebrospinal fluid (CSF) markers of synaptic injury in presymptomatic and symptomatic AD. While these synaptic markers have been shown to correlate with cognitive impairment and whole brain or regional atrophy in previous studies of AD, to our knowledge, the relationship between fluid markers of synaptic injury and functional brain imaging has not been previously investigated. Objective The main objective of this study is to examine the relationship between CSF markers of synaptic injury (Ng and SNAP-25) and functional connectivity (FC) in the default mode and semantic memory networks in individuals with mild cognitive impairment (MCI) and mild dementia due to AD (Clinical Dementia Rating [CDR] 0.5-1) and cognitively normal controls (CDR 0), adjusting for age, gender, and the apolipoprotein E4 (APOE4) genotype. Secondary objectives include investigating the associations between CSF markers of amyloid and tau pathology (CSF tau, p-tau181, and Aβ42) and FC in the default mode and semantic memory networks in AD (CDR 0.5-1) and controls (CDR 0), adjusting for age, gender, and the APOE4 genotype. Methods This is a cross-sectional study of individuals with MCI or mild dementia due to AD (CDR 0.5-1; n=20), and cognitively normal controls (CDR 0; n=20). Participants will undergo detailed clinical and neuropsychological assessments, CSF biomarker assessments (CSF Ng, SNAP-25, tau, p-tau181, and Aβ42 levels) and functional magnetic resonance imaging assessments, using a Siemens 3.0 Tesla Prisma scanner, during resting state and during the performance of a semantic memory task. All study procedures will be completed within 4 months of enrollment. Partial correlation analyses will examine associations of CSF biomarker measures with FC in the default mode and semantic memory networks in AD and controls. Results This study was funded by the Chronic Brain Injury Discovery Themes of the Ohio State University College of Medicine. Study enrollment began in April 2018. Study procedures and data analysis are currently underway. Results are expected by December 2019. Conclusions Findings from this study will further support the utility of CSF Ng and SNAP-25 as markers of synaptic injury by examining their associations with functional alterations in cortical networks affected by early AD pathology. International Registered Report Identifier (IRRID) DERR1-10.2196/14302
Collapse
Affiliation(s)
- Rawan Tarawneh
- Department of Neurology, College of Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
45
|
Keine D, Zelek M, Walker JQ, Sabbagh MN. Polypharmacy in an Elderly Population: Enhancing Medication Management Through the Use of Clinical Decision Support Software Platforms. Neurol Ther 2019; 8:79-94. [PMID: 30900186 PMCID: PMC6534631 DOI: 10.1007/s40120-019-0131-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Polypharmacy is a growing problem in the United States. The use of multiple medications increases the likelihood that a patient will experience potential drug interactions and adverse drug reactions (ADRs). Those individuals with dementia or Alzheimer's disease (AD) are at greater risk, due to age, comorbidities, and an increased likelihood of being on a greater number of neuroactive medications. METHODS uMETHOD Health (uMH) has developed a precision medicine platform to address dementia and mild AD through the creation of personalized, multidomain treatment plans. Many interactions and ADRs may be observed, such as drug-drug interactions (DDIs), drug-gene interactions (DGIs), anticholinergic cognitive burden (ACB), and depression-inducing drugs (DIDs). uMH's algorithms can parse these interactions, rate them based on input from open-source databases, and then record all these interactions in a generated treatment plan. A total of 295 individuals aged 65 and older were included in this analysis. RESULTS Of 295 individuals, 97.59% were on at least one medication, with an overall mean of 11.5 medications per person; 83.66% were on five or more medications. A total of 102 DGIs, 3642 DDIs, and one high-priority DDI were found in this population. There was a significant increase in the number of DDIs as medications per person increased (P value < 0.0001). Of the population, 65.86% were on one or more anticholinergic drugs. There was a significant difference in the ACB score between individuals with cognitive decline and those without. In total, 60.98% of the overall population were on DIDs, with a mean of 1.19 medications per person. CONCLUSIONS The results of this work show that older populations have a high medication burden. With the growing elderly and AD populations, medication management for polypharmacy is a need that grows direr every year. uMH's platform was able to identify a multitude of polypharmacy problems that individuals are currently facing. FUNDING uMETHOD Health.
Collapse
Affiliation(s)
| | | | | | - Marwan N Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| |
Collapse
|
46
|
McLeod syndrome: Five new pedigrees with novel mutations. Parkinsonism Relat Disord 2019; 64:293-299. [PMID: 31103486 DOI: 10.1016/j.parkreldis.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/20/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present five new McLeod Syndrome (MLS) pedigrees with novel XK gene mutations, review the literature of this disorder, and discuss the typical and atypical clinical features noted with these new mutations. METHODS This is a multi-center retrospective review of five MLS cases with novel gene mutations. Genotypic and phenotypic information has been obtained from each center. RESULTS Five novel mutations are reported in this Case series. New clinical findings include prolonged asymptomatic elevated creatine kinase (CK) levels, vocal tics, presence of obstructive sleep apnea (OSA), and one patient of Vietnamese ethnicity. CONCLUSIONS We expand on the clinical and genetic spectrum of MLS demonstrating the clinical variability of MLS.
Collapse
|
47
|
Abstract
OBJECTIVE Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition. METHODS We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition. RESULTS Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post-high school reading levels (70.1% vs 33.3%, P < 0.001). CONCLUSIONS Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.
Collapse
|
48
|
Janssen J, Koekkoek PS, Biessels GJ, Kappelle JL, Rutten GEHM. Depressive symptoms and quality of life after screening for cognitive impairment in patients with type 2 diabetes: observations from the Cog-ID cohort study. BMJ Open 2019; 9:e024696. [PMID: 30782740 PMCID: PMC6340460 DOI: 10.1136/bmjopen-2018-024696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess changes in depressive symptoms and health-related quality of life (HRQOL) after screening for cognitive impairment in people with type 2 diabetes. DESIGN A prospective cohort study, part of the Cognitive Impairment in Diabetes (Cog-ID) study. SETTING Participants were screened for cognitive impairment in primary care. People suspected of cognitive impairment (screen positives) received a standardised evaluation at a memory clinic. PARTICIPANTS Participants ≥70 years with type 2 diabetes were included in Cog-ID between August 2012 and September 2014, the current study includes 179 patients; 39 screen positives with cognitive impairment, 56 screen positives without cognitive impairment and 84 participants not suspected of cognitive impairment during screening (screen negatives). OUTCOME MEASURES Depressive symptoms and HRQOL assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), 36-Item Short-Form Health Survey, European Quality of Life-5 Dimensions questionnaire and the EuroQol Visual Analogue Scale. Outcomes were assessed before the screening, and 6 and 24 months after screening. An analysis of covariance model was fitted to assess differences in score changes among people diagnosed with cognitive impairment, screen negatives and screen positives without cognitive impairment using a factor group and baseline score as a covariate. RESULTS Of all participants, 60.3% was male, mean age was 76.3±5.0 years, mean diabetes duration 13.0±8.5 years. At screening, participants diagnosed with cognitive impairment had significantly more depressive symptoms and a worse HRQOL than screen negatives. Scores of both groups remained stable over time. Screen positives without cognitive impairment scored between the other two groups at screening, but their depressive symptoms decreased significantly during follow-up (mean CES-D: -3.1 after 6 and -2.1 after 24 months); their HRQOL also tended to improve. CONCLUSIONS Depressive symptoms are common in older people with type 2 diabetes. Screening for and a subsequent diagnosis of cognitive impairment will not increase depressive symptoms.
Collapse
Affiliation(s)
- Jolien Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paula S Koekkoek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Biessels
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jaap L Kappelle
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
49
|
Lauraitis A, Maskeliunas R, Damasevicius R, Polap D, Wozniak M. A Smartphone Application for Automated Decision Support in Cognitive Task Based Evaluation of Central Nervous System Motor Disorders. IEEE J Biomed Health Inform 2019; 23:1865-1876. [PMID: 30629520 DOI: 10.1109/jbhi.2019.2891729] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE New technology enables constant boost to the powers of mobile devices, which in the previous years have transformed from simple mobile phones to smart phones. Computational powers of these electronics enable actions that previously were possible only for computers. By the use of special applications, we may benefit from sensors and multimedia capabilities of operating systems. Therefore, a new era for devoted implementations opens, in which a smart application can take a role of computing system to estimate the symptoms of diseases by evaluating signals coming from a human body. METHODS We propose a model of an application implemented for mobile android systems, which can be used for examination of central nervous system motor disorders occurring in patients suffering from Huntington (HD), Alzheimer, or Parkinson diseases. In particular, the model tracks tremors (involuntary movements), and cognitive (memory loss or dementia) impairments using touch and visual stimulus modalities. The proposed model interprets the symptoms from human bodies that indicate one of the diseases of the nervous system. Pre-processing of collected data for feature extraction is executed on a mobile device by using core functionality and methods provided in android's application programming interface. The information is evaluated by a back-propagation neural network classifier and the result is presented to the end user. The system is able to contact medical supervision and provide an assistance from the clinic. RESULTS The system uses a collected dataset of 1928 records, taken from 11 HD patients and 11 healthy persons in Lithuania, to gather statistics about examinations and presents the results as medical evaluation with prediction on the state of health. The accuracy of recognition of early, prodromal symptoms for central nervous system motor disorders is 86.4% (F-measure 0.859). The app (available on Google Play) is easy to use and is efficient tool for decision support in medical examinations. CONCLUSIONS The use of intelligent apps which can help to evaluate neurodegenerative disorders is an important enhancement to medical diagnosis. The developed smartphone app supports the doctor with additional results that are easy to compare with other examinations. This kind of examination is a nice change from classic stereotypes, especially for younger age patients, who are used to various aspects of information technology.
Collapse
|
50
|
Myakotnykh VS, Ostapchuk ES, Postovalova VL. The Main Diseases and Syndromes Identified in Elderly and Senile Patients Hospitalized at Inpatient Clinics of Different Specialties. ADVANCES IN GERONTOLOGY 2019. [DOI: 10.1134/s2079057019010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|