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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [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: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Cabreira V, McWhirter L, Carson A. Functional Cognitive Disorder: Diagnosis, Treatment, and Differentiation from Secondary Causes of Cognitive Difficulties. Neurol Clin 2023; 41:619-633. [PMID: 37775194 DOI: 10.1016/j.ncl.2023.02.004] [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: 03/17/2023]
Abstract
Functional cognitive disorder is an increasingly common cause of referral to the memory clinic. As a substantial source of disability, clinicians involved in the management of patients with cognitive complaints need to familiarize themselves with this important differential diagnosis. Our approach focuses on the identification of positive features of internal inconsistency (historical and clinical clues alongside patterns of performance) instead of an exclusionary approach. Although effective treatments are desperately needed, promising therapies include metacognitive retraining and cognitive-behavioral therapy modalities. Future research should focus on a better understanding of disease trajectories and outcomes as well as the development of evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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3
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Mäurer A, Himmel G, Lange C, Mathies F, Apostolova I, Peters O, Buchert R. Individualized Summary Assessment of Detailed Neuropsychological Testing for the Etiological Diagnosis of Newly Detected Cognitive Impairment in Hospitalized Geriatric Patients. J Alzheimers Dis 2023:JAD221273. [PMID: 37302033 DOI: 10.3233/jad-221273] [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: 06/12/2023]
Abstract
BACKGROUND Neuropsychological testing (NPT) of geriatric inpatients can be affected by the acute illness and/or the hospitalization. OBJECTIVE To test individualized interpretation of detailed NPT for the differentiation between primary 'neurodegenerative' etiologies (predominantly Alzheimer's disease) and 'other' etiologies (including cerebrovascular disease) of newly detected cognitive impairment in geriatric inpatients without and with delirium in remission. METHODS 96 geriatric inpatients (81.9±5.6 years, 64.6% females) with clinically uncertain cognitive impairment were included. 31.3% had delirium in remission that was not considered the primary cause of the cognitive impairment. Categorization of the most likely etiology as 'neurodegenerative' or 'other' was established retrospectively by a study neuropsychologist based on individualized summary assessment of detailed NPT compiled in a standardized vignette. The etiological diagnosis based on FDG-PET served as gold standard (54.2% 'neurodegenerative', 45.8% 'other'). RESULTS Individualized summary assessment by the study neuropsychologist was correct in 80 patients (83.3%, 8 false positive, 8 false negative). The impact of delirium in remission was not significant (p = 0.237). Individualized summary assessment by an independent neuropsychologist resulted in more false positive cases (n = 22) at the same rate of false negative cases (n = 8). Automatic categorization with a decision tree model based on the most discriminative NPT scores was correct in 68 patients (70.8%, 14 false positive, 14 false negative). CONCLUSION Individualized summary assessment of detailed NPT in the context of relevant clinical information might be useful for the etiological diagnosis of newly detected cognitive impairment in hospitalized geriatric patients, also in patients with delirium in remission, but requires task-specific expertise.
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Affiliation(s)
- Anja Mäurer
- Vivantes Ida-Wolff-Krankenhaus, Berlin, Germany
| | | | - Catharina Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Franziska Mathies
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Screening for neuropsychological assessment in the diagnostics of neurocognitive disorder. Int Psychogeriatr 2022; 34:519-521. [PMID: 35331358 DOI: 10.1017/s104161022200031x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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5
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Hansen S, Keune J, Küfner K, Meister R, Habich J, Koska J, Förster S, Oschmann P, Keune PM. The congruency of neuropsychological and F18-FDG brain PET/CT diagnostics of Alzheimer's Disease (AD) in routine clinical practice: insights from a mixed neurological patient cohort. BMC Neurol 2022; 22:83. [PMID: 35264143 PMCID: PMC8905792 DOI: 10.1186/s12883-022-02614-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Diagnostics of Alzheimer’s Disease (AD) require a multimodal approach. Neuropsychologists examine the degree and etiology of dementia syndromes and results are combined with those of cerebrospinal fluid markers and imaging data. In the diagnostic process, neuropsychologists often rely on anamnestic and clinical information, as well as cognitive tests, prior to the availability of exhaustive etiological information. The congruency of this phenomenological approach with results from FDG-PET/CT examinations remains to be explored. The latter yield highly accurate diagnostic information. Method A mixed sample of N = 127 hospitalized neurological patients suspected of displaying a dementia syndrome underwent extensive neuropsychological and FDG-PET/CT examinations. Neuropsychological examinations included an anamnestic and clinical interview, and the CERAD cognitive test battery. Two decisional approaches were considered: First, routine diagnostic results were obtained, i.e. the final clinical decision of the examining neuropsychologist (ADClinical vs. non-ADClinical). Secondly, a logistic regression model was implemented, relying on CERAD profiles alone. CERAD subscales that best predicted AD based on FDG-PET/CT were identified and a nominal categorization obtained (ADTest vs. non-ADTest). Congruency of results from both approaches with those of the FDG-PET/CT (ADPET vs. non-ADPET) were estimated with Cohen’s Kappa (κ) and Yule’s Y coefficient of colligation. Descriptive estimates of accuracy, sensitivity and specificity of CERAD relative to FDG-PET/CT diagnostics were derived. Results ADPET patients constituted N = 33/127 (26%) of the sample. The clinical decision approach (ADClinical vs. non-ADClinical) showed substantial agreement with the FDG-PET/CT classification (κ = .69, Y = .72) involving good accuracy (84.2%), moderate sensitivity (75.8%) and excellent specificity (92.6%). In contrast, the decisional approach that relied on CERAD data alone (ADTest vs. non-ADTest) involved only moderate agreement with the FDG-PET/CT (κ = .54, Y = .62) with lower accuracy (74.8%), attributable to decreased sensitivity (56.3%) and comparable specificity (93.3%). Conclusions It is feasible to identify AD through a comprehensive neuropsychological examination in a mixed sample of neurological patients. However, within the boundaries of methods applied here, decisions based on cognitive test results alone appear limited. One may conclude that the clinical impression based on anamnestic and clinical information obtained by the neuropsychological examiner plays a crucial role in the identification of AD patients in routine clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02614-4.
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Affiliation(s)
- Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany. .,Institute of Physiological Psychology, University of Bamberg, Bamberg, Germany.
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Kim Küfner
- Institute of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Regina Meister
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Juliane Habich
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Julia Koska
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Stefan Förster
- Department of Nuclear Medicine, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Germany.,Institute of Physiological Psychology, University of Bamberg, Bamberg, Germany
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6
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1091-1102. [DOI: 10.1093/arclin/acac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
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7
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Choi JH, Kim DW, La HJ, Son H, Lee ST. Food memory test to evaluate memory function. ENCEPHALITIS 2021; 1:45-50. [PMID: 37469764 PMCID: PMC10295888 DOI: 10.47936/encephalitis.2021.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 07/21/2023] Open
Abstract
Purpose To evaluate cognitive function with ease at bedside, we developed a novel neurologic exam called the "food memory test (FMT)" and evaluated its validity for use in clinical practice. Methods In this prospective study in a neurology clinic, we asked patients about what they had eaten for the soup and main dish at the last meal [FMT1] and the second-to-last meal [FMT2]. If they answered correctly for both the soup and main dish, they received a "pass" score. If they did not answer or chose the wrong food, they received a "fail" score. We also performed conventional cognitive function tests for comparison. Results A total of 27 patients was enrolled, and 12 (44.4%) passed the FMT1 test. FMT1 has a strong correlation with conventional memory function tests, including time-place orientation, three-word recall, the Seoul Verbal Learning Test, and the Rey Complex Figure Test . FMT1 was not correlated with a depression score or with frontal lobe function tests. FMT2 showed less significant correlation with conventional memory tests. Conclusion These results suggest that FMT1 is a reliable bedside test to evaluate recent memory. Clinical application of FMT in daily clinical practice is warranted.
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Affiliation(s)
- Ji-Hun Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Woo Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Jee La
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Turner DT, Hu MX, Generaal E, Bos D, Ikram MK, Heshmatollah A, Fani L, Ikram MA, Penninx BWJH, Cuijpers P. Physical Exercise Interventions Targeting Cognitive Functioning and the Cognitive Domains in Nondementia Samples: A Systematic Review of Meta-Analyses. J Geriatr Psychiatry Neurol 2021; 34:91-101. [PMID: 32295450 PMCID: PMC7859677 DOI: 10.1177/0891988720915523] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We investigated whether physical exercise interventions improve cognitive functioning in nondementia populations. METHODS We conducted a systematic review of meta-analyses including only randomized controlled trials (RCTs). Two reviewers completed a systematic search of PubMed, Embase, PsychInfo, and Cochrane Controlled Register of Trials. Study characteristics, effect size data, and heterogeneity estimates were extracted and presented in tabular form. Methodological quality was assessed by 2 reviewers using the AMSTAR-2 checklist. The validity of results was considered based on AMSTAR-2 scores and study characteristics. RESULTS We included 11 meta-analyses: 6 focused on disease-free older adults and 5 on mild cognitive impairment (MCI) excluding dementia. These meta-analyses summarized 97 unique RCTs. Methodological quality ranged from critically low to high. For overall cognitive functioning, which was the outcome of 6 meta-analyses, 1 showed improvement due to exercise interventions in disease-free older adults (g = 0.29, P < .01), while 2 reported nonsignificant effects. In patients with MCI, 3 meta-analyses reported significant benefits of exercise interventions on overall cognitive functioning (g = 0.25-0.57, P < .01). For cognitive domains such as attention and memory, there was limited evidence of beneficial effects of exercise demonstrated in either disease-free or MCI samples. CONCLUSIONS Exercise may improve overall cognitive functioning in disease-free older adults, but there is too little high-quality evidence to conclude whether this is achieved through improvement in any of the specific cognitive domains assessed. There is clearer evidence that exercise may improve cognitive functioning in MCI, but again there is limited evidence across most cognitive domains.
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Affiliation(s)
- David T. Turner
- Department of Clinical, Neuro and Developmental Psychology,
Amsterdam Public Health Research Institute, Vrije Universiteit
Amsterdam, the Netherlands,David T. Turner, Department of Clinical,
Neuro and Developmental Psychology, Amsterdam Public Health Research Institute,
Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the
Netherlands.
| | - Mandy X. Hu
- Department of Psychiatry, Amsterdam Public Health Research
Institute, Amsterdam UMC, Vrije Universiteit
Amsterdam, the Netherlands
| | - Ellen Generaal
- Department of Psychiatry, Amsterdam Public Health Research
Institute, Amsterdam UMC, Vrije Universiteit
Amsterdam, the Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Alis Heshmatollah
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Lana Fani
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Brenda W. J. H. Penninx
- Department of Clinical, Neuro and Developmental Psychology,
Amsterdam Public Health Research Institute, Vrije Universiteit
Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,
Amsterdam Public Health Research Institute, Vrije Universiteit
Amsterdam, the Netherlands
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Kavé G, Bloch A, Maril S, Shabi A. Familiarity with Neuropsychological Assessment among Israeli Physicians. Arch Clin Neuropsychol 2020; 35:553-561. [PMID: 32129454 DOI: 10.1093/arclin/acaa007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The current study examines whether Israeli physicians are familiar with neuropsychological assessment (NPA) in general and with referral to NPA in particular. METHOD In total, 274 physicians in relevant fields participated in an online survey that targeted levels of familiarity with NPA, beliefs about assessment needs, and actual referral practices. RESULTS Israeli physicians see many patients with neuropsychological difficulties, but assess fewer patients for these difficulties by themselves. Approximately 80% of participants reported that they had heard of NPA before, but only 25% knew how to refer patients to NPA. Familiarity was greater among neurologists and neurosurgeons than among family doctors. CONCLUSIONS Physicians had only general knowledge about NPA, with little practical understanding of how to refer patients to such a service. To increase referral rates and create consistent demand for effective neuropsychological services, neuropsychologists should engage in greater advocacy activity that will lead to clarification of referral procedures.
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Affiliation(s)
- Gitit Kavé
- Department of Education and Psychology, The Open University, Ra'anana, Israel.,Center for Memory and Attention Disorders, Sourasky Medical Center, Tel Aviv, Israel
| | - Ayala Bloch
- The National Institute for the Rehabilitation of the Brain Inured, Tel Aviv, Israel.,Department of Psychology, Ariel University, Ariel, Israel
| | - Sari Maril
- The National Institute for the Rehabilitation of the Brain Inured, Tel Aviv, Israel
| | - Adi Shabi
- Center for Memory and Attention Disorders, Sourasky Medical Center, Tel Aviv, Israel.,The National Institute for the Rehabilitation of the Brain Inured, Tel Aviv, Israel
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Glen T, Hostetter G, Roebuck-Spencer TM, Garmoe WS, Scott JG, Hilsabeck RC, Arnett P, Espe-Pfeifer P. Return on Investment and Value Research in Neuropsychology: A Call to Arms†. Arch Clin Neuropsychol 2020; 35:459-468. [PMID: 32219365 DOI: 10.1093/arclin/acaa010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/08/2023] Open
Abstract
There is substantial empirical evidence to support the clinical value of neuropsychological evaluation and the incremental value of neuropsychological assessment, suggesting such evaluation is beneficial in the prediction and management of clinical outcomes. However, in the cost-conscious and evolving era of healthcare reform, neuropsychologists must also establish the economic value, or return on investment, of their services. There is already a modest body of literature that demonstrates the economic benefits of neuropsychological evaluation, which is reviewed in the current paper. Neuropsychologists will need to be able to communicate, and develop evidence of, economic value of their services; thus, this paper also discusses common concepts, terms, and models used in healthcare valuation studies. Finally, neuropsychologists are urged to incorporate these financial concepts in their clinical practice and research.
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Affiliation(s)
| | | | | | - William S Garmoe
- Department of Neurology, MedStar National Rehabilitation Network, Washington, DC, USA
| | - James G Scott
- Department of Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Peter Arnett
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Patricia Espe-Pfeifer
- Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA, USA
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11
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de Vos F, Schouten TM, Koini M, Bouts MJRJ, Feis RA, Lechner A, Schmidt R, van Buchem MA, Verhey FRJ, Olde Rikkert MGM, Scheltens P, de Rooij M, van der Grond J, Rombouts SARB. Pre-trained MRI-based Alzheimer's disease classification models to classify memory clinic patients. NEUROIMAGE-CLINICAL 2020; 27:102303. [PMID: 32554321 PMCID: PMC7303669 DOI: 10.1016/j.nicl.2020.102303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/04/2023]
Abstract
Multimodal MRI AD classification models were pre-trained on AD patients and controls. Generalisation of these models was tested on a multi-centre memory clinic data set. AD scores were assigned to AD patients, MCI patients and memory complainers. Anatomical MRI performed better than diffusion MRI and resting state fMRI. Combining imaging modalities did not improve the results over anatomical MRI only.
Anatomical magnetic resonance imaging (MRI), diffusion MRI and resting state functional MRI (rs-fMRI) have been used for Alzheimer’s disease (AD) classification. These scans are typically used to build models for discriminating AD patients from control subjects, but it is not clear if these models can also discriminate AD in diverse clinical populations as found in memory clinics. To study this, we trained MRI-based AD classification models on a single centre data set consisting of AD patients (N = 76) and controls (N = 173), and used these models to assign AD scores to subjective memory complainers (N = 67), mild cognitive impairment (MCI) patients (N = 61), and AD patients (N = 61) from a multi-centre memory clinic data set. The anatomical MRI scans were used to calculate grey matter density, subcortical volumes and cortical thickness, the diffusion MRI scans were used to calculate fractional anisotropy, mean, axial and radial diffusivity, and the rs-fMRI scans were used to calculate functional connectivity between resting state networks and amplitude of low frequency fluctuations. Within the multi-centre memory clinic data set we removed scan site differences prior to applying the models. For all models, on average, the AD patients were assigned the highest AD scores, followed by MCI patients, and later followed by SMC subjects. The anatomical MRI models performed best, and the best performing anatomical MRI measure was grey matter density, separating SMC subjects from MCI patients with an AUC of 0.69, MCI patients from AD patients with an AUC of 0.70, and SMC patients from AD patients with an AUC of 0.86. The diffusion MRI models did not generalise well to the memory clinic data, possibly because of large scan site differences. The functional connectivity model separated SMC subjects and MCI patients relatively good (AUC = 0.66). The multimodal MRI model did not improve upon the anatomical MRI model. In conclusion, we showed that the grey matter density model generalises best to memory clinic subjects. When also considering the fact that grey matter density generally performs well in AD classification studies, this feature is probably the best MRI-based feature for AD diagnosis in clinical practice.
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Affiliation(s)
- Frank de Vos
- Institute of Psychology, Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands.
| | - Tijn M Schouten
- Institute of Psychology, Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands
| | - Marisa Koini
- Department of Neurology, Medical University of Graz, Austria
| | - Mark J R J Bouts
- Institute of Psychology, Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands
| | - Rogier A Feis
- Institute of Psychology, Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands
| | - Anita Lechner
- Department of Neurology, Medical University of Graz, Austria
| | | | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, the Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Donders Institute for Medical Neurosciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mark de Rooij
- Institute of Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands
| | | | - Serge A R B Rombouts
- Institute of Psychology, Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands
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12
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Gruters AAA, Christie HL, Ramakers IHGB, Verhey FRJ, Kessels RPC, de Vugt ME. Neuropsychological assessment and diagnostic disclosure at a memory clinic: A qualitative study of the experiences of patients and their family members. Clin Neuropsychol 2020; 35:1398-1414. [PMID: 32301377 DOI: 10.1080/13854046.2020.1749936] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to gain insight into the experiences of patients and their family members regarding a neuropsychological assessment (NPA) and the diagnostic disclosure given by the medical specialist (psychiatrist, geriatrician, or their residents) at the memory clinic (MC). METHOD Patients with and without a cognitive impairment and their family members were recruited from three Dutch MCs. Four focus groups with 14 patients and 13 family members were analyzed using both inductive and deductive content analysis. RESULTS Three themes were identified: uncertainty, early diagnostic paradox, and knowledge utilization. High levels of uncertainty were experienced throughout the NPA and diagnostic disclosure. The early diagnostic paradox refers to the coexistence of negative emotions, feeling distressed due to undergoing an NPA that made them aware of their cognitive complaints, and the experience of relief due to insight given by the outcome of the NPA and medical diagnosis. Knowledge utilization refers to a low retention of medical information. CONCLUSION Clinicians can reduce uncertainty by using clear communication, limiting interruptions during an NPA, and paying attention to contextual factors. Low information retention could possibly be improved by involving a family member and using visual aids or written information during the diagnostic disclosure. Finally, participants also appreciated being provided with neuropsychological feedback on the strengths and weaknesses of their cognitive profiles and with guidance on how to manage this diagnosis in their daily lives.
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Affiliation(s)
- Angélique A A Gruters
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Hannah L Christie
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
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13
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McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: a systematic review. Lancet Psychiatry 2020; 7:191-207. [PMID: 31732482 DOI: 10.1016/s2215-0366(19)30405-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.
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Affiliation(s)
- Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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14
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Gruters AA, Ramakers IH, Kessels RP, Bouwman FH, Olde Rikkert MG, Blom MM, de Vugt ME, Verhey FR. Development of memory clinics in the Netherlands over the last 20 years. Int J Geriatr Psychiatry 2019; 34:1267-1274. [PMID: 31034652 PMCID: PMC6767517 DOI: 10.1002/gps.5132] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Memory clinics (MCs) have been established to improve diagnosis and treatment of cognitive disorders, including dementia. The aim of this study was to determine the characteristics and working methods of MCs in the Netherlands in 2016. More insight into different working methods can be used to improve the quality of care in Dutch MCs. Additionally, the findings will be compared with earlier results to investigate the development of MCs since 1998. METHODS A survey was sent in 1998, 2004, 2009, and 2017 to all operational Dutch MCs with questions about organization, collaboration, patients, and diagnostic procedures. RESULTS From 1998 to 2016, the number of MCs increased substantially from 12 to 91. The capacity increased from 1560 patients to 24,388. In 1998, most patients received a dementia diagnosis (85%), while in 2016, half of the patients were diagnosed with milder cognitive problems. MCs are more often part of regional care chains and are better embedded within regional care organizations. Diagnostic tools, such as blood tests (97%), neuropsychological assessment (NPA) (95%), and neuroimaging (92%), were used in nearly all MCs. The number of patients in whom these tools were used differed greatly between MCs (NPA: 5%-100%, neuroimaging: 10%-100%, and CSF: 0.5%-80%). There was an increase in the use of NPA, while the use of neuroimaging, CSF, and EEG/ECG decreased by 8% to 15% since 2009. CONCLUSIONS Since 1998, MCs have developed substantially and outgrown the primarily research-based university settings. They are now accepted as regular care facilities for people with cognitive problems.
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Affiliation(s)
- Angélique A.A. Gruters
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Inez H.G.B. Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and BehaviourRadboud University NijmegenNijmegenThe Netherlands,Department of Medical Psychology and Radboudumc Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands
| | - Femke H. Bouwman
- Alzheimer Center and Department of NeurologyVU University Medical Center, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Marcel G.M. Olde Rikkert
- Radboudumc Alzheimer Center and Department of GeriatricsRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
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15
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Abstract
Objective: The purpose of this critical review was to evaluate the current state of research regarding the incremental value of neuropsychological assessment in clinical practice, above and beyond what can be accounted for on the basis of demographic, medical, and other diagnostic variables. The focus was on neurological and other medical conditions across the lifespan where there is known risk for presence or future development of cognitive impairment.Method: Eligible investigations were group studies that had been published after 01/01/2000 in English in peer-reviewed journals and that had used standardized neuropsychological measures and reported on objective outcome criterion variables. They were identified through PubMed and PsychInfo electronic databases on the basis of predefined specific selection criteria. Reference lists of identified articles were also reviewed to identify potential additional sources. The Grades of Recommendation, Assessment, Development and Evaluation Working Group's (GRADE) criteria were used to evaluate quality of studies.Results: Fifty-six studies met the final selection criteria, including 2 randomized-controlled trials, 9 prospective cohort studies, 12 retrospective cohort studies, 21 inception cohort studies, 2 case control studies, and 10 case series studies. The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.Conclusions: Neuropsychological assessment can improve both diagnostic classification and prediction of long-term daily-life outcomes in patients across the lifespan. Future high-quality prospective cohort studies and randomized-controlled trials are necessary to demonstrate more definitively the incremental value of neuropsychological assessment in the management of patients with various neurological and other medical conditions.
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Affiliation(s)
- Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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16
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Watt S, Crowe SF. Examining the beneficial effect of neuropsychological assessment on adult patient outcomes: a systematic review. Clin Neuropsychol 2017; 32:368-390. [DOI: 10.1080/13854046.2017.1414885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stephanie Watt
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Simon F. Crowe
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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17
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Dolci GAM, Damanti S, Scortichini V, Galli A, Rossi PD, Abbate C, Arosio B, Mari D, Arighi A, Fumagalli GG, Scarpini E, Inglese S, Marcucci M. Alzheimer's Disease Diagnosis: Discrepancy between Clinical, Neuroimaging, and Cerebrospinal Fluid Biomarkers Criteria in an Italian Cohort of Geriatric Outpatients: A Retrospective Cross-sectional Study. Front Med (Lausanne) 2017; 4:203. [PMID: 29214153 PMCID: PMC5702632 DOI: 10.3389/fmed.2017.00203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/06/2017] [Indexed: 01/05/2023] Open
Abstract
Background The role of cerebrospinal fluid (CSF) biomarkers, and neuroimaging in the diagnostic process of Alzheimer's disease (AD) is not clear, in particular in the older patients. Objective The aim of this study was to compare the clinical diagnosis of AD with CSF biomarkers and with cerebrovascular damage at neuroimaging in a cohort of geriatric patients. Methods Retrospective analysis of medical records of ≥65-year-old patients with cognitive impairment referred to an Italian geriatric outpatient clinic, for whom the CSF concentration of amyloid-β (Aβ), total Tau (Tau), and phosphorylated Tau (p-Tau) was available. Clinical diagnosis (no dementia, possible and probable AD) was based on the following two sets of criteria: (1) the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) plus the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and (2) the National Institute on Aging-Alzheimer's Association (NIA-AA). The Fazekas visual scale was applied when a magnetic resonance imaging scan was available. Results We included 94 patients, mean age 77.7 years, mean Mini Mental State Examination score 23.9. The concordance (kappa coefficient) between the two sets of clinical criteria was 70%. The mean CSF concentration (pg/ml) (±SD) of biomarkers was as follows: Aβ 687 (±318), Tau 492 (±515), and p-Tau 63 (±56). There was a trend for lower Aβ and higher Tau levels from the no dementia to the probable AD group. The percentage of abnormal liquor according to the local cutoffs was still 15 and 21% in patients without AD based on the DSM-IV plus NINCDS-ADRDA or the NIA-AA criteria, respectively. The exclusion of patient in whom normotensive hydrocephalus was suspected did not change these findings. A total of 80% of patients had the neuroimaging report describing chronic cerebrovascular damage, while the Fazekas scale was positive in 45% of patients overall, in 1/2 of no dementia or possible AD patients, and in about 1/3 of probable AD patients, with no difference across ages. Conclusion We confirmed the expected discrepancy between different approaches to the diagnosis of AD in a geriatric cohort of patients with cognitive impairment. Further research is needed to understand how to interpret this discrepancy and provide clinicians with practical guidelines.
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Affiliation(s)
- Giulia A M Dolci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valeria Scortichini
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Geriatric Unit, Medical Department Maggiore Hospital, Bologna, Italy
| | - Alessandro Galli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Geriatric Unit, ASST Lariana, Ospedale Sant'Anna, Como, Italy
| | - Paolo D Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio G Fumagalli
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Elio Scarpini
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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