Planning ability impairments in probable Alzheimer's disease patients: Evidence from the Tower of London test

Normative data for the Tower of London (Drexel version) in the Quebec-French population aged between 50 and 88 years

The Tower of London (ToL) is a neuropsychological test used to assess several executive functions such as strategical reasoning, mental planning, and problem-solving. Like other cognitive tests, performance on the ToL can vary according to age, level of education, sex, and cultural background of individuals. The present study aimed to establish normative data for the Drexel version of the ToL among French-Quebec people aged 50 years and over. The normative sample consisted of 174 healthy individuals aged 50-88 years, all from the province of Quebec, Canada. Analyses were performed to estimate the associations between age, sex, and education level on one hand, and ToL performance, on the other hand. Results indicated that Total Execution Time was associated with age, whereas the Total Type II Errors and Total Rule Violation score (Type I + II Errors) were associated with both age and education level. All other scores were not significantly associated with the demographic characteristics of the participants. Since the distributions of the data were all skewed, the normative data are presented in the form of percentile ranks. To conclude, the present norms will ease the detection of executive impairments in French-Quebec middle-aged and older adults.

Goal-Directed Action Is Initially Impaired in a hAPP-J20 Mouse Model of Alzheimer's Disease

Cognitive-behavioral testing in preclinical models of Alzheimer's disease has failed to capture deficits in goal-directed action control. Here, we provide the first comprehensive investigation of goal-directed action in a transgenic mouse model of Alzheimer's disease. Specifically, we tested outcome devaluation performance in male and female human amyloid precursor protein (hAPP)-J20 mice. Mice were first trained to press left and right levers for pellet and sucrose outcomes, respectively (counterbalanced), over 4 d. On test, mice were prefed one of the outcomes to satiety and given a choice between levers. Devaluation performance was intact for 36-week-old wild-types of both sexes, who responded more on the valued relative to the devalued lever (Valued > Devalued). By contrast, devaluation was impaired (Valued = Devalued) for J20 mice of both sexes, and for 52-week-old male mice regardless of genotype. After additional lever press training (i.e., 8-d lever pressing in total), devaluation was intact for all mice, demonstrating that the initial deficits were not a result of a nonspecific impairment in reward processing, depression, or locomotor activity in J20 or aging mice. Follow-up analyses revealed that microglial expression in the dorsal CA1 region of the hippocampus was associated with poorer outcome devaluation performance on initial, but not later tests. Together, these data demonstrate that goal-directed action is initially impaired in J20 mice of both sexes and in aging male mice regardless of genotype, and that this impairment is related to neuroinflammation in the dorsal CA1 hippocampal region.

Respect for Autonomy and Dementia Care in Nursing Homes: Revising Beauchamp and Childress's Account of Autonomous Decision-Making

Specifying the moral demands of respect for the autonomy of people with dementia (PWD) in nursing homes (NHs) remains a challenging conceptual task. These challenges arise primarily because received notions of autonomous decision-making and informed consent do not straightforwardly apply to PWD in NHs. In this paper, I investigate whether, and to what extent, the influential account of autonomous decision-making and informed consent proposed by Beauchamp and Childress has applicability and relevance to PWD in NHs. Despite its otherwise practical orientation and suitability for acute care settings, I identify three problems with this account when applied to PWD in NHs. These problems include (1) intentionality as an all-or-nothing condition of autonomous decision-making, (2) construing consent as one-off authorization, and (3) unresolved ambiguities around the primacy of precedent autonomy over best interest considerations. To address these problems, I propose and defend a number of revisions to Beauchamp and Childress's account. First, I suggest that we consider intentionality as a non-binary criterion of autonomous decision-making. Second, I argue for a model of process consent to overcome the moral inadequacy of construing consent as one-off authorization in NHs. And, to overcome the third problem, I suggest accounting for both precedent and extant autonomy of PWD, considering mandates of precedent autonomy not as prescriptive but as informative, and drawing a less rigid distinction between autonomy considerations and best interest judgements. I conclude that this revised version of Beauchamp and Childress's account fares better than the original version in capturing relevant autonomy considerations to care for PWD in NHs.

Acute cognitive impairment after traumatic brain injury predicts the occurrence of brain atrophy patterns similar to those observed in Alzheimer's disease

Traumatic brain injuries (TBIs) are often followed by persistent structural brain alterations and by cognitive sequalae, including memory deficits, reduced neural processing speed, impaired social function, and decision-making difficulties. Although mild TBI (mTBI) is a risk factor for Alzheimer's disease (AD), the extent to which these conditions share patterns of macroscale neurodegeneration has not been quantified. Comparing such patterns can not only reveal how the neurodegenerative trajectories of TBI and AD are similar, but may also identify brain atrophy features which can be leveraged to prognosticate AD risk after TBI. The primary aim of this study is to systematically map how TBI affects white matter (WM) and gray matter (GM) properties in AD-analogous patterns. Our findings identify substantial similarities in the regional macroscale neurodegeneration patterns associated with mTBI and AD. In cerebral GM, such similarities are most extensive in brain areas involved in memory and executive function, such as the temporal poles and orbitofrontal cortices, respectively. Our results indicate that the spatial pattern of cerebral WM degradation observed in AD is broadly similar to the pattern of diffuse axonal injury observed in TBI, which frequently affects WM structures like the fornix, corpus callosum, and corona radiata. Using machine learning, we find that the severity of AD-like brain changes observed during the chronic stage of mTBI can be accurately prognosticated based on acute assessments of post-traumatic mild cognitive impairment. These findings suggest that acute post-traumatic cognitive impairment predicts the magnitude of AD-like brain atrophy, which is itself associated with AD risk.

Developing and Implementing an Entrustable Professional Activity Assessment for Pharmacy Practice Experiences

Objective. To develop, implement, and validate an entrustable professional activity (EPA) assessment tool that could be used to calculate course grades for experiential students in all practice environments. Methods. An EPA assessment tool was developed and directly mapped to 18 EPAs, and a criterion, or passing score, for each EPA was established for all practice experiences. The EPA assessment tool was implemented in the college's experiential program during summer 2018 and comparative outcomes and reliability of the EPA assessment tool were assessed within the core advanced pharmacy practice experiences (APPEs). Results. The EPA assessment tool reliability was strong (Cronbach's alpha=0.93), with preceptor-suggested grades and grades calculated using the EPA assessment tool equivalent in 95% of completed APPEs. All nonequivalent calculated-preceptor grade pairs were evenly split between one grade higher than scored and one grade lower than scored. Conclusion. The EPA assessment tool is a reliable and valid instrument for assessing EPA achievement in the APPE year. Future work should focus on determining the longitudinal utility of the EPA tool by comparing outcomes in introductory and advanced pharmacy practice experiences.