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Lee MK, Kim SW, Kim H, Park MJ, Fava M, Mischoulon D, Jeon HJ. Association between cerebral artery stenosis and depressive symptoms in elderly patients. J Affect Disord 2024; 361:53-58. [PMID: 38844169 DOI: 10.1016/j.jad.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To examine the association between cerebral artery stenosis and depressive symptoms in elderly patients. METHODS The study participants were 365 patients aged ≥65 years who visited the psychiatric outpatient clinic, Samsung Medical Center between January 1, 2000, and December 31, 2019, and were diagnosed with depressive disorder. They had brain imaging tests including magnetic resonance angiography (MRA), psychological evaluations including the 15-item Geriatric Depression Scale (GDS-15), and lab tests. Individuals' cerebral artery stenosis was identified and the association with significant depressive symptoms was examined. RESULTS Of the 365 subjects, 108 had at least one location of cerebral artery stenosis (29.6 %). The mean score of GDS-15 in the stenosis group was 8.1 (SD, 3.8), higher than the mean GDS-15 score of 6.5 (SD, 4.0) for the group without stenosis (p < 0.001). Compared to no middle cerebral artery (MCA) stenosis, having MCA stenosis was associated with significant depressive symptoms (p = 0.005). Compared to no posterior cerebral artery (PCA) stenosis, having left PCA stenosis was associated with significant depressive symptoms (p = 0.022). In the multivariable linear regression analysis, only bilateral MCA stenosis had a positive association with the score of GDS-15 (p = 0.013). CONCLUSION Bilateral MCA stenosis and left PCA stenosis are associated with significant depressive symptoms among elderly patients, with bilateral MCA stenosis positively associated with the severity of depression.
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Affiliation(s)
- Min Kang Lee
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Woo Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyewon Kim
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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Brauner FDO, Oliveira M, Hausen DO, Schiavo A, Balbinot G, Mestriner RG. Association Between Depressive Symptoms, Cognitive Status, and the Dual-Task Performance Index in Older Adults: A Cross-Sectional Study. J Aging Phys Act 2024:1-9. [PMID: 38729617 DOI: 10.1123/japa.2023-0152] [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: 05/02/2023] [Revised: 02/03/2024] [Accepted: 03/19/2024] [Indexed: 05/12/2024]
Abstract
The Performance Index (P-Index) is a measure for evaluating mobility-related dual-task performance in older adults. The identification of specific clinicodemographic factors predictive of P-Index scores, however, remains unclear. This cross-sectional study analyzed data from 120 community-dwelling older adults (average age 71.3 ± 11.23 years) to explore clinicodemographic variables that influence P-Index scores during the instrumented timed up and go test. Unadjusted analyses suggested several factors, including age, gender, body mass index, Mini-Mental Status Examination scores, functional reach test performance, history of falls, ethnicity, Geriatric Depression Scale scores, alcohol consumption, and educational levels, as potential predictors of P-Index. However, adjusted multinomial multiple regression analysis revealed Geriatric Depression Scale and Mini-Mental Status Examination scores as the exclusive independent predictors of P-Index classifications, segmented into high, intermediate, or low (percentiles ≤ 25, 26-74, or ≥ 75, respectively). A significant association was observed between the manifestation of depressive symptoms, lower Mini-Mental Status Examination scores, and reduced cognitive-motor performance. The findings implicate depressive symptoms and low cognitive performance as substantial impediments to optimal dual-task mobility within this cohort. Further studies are warranted to examine the efficacy of cognitive stimulation and antidepressant therapy, in augmenting mobility-related dual-task performance among older adults.
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Affiliation(s)
- Fabiane de Oliveira Brauner
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Mariana Oliveira
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Daiane Oliveira Hausen
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Wall B, Kelly AM, White P, McCann M. Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S16-S28. [PMID: 38722011 DOI: 10.12968/bjon.2024.33.9.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. AIM To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. DESIGN Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. METHODS Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). RESULTS The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. CONCLUSIONS The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.
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Affiliation(s)
- Breda Wall
- Clinical Nurse Specialist in Wound Management and Tissue Viability, St Vincent's Hospital, Athy, Ireland
| | - Anne Marie Kelly
- Clinical Nurse Specialist - Continence Promotion and Management of Incontinence, Continence Promotion Service, Meath Campus, Dublin, Ireland
| | - Patricia White
- Project Officer, European Association for Palliative Care, previously Research Fellow at Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret McCann
- Assistant Professor and Postgraduate Specialist Educational Facilitator, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Kim H, Jung JH, Han K, Jeon HJ. Weight change in people with depression and the risk of dementia: a nationwide cohort study. Psychol Med 2024; 54:1284-1293. [PMID: 38179671 DOI: 10.1017/s0033291723003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Depression is a risk factor for dementia and weight change can appear as a symptom of depression. However, the association between weight change after the diagnosis of depression and the risk of dementia is poorly established. This study aimed to investigate the association between weight change before and after a diagnosis of depression with the subsequent risk of dementia. METHODS The National Health Insurance Sharing Service database was used. 1 308 730 patients aged ⩾40 years diagnosed with depression were identified to be eligible. Weight changes after their depression diagnosis were categorized and subsequent incidence of dementia was followed up. RESULTS During an average follow-up period of 5.2 years (s.d., 2.0 years), 69 373 subjects were newly diagnosed with all-cause dementia (56 351 were Alzheimer's disease and 6877 were vascular dementia). Regarding all outcomes, compared to those with a minimal weight change (-5 to 5%), all groups with weight gain or loss showed increased risks of dementia after adjusting potential risk factors for dementia, in all analysis models with a dose-response relationship, showing a U-shaped association. CONCLUSIONS Weight change as a symptom of depression could be a predictor for the future development of dementia.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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Possemis N, Verhey F, Prickaerts J, Blokland A, Ramakers I. A proof of concept phase II study with the PDE-4 inhibitor roflumilast in patients with mild cognitive impairment or mild Alzheimer's disease dementia (ROMEMA): study protocol of a double-blind, randomized, placebo-controlled, between-subjects trial. Trials 2024; 25:162. [PMID: 38438923 PMCID: PMC10910786 DOI: 10.1186/s13063-024-08001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Research into the neurobiological underpinnings of learning and memory has demonstrated the cognitive-enhancing effects associated with diverse classes of phosphodiesterase (PDE) inhibitors. Specific PDE inhibitors have been identified to improve neuronal communication through selective inhibition of PDE activity. Roflumilast, a PDE4 inhibitor, has demonstrated efficacy in enhancing episodic memory in healthy adults and elderly participants with pronounced memory impairment, indicative of amnestic mild cognitive impairment (aMCI). In alignment with these findings, the present protocol aims to provide a proof of concept phase II of the potential of roflumilast to aid patients diagnosed with (a)MCI or mild Alzheimer's disease (AD) dementia. METHODS The study will be conducted according to a double-blind, randomized placebo-controlled, between-subjects design. Participants with (a)MCI and mild AD dementia will be recruited through the Memory Clinic at the Maastricht University Medical Centre + (MUMC +) in Maastricht, the Netherlands, alongside outreach through regional hospitals, and social media. The study will have three arms: placebo, 50 μg roflumilast, and 100 μg roflumilast, with a treatment duration of 24 weeks. The primary outcome measure will focus on the assessment of episodic memory, as evaluated through participants' performance on the 15-word Verbal Learning Task (VLT). Our secondary objectives are multifaceted, including an exploration of various cognitive domains. In addition, insights into the well-being and daily functioning of participants will be investigated through interviews with both the participants and their (informal) caregivers, we are interested in the well-being and daily functioning of the participants. DISCUSSION The outcomes of the present study aim to elucidate the significance of the PDE4 inhibition mechanism as a prospective therapeutic target for enhancing cognitive function in individuals with (a)MCI and mild AD dementia. Identifying positive effects within these patient cohorts could extend the relevance of this treatment to encompass a broader spectrum of neurological disorders. TRIAL REGISTRATION The Medical Ethics Committee of MUMC + granted ethics approval for the 4th version of the protocol on September 10th, 2020. The trial was registered at the European Drug Regulatory Affairs Clinical Trials (EudraCT) registered on the 19th of December 2019 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-004959-36/NL ) and ClinicalTrial.gov (NCT04658654, https://clinicaltrials.gov/study/NCT04658654?intr=roflumilast&cond=mci&rank=1 ) on the 8th of December 2020. The Central Committee on Research Involving Human Subjects (CCMO) granted approval on the 30th of September 2020.
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Affiliation(s)
- Nina Possemis
- Dept. of Psychiatry and Neuropsychology, School for Mental, Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre+ (MUMC+), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Jos Prickaerts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Arjan Blokland
- Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, EURON, Maastricht University, Maastricht, the Netherlands
| | - Inez Ramakers
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre+ (MUMC+), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands.
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Lee EH, Kim GH, Park HK, Kang HJ, Park YK, Lee HA, Hong CH, Moon SY, Kang W, Oh HS, Yoon HJ, Choi SH, Jeong JH. Effects of the multidomain intervention with nutritional supplements on cognition and gut microbiome in early symptomatic Alzheimer's disease: a randomized controlled trial. Front Aging Neurosci 2023; 15:1266955. [PMID: 38020771 PMCID: PMC10652389 DOI: 10.3389/fnagi.2023.1266955] [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: 07/25/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background The SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN) is a part of the World-Wide Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (WW-FINGERS) network. This study aimed to demonstrate the effects of the SUPERBRAIN-based multidomain intervention with nutritional supplements in amyloid positive emission tomography (PET) proven early symptomatic Alzheimer's disease patients. Methods Forty-six participants who were diagnosed with mild cognitive impairment or mild dementia and were positive in the amyloid PET study randomized into three groups: group A, the multidomain intervention with nutritional supplements; group B, nutritional supplements only; and a control group. The primary outcome was a change in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total scale index score after an 8-week intervention. Secondary outcomes, including gut microbiome data, were also analyzed. Results The RBANS total scale index score improved significantly in group A compared with group B (p < 0.032) and compared with the control group (p < 0.001). After intervention, beta diversity of the gut microbiome between group A and the control group increased, and patients in group A were more enriched with Bifidobacterium. Conclusion SUPERBRAIN-based multidomain intervention with nutritional supplements improves cognition and gut microbiota in patients with early symptomatic Alzheimer's disease who were amyloid-positive by PET.
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Affiliation(s)
- Eun Hye Lee
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Geon Ha Kim
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hee Kyung Park
- Division of Psychiatry, Department of Mental Health Care of Older People, University College London, London, United Kingdom
| | - Hae Jin Kang
- Department of Medical Nutrition (AgeTech-Service Convergence Major), Kyung Hee University, Yongin, Republic of Korea
| | - Yoo Kyoung Park
- Department of Medical Nutrition (AgeTech-Service Convergence Major), Kyung Hee University, Yongin, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Woorim Kang
- CJ Bioscience Inc., Seoul, Republic of Korea
| | | | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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Shim Y. Facial Emotion Recognition in Older Adults With Cognitive Complaints. Dement Neurocogn Disord 2023; 22:158-168. [PMID: 38025409 PMCID: PMC10654485 DOI: 10.12779/dnd.2023.22.4.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Purpose Facial emotion recognition deficits impact the daily life, particularly of Alzheimer's disease patients. We aimed to assess these deficits in the following three groups: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and mild Alzheimer's dementia (AD). Additionally, we explored the associations between facial emotion recognition and cognitive performance. Methods We used the Korean version of the Florida Facial Affect Battery (K-FAB) in 72 SCD, 76 MCI, and 76 mild AD subjects. The comparison was conducted using the analysis of covariance (ANCOVA), with adjustments being made for age and sex. The Mini-Mental State Examination (MMSE) was utilized to gauge the overall cognitive status, while the Seoul Neuropsychological Screening Battery (SNSB) was employed to evaluate the performance in the following five cognitive domains: attention, language, visuospatial abilities, memory, and frontal executive functions. Results The ANCOVA results showed significant differences in K-FAB subtests 3, 4, and 5 (p=0.001, p=0.003, and p=0.004, respectively), especially for anger and fearful emotions. Recognition of 'anger' in the FAB subtest 5 declined from SCD to MCI to mild AD. Correlations were observed with age and education, and after controlling for these factors, MMSE and frontal executive function were associated with FAB tests, particularly in the FAB subtest 5 (r=0.507, p<0.001 and r=-0.288, p=0.026, respectively). Conclusions Emotion recognition deficits worsened from SCD to MCI to mild AD, especially for negative emotions. Complex tasks, such as matching, selection, and naming, showed greater deficits, with a connection to cognitive impairment, especially frontal executive dysfunction.
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Affiliation(s)
- YongSoo Shim
- Department of Neurology, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea
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Wollesen B, Schott N, Klotzbier T, Bischoff LL, Cordes T, Rudisch J, Otto AK, Zwingmann K, Hildebrand C, Joellenbeck T, Vogt L, Schoene D, Weigelt M, Voelcker-Rehage C. Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project. Eur Rev Aging Phys Act 2023; 20:17. [PMID: 37697252 PMCID: PMC10494417 DOI: 10.1186/s11556-023-00327-2] [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: 05/10/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. METHODS The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). RESULTS Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. DISCUSSION AND CONCLUSION Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. TRIAL REGISTRATION Trial registration number: DRKS00014957.
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Affiliation(s)
- Bettina Wollesen
- Department of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany.
| | - Nadja Schott
- Department of Sports and Movement Science, University of Stuttgart, Stuttgart, Germany
| | - Thomas Klotzbier
- Department of Sports and Movement Science, University of Stuttgart, Stuttgart, Germany
| | - Laura Luise Bischoff
- Department of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany
| | - Thomas Cordes
- Department of Human Movement Science, University of Vechta, Vechta, Germany
| | - Julian Rudisch
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Ann-Kathrin Otto
- Department of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Claudia Hildebrand
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Thomas Joellenbeck
- Department of Sport & Health Sciences, University of Paderborn, Paderborn, Germany
| | - Lutz Vogt
- Institute of Sports Sciences, Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Weigelt
- Department of Sport & Health Sciences, University of Paderborn, Paderborn, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
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Santamaria-Garcia H, Sainz-Ballesteros A, Hernandez H, Moguilner S, Maito M, Ochoa-Rosales C, Corley M, Valcour V, Miranda JJ, Lawlor B, Ibanez A. Factors associated with healthy aging in Latin American populations. Nat Med 2023; 29:2248-2258. [PMID: 37563242 PMCID: PMC10504086 DOI: 10.1038/s41591-023-02495-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
Latin American populations may present patterns of sociodemographic, ethnic and cultural diversity that can defy current universal models of healthy aging. The potential combination of risk factors that influence aging across populations in Latin American and Caribbean (LAC) countries is unknown. Compared to other regions where classical factors such as age and sex drive healthy aging, higher disparity-related factors and between-country variability could influence healthy aging in LAC countries. We investigated the combined impact of social determinants of health (SDH), lifestyle factors, cardiometabolic factors, mental health symptoms and demographics (age, sex) on healthy aging (cognition and functional ability) across LAC countries with different levels of socioeconomic development using cross-sectional and longitudinal machine learning models (n = 44,394 participants). Risk factors associated with social and health disparities, including SDH (β > 0.3), mental health (β > 0.6) and cardiometabolic risks (β > 0.22), significantly influenced healthy aging more than age and sex (with null or smaller effects: β < 0.2). These heterogeneous patterns were more pronounced in low-income to middle-income LAC countries compared to high-income LAC countries (cross-sectional comparisons), and in an upper-income to middle-income LAC country, Costa Rica, compared to China, a non-upper-income to middle-income LAC country (longitudinal comparisons). These inequity-associated and region-specific patterns inform national risk assessments of healthy aging in LAC countries and regionally tailored public health interventions.
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Affiliation(s)
- Hernando Santamaria-Garcia
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, San Ignacio, Colombia.
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, San Ignacio, Colombia.
| | | | - Hernán Hernandez
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Faculty of Engineering, University of Concepción, Concepción, Chile
| | - Sebastian Moguilner
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Cognitive Neuroscience Center, Universidad de San Andrés and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo Maito
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Carolina Ochoa-Rosales
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Michael Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Memory and Aging Center, University California San Francisco, San Francisco, CA, USA
| | - J Jaime Miranda
- Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Lawlor
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Agustin Ibanez
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center, Universidad de San Andrés and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
- Trinity College Dublin, The University of Dublin, Dublin, Ireland.
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10
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Ghamari N, Ghaderpanah R, Sadrian SH, Fallah N. Effect of a visual dual task on postural stability-A comparative study using linear and nonlinear methods. Health Sci Rep 2023; 6:e1437. [PMID: 37520463 PMCID: PMC10375842 DOI: 10.1002/hsr2.1437] [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: 04/06/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background and Aims The dual-task experimental paradigm is used to study the attentional demands of postural control. Postural control is impaired in poststroke patients, and dual-task balance studies address the visual needs of postural control in stroke patients. A nonlinear approach can help us understand the overall behavior of the dynamic system. Methods A total of 20 chronic stroke patients and 20 healthy subjects with similar age, height, and weight participated in this study. The stability and complexity of postural control were assessed using linear and nonlinear methods. All data and parameters (center of pressure [COP] velocity, anteroposterior and mediolateral directions displacement, length of COP path, and phase plane) were analyzed using the Kolmogorov-Smirnov test. Results When postural control was examined based on linear analysis, the results showed that the main effect of the group was not significant, but the main impact of position was significant for all parameters of the COP variation (p < 0.05). Examination of postural control based on nonlinear analysis also showed that the main effect of the group was not significant, and the main effect of status was significant only for the parameters of approximate entropy in both directions and short-term Lyapunov view in the anterior-posterior direction (p < 0.05). Conclusion According to the results of this study, the assessment of postural control and gait performance in poststroke patients, as well as the dual tasks they have to perform in daily life, is crucial for their independence in activities of daily living.
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Affiliation(s)
- Narges Ghamari
- Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
| | - Rezvan Ghaderpanah
- Department of Physical Medicine and Rehabilitation, Students Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Seyed Hassan Sadrian
- Department of Physical Medicine and Rehabilitation, Students Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Nahid Fallah
- Department of Health, Sports Physiotherapy Research CommitteeUniversity of Bath, Claverton DownBathUK
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11
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Kim J, Ko M, Lee J, Kim Y. The effects of a mobile-based multi-domain intervention on cognitive function among older adults. Prev Med Rep 2023; 32:102165. [PMID: 36942284 PMCID: PMC10023949 DOI: 10.1016/j.pmedr.2023.102165] [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: 09/01/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Behavioral and social research has stressed the importance of multi-domain lifestyle interventions to prevent, delay, or remedy age-related cognitive decline among older adults at high risk for dementia. In light of the benefits of multi-domain interventions, some studies demonstrate the effectiveness of a mobile-based program for dementia prevention. Unfortunately, there is limited evidence of whether or not a mobile application of a multi-domain program is effective in improving cognitive functioning among older adults who are a high risk for dementia. Thus, the purpose of this study was to determine whether there was a pre-post change of cognition and there were age-group differences in pre-post change after the 12 weeks multi-domain program, Silvia program (N = 59). The Silvia program consisted of five domains, including (a)daily smart routine, (b)cognitive training, (c)lifestyle monitoring, (d)home-based exercise, and (e)voice-based AI cognitive assessment. Using a paired t-test and analysis of variance, this study found that there was a significant mean difference in cognitive function scores between pre and post-intervention (95 % CI = 1.10-1.87, P <.05). The difference score in cognitive function was higher in the old-old group than in the young-old group (95 % CI = -2.29-0.10, p <.05). The findings of this study demonstrated that Silvia program was effective in promoting cognitive function among older Korean adults, especially for the old-old group.
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Affiliation(s)
- Junhyoung Kim
- Department of Health & Wellness Design, School of Public Health, Indiana University Bloomington, IN, United States
| | - Myungjin Ko
- School of Medicine, Seoul National University, Seoul, South Korea
- Silvia Health Inc. Seoul, South Korea
- Corresponding author at: Silvia Health Inc. Seoul, South Korea.
| | - Jungjoo Lee
- Department of Health & Wellness Design, School of Public Health, Indiana University Bloomington, IN, United States
| | - Yongseop Kim
- Department of Health & Wellness Design, School of Public Health, Indiana University Bloomington, IN, United States
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12
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Hammerle MB, Sales DS, Pinheiro PG, Gouvea EG, de Almeida PIFM, de Araujo Davico C, Souza RS, Spedo CT, Nicaretta DH, Alvarenga RMP, Pires KL, Thuler LCS, Vasconcelos CCF. Cognitive Complaints Assessment and Neuropsychiatric Disorders After Mild COVID-19 Infection. Arch Clin Neuropsychol 2023; 38:196-204. [PMID: 36464245 DOI: 10.1093/arclin/acac093] [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: 03/15/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES This study aimed to analyze cognitive impairment associated with long-term coronavirus disease 2019 (COVID-19) syndrome and its correlation with anxiety, depression, and fatigue in patients infected with severe acute respiratory syndrome coronavirus. METHODS This was a cross-sectional study of 127 patients with COVID-19. Tests to screen for neuropsychiatric symptoms included the Fatigue Severity Scale, Mini-Mental State Exam 2 (MMSE-2), Symbol Digit Modalities Test (SDMT), and Hospital Anxiety and Depression Scale. RESULTS In cognitive tests, SDMT was abnormal in 22%, being more sensitive than MMSE-2 to detect cognitive changes. Furthermore, although manifestations such as fatigue, depression, and anxiety were frequent in the post-COVID-19 phase, these 3 conditions, known to contribute to cognitive impairment, were slightly correlated with worse performance on the rapid screening tests. CONCLUSIONS In patients with mild COVID-19 and cognitive complaints, SDMT helped to confirm disturbances in the attention domain and processing speed.
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Affiliation(s)
- Mariana Beiral Hammerle
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Deborah Santos Sales
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Patricia Gomes Pinheiro
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Elisa Gutman Gouvea
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Pedro Ignacio F M de Almeida
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Clarissa de Araujo Davico
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Rayanne S Souza
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | | | - Denise Hack Nicaretta
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Regina Maria Papais Alvarenga
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Karina Lebeis Pires
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | | | - Claudia Cristina Ferreira Vasconcelos
- Departamento de Neurologia, Hospital Universitário Gaffrée e Guinle/HUGG Programa de Pós Graduação em Neurologia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
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Lee C, Park YH, Cho B. Leveraging network analysis to determine sex differences in factors associated with frailty among older adults living alone. BMC Geriatr 2023; 23:38. [PMID: 36670369 PMCID: PMC9862846 DOI: 10.1186/s12877-023-03755-y] [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: 07/14/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Frailty is a complex geriatric syndrome typically characterized by multiple underlying etiological factors. We determined the contributing factors, by sex, using a network analysis. METHODS The study sample consisted of a cross-sectional cohort of community-dwelling older adults aged ≥ 65 years living alone in a Korean city (N = 1,037). Frailty was assessed via the Korean Frailty Index. Participants were assessed for sociodemographic, health-related, mental and cognitive, and social characteristics. Mixed graphical models including all variables were estimated using the R-package mgm discretely by sex. We also used the Walktrap cluster algorithm to identify differences in the network structure in terms of connectivity around frailty between the sex groups for further insights. RESULTS In both the networks for males and females, frailty correlated most strongly with nutritional status, presence of complex chronic disease, and self-efficacy, and exhibited proximity to decreased sleep quality and loneliness. However, frailty showed an association with suicidal ideation and the number of falls per year only in males, whereas it showed an association with functional disabilities only in females. The overall network connectivity around frailty was stronger with dense interactions (more edges) in the network for females than for males. CONCLUSIONS The results signify the need for sex-group customized multi-domain assessments and interventions for the prevention and improvement of frailty among community-dwelling older adults.
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Affiliation(s)
- Chiyoung Lee
- grid.34477.330000000122986657School of Nursing & Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA 98011 USA
| | - Yeon-Hwan Park
- grid.31501.360000 0004 0470 5905College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080 ,grid.31501.360000 0004 0470 5905The Research Institute of Nursing Science, College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080
| | - Belong Cho
- grid.31501.360000 0004 0470 5905Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080 ,grid.412484.f0000 0001 0302 820XHealth Promotion Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080
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Kang MG, Choi JY, Yoo HJ, Park SY, Kim Y, Kim JY, Kim SW, Kim CH, Kim KI. Impact of malnutrition evaluated by the mini nutritional assessment on the prognosis of acute hospitalized older adults. Front Nutr 2023; 9:1046985. [PMID: 36687683 PMCID: PMC9849807 DOI: 10.3389/fnut.2022.1046985] [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: 09/17/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Background Malnutrition is prevalent among hospitalized older patients. Therefore, this study aimed to investigate the association between nutritional status [assessed using the Mini Nutritional Assessment (MNA) and serum albumin levels] and adverse outcomes in hospitalized older patients. We also aimed to compare the predictive utility of our findings. Methods This retrospective cohort study was conducted between January 2016 and June 2020. In total, 808 older patients (aged ≥ 65 years, mean age 82.8 ± 6.70 years, 45.9% male) admitted to the acute geriatric unit were included in our sample. Comprehensive geriatric assessments, including the MNA, were performed. Malnutrition and risk of malnutrition were defined as MNA < 17, albumin < 3.5 g/dL and 17 ≤ MNA ≤ 24, 3.5 g/dL ≤ albumin < 3.9 g/dL, respectively. The primary outcome was that patients could not be discharged to their own homes. The secondary outcomes were overall all-cause mortality, 3-month all-cause mortality, and incidence of geriatric syndrome, including delirium, falls, and newly developed or worsening pressure sores during hospitalization. Results Poor nutritional status was associated with older age; female sex; admission from the emergency room; high risk of pressure sores and falls; lower physical and cognitive function; higher depressive score; and lower serum albumin, protein, cholesterol, and hemoglobin levels. In the fully adjusted model, malnutrition assessed using the MNA predicted discharge to nursing homes or long-term care hospitals [odds ratio (OR) 5.822, 95% confidence interval (CI): 2.092-16.199, P = 0.001], geriatric syndrome (OR 2.069, 95% CI: 1.007-4.249, P = 0.048), and 3-month mortality (OR 3.519, 95% CI: 1.254-9.872, P = 0.017). However, malnutrition assessed using albumin levels could only predict 3-month mortality (OR 3.848, 95% CI: 1.465-10.105, P = 0.006). The MNA predicted 3-month mortality with higher precision than serum albumin levels (P = 0.034) when comparing the areas under the receiver operating characteristic curve. Conclusion Nutritional risk measured by the MNA was an independent predictor of various negative outcomes in hospitalized older patients. Poor nutritional status assessed by serum albumin levels, the most widely used biochemical marker, could predict mortality, but not the development of geriatric syndrome or discharge location reflecting functional status.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyun-Jung Yoo
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Si-Young Park
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yoonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji Yoon Kim
- Department of Nutrition Care Service, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sun-wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea,*Correspondence: Kwang-il Kim,
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15
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Lee J, Kim J, Park A, Hong RK, Ko M, Heo M, Kim H, Chung JY. Efficacy of a Mobile-Based Multidomain Intervention to Improve Cognitive Function and Health-Related Outcomes Among Older Korean Adults with Subjective Cognitive Decline. J Alzheimers Dis 2023; 93:1551-1562. [PMID: 37212108 PMCID: PMC10357136 DOI: 10.3233/jad-221299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is a self-reported experience of declining cognitive function showing normal performance in cognitive assessments, which is a known risk factor for dementia. Recent studies highlight the importance of nonpharmacological multidomain interventions that can target multiple risk factors of dementia in older adults. OBJECTIVE This study investigated the efficacy of the Silvia program, a mobile-based multidomain intervention, to improve cognitive function and health-related outcomes of older adults with SCD. We compare its effects to a conventional paper-based multidomain program on various health indicators related to risk factors of dementia. METHODS This prospective randomized controlled trial involved 77 older adults with SCD recruited from the Dementia Prevention and Management Center in Gwangju, South Korea during May to October 2022. Participants were randomly assigned to either the mobile- or paper-based group. Interventions were administered for 12 weeks, where pre- and post-assessments were conducted. RESULTS The K-RBANS total score did not show significant differences between groups. The mobile group showed better improvement in K-PRMQ scores and PSS scores than the paper group. Differences within groups showed that mobile-based interventions significantly improved K-PRMQ, STAI-X-1, PSS, and EQ-5D-5 L scores, while paper-based interventions significantly improved PSS, and EQ-5D-5 L scores. Patient adherence rate was 76.6%. CONCLUSION Overall, the Silvia program was effective for improving self-reported memory failures, stress, anxiety, and health-related quality of life in older adults with SCD. However, longer periods of administration for more than 12 weeks may be needed to achieve significant improvements in cognitive function by objective measures.
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Affiliation(s)
| | | | | | | | | | - Mina Heo
- Gwangju Alzheimer’s Disease and Related Dementia Cohort Research Center, Chosun University, Gwangju, South Korea
| | - Hoowon Kim
- Department of Neurology, School of Medicine, Chosun University, Chosun University Hospital, Gwangju, South Korea
| | - Ji Yeon Chung
- Department of Neurology, School of Medicine, Chosun University, Chosun University Hospital, Gwangju, South Korea
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16
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Zhao Y, Hughes M, Teaster PB. Exploring caregiving stressors and informal resources among Alzheimer's caregivers. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Choi JY, Lee JY, Shin J, Kim CO, Kim KJ, Hwang IG, Lee YG, Koh SJ, Hong S, Yoon SJ, Kang MG, Kim JW, Kim JH, Kim KI. COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort. BMJ Open 2022; 12:e060913. [PMID: 35914913 PMCID: PMC9345040 DOI: 10.1136/bmjopen-2022-060913] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea. METHODS AND ANALYSIS A multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published. TRIAL REGISTRATION NUMBER KCT0006270.
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Affiliation(s)
- Jung-Yeon Choi
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, Korea
| | - Jaeyong Shin
- Preventive Medicine and Institute of Health Service Research, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Chang Oh Kim
- Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Kwang Joon Kim
- Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - In Gyu Hwang
- Internal Medicine, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Yun-Gyoo Lee
- Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Jin Koh
- Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Soojung Hong
- Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Sol-Ji Yoon
- Internal Medicine, Kangwon National University Hospital, Chuncheon, Kangwon, Korea
| | - Min-Gu Kang
- Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwang-ju, Korea
| | - Jin Won Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Hyun Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Il Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Park HJ, Oh DW, Kang TW. Music-Based Sling Exercise for Cognition and Function of Older Adults with Dementia. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2091722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hyun-Ju Park
- Dr Ara Pilaes Lab, Seo-gu, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju_Gun, Jeollabuk-do, Republic of Korea
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Ang SF, Low SKM, Ng TP, Ang K, Yap PLK, Cheong CY, Lim Z, Tang WE, Moh AMC, Subramaniam T, Sum CF, Lim SC. Association of early-onset Type 2 diabetes with cognitive impairment is partially mediated by increased pulse pressure. J Diabetes Complications 2022; 36:108209. [PMID: 35660335 DOI: 10.1016/j.jdiacomp.2022.108209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) has been shown to be associated with cognitive decline and dementia. As earlier onset of diabetes implies a longer disease duration and an increased risk to complications, we sought to investigate the effect of T2DM onset on cognitive function of our patients. METHODS We administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to T2DM patients aged 45-85 from our SMART2D cohort. We assessed the association of the T2DM onset age (both continuous and stratified into 3 groups: early-onset ≤40 (n = 326), middle-aged onset 41-64 (n = 703) and late-onset ≥65 years old (n = 38)) and RBANS cognitive indices in 1067 patients. Potential mediation of this association by vascular compliance using mediation analysis was investigated. RESULTS T2DM onset associates significantly with RBANS total score. Patients with early T2DM onset have lower RBANS total score as compared to patients with middle-aged onset (β = -2.01, p = 0.0102) and those with late-onset (β = -5.80, p = 0.005). This association was partially mediated by pulse pressure index (25.8%), with indirect effect of 0.028 (Bootstrapped-CI: 0.008-0.047). CONCLUSIONS Association of early-onset T2DM with cognitive impairment is partly mediated by diminished vascular compliance. Appropriate screening and assessment of cognitive function is important for early intervention and management of cognitive impairment.
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Affiliation(s)
- Su Fen Ang
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Serena K M Low
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Philip L K Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Chin Yee Cheong
- Department of Geriatric Medicine, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics (NHGP), Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics (NHGP), Singapore
| | - Angela M C Moh
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre (AdMC), Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore; Diabetes Centre, Admiralty Medical Centre (AdMC), Singapore; Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore.
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20
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Kang TW, Lee NG, Park HJ. Relationship between aging-related pulmonary function, cognition, motor function, and activities of daily living in older adults with dementia. NeuroRehabilitation 2022; 50:425-432. [DOI: 10.3233/nre-210297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND: The aging process is related to cerebrovascular dysfunction and physiological changes, such as reduced pulmonary function. This ultimately induces cognitive impairment or dementia. OBJECTIVE: This study aimed to determine the relationship between aging-related pulmonary function, cognition, motor function, and activities of daily living (ADLs) in older adults with dementia. METHODS: This cross-sectional study included 69 older adults diagnosed with dementia. Aging-related pulmonary function and cognition were measured using a hand-held spirometer and the Korean version of the Mini-Mental State Examination (MMSE-K), respectively. To assess motor function and ADLs, the Berg Balance Scale (BBS), 10-meter walk test (10-MWT), 6-minute walk test (6-MWT), and modified Barthel index (MBI) were used to measure balance, walking speed, physical functional capacity (or walking tolerance), and ADLs, respectively. All data were analyzed using the Pearson’s product correlation coefficient (r). RESULTS: Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) as measures of aging-related pulmonary function correlated only with the 6-MWT (FVC: r = 0.483, p = 0.002; FEV1: r = 0.512, p = 0.001). In cognitive function, MMSE-K was associated with BBS (r = 0.283, p = 0.022) and MBI (r = 0.454, p = 0.000). Additionally, there were significant correlations (r = 0.425–0.671, p = 0.000) between all motor function and ADLs measures in older adults with dementia. CONCLUSIONS: Our findings demonstrated that aging-pulmonary function was related to a lower physical functional capacity, and hence, suggested that the reduced pulmonary function were unable to walk for longer distance in older adults with dementia.
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Affiliation(s)
- Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju, Republic of Korea
| | - Nam-Gi Lee
- Department of Physical Therapy, Kwangju Women’s University, Gwangju, Republic of Korea
| | - Hyun-Ju Park
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
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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.
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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.)
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Ilari S, Russo P, Proietti S, Vitiello L, Muscoli C, Tomino C, Milic M, Bonassi S. DNA damage in dementia: Evidence from patients affected by severe Chronic Obstructive Pulmonary Disease (COPD) and meta-analysis of most recent literature. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 878:503499. [PMID: 35649670 DOI: 10.1016/j.mrgentox.2022.503499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Oxidative stress that leads to oxidatively damaged DNA, plays a crucial role in chronic obstructive pulmonary disease (COPD) as well as in the onset of neurodegenerative diseases. The consequent genomic instability is the first neuropathological event found in the preclinical phase of cognitive impairment (CI), and the level of DNA damage is closely related to the degree of dementia. Since CI has been associated with COPD, we investigated the extent of DNA damage in isolated lymphocytes with the Comet assay, in a group of severe COPD patients with cognitive function measured by the Mini-Mental State Examination (MMSE). An increase in DNA damage was observed in COPD patients with dementia (MMSE≤24), although the difference was only borderline (22.4 ± 6.9 vs. 18.5 ± 7.1; p = 0.055). Meta-analysis, including the results of the current study, confirmed that patients with MMSE≤ 24 showed higher level of DNA damage than patients with MMSE> 24. We observed a significant reduction (p < 0.001) in the MMSE score in patients with cognitive decline in areas I (Orientation), III (Attention and Calculus) and V (Language). Only the temporal orientation category in area I was also associated with the level of oxidative damage, with higher levels of MDA (p < 0.01) and DNA damage (p < 0.03). Patients with the lowest temporal orientation score had a 12% higher mean DNA damage (Odds Ratio=1.12; 95% confidence interval (95%CI) 1.01-1.25; p < 0.036). Temporal orientation is a component of most screening tests for the diagnosis of cognitive impairment, on the bases that disorientation is a common factor in dementia. Present results show that each component of cognitive decline can have a different etiopathogenesis and clinical relevance. A more thorough assessment of the cognitive functions of patients starting COPD rehabilitation, together with the assessment of DNA and the level of oxidative stress, can provide essential information to adapt and customize the rehabilitation project.
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Affiliation(s)
- Sara Ilari
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University "Magna Graecia" of Catanzaro, 88201 Catanzaro, Italy
| | - Patrizia Russo
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy.
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy
| | - Laura Vitiello
- Laboratory of Flow Cytometry, IRCCS San Raffaele Roma, 00166 Rome, Italy
| | - Carolina Muscoli
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University "Magna Graecia" of Catanzaro, 88201 Catanzaro, Italy
| | - Carlo Tomino
- Scientific Direction, IRCCS San Raffaele Roma, 00166 Rome, Italy
| | - Mirta Milic
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia
| | - Stefano Bonassi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy
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Ang SF, Low S, Ng TP, Tan CS, Ang K, Lim Z, Tang WE, Subramaniam T, Sum CF, Lim SC. Ethnic-Specific Type 2 Diabetes Risk Factor PAX4 R192H Is Associated with Attention-Specific Cognitive Impairment in Chinese with Type 2 Diabetes. J Alzheimers Dis 2022; 88:241-249. [DOI: 10.3233/jad-220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Type 2 diabetes mellitus (T2DM) has been shown to increase the risks of cognitive decline and dementia. Paired box gene 4 (PAX4), a transcription factor for beta cell development and function, has recently been implicated in pathways intersecting Alzheimer’s disease and T2DM. Objective: In this report, we evaluated the association of the ethnic-specific PAX4 R192H variant, a T2DM risk factor for East Asians which contributes to earlier diabetes onset, and cognitive function of Chinese T2DM patients. Methods: 590 Chinese patients aged 45–86 from the SMART2D study were genotyped for PAX4 R192H variation using Illumina OmniExpress-24 Array. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) which had been validated in the Singapore population was administered to assess five cognitive domains: immediate memory, visuospatial/constructional, language, attention, and delayed memory. Multiple linear regression was used to assess the association of the R192H risk allele and cognitive domains. Results: Patients with two PAX4 R192H risk alleles showed significantly lower attention index score (β= –8.46, 95% CI [–13.71, –3.21], p = 0.002) than patients with wild-type alleles after adjusting for age, gender, diabetes onset age, HbA1c, body-mass index, renal function, lipid profiles, systolic blood pressure, metformin usage, smoking history, education level, Geriatric Depression Scale score, and presence of APOE ɛ4 allele. Conclusion: Ethnic-specific R192H variation in PAX4 is associated with attention-specific cognitive impairment in Chinese with T2DM. Pending further validation studies, determining PAX4 R192H genotype may be helpful for early risk assessment of early-onset T2DM and cognitive impairment to improve diabetes care.
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Affiliation(s)
- Su Fen Ang
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, Gerontology Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clara S.H. Tan
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics (NHGP), Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics (NHGP), Singapore
| | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre (AdMC) c/o Khoo Teck Puat Hospital, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital (KTPH), Singapore
- Diabetes Centre, Admiralty Medical Centre (AdMC) c/o Khoo Teck Puat Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
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Wang X, Bai Z, He Y, Wu Q. Relationship between blood amyloid A and resting magnetic resonance functional brain connections in patients with obstructive sleep apnea-hypopnea syndrome. Sleep Breath 2022; 27:477-485. [PMID: 35503197 DOI: 10.1007/s11325-022-02613-2] [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] [Received: 08/25/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the relationship between serum amyloid A (SAA) concentrations in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and their magnetic resonance imaging (MRI) of resting brain function. METHODS Male patients with OSAHS were enrolled from January to June 2019 in Suzhou Ninth People's Hospital Affiliated to Soochow University, and nineteen healthy male volunteers were selected as the normal control group. The patients with OSAHS were divided into mild, moderate, and severe groups according to their apnea-hypopnea index (AHI). Early in the morning after the polysomnography (PSG), blood samples were collected and serum levels of serum amyloid A (SAA) were measured by enzyme-linked immunosorbent assay. All subjects were scored by the Auditory Verbal Learning Test (AVLT) scale. Resting brain function images of healthy male volunteers and patients in the severe group were collected by 3.0 T magnetic resonance scanner. SPSS25.0 software was used for statistical analysis. RESULTS The SAA of the OSAHS group (n = 43) were higher than those of control group (n = 19). The scores of AVLT-immediate and AVLT-delay in the severe OSAHS group were lower than those in the control group (P < 0.05), and it was negatively correlated with SAA. In the severe OSAHS group, the rest state Function Connection (rsFC) in temporal lobe, marginal lobe, and frontal lobe was lower than that in the control group (P < 0.05) and was significantly negatively correlated with SAA. The rsFC in bilateral parietal lobes was higher than that in the control group (P < 0.05), was significantly positively correlated with SAA, and was negatively correlated with AVLT-delay. CONCLUSIONS The significant increase in SAA concentration in patients with OSAHS correlated with brain rsFC intensity, providing a reference role for the diagnosis, treatment, and prognosis of cognitive dysfunction in patients with OSAHS.
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Affiliation(s)
- Xiang Wang
- Department of Respiratory, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou, 215200, China
| | - Zhiyu Bai
- Department of Respiratory, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou, 215200, China
| | - Yaqing He
- Department of Respiratory, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou, 215200, China
| | - Qiaozhen Wu
- Department of Respiratory, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou, 215200, China.
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Tang X, Zhao S, Zhang M, Zhou J, Wang Y, He B. Effects of Disability Severity on the Family Burden of Home-Dwelling Uygur and Kazakh Aged in Rural Western China: Family Function as a Mediator. J Transcult Nurs 2022; 33:511-520. [PMID: 35481759 DOI: 10.1177/10436596221090271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Caring for the disabled elderly puts heavy burdens on their families. This study aimed to explore family function (FF) as a mediator in the relationship between disability severity (DS) and family burden (FB) of the Uygur and Kazakh home-dwelling disabled elderly cared for by informal caregivers in China. METHOD A cross-sectional design with multistage sampling was used to recruit 431 families with Uygur and Kazakh disabled elderly in Bortala, Xinjiang, China. Data were collected using the Activities of Daily Living Scale, Family Burden Interview Schedule, and Family Adaptation, Partnership, Growth, Affection, and Resolve Index Scale and then analyzed using hierarchical regression. RESULTS FF had a partial mediating effect on the relationship between DS and FB (β = 0.131; 95% confidence interval [CI] = [0.074, 0.197]; p < .01); the effective rate was 41.46%. DISCUSSION Multidisciplinary care teams should implement targeted interventions to improve FF of the disabled elderly to alleviate FB.
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Affiliation(s)
| | - Shuhua Zhao
- Medical College of Shihezi University, China
| | | | - Jia Zhou
- Medical College of Shihezi University, China
| | - Yuhuan Wang
- Medical College of Shihezi University, China
| | - Bin He
- The Third Affiliated Hospital of Shihezi University Medical College, China
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26
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LaRose BS, Wiese LK, de Los Ángeles Ortega Hernández M. Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia Through the Use of Therapeutic Interactive Pets. Issues Ment Health Nurs 2022; 43:330-343. [PMID: 34644221 PMCID: PMC9233180 DOI: 10.1080/01612840.2021.1979142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the US, one in three older adults die with Alzheimer's disease or a related dementia. Currently, there is no cure for the rapidly growing burden, but there are pharmacological treatments to manage the symptoms, which lead to numerous side effects. We tested the effectiveness of a non-pharmacological therapeutic interactive pet (TIP) in improving mood/behavior and cognition among 12 persons with mild-moderate dementia attending an adult day center (ADC) over 12 visits. Mood/behavioral symptoms were assessed using the Alzheimer's Disease and Related Dementias Mood Scale (AD-RD), Observed Emotion Rating Scale (OERS), and the Cornell Scale for Depression in Dementia (CSDD). Cognition was assessed via Mini Mental State Examination (MMSE). Paired-sample t-tests, Pearson's correlation, repeated measures t-test, and a post-intervention qualitative inquiry were used to examine the significance of TIP. As a result, all mood scores improved over time, with two showing significance: OERS (M = 73.7/SD = 9.6); conditions t(11) = -19.18, p<.001, and CSDD (M = 8.8/SD = 7.2); conditions t(11) = 4.12, p =.002. Over half (0.67%) scored higher on the MMSE post-test than the pretest: M = 10.7(SD = 5.5) and M = 12.2(SD = 7.1), respectively. Participants stroked and spoke often to their pets. Several family members reported participants sleeping with their pet following the program's conclusion. TIP proved to be a safe alternative method to improving mood/behavior in persons with dementia attending an ADC. MMSE scores also improved, although confounding factors such as inter-rater reliability and a potential endorphin effect may have impacted scores. Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia through the Use of Therapeutic Interactive Pets.
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Affiliation(s)
- Bryanna Streit LaRose
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - María de Los Ángeles Ortega Hernández
- Louis and Anne Green Memory and Wellness Center, Alzheimer's Disease Initiative, Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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27
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Wang X, Li F, Gao Q, Jiang Z, Abudusaimaiti X, Yao J, Zhu H. Evaluation of the Accuracy of Cognitive Screening Tests in Detecting Dementia Associated with Alzheimer's Disease: A Hierarchical Bayesian Latent Class Meta-Analysis. J Alzheimers Dis 2022; 87:285-304. [PMID: 35275533 DOI: 10.3233/jad-215394] [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: 01/16/2023]
Abstract
BACKGROUND Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) are neuropsychological tests commonly used by physicians for screening cognitive dysfunction of Alzheimer's disease (AD). Due to different imperfect reference standards, the performance of MoCA and MMSE do not reach consensus. It is necessary to evaluate the consistence and differentiation of MoCA and MMSE in the absence of a gold standard for AD. OBJECTIVE We aimed to assess the accuracy of MoCA and MMSE in screening AD without a gold standard reference test. METHODS Studies were identified from PubMed, Web of Science, CNKI, Chinese Wanfang Database, China Science and Technology Journal Database, and Cochrane Library. Our search was limited to studies published in English and Chinese before August 2021. A hierarchical Bayesian latent class model was performed in meta-analysis when the gold standard was absent. RESULTS A total of 67 studies comprising 5,554 individuals evaluated for MoCA and 76,862 for MMSE were included in this meta-analysis. The pooled sensitivity was 0.934 (95% CI 0.906 to 0.954) for MoCA and 0.883 (95% CI 0.859 to 0.903) for MMSE, while the pooled specificity was 0.899 (95% CI 0.859 to 0.928) for MoCA and 0.903 (95% CI 0.879 to 0.923) for MMSE. MoCA was useful to rule out dementia associated with AD with lower negative likelihood ratio (LR-) (0.074, 95% CI 0.051 to 0.108). MoCA showed better performance with higher diagnostic odds ratio (DOR) (124.903, 95% CI 67.459 to 231.260). CONCLUSION MoCA had better performance than MMSE in screening dementia associated with AD from patients with mild cognitive impairment or healthy controls.
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Affiliation(s)
- Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Fengjie Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Zhen Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Xiayidanmu Abudusaimaiti
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Jiangyue Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
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Moriichi K, Fujiya M, Ro T, Ota T, Nishimiya H, Kodama M, Yoshida N, Hattori Y, Hosokawa T, Hishiyama H, Kunimoto M, Hayashi H, Hirokawa H, Yoshida A. A novel telerehabilitation with an educational program for caregivers using telelecture is feasible for fall prevention in elderly people: A case series. Medicine (Baltimore) 2022; 101:e27451. [PMID: 35147084 PMCID: PMC8830826 DOI: 10.1097/md.0000000000027451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/20/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The importance of fall prevention rehabilitations has been well recognized. Recently telerehabilitation was developed, however, there have been no reports on telerehabilitation with direct support from specialists for fall prevention among the elderly. We herein reported telerehabilitation by caregivers educated by our novel educational program. METHODS Caregivers were educated with our educational program using a telelecture system and supported telerehabilitation following instructions from rehabilitation specialists in our university using the telemedicine system every two to four weeks for three months. Caregivers were assessed with our original questionnaire before and after the telelecture. Participants were assessed by the Berg Balance Scale (BBS), Timed Up & Go test (TUG test), Hand-held dynamometer (HHD) and Mini-Mental State Examination (MMSE) before and after telerehabilitation. Wilcoxon's signed-rank test was used for the statistical analyses. A value of P<.05 was considered statistically significant. RESULTS Nine elderly people were enrolled. The mean age was 84.7 (78-90) years old and the sex ratio was 1:8 (males:females). The average number of telerehabilitation sessions was 4.7. The average score of nineteen caregivers before the lecture was 15.3, while that after the lecture was 18.3. Caregivers' understanding was significantly increased after the telelecture (P<.001). No adverse events occurred during the study period. The median values of the BBSs, TUG test, right and left HHD and MMSE before and after 3 months' telerehabilitation were 43 (95% confidence interval [CI]: 40.10, 49.01) and 49 (95% CI: 41.75, 50.91), 17.89 (95% CI: 15.51, 23.66) and 18.53 (95% CI: 14.56, 25.67), 7.95 (95% CI: 4.38, 10.14) and 11.55 (95% CI: 7.06, 13.55), 9.85 (95% CI: 6.79, 12.59) and 13.20 (95% CI: 7.96, 14.42), and 19 (95% CI: 12.34, 21.66) and 16 (95% CI: 10.81, 21.00), respectively. Although approximately half of the participants showed improvement in the BBS, TUG test, right and left HHD and MMSE, no significant changes were observed (P=.7239, P=.3446, P=.1023, P=.3538 and P=.8253, respectively). CONCLUSIONS Our telerehabilitation program exhibited significant effects in elderly people and improved the degree of understanding concerning rehabilitation among caregivers in facilities for elderly people.
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Affiliation(s)
- Kentaro Moriichi
- Joint Research Department of Telemedicine and Telecare, Asahikawa Medical University, Asahikawa, Japan
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Mikihiro Fujiya
- Joint Research Department of Telemedicine and Telecare, Asahikawa Medical University, Asahikawa, Japan
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takanori Ro
- Rehabilitation Unit, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Tetsuo Ota
- Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Hitomi Nishimiya
- Joint Research Department of Telemedicine and Telecare, Asahikawa Medical University, Asahikawa, Japan
| | - Mariko Kodama
- Department of Nursing, Asahikawa Medical University, Asahikawa, Japan
| | - Nana Yoshida
- Joint Research Department of Telemedicine and Telecare, Asahikawa Medical University, Asahikawa, Japan
| | - Yukari Hattori
- Department of Nursing, Asahikawa Medical University, Asahikawa, Japan
| | - Tetsuya Hosokawa
- Joint Research Department of Telemedicine and Telecare, Asahikawa Medical University, Asahikawa, Japan
| | | | | | - Hiroki Hayashi
- Telemedicine Center, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Hirokawa
- Management Planning Department, Asahikawa Medical University Hospital, Asahikawa, Japan
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Lee B, Lee T, Jeon H, Lee S, Kim K, Cho W, Hwang J, Chae YW, Jung JM, Kang HJ, Kim NH, Shin C, Jang J. Synergy through Integration of Wearable EEG and Virtual Reality for Mild Cognitive Impairment and Mild Dementia Screening. IEEE J Biomed Health Inform 2022; 26:2909-2919. [PMID: 35104235 DOI: 10.1109/jbhi.2022.3147847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Virtual reality (VR) technologies have shown promising potential in the early diagnosis of dementia by enabling accessible and regular assessment. However, previous VR studies were restricted to the analysis of behavioral responses, so information about degenerated brain dynamics could not be directly acquired. To address this issue, we provide a cognitive impairment (CI) screening tool based on a wearable EEG device integrated into a VR platform. Subjects were asked to use a hardware setup consisting of a frontal six-channel EEG device mounted on a VR device and to perform four cognitive tasks in VR. Behavioral response profiles and EEG features were extracted during the tasks, and classifiers were trained on extracted features to differentiate subjects with CI from healthy controls (HCs). Notably, the performance of the patient classification consistently improved when EEG characteristics measured during cognitive tasks were additionally included in feature attributes than when only the task scores or resting-state EEG features were used, suggesting that our protocol provides discriminative information for screening. These results propose that the integration of EEG devices into a VR framework could emerge as a powerful and synergistic strategy for constructing an easily accessible EEG-based dementia screening tool.
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30
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Lee YC, Lee SC, Chiu EC. Practice effect and test-retest reliability of the Mini-Mental State Examination-2 in people with dementia. BMC Geriatr 2022; 22:67. [PMID: 35062877 PMCID: PMC8780811 DOI: 10.1186/s12877-021-02732-7] [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: 08/20/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background The Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia. Methods One hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a paired t-test and Cohen’s d. The test-retest reliability was examined using the intraclass correlation coefficient (ICC). Results For the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061–1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106–1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen’s d of all three versions’ total scores and subtests were 0.00–0.20 and 0.00–0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60–0.93 and 0.56–0.93, respectively. Conclusion Our results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02732-7.
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Lippke S, Ratz T, Keller FM, Juljugin D, Peters M, Pischke C, Voelcker-Rehage C. Mitigating feelings of loneliness and depression by means of web-based or print-based physical activity interventions: Pooled analysis of two community-based intervention trials (Preprint). JMIR Aging 2022; 5:e36515. [PMID: 35943790 PMCID: PMC9399846 DOI: 10.2196/36515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/20/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09). Conclusions Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID) RR2-10.2196/15168
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Affiliation(s)
- Sonia Lippke
- Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Tiara Ratz
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | | | | | - Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, Muenster, Germany
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Pitrou I, Vasiliadis HM, Hudon C. Body mass index and cognitive decline among community-living older adults: the modifying effect of physical activity. Eur Rev Aging Phys Act 2022; 19:3. [PMID: 35033022 PMCID: PMC8903608 DOI: 10.1186/s11556-022-00284-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To examine the associations between BMI categories and subsequent 3-year cognitive decline among older adults, and to test whether physical activity modifies the associations. Methods Study sample included n = 1028 cognitively unimpaired older adults participating in the Étude sur la Santé des Aînés (ESA)-Services longitudinal study and followed 3 years later. Cognitive decline was defined as a decrease of > 3 points in MMSE scores between baseline and follow-up. BMI categories (normal weight (reference), underweight, overweight, obese) were derived from self-reported weight and height. Moderate to vigorous physical activity of ≥20 min (# of times per week) was self-reported. The presence of chronic disorders was ascertained from administrative and self-reported data. Logistic regression analyses were used to study the risk of cognitive decline associated with BMI categories stratified by weekly physical activity (≥140 min), the presence of metabolic, cardiovascular and anxio-depressive disorders. Results In the overall sample, there was no evidence that underweight, overweight, or obesity, as compared to normal weight, was associated with cognitive decline, after adjusting for sociodemographic, lifestyle factors, and comorbidities. Individuals with overweight reporting high physical activity had lower odds of cognitive decline (OR = 0.25, 95% CI = 0.07–0.89), whereas no association was observed in individuals with overweight reporting low physical activity (OR = 0.85, 95% CI = 0.41–1.75). Among participants with metabolic and cardiovascular disorders, individuals with overweight reporting high physical activity had lower odds of cognitive decline (OR = 0.09, 95% CI = 0.01–0.59 and OR = 0.03, 95% CI = 0.01–0.92 respectively), whereas no association was observed in those with low physical activity. Conclusion Physical activity modifies the association between overweight and cognitive decline in older adults overall, as in those with metabolic and cardiovascular disorders. Results highlight the importance of promoting and encouraging regular physical activity in older adults with overweight as prevention against cognitive decline. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00284-2.
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Affiliation(s)
- Isabelle Pitrou
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Charles-Le Moyne Research Center (CRCLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Charles-Le Moyne Research Center (CRCLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Carol Hudon
- School of Psychology, Université Laval, CERVO Brain Research Center, 2601 chemin de la Canardière (F-2400), Québec, QC, G1J 2G3, Canada
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Liu CR, Liou YM, Jou JH. Pilot Study of the Effects of Bright Ambient Therapy on Dementia Symptoms and Cognitive Function. Front Psychol 2022; 12:782160. [PMID: 35002870 PMCID: PMC8740310 DOI: 10.3389/fpsyg.2021.782160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Light therapy potentially improves dementia symptoms. In this study, we examined the effects of bright light therapy on neuropsychiatric behaviors and cognitive function. Thirty-five participants were assigned to either the experimental or comparison group. The experimental group was exposed to bright light at 2,500 lux, and the comparison group was exposed to 114–307 lux. The instruments used were the Neuropsychiatric Inventory and the Mini-Mental State Examination. The experimental group showed a significant improvement in Neuropsychiatric Inventory scores; these scores, which were calculated using generalized estimating equations with medication (benzodiazepines) as a covariate, were reduced by 65% (P < 0.001) and 78% (P = 0.001) by the 5th and 9th weeks, respectively. At the same time, Mini-Mental State Examination scores increased by 19% (P = 0.007) and 28% (P = 0.04), respectively. However, differences in outcomes between the 5th and 9th weeks were not significant. A 4-week regimen of bright light therapy was the most effective, with higher adherence and acceptability.
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Affiliation(s)
- Chuen-Ru Liu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Psychiatric Nurse of City Hospital, Songde Branch, Taipei, Taiwan
| | - Yiing Mei Liou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jwo-Huei Jou
- Department of Materials Science and Engineering, National Tsing Hua University, Hsinchu, Taiwan
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The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study. J Aging Phys Act 2022; 31:303-310. [PMID: 36216335 DOI: 10.1123/japa.2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.
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Dun Y, Liu C, Ripley-Gonzalez JW, Liu P, Zhou N, Gong X, You B, Du Y, Liu J, Li B, Liu S. Six-month outcomes and effect of pulmonary rehabilitation among patients hospitalized with COVID-19: a retrospective cohort study. Ann Med 2021; 53:2099-2109. [PMID: 34766857 PMCID: PMC8592619 DOI: 10.1080/07853890.2021.2001043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients appear to maintain sequelae post-coronavirus disease 2019 (COVID-19) affecting daily life and physical health. We investigated the changes in and the effects of pulmonary rehabilitation (PR) on exercise capacity and immunology six months after COVID-19 hospitalization. METHODS This retrospective cohort reviewed 233 COVID-19 patients admitted from 17 January 2020 to 29 February 2020. Ninety-eight patients who completed 2-week and 6-month follow-ups and tests were included. Among 98 patients, 27 completed at least five sessions of PR at the First Hospital of Changsha, China, during the 6-month convalescence were allocated to the PR group; the reminder who had not performed any PR were assigned to the control group. The primary outcome was the change in six-minute walk distance (6-MWD) between the 2-week and 6-month follow-ups, which was assessed via analysis of covariance with a covariate of propensity score that adjusted for the potential confounders. Secondary outcomes were the changes in 6-MWD, SARS-CoV-2 immunoglobulins, T-lymphocytes and blood chemistry, which were evaluated via paired tests. RESULTS Participants' ages ranged from 19 to 84 years (M = 47, standard deviation (SD)=15) 45.9% identified as male. During the 6-month convalescence, 6-MWD increased 27.0%, with a mean [95% CI] of 113 [92-134] m (p < .001). SARS-CoV-2 IgG and IgM decreased 33.3% (p = .002) and 43.8% (p = .009), CD4+ T cells increased 7.9% (p = .04), and the majority of blood chemistry significantly changed. The patients in the PR group acquired a greater increase in 6-MWD than those in control (unadjusted, 194 [167-221] m, p < .001; adjusted, 123 [68-181] m, p < .001), dose-responsiveness of PR on 6-MWD was observed (p < .001). No differences in immunity variables and blood chemistry were observed between groups. CONCLUSIONS These findings suggest PR may be a strategy to promote the improvement of exercise capacity after COVID-19.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chao Liu
- The First Hospital of Changsha, Changsha, China
| | - Jeffrey W. Ripley-Gonzalez
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Ping Liu
- The First Hospital of Changsha, Changsha, China
| | - Nanjiang Zhou
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Xun Gong
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Baiyang You
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Yang Du
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - Jiyang Liu
- The First Hospital of Changsha, Changsha, China
| | - Bo Li
- The First Hospital of Changsha, Changsha, China
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
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Jeong SA, Park C, Oh SJ, You JSH. Multiple relationships between cognition-motor impairment and activity-based clinical outcome measures in 218 hemiplegic stroke patients. NeuroRehabilitation 2021; 49:553-563. [PMID: 34776427 DOI: 10.3233/nre-210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization has developed the International Classification of Functions, Disabilities, and Health (ICF) model providing a theoretical basis for physical therapy diagnosis and interventions related to health conditions. However, the multiple relationship between body structure/function and activity domain variables is unknown on the cognition, spasticity, trunk and lower extremity recovery of the sensorimotor function and activity. OBJECTIVE Our study aimed to determine the relationship between body structure/functions and body activity domain variables in adults with stroke. METHODS A total of 218 hemiplegic survivors (102 females, mean age 64.98±13.53) were recruited from the Chungdam Hospital Center for our retrospective study. We used Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment for lower extremity (FMA-LE), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Trunk Impairment Scale (TIS) as clinical outcome measures. The Pearson correlation coefficient was used to determine the multiple relationships among the variables at P < 0.05. RESULTS The correlations between body structure/function domain (MMSE, FMA-LE, MAS) and activity domain variables (BBS, MBI, and TIS) were significant, rending from pre -intervention r = -0.216 to 0.766 and post-intervention r = -0.213 to 0.776, P < 0.05, except for MMSE and MAS. CONCLUSIONS Establishing a significant difference between body structure/functions and activity domain variables in our research implies important multiple relationships between cognitive function, lower extremity function, lower extremity spasticity, and balance, and performance of ADL and trunk control coordination after stroke.
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Affiliation(s)
- Seon Ah Jeong
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Seung Jun Oh
- Department of Physical Therapy, College of Nursing and Health, Kyungwoon University, Gumi, Republic of Korea
| | - Joshua Sung H You
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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Liu CR, Liou YM, Jou JH. Ambient bright lighting in the morning improves sleep disturbances of older adults with dementia. Sleep Med 2021; 89:1-9. [PMID: 34844127 DOI: 10.1016/j.sleep.2021.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ambient light therapies are potentially effective in improving sleep disturbances and circadian rhythms. This study created a new lighting intervention model for elderly patients with dementia. It is hypothesized that exposure to bright ambient light in the morning is more effective than general lighting in improving sleep disturbances and circadian rhythms. METHODS A single-blind longitudinal-group experimental design was employed. The dementia participants came from the community and nursing homes. Those in the experimental group were exposed to ambient light at 2500 lux, and those in the comparison group were exposed to 114-307 lux. The corresponding sleep disturbances and circadian rhythms were determined using an accelerometer (XA-5). A longitudinal experimental design was adopted to observe the time to an effective response. RESULTS The covariates of benzodiazepine use and total activity during the day were analyzed using generalized estimating equations. The experimental group showed significant sleep efficiency improvement, with mean increases of 41.9% (P < 0.001) and 31.7% (P = 0.002), sleep time increases of 141 min (P = 0.001) and 135 min (P = 0.008), awakening time decreases of 116 min (P = 0.001) and 108 min (P = 0.002), and sleep onset advancements of 60-84 min/sleep offset delays of 57-79 min upon the fifth and ninth week, respectively. A 4-week bright ambient light intervention was the most effective. CONCLUSIONS This study found that bright ambient light in the morning is beneficial for improving sleep disturbances and was driven by stabilizing circadian rhythms.
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Affiliation(s)
- Chuen-Ru Liu
- School of Nursing, National Yang Ming Chiao Tung University, (School of Nursing, National Yang-Ming University), Psychiatric Nurse of City Hospital, Songde Branch, Taiwan
| | - Yiing Mei Liou
- Institute of Community Health Care, School of Nursing, National Yang Ming Chiao Tung University (School of Nursing, National Yang-Ming University), President of Lambda Beta-at-Large Chapter, The Honor Society of Nursing, Sigma Theta Tau International, Taiwan.
| | - Jwo-Huei Jou
- Department of Materials Science and Engineering, National Tsing Hua University, Taiwan
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Fricke M, Kruse A, Schwenk M, Jansen CP, Muehlbauer T, Gramann K, Wollesen B. Requirements of a cognitive-motor spatial orientation training for nursing home residents: an iterative feasibility study. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [PMCID: PMC8515784 DOI: 10.1007/s12662-021-00762-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A sedentary lifestyle in nursing home residents is often accompanied with reduced life space mobility and in turn affects satisfaction with life. One of the reasons for this may be limited ability to find one’s way around the care facility and its environment. However, spatial orientation exercises might reduce these problems if they are integrated into an adequate cognitive-motor training. Therefore, we integrated six novel and target group-specific spatial orientation exercises into an established multicomponent cognitive-motor group training for nursing home residents and evaluated its feasibility. Forty nursing home residents (mean age: 87.3 ± 7 years) participated in the spatial orientation cognitive motor training (45–60 min, twice a week over a period of 12 weeks). The main outcomes included the feasibility criteria (adherence, completion time, acceptance, instructions, motor performance, materials/set up, complexity) and first measurements of mobility and satisfaction with life (SPPB [Short Physical Performance Battery], SWLS [Satisfaction with Life Scale]). Adherence increased over time. The increase was associated with the adaptions and modifications of the spatial orientation exercises that were made to meet the participants’ requirements. A positive trend was discerned for mobility and life satisfaction, comparing pre- and posttraining data. In summary, the feasibility analysis revealed that future interventions should consider that (a) instructions of demanding spatial tasks should be accompanied by an example task, (b) trainers should be encouraged to adjust task complexity and materials on an individual basis, (c) acceptance of the training should be promoted among nursing staff, and (d) surroundings with as little disturbance as possible should be selected for training.
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Affiliation(s)
- Madeleine Fricke
- Department of Biological Psychology and Neuroergonomics, TU Berlin, Fasanenstr. 1, 10623 Berlin, Germany
| | - Adele Kruse
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Michael Schwenk
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Carl-Philipp Jansen
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| | - Klaus Gramann
- Department of Biological Psychology and Neuroergonomics, TU Berlin, Fasanenstr. 1, 10623 Berlin, Germany
| | - Bettina Wollesen
- Department of Biological Psychology and Neuroergonomics, TU Berlin, Fasanenstr. 1, 10623 Berlin, Germany
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
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Martínez-Arnau FM, Prieto-Contreras L, Pérez-Ros P. Factors associated with fear of falling among frail older adults. Geriatr Nurs 2021; 42:1035-1041. [PMID: 34256153 DOI: 10.1016/j.gerinurse.2021.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.
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Affiliation(s)
- Francisco M Martínez-Arnau
- Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain; Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| | - Lucía Prieto-Contreras
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Espartero 7, 46007, Valencia, Spain
| | - Pilar Pérez-Ros
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain; Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Meléndez y Pelayo s/n, 46010 Valencia, Spain.
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Vanderlinden JA, Holden RM, Scott SH, Boyd JG. Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study. Can J Kidney Health Dis 2021; 8:20543581211010654. [PMID: 34017595 PMCID: PMC8114747 DOI: 10.1177/20543581211010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown. Objective To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters. Design Prospective observational study. Setting Single-center tertiary academic teaching hospital in Ontario, Canada. Participants Six patients initiating HD were enrolled in the study. Methods Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm. Results Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis. Limitation This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters. Conclusions Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated. Trial Registration Due to the feasibility nature of this study, no trial registration was performed.
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Affiliation(s)
| | - Rachel Mary Holden
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Stephen Harold Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - John Gordon Boyd
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
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Lee B, Lee T, Jeon H, Lee S, Kim K, Cho W, Hwang J, Chae YW, Jung JM, Kang HJ, Kim NH, Shin C, Jang J. Synergy through Integration of Wearable EEG and Virtual Reality for Mild Cognitive Impairment and Mild Dementia Screening: Protocol Design and Feasibility Study (Preprint). JMIR Form Res 2021. [DOI: 10.2196/30028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Doan DNT, Ku B, Choi J, Oh M, Kim K, Cha W, Kim JU. Predicting Dementia With Prefrontal Electroencephalography and Event-Related Potential. Front Aging Neurosci 2021; 13:659817. [PMID: 33927610 PMCID: PMC8077968 DOI: 10.3389/fnagi.2021.659817] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine whether prefrontal electroencephalography (EEG) can be used for screening dementia. Methods: We estimated the global cognitive decline using the results of Mini-Mental Status Examination (MMSE), measurements of brain activity from resting-state EEG, responses elicited by auditory stimulation [sensory event-related potential (ERP)], and selective attention tasks (selective-attention ERP) from 122 elderly participants (dementia, 35; control, 87). We investigated that the association between MMSE and each EEG/ERP variable by using Pearson’s correlation coefficient and performing univariate linear regression analysis. Kernel density estimation was used to examine the distribution of each EEG/ERP variable in the dementia and non-dementia groups. Both Univariate and multiple logistic regression analyses with the estimated odds ratios were conducted to assess the associations between the EEG/ERP variables and dementia prevalence. To develop the predictive models, five-fold cross-validation was applied to multiple classification algorithms. Results: Most prefrontal EEG/ERP variables, previously known to be associated with cognitive decline, show correlations with the MMSE score (strongest correlation has |r| = 0.68). Although variables such as the frontal asymmetry of the resting-state EEG are not well correlated with the MMSE score, they indicate risk factors for dementia. The selective-attention ERP and resting-state EEG variables outperform the MMSE scores in dementia prediction (areas under the receiver operating characteristic curve of 0.891, 0.824, and 0.803, respectively). In addition, combining EEG/ERP variables and MMSE scores improves the model predictive performance, whereas adding demographic risk factors do not improve the prediction accuracy. Conclusion: Prefrontal EEG markers outperform MMSE scores in predicting dementia, and additional prediction accuracy is expected when combining them with MMSE scores. Significance: Prefrontal EEG is effective for screening dementia when used independently or in combination with MMSE.
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Affiliation(s)
- Dieu Ni Thi Doan
- Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Convergence Medicine, University of Science and Technology, Daejeon, South Korea
| | - Boncho Ku
- Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jungmi Choi
- Human Anti-Aging Standards Research Institute, Uiryeong-gun, South Korea
| | - Miae Oh
- Korea Institute for Health and Social Affairs, Sejong, South Korea
| | - Kahye Kim
- Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Wonseok Cha
- Human Anti-Aging Standards Research Institute, Uiryeong-gun, South Korea
| | - Jaeuk U Kim
- Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Convergence Medicine, University of Science and Technology, Daejeon, South Korea
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Park HJ, Lee NG, Kang TW. Fall-related cognition, motor function, functional ability, and depression measures in older adults with dementia. NeuroRehabilitation 2021; 47:487-494. [PMID: 33164957 DOI: 10.3233/nre-203249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As the severity of dementia progresses over time, cognition and motor functions such as muscle strength, balance, and gait are disturbed, and they eventually increase the risk of fall in patients with dementia. OBJECTIVE To determine the relationship between the fall risk and cognition, motor function, functional ability, and depression in older adults with dementia. METHODS Seventy-four older adults diagnosed with dementia were recruited. Clinical measurements included the Fall Risk Scale by Huh (FSH), Korean version of the Mini-Mental State Examination (MMSE-K), hand grip strength (HGS), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test (10-MWT), Korean version of the Modified Barthel Index (MBI-K), and the Geriatric Depression Scale (GDS). RESUTLS The MMSE-K was significantly correlated with the FSH, HGS, and the MBI-K, and FSH was significantly correlated with all of the other outcome measures. In particular, the MMSE-K, HGS, POMA, and the MBI-K were negatively correlated with fall history among the FHS sub-items. Additionally, the MMSE sub-item, attention/concentration was associated with the FSH, HGS, POMA, and the MBI-K. CONCLUSIONS These findings suggest that falling is significantly related to impaired cognition, reduced muscle strength, impaired balance, gait, and activities of daily living abilities, and depression in older adults with dementia.
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Affiliation(s)
- Hyun-Ju Park
- Department of physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
| | - Nam-Gi Lee
- Rehabilitation Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju, Republic of Korea
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Lee YC, Lin YT, Chiu EC. A comparison of test-retest reliability of four cognitive screening tools in people with dementia. Disabil Rehabil 2021; 44:4090-4095. [PMID: 33689519 DOI: 10.1080/09638288.2021.1891466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to compare the test-retest reliability and minimal detectable change (MDC) of the Mini-Mental State Examination (MMSE), the Short Portable Mental Status Questionnaire (SPMSQ), the Montreal Cognitive Assessment (MoCA), and the Saint Louis University Status Examination (SLUMS) in a single sample of people with dementia. METHODS Sixty people with dementia were assessed twice two weeks apart, and the test-retest reliability was examined using the intraclass correlation coefficient (ICC) for four screening tools. The MDC95 value was calculated based on the standard error of measurement to estimate the random measurement error. RESULTS The ICC values for screening tools were 0.86-0.90. The MDC95 values (MDC95%) were 5.0 (17.2%), 2.74 (27%), 4.71(20%), and 6.26 (24%) for the MMSE, SPMSQ, MoCA, and SLUMS, respectively. CONCLUSIONS Overall, the four screening tools were similar in test-retest reliability which imply that the MMSE, MoCA, SPMSQ, and SLUMS were reliable in monitoring cognitive function in people with dementia. The results of the direct comparisons of test-retest reliability of the four screening tools provide useful information for both clinicians and researchers to select an appropriate cognitive screening tool.Implications for RehabilitationThe MMSE, MoCA, SPMSQ, and SLUMS are equally reliable and thus they could be used to monitor the cognitive function in people with dementia.The MDC values are useful in determining whether a real change has occurred between repeated assessments for people with dementia.
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Affiliation(s)
- Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Te Lin
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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45
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Association between Sour Taste SNP KCNJ2-rs236514, Diet Quality and Mild Cognitive Impairment in an Elderly Cohort. Nutrients 2021; 13:nu13030719. [PMID: 33668367 PMCID: PMC7996326 DOI: 10.3390/nu13030719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Differences in sour-taste thresholds have been identified in cognition-related diseases. Diet is a modulator of cognitive health, and taste perception influences dietary preferences and habits. Heritable genetics and polymorphisms in the KCNJ2 gene involved in the transduction of sour taste have been linked to variations in sour taste and non-gustatory functions. However, relationships between sour taste genetics, mild cognitive impairment, and diet quality are yet to be elucidated. This study investigated the associations between the presence of the KCNJ2-rs236514 variant (A) allele, diet quality indices, and mild cognitive impairment evaluated by the Mini-Mental State Examination (MMSE), in a secondary cross-sectional analysis of data from the Retirement Health & Lifestyle Study. Data from 524 elderly Australians (≥65y) were analyzed, using standard least squares regression and nominal logistic regression modeling, with demographic adjustments applied. Results showed that the presence of the KCNJ2-A allele is associated with increased proportions of participants scoring in the range indicative of mild or more severe cognitive impairment (MMSE score of ≤26) in the total cohort, and males. These associations remained statistically significant after adjusting for age, sex, and diet quality indices. The absence of association between the KCNJ2-A allele and cognitive impairment in women may be related to their higher diet quality scores in all indices. The potential link between sour taste genotype and cognitive impairment scores may be due to both oral and extra-oral functions of sour taste receptors. Further studies are required on the role and relationship of neurotransmitters, sour taste genotypes and sour taste receptors in the brain, and dietary implications, to identify potential risk groups or avenues for therapeutic or prophylactic interventions.
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46
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Vanderlinden JA, Holden RM, Scott SH, Boyd JG. Robotic technology quantifies novel perceptual-motor impairments in patients with chronic kidney disease. J Nephrol 2021; 34:1243-1256. [PMID: 33400140 DOI: 10.1007/s40620-020-00912-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neurocognitive impairment is commonly reported in patients with chronic kidney disease (CKD). The precise nature of this impairment is unclear, due to the lack of objective and quantitative assessment tools used. The feasibility of using robotic technology to precisely quantify neurocognitive impairment in patients with CKD is unknown. METHODS Patients with stage 4 and 5 CKD with no previous history of stroke or neurodegenerative disease were eligible for study enrollment. Feasibility was defined as successful study enrollment, high data capture rates (> 90%), and assessment tolerability. Our assessment included a traditional assessment: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and a robot-based assessment: Kinarm. RESULTS Our enrollment rate was 1.6 patients/month. All patients completed the RBANS portion of the assessment, with a 97.8% (range 92-100%) completion rate on Kinarm. Missing data on Kinarm were mainly due to time constraints. Data from 49 CKD patients were analyzed. Kinarm defined more individuals as impaired, compared to RBANS, particularly in the domains of perceptual-motor function (17-49% impairment), complex attention (22-49% impairment), and executive function (29-37.5% impairment). Demographic features (sex and education) predicted performance on some, but not all neurocognitive tasks. CONCLUSIONS It is feasible to quantify neurocognitive impairments in patients with CKD using robotic technology. Kinarm characterized more patients with CKD as impaired, and importantly identified novel perceptual-motor impairments in these patients, when compared to traditional assessments.
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Affiliation(s)
| | - Rachel Mary Holden
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Stephen Harold Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - John Gordon Boyd
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada. .,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada. .,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. .,Departments of Medicine (Neurology) and Critical Care Medicine, Kingston General Hospital, Rm 22.2.358 Davies 2, 76 Stuart St, Kingston, ON, K7L 3C9, Canada.
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47
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Park KH, Yang Y, Chen C, Shim YS, Domingueze JC, Lee CN, Kang K, Kim HJ, Jeong SK, Jeong JH, Hong Z, Yoon SJ, Zhang ZX, Kim EJ, Jang JW, Li Y, Xu Y, Lin YT, Qu Q, Hu CJ, Chou CH, Fan D, Kandiah N, Yang YH, Lau CI, Chu LW, Wang H, Jung S, Choi SH, Kim S. Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer's Disease Patients in Asia. J Clin Neurol 2021; 17:376-384. [PMID: 34184445 PMCID: PMC8242303 DOI: 10.3988/jcn.2021.17.3.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer's disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation, treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.
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Affiliation(s)
- Kee Hyung Park
- Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - YoungSoon Yang
- Department of Neurology, Soonchunhyang University of College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yong S Shim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Chan Nyoung Lee
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hee Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Seul Ki Jeong
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Zhen Xin Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Eun Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jae Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yansheng Li
- Department of Neurology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xu
- Nanjing Drum Tower Hospital, Nanjing, China
| | - Yu Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Qiumin Qu
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Chaur Jong Hu
- Dementia Center, Department of Neurology, Taipei Medical University Shuang-Ho Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih Ho Chou
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute; Singapore, Duke-NUS Graduate Medical School, Singapore: Lee Kong Chian Medical School-NTU, Singapore
| | - Yuan Han Yang
- Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi Ieong Lau
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Leung Wing Chu
- Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - San Jung
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Harrison EC, Earhart GM, Leventhal D, Quinn L, Pietro Mazzoni. A walking dance to improve gait speed for people with Parkinson disease: a pilot study. Neurodegener Dis Manag 2020; 10:301-308. [PMID: 32878538 DOI: 10.2217/nmt-2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To determine the effectiveness of a targeted dance intervention to improve walking speed for people with Parkinson disease (PD) by increasing motor motivation. Materials & methods: 11 participants with PD participated in a 6-week pilot study in which they learned a contemporary dance composed of walking steps and designed to mimic everyday walking. 1 h classes occurred twice-weekly. Results: Pre- and post-intervention assessments revealed a significant increase in gait speed (t9 = 3.30; p = 0.009), cadence (t9 = 2.345; p = 0.044), and stride length (t9 = 3.757; p = 0.005), and a significant decrease (improvement) in single support time variability (t9 = -2.744; p = 0.022). There were no significant changes in other measures of gait variability nor in motor symptoms, mood and anxiety, extent of life-space mobility, or quality of life. No adverse events were reported. Conclusion: Joywalk provides preliminary evidence that a targeted physical intervention for people with PD may specifically counter bradykinesia.
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Affiliation(s)
- Elinor C Harrison
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Gammon M Earhart
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David Leventhal
- Dance For PD®, Mark Morris Dance Group, Brooklyn, NY 11217, USA
| | - Lori Quinn
- Department of Movement Science & Kinesiology, Teachers College, Columbia University, New York City, NY 10027, USA
| | - Pietro Mazzoni
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
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Validity of the Mini-Mental State Examination-2 in Diagnosing Mild Cognitive Impairment and Dementia in Patients Visiting an Outpatient Clinic in the Netherlands. Alzheimer Dis Assoc Disord 2020; 34:278-281. [PMID: 32826418 PMCID: PMC7497592 DOI: 10.1097/wad.0000000000000403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. This study examined the utility of the recently published MMSE-2:SV in detecting cognitive impairment. We used receiver operating characteristics to test the discriminative power of the MMSE-2:SV for distinguishing between older adults without mild cognitive impairment (MCI) or dementia (n=67) and patients with MCI (n=76) or dementia (n=79). The results show that the MMSE-2:SV had excellent discriminative ability in distinguishing older controls from patients with dementia, with cut-off scores of 26 and 27 (max=30) yielding appropriate sensitivity (0.810 and 0.924, respectively) and specificity (0.940 and 0.806). Discriminative power was close to good in distinguishing between older controls and patients with MCI. Here, however, no optimal cut-off point could be determined. Even though this study shows good sensitivity and adequate specificity for the MMSE-2:SV in discriminating individuals without MCI or dementia from those with dementia, its validity is limited for identifying patients with MCI.
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50
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Barnes-Marrero I, Horter L, Hayden JD, Patel NC, Mendoza L, Castillo L. Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer's disease among Hispanic older adults in the United States reporting memory problems. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:509-519. [PMID: 32584154 DOI: 10.1080/23279095.2020.1777554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer's disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of -1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.
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Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | | | - Nick C Patel
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Lisandra Mendoza
- Department of Clinical Psychology, Albizu University, Miami, FL, USA
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