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Breneman CB, Valmas MM, Skalina LM, Cypel Y, Spiro A, Frayne SM, Magruder KM, Kilbourne AM, Kimerling R, Reinhard MJ. Mental Health and Cognition in Women Veterans Enrolled in the Health of Vietnam Era Veteran Women's Study (HealthViEWS). J Womens Health (Larchmt) 2024. [PMID: 38913339 DOI: 10.1089/jwh.2023.0974] [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: 06/25/2024] Open
Abstract
Objective: This analysis explored relationships between mental health symptoms and conditions and cognitive function in a cohort of Vietnam-era women veterans from the Health of Vietnam Era Veteran Women's Study (HealthViEWS). Methods: Vietnam-era women veterans completed a mail survey assessing self-reported symptom severity of posttraumatic stress disorder (PTSD) and depression. A telephone-based structured interview assessed mental health conditions and cognitive function (telephone interview for cognitive status [TICS]). Participants were categorized using a TICS threshold of ≤29 to designate possible cognitive impairment versus nonimpaired. Separate logistic regression models were used to determine associations between possible cognitive impairment and each self-reported and interviewer-rated assessment of PTSD and depression while adjusting for age, education, race, marital status, and wartime service location. Results: The sample consisted of 4,077 women veterans who were ≥60 years old and completed the TICS. Of these women, 7.20% were categorized with possible cognitive impairment. Logistic regression models indicated that self-reported PTSD and depression symptom severity were each significantly associated with higher odds of possible cognitive impairment (adjusted odds ratios [aOR]: 1.03 [95% confidence interval [CI]: 1.02-1.04] and 1.07 [95% CI: 1.04-1.09], respectively). Women veterans with a probable diagnosis of depression had higher odds of possible cognitive impairment compared to those without depression (aOR: 1.61 [95% CI: 1.07-2.42]). No association was found for probable diagnosis of PTSD. Conclusions: Although further examination remains necessary, results suggest that Vietnam-era women veterans with self-reported PTSD and depression symptom severity or a probable diagnosis of depression may benefit from screening of cognitive function to inform clinical care.
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Affiliation(s)
- Charity B Breneman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
| | - Mary M Valmas
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Lauren M Skalina
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Yasmin Cypel
- Department of Veterans Affairs, Health Outcomes Military Exposures, Veterans Health Administration, Washington, District of Columbia, USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, Massachusetts, USA
| | - Susan M Frayne
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kathryn M Magruder
- Departments of Psychiatry and Behavioral Sciences and Public Health, Medical University of SC, Charleston, South Carolina, USA
| | - Amy M Kilbourne
- US Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI), Washington, District of Columbia, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rachel Kimerling
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew J Reinhard
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
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Aiello EN, Pucci V, Diana L, Corvaglia A, Niang A, Mattiello S, Preti AN, Durante G, Ravelli A, Consonni L, Guerra C, Ponti AD, Sangalli G, Difonzo T, Scarano S, Perucca L, Zago S, Appollonio I, Mondini S, Bolognini N. The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment. Neurol Sci 2024; 45:1989-2001. [PMID: 38010584 PMCID: PMC11021315 DOI: 10.1007/s10072-023-07149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. METHODS The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. RESULTS The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). DISCUSSION The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Veronica Pucci
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Lorenzo Diana
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Corvaglia
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Aida Niang
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Silvia Mattiello
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Alice Naomi Preti
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgia Durante
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Adele Ravelli
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Lucia Consonni
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Carolina Guerra
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Adriana Delli Ponti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Gaia Sangalli
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Teresa Difonzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Zago
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
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Stein AL, Tolle KA, Stover AN, Shidler MD, Krikorian R. Detecting mild cognitive impairment remotely with the modified memory impairment screen by telephone. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:404-416. [PMID: 36951391 DOI: 10.1080/13825585.2023.2189688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
The original Memory Impairment Screen by Telephone (MIST) was designed to identify individuals with dementia but was relatively ineffective for identification of less severe impairment observed in mild cognitive impairment (MCI). We expanded the original MIST to create a modified instrument (mMIST) with greater sensitivity to less severe memory impairment. Older men and women with subjective cognitive decline were assessed by phone with the mMIST and subsequently classified independently with MCI or non-pathological cognitive decline. Participants with MCI produced lower scores on the mMIST than did participants without MCI, 10.8 ± 2.7 vs 13.3 ± 1.3, t = 5.68, p < 0.001, and performance on the mMIST predicted performances on the California Verbal Learning Test (CVLT), Verbal Paired Associate Learning Test (VPAL), Montreal Cognitive Assessment (MoCA) total score, and MoCA memory index score, p < 0.001. Receiver operating characteristic (ROC) analyses identified the optimal cut score on the mMIST to distinguish participants with and without MCI with Sensitivity = 73.1%, Specificity = 79.1%, and AUC = 0.79. Predictive values for distinguishing the amnestic form of MCI (aMCI) from non-amnestic MCI were Sensitivity = 81.8%, Specificity = 30%, and AUC = 0.82. These findings indicate that the mMIST is a valid screening instrument for identifying MCI. It can be administered remotely at low cost and low participant burden. Also, the mMIST has potential utility for remote cross-sectional and longitudinal evaluation in research and clinical contexts. Further investigation is indicated to corroborate its utility for assessment of aging patients and research participants.
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Affiliation(s)
- Amanda L Stein
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
| | - Kathryn A Tolle
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
- Neurobehavioral Consultants LLC, Indianapolis, IN, US Current affiliation
| | - Amanda N Stover
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
- Department of Public Health Sciences, Clemson University, Clemson, SC, US Current affiliation
| | - Marcelle D Shidler
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
| | - Robert Krikorian
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati Academic Health Center, Cincinnati, OH, US
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Giacona JM, Bates BM, Sundaram V, Brinker S, Moss E, Paspula R, Kassa S, Zhang R, Ahn C, Zhang S, Basit M, Burkhalter L, Cullum CM, Carlew A, Kelley BJ, Plassman BL, Vazquez M, Vongpatanasin W. Preventing cognitive decline by reducing BP target (PCOT): A randomized, pragmatic, multi-health systems clinical trial. Contemp Clin Trials 2024; 138:107443. [PMID: 38219797 DOI: 10.1016/j.cct.2024.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Growing evidence suggests that intensive lowering of systolic blood pressure (BP) may prevent mild cognitive impairment (MCI) and dementia. However, current guidelines provide inconsistent recommendations regarding optimal BP targets, citing safety concerns of excessive BP lowering in the diverse population of older adults. We are conducting a pragmatic trial to determine if an implementation strategy to reduce systolic BP to <130 and diastolic BP to <80 mmHg will safely slow cognitive decline in older adults with hypertension when compared to patients receiving usual care. METHODS The Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) is an embedded randomized pragmatic clinical trial in 4000 patients from two diverse health-systems who are age ≥ 70 years with BP >130/80 mmHg. Participants are randomized to the intervention arm or usual care using a permuted block randomization within each health system. The intervention is a combination of team-based care with clinical decision support to lower home BP to <130/80 mmHg. The primary outcome is cognitive decline as determined by the change in the modified Telephone Interview for Cognitive Status (TICS-m) scores from baseline. As a secondary outcome, patients who decline ≥3 points on the TICS-m will complete additional cognitive assessments and this information will be reviewed by an expert panel to determine if they meet criteria for MCI or dementia. CONCLUSION The PCOT trial will address the effectiveness and safety of hypertension treatment in two large health systems to lower BP targets to reduce risk of cognitive decline in real-world settings.
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Affiliation(s)
- John M Giacona
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, USA
| | - Brooke M Bates
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA
| | | | - Stephanie Brinker
- Division of General Internal Medicine, University of Texas Southwestern Medical Center, USA
| | - Elizabeth Moss
- Ambulatory Clinical Pharmacy Services, Parkland Health & Hospital System, USA
| | - Raja Paspula
- Geriatrics and Senior Care Center, Parkland Health & Hospital System, USA
| | - Sentayehu Kassa
- Vickery Health Center, Parkland Health & Hospital System, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, USA; Department of Neurology, UT Southwestern Medical Center, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - Song Zhang
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - Mujeeb Basit
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA
| | - Lorrie Burkhalter
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - C Munro Cullum
- Department of Neurology, UT Southwestern Medical Center, USA; Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, USA
| | - Anne Carlew
- Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, USA
| | | | - Brenda L Plassman
- Behavioral Medicine & Neurosciences Division, Department of Psychiatry, Duke University School of Medicine, USA
| | - Miguel Vazquez
- Nephrology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA.
| | - Wanpen Vongpatanasin
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA.
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5
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Al-Saleh S, Conley S, Pace T, Insel KC. A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation. West J Nurs Res 2024; 46:164-171. [PMID: 38146266 DOI: 10.1177/01939459231220283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
BACKGROUND There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. OBJECTIVE The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. METHODS A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships. RESULTS Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. CONCLUSION Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.
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Affiliation(s)
| | | | - Thaddeus Pace
- College of Nursing, The University of Arizona, Tucson, AZ, USA
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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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Gierzynski TF, Gregoire A, Reader JM, Pantis R, Campbell S, Bhaumik A, Rahman-Filipiak A, Heidebrink J, Giordani B, Paulson H, Hampstead BM. Evaluation of the Uniform Data Set version 3 teleneuropsychological measures. J Int Neuropsychol Soc 2024; 30:183-193. [PMID: 37366070 PMCID: PMC10751395 DOI: 10.1017/s1355617723000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Few studies have evaluated in-home teleneuropsychological (teleNP) assessment and none, to our knowledge, has evaluated the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 t-cog). The current study evaluates the reliability of the in-home UDS v3.0 t-cog with a prior in-person UDS v3.0 evaluation. METHOD One hundred and eighty-one cognitively unimpaired or cognitively impaired participants from a longitudinal study of memory and aging completed an in-person UDS v3.0 and a subsequent UDS v3.0 t-cog evaluation (∼16 months apart) administered either via video conference (n = 122) or telephone (n = 59). RESULTS We calculated intraclass correlation coefficients (ICCs) between each time point for the entire sample. ICCs ranged widely (0.01-0.79) but were generally indicative of "moderate" (i.e., ICCs ranging from 0.5-0.75) to "good" (i.e., ICCs ranging from 0.75-0.90) agreement. Comparable ICCs were evident when looking only at those with stable diagnoses. However, relatively stronger ICCs (Range: 0.35-0.87) were found between similarly timed in-person UDS v3.0 evaluations. CONCLUSIONS Our findings suggest that most tests on the UDS v3.0 t-cog battery may serve as a viable alternative to its in-person counterpart, though reliability may be attenuated relative to the traditional in-person format. More tightly controlled studies are needed to better establish the reliability of these measures.
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Affiliation(s)
| | - Allyson Gregoire
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rebecca Pantis
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Campbell
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Arijit Bhaumik
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Bruno Giordani
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin M. Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
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Ghonoodi F, Sharifi F, Shahsavari H, Shahrestanaki SK, Navab E. Validity and reliability of the persian version of the modified telephone interview for cognitive status among community-dwelling older adults in Iran. Dement Neuropsychol 2024; 17:e20230020. [PMID: 38189034 PMCID: PMC10768643 DOI: 10.1590/1980-5764-dn-2023-0020] [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: 05/13/2023] [Revised: 09/08/2023] [Accepted: 10/12/2023] [Indexed: 01/09/2024] Open
Abstract
Due to the increase in the population of the elderly, there is a growing trend in some diseases such as cognitive disorders (dementia) which are common in this era, and the diagnosis and treatment of this disease are still facing challenges. Therefore, early identification of cognitive disorders is of particular importance. In this regard, the use of any tool or cognitive tests may not be enough to diagnose dementia in the early stages and a special tool is needed. Objective The validity and reliability of the Persian version of the Modified Telephone Interview for Cognitive Status (P-TICS-M) in older adults living in the Iranian community for a comprehensive screening of mild cognitive impairment and dementia was investigated. Methods In the first phase, translation, re-translation, and word-taking were performed by using the face validity and content validity. In the second phase, a stratified convenient sampling with 150 participants aged ≥60 years was conducted based on cognitive status using the global deterioration scale in 2018. The external and internal reliability of the P-TICS-M using the interclass correlation coefficient and Cronbach's alpha coefficient of total items of this tool were estimated. Results The mean age of the participants was 68.6 (standard deviation±7.4) years. According to global deterioration scale, 87 (58.0%) had normal cognition, 40 (26.7%) had mild cognitive impairment, and 23 (15.3%) had dementia. The Spearman's correlation coefficient between P-TICS-M scores and Mini-Mental State Examination scale was 0.764. In exploratory factor analysis, seven domains were detected, which were compatible with those defined by the tool developer. The Cronbach's alpha of the P-TICS-M was 0.920. The absolute agreement between test-retest score was >0.90. The sensitivity of 92.2, 94.8, and 100%, and also the specificity of 79.4, 88.2, and 89.8% were calculated for detecting subjects with dementia, respectively. Furthermore, a mild cognitive impairment cutoff of >28 was determined. Conclusion The development and validation of a P-TICS-M tool can be useful in identifying older adult people with cognitive impairment. Demographic characteristics (level of education, age) can also affect the cutoff point of this tool.
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Affiliation(s)
- Fatemeh Ghonoodi
- Tehran University of Medical Sciences, School of Nursing and Midwifery, Department of Geriatric Nursing, Tehran, Iran
| | - Farshad Sharifi
- Tehran University of Medical Sciences, Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
| | - Hooman Shahsavari
- Tehran University of Medical Sciences, School of Nursing and Midwifery, Department of Medical-Surgical Nursing, Tehran, Iran
| | - Sahar Keyvanloo Shahrestanaki
- Iran University of Medical Sciences, School of Nursing and Midwifery, Tehran, Iran
- Tehran University of Medical Sciences, School of Nursing and Midwifery, Department of Geriatric Nursing, Tehran, Iran
| | - Elham Navab
- Tehran University of Medical Sciences, School of Nursing and Midwifery, Department of Critical Care and Geriatric Nursing, Tehran, Iran
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Carvalho CM, de Andrade KR, Poltronieri BC, de Oliveira YG, Ferreira RG, Woodruff E, Panizzutti R. Translation and validation of the audiovisual version of the Montreal cognitive assessment in older adults in Brazil. BMC Geriatr 2024; 24:10. [PMID: 38172673 PMCID: PMC10765722 DOI: 10.1186/s12877-023-04553-2] [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: 06/07/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of a reliable remote cognitive screening test for older adults is crucial for the diagnosis of cognitive impairment. This study aimed to translate and validate the audiovisual Montreal Cognitive Assessment (MoCA)for older adults in Brazil. METHODS One hundred and fourteen older adults were recruited from the community and demographic, functional, mood, and cognitive data were collected. Participants were classified into two groups: cognitively healthy or mild cognitive impairment (MCI). Statistical analyses were performed in order to assess the validity of the test and the cutoff score. RESULTS The psychometric properties of the audiovisual MoCA showed good convergent validity. The audiovisual MoCA was represented as a unifactorial adjusted model, the composite reliability value was acceptable and a cutoff point of ≥23 reached adequate sensitivity and specificity at 0.77 and 0.92, respectively. CONCLUSIONS The translated audiovisual MoCA is a valid and reliable cognitive screening test that can be administered remotely in older adults in Brazil. The test demonstrated a great ability to discriminate older adults with MCI from cognitively healthy adults. Future studies should focus on validating the audiovisual MoCA using other target population groups in order to expand the use of this remote screening test.
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Affiliation(s)
- Cíntia Monteiro Carvalho
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karin Reuwsaat de Andrade
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Costa Poltronieri
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yasmin Guedes de Oliveira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafaela Guilherme Ferreira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erica Woodruff
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogerio Panizzutti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás 71, Rio de Janeiro, RJ, 22290140, Brazil.
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Tanev KS, Camprodon JA, Caplan DN, Dickerson BC, Chemali Z, Eldaief MC, Kim DD, Josephy-Hernandez SE, Kritzer MD, Moo LR, Newhouse A, Perez DL, Ramirez Gomez LA, Razafsha M, Rivas-Grajales AM, Scharf JM, Schmahmann JD, Sherman JC. Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group. J Neuropsychiatry Clin Neurosci 2023; 36:87-100. [PMID: 38111331 DOI: 10.1176/appi.neuropsych.20220154] [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: 12/20/2023]
Abstract
Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.
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Affiliation(s)
- Kaloyan S Tanev
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Joan A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David N Caplan
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Bradford C Dickerson
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Zeina Chemali
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mark C Eldaief
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David Dongkyung Kim
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Sylvia E Josephy-Hernandez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Michael D Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Lauren R Moo
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Amy Newhouse
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David L Perez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Liliana A Ramirez Gomez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mahdi Razafsha
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Ana Maria Rivas-Grajales
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremiah M Scharf
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremy D Schmahmann
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Janet C Sherman
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
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Choi EY, Lee H, Chang VW. Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA. J Epidemiol Community Health 2023; 77:728-735. [PMID: 37541774 DOI: 10.1136/jech-2023-220675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status. METHODS Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older. RESULTS We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods. CONCLUSION Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.
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Affiliation(s)
- Eun Young Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Haena Lee
- Department of Sociology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
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12
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Montemurro S, Mondini S, Pucci V, Durante G, Riccardi A, Maffezzini S, Scialpi G, Signorini M, Arcara G. Tele-Global Examination of Mental State (Tele-GEMS): an open tool for the remote neuropsychological screening. Neurol Sci 2023; 44:3499-3508. [PMID: 37248426 PMCID: PMC10226870 DOI: 10.1007/s10072-023-06862-1] [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: 01/06/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Tele-neuropsychology, i.e., the application of remote audio-visual technologies to neuropsychological evaluation or rehabilitation, has become increasingly popular and widespread during and after the COVID-19 pandemic. New tools with updated normative data and appropriate methodological developments are necessary. We present Tele-GEMS, a telephone-based cognitive screening developed on N = 601 Italian participants. It yields a global score tapping on orientation, memory, spatial representation, language, and pragmatic abilities. Its administration lasts about 10 min. Clinical cut-offs are provided, accounting for demographic variables (age, education, and sex) and also for a comprehensive index taking into account cognitively stimulating life experiences that can build up a cognitive reserve. Tele-GEMS shows good internal consistency and a good inter-rater agreement. The test includes the thresholds for estimating a significant change after repeated measurements. Tele-GEMS has a good construct validity as assessed with MoCA and a suitable criterion validity assessed with its in-person version (GEMS). All the materials and the instructions, including scripts and an online Application for the automatic calculation of cut-offs, are accessible on OSF at https://osf.io/t3bma/ under a Creative Commons license.
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Affiliation(s)
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Centro di Ateneo Servizi Clinici Universitari Psicologici (SCUP), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Veronica Pucci
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Giorgia Durante
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
| | - Alice Riccardi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Sabrina Maffezzini
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Graziana Scialpi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
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Chappelle SD, Gigliotti C, Léger GC, Peavy GM, Jacobs DM, Banks SJ, Little EA, Galasko D, Salmon DP. Comparison of the telephone-Montreal Cognitive Assessment (T-MoCA) and Telephone Interview for Cognitive Status (TICS) as screening tests for early Alzheimer's disease. Alzheimers Dement 2023; 19:4599-4608. [PMID: 36939111 PMCID: PMC10509307 DOI: 10.1002/alz.13039] [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: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Remote screening for cognitive impairment associated with Alzheimer's disease (AD) has grown in importance with the expected rise in prevalence of AD in an aging population and with new potential treatment options. METHODS The Telephone Interview for Cognitive Status (TICS) and new telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) were administered to participants independently classified through in-person clinical evaluation as cognitively normal (CN; n = 167), mild cognitive impairment (MCI; n = 25), or dementia (n = 23). Cerebrospinal fluid AD biomarkers were measured (n = 79). RESULTS TICS and T-MoCA were highly correlated (r = 0.787; P < 0.001): groups differed on both (CN DISCUSSION TICS and T-MoCA are effective for remotely detecting cognitive impairment associated with AD in older adults. Strong correlation between tests provides construct validity for the newer T-MoCA. HIGHLIGHTS Construct validity for the telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) was newly established against the Telephone Interview for Cognitive Status (TICS). TICS and T-MoCA effectively detected cognitive impairment with remote administration. Both tests negatively correlated with a composite cerebrospinal fluid Alzheimer's disease (AD) biomarker (tau/amyloid beta 1-42).
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Affiliation(s)
- Sheridan D Chappelle
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Christina Gigliotti
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Gabriel C Léger
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Guerry M Peavy
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Diane M Jacobs
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Sarah J Banks
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Emily A Little
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Douglas Galasko
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - David P Salmon
- Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
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Macnab TMP, Espahbodi S, Hogervorst E, Thanoon A, Fernandes GS, Millar B, Duncan A, Goodwin M, Batt M, Fuller CW, Fuller G, Ferguson E, Bast T, Doherty M, Zhang W. Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study. SPORTS MEDICINE - OPEN 2023; 9:43. [PMID: 37289312 DOI: 10.1186/s40798-023-00588-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Previous studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men. METHODS A cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function. RESULTS Retired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11-3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18-2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25-9.63) after adjustment for age and possible confounders. CONCLUSIONS UK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors.
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Affiliation(s)
- Tara-Mei Povall Macnab
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Shima Espahbodi
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Eef Hogervorst
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Ahmed Thanoon
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Gwen Sascha Fernandes
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie Millar
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Ashley Duncan
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Maria Goodwin
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark Batt
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | | | - Gordon Fuller
- Centre for Urgent and Emergency Research, University of Sheffield, Sheffield, UK
| | - Eamonn Ferguson
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Tobias Bast
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- Neuroscience@Nottingham, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK.
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK.
- School of Psychology, University of Nottingham, Nottingham, UK.
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
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15
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Márquez NG, Jamal A, Johnston R, Richter EI, Gorbach PM, Vannorsdall TD, Rubin LH, Jennings C, Landay AL, Peluso MJ, Antar AAR. Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study. JMIR Res Protoc 2023; 12:e47079. [PMID: 37104709 PMCID: PMC10234419 DOI: 10.2196/47079] [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: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID. OBJECTIVE This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID. METHODS This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV-COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID- arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV-COVID- arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post-acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID- arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID- arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID- arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored. RESULTS This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22%) HIV+COVID+, 121 (35.1%) HIV-COVID+, 78 (22.6%) HIV+COVID-, and 70 (20.3%) HIV-COVID- participants. CONCLUSIONS This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47079.
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Affiliation(s)
- Nuria Gallego Márquez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Armaan Jamal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rowena Johnston
- amfAR, The Foundation for AIDS Research, New York, NY, United States
| | - E India Richter
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leah H Rubin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cheryl Jennings
- Department of Internal Medicine, Rush University Medical College, Chicago, IL, United States
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical College, Chicago, IL, United States
| | - Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, California, CA, United States
| | - Annukka A R Antar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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16
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Voon NS, Manan HA, Yahya N. Remote assessment of cognition and quality of life following radiotherapy for glioma: deep-learning-based predictive models and MRI correlates. J Neurooncol 2023; 162:407-415. [PMID: 37014593 PMCID: PMC10071464 DOI: 10.1007/s11060-023-04303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Glioma irradiation often unavoidably damages the brain volume and affects cognition. This study aims to evaluate the relationship of remote cognitive assessments in determining cognitive impairment of irradiated glioma patients in relation to the quality of life and MRI changes. METHODS Thirty patients (16-76 aged) with two imaging (pre- and post-RT) and completed cognitive assessments were recruited. Cerebellum, right and left temporal lobes, corpus callosum, amygdala and spinal cord were delineated and their dosimetry parameters were collected. Cognitive assessments were given post-RT via telephone (Telephone Interview Cognitive Status (TICS), Telephone Montreal Cognitive Assessment (T-MoCA), Telephone Mini Addenbrooke's Cognitive Examination (Tele-MACE)). Regression models and deep neural network (DNN) were used to evaluate the relationship between brain volume, cognition and treatment dose in patients. RESULTS Cognitive assessments were highly inter-correlated (r > 0.9) and impairment was shown between pre- and post-RT findings. Brain volume atrophy was shown post-RT, and cognitive impairments were correlated with radiotherapy-associated volume atrophy and dose-dependent in the left temporal lobe, corpus callosum, cerebellum and amygdala. DNN showed a good area under the curve for cognitive prediction; TICS (0.952), T-MoCA (0.909) and Tele-MACE (0.822). CONCLUSIONS Cognition can be evaluated remotely in which radiotherapy-related brain injury is dose-dependent and volume-dependent. Prediction models can assist in the early identification of patients at risk for neurocognitive decline following RT for glioma, thus facilitating potential treatment interventions.
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Affiliation(s)
- Noor Shatirah Voon
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur, 50300, Malaysia
- National Cancer Institute, Ministry of Health, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur, 50300, Malaysia.
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17
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Voon NS, Manan HA, Yahya N. Remote assessment of cognition and quality of life following radiotherapy for nasopharyngeal carcinoma: deep-learning-based predictive models and MRI correlates. J Cancer Surviv 2023:10.1007/s11764-023-01371-8. [PMID: 37010777 PMCID: PMC10069366 DOI: 10.1007/s11764-023-01371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Irradiation of the brain regions from nasopharyngeal carcinoma (NPC) radiotherapy (RT) is frequently unavoidable, which may result in radiation-induced cognitive deficit. Using deep learning (DL), the study aims to develop prediction models in predicting compromised cognition in patients following NPC RT using remote assessments and determine their relation to the quality of life (QoL) and MRI changes. METHODS Seventy patients (20-76 aged) with MRI imaging (pre- and post-RT (6 months-1 year)) and complete cognitive assessments were recruited. Hippocampus, temporal lobes (TLs), and cerebellum were delineated and dosimetry parameters were extracted. Assessments were given post-RT via telephone (Telephone Interview Cognitive Status (TICS), Telephone Montreal Cognitive Assessment (T-MoCA), Telephone Mini Addenbrooke's Cognitive Examination (Tele-MACE), and QLQ-H&N 43). Regression and deep neural network (DNN) models were used to predict post-RT cognition using anatomical and treatment dose features. RESULTS Remote cognitive assessments were inter-correlated (r > 0.9). TLs showed significance in pre- and post-RT volume differences and cognitive deficits, that are correlated with RT-associated volume atrophy and dose distribution. Good classification accuracy based on DNN area under receiver operating curve (AUROC) for cognitive prediction (T-MoCA AUROC = 0.878, TICS AUROC = 0.89, Tele-MACE AUROC = 0.919). CONCLUSION DL-based prediction models assessed using remote assessments can assist in predicting cognitive deficit following NPC RT. Comparable results of remote assessments in assessing cognition suggest its possibility in replacing standard assessments. IMPLICATIONS FOR CANCER SURVIVORS Application of prediction models in individual patient enables tailored interventions to be provided in managing cognitive changes following NPC RT.
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Affiliation(s)
- Noor Shatirah Voon
- Diagnostic Imaging and Radiotherapy, Centre for Diagnostic, Therapeutic and Investigative Sciences (CODTIS), Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia
- National Cancer Institute, Ministry of Health, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Centre for Diagnostic, Therapeutic and Investigative Sciences (CODTIS), Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia.
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18
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Smith JR, Gibbons LE, Crane PK, Mungas DM, Glymour MM, Manly JJ, Zahodne LB, Rose Mayeda E, Jones RN, Gross AL. Shifting of Cognitive Assessments Between Face-to-Face and Telephone Administration: Measurement Considerations. J Gerontol B Psychol Sci Soc Sci 2023; 78:191-200. [PMID: 36099407 PMCID: PMC9938920 DOI: 10.1093/geronb/gbac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Telephone-administered cognitive assessments are a cost-effective and sometimes necessary alternative to face-to-face assessments. There is limited information in large studies concerning mode effects, or differences in cognition attributable to the assessment method, as a potential measurement threat. We evaluated mode effects on cognitive scores using a population-based sample of community-living older adults. METHODS We used data from participants aged 65-79 in the 2014 Health and Retirement Study for whom the interview mode was randomized (n = 6,825). We assessed mode differences in test means, whether mode modifies associations of cognition with criterion variables, and formal measurement invariance testing. RESULTS Relative to face-to-face assessment, telephone assessment was associated with higher scores for memory and calculation (0.06 to 0.013 standard deviations [SD]) and lower scores for nonmemory items (-0.09 to -0.01 SD). Cognition was significantly differentially related to instrumental activities of daily living difficulty depending on assessment mode. Measurement invariance testing identified evidence of mode differences in certain tests as a function of mode: adjusting for underlying cognition, the largest mode differences in memory and attention: immediate noun recall, delayed word recall, and serial-7s scores were higher given telephone administration. DISCUSSION Differences by mode of administration are apparent in cognitive measurement in older adults, albeit to a small degree in our study, and most pronounced for tests of memory and attention. The importance of accounting for mode differences ultimately depends on one's research question and study sample: not all associations may be affected by mode differences, and such modification may only be apparent among those with lower cognitive functioning.
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Affiliation(s)
- Jason R Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Gibbons
- General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Paul K Crane
- General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Dan M Mungas
- Department of Neurology, University of California, Davis, California, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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van Zuylen ML, van Wilpe R, Ten Hoope W, Willems HC, Geurtsen GJ, Hulst AH, Hollmann MW, Preckel B, DeVries JH, Hermanides J. Comparison of Postoperative Neurocognitive Function in Older Adult Patients with and without Diabetes Mellitus. Gerontology 2023; 69:189-200. [PMID: 35660665 DOI: 10.1159/000524886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Delayed neurocognitive recovery (DNR; neurocognitive disorder up to 30 days postoperative) and postoperative neurocognitive disorders (POCD; neurocognitive disorder 1-12 months postoperative) occur frequently after surgery, with diabetes mellitus (DM) suggested to contribute to this. This was a single-center prospective cohort study. The main aim of this study was to investigate the role of DM and preoperative hemoglobin A1c (HbA1c) in the development of POCDs after noncardiac surgery. METHODS Older adult patients ≥65 years of age scheduled for elective surgery were recruited. The Modified Telephone Interview for Cognitive Status questionnaire (TICS-M), a test of global cognitive functioning, was administered to determine cognition. Preoperative, 30-day postoperative, and 6-month postoperative cognition were compared for patients with and without DM. Cognitive decline was subdivided into mild (1 to 2 standard deviations below controls) and major (≥2 standard deviations below controls) DNR or POCD. Preoperative HbA1c levels were correlated with TICS-M scores. RESULTS We analyzed 102 patients [median (IQR [range]) age 72.0 (5 [68-74])]), who were divided into patients with DM (80 patients [78%]) and patients without DM (22 patients [22%]). Baseline cognitive function was similar for both groups. Repeated measures ANOVA showed that mean DM patient TICS-M scores decreased 30 days postoperative (F(2, 200) = 4.0, p = 0.02), with subsequent recovery 6-month postoperative, compared to stable TICS-M scores in non-DM patients. There were significantly more DM patients with DNR than non-DM patients (n = 11 [50%] vs. n = 14 [17.5%]; p = 0.031). There were no between-group differences in mild or major POCD. Higher preoperative HbA1c levels were significantly correlated with decreased 30-day Δcognition scores (F(1, 54) = 9.4, p = 0.003) with an R2 of 0.149 (β -0.45, 95% confidence interval: -0.735 to -0.154). CONCLUSIONS Older adult patients with DM undergoing surgery have an increased risk of DNR compared to older adult non-DM patients, but no increased risk of POCD. In DM patients, higher preoperative HbA1c levels were associated with an increased risk of DNR.
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Affiliation(s)
- Mark L van Zuylen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert van Wilpe
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Werner Ten Hoope
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abraham H Hulst
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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van Zuylen ML, Kampman JM, Turgman O, Gribnau A, Ten Hoope W, Preckel B, Willems HC, Geurtsen GJ, Hermanides J. Prospective comparison of three methods for detecting peri-operative neurocognitive disorders in older adults undergoing cardiac and non-cardiac surgery. Anaesthesia 2023; 78:577-586. [PMID: 36632036 DOI: 10.1111/anae.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
Postoperative neurocognitive disorders occur frequently in older adult patients. Neuropsychological assessment is the gold standard for diagnosis, but the resources required for routine use are significant. Instead, it is common for simplified and unvalidated tests to be used for trials and in clinical practice. We undertook a single-centre prospective observational study in elective surgical patients aged ≥ 65 years recruited between September 2019 and January 2021. Patients underwent neuropsychological assessment, the Modified Telephone Interview for Cognitive Status and Montreal Cognitive Assessment before surgery. Tests were repeated at approximately four to eight postoperative weeks. We included 105 patients and 28 (27%) were lost to follow-up. Pre-operative Modified Telephone Interview for Cognitive Status and cognitive domain scores were very weakly to moderately correlated (r = 0.09-0.41). Pre-operative Montreal Cognitive Assessment and cognitive domain scores were very weakly to weakly correlated (r = 0.17-0.37) Postoperative Modified Telephone Interview for Cognitive Status and cognitive domain scores were very weakly to weakly correlated (r = 0.09-0.36). Postoperative Montreal Cognitive Assessment score and cognitive domain scores were very weakly to weakly correlated (r = 0.07-0.36). Overall, there was limited agreement between tests. We conclude that the Modified Telephone Interview for Cognitive Status and Montreal Cognitive Assessment should not be used in isolation to diagnose postoperative neurocognitive disorders. There seems to be little to no pre-operative, postoperative or pre- to postoperative correlation between these tests and the neuropsychological assessment in older adults without pre-operative cognitive impairment.
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Affiliation(s)
- M L van Zuylen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - J M Kampman
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - O Turgman
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - A Gribnau
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - W Ten Hoope
- Department of Anaesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - B Preckel
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - H C Willems
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - G J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - J Hermanides
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, The Netherlands
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ter Huurne D, Possemis N, Banning L, Gruters A, König A, Linz N, Tröger J, Langel K, Verhey F, de Vugt M, Ramakers I. Validation of an Automated Speech Analysis of Cognitive Tasks within a Semiautomated Phone Assessment. Digit Biomark 2023; 7:115-123. [PMID: 37901366 PMCID: PMC10601928 DOI: 10.1159/000533188] [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: 05/03/2023] [Accepted: 07/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction We studied the accuracy of the automatic speech recognition (ASR) software by comparing ASR scores with manual scores from a verbal learning test (VLT) and a semantic verbal fluency (SVF) task in a semiautomated phone assessment in a memory clinic population. Furthermore, we examined the differentiating value of these tests between participants with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). We also investigated whether the automatically calculated speech and linguistic features had an additional value compared to the commonly used total scores in a semiautomated phone assessment. Methods We included 94 participants from the memory clinic of the Maastricht University Medical Center+ (SCD N = 56 and MCI N = 38). The test leader guided the participant through a semiautomated phone assessment. The VLT and SVF were audio recorded and processed via a mobile application. The recall count and speech and linguistic features were automatically extracted. The diagnostic groups were classified by training machine learning classifiers to differentiate SCD and MCI participants. Results The intraclass correlation for inter-rater reliability between the manual and the ASR total word count was 0.89 (95% CI 0.09-0.97) for the VLT immediate recall, 0.94 (95% CI 0.68-0.98) for the VLT delayed recall, and 0.93 (95% CI 0.56-0.97) for the SVF. The full model including the total word count and speech and linguistic features had an area under the curve of 0.81 and 0.77 for the VLT immediate and delayed recall, respectively, and 0.61 for the SVF. Conclusion There was a high agreement between the ASR and manual scores, keeping the broad confidence intervals in mind. The phone-based VLT was able to differentiate between SCD and MCI and can have opportunities for clinical trial screening.
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Affiliation(s)
- Daphne ter Huurne
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Nina Possemis
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Leonie Banning
- Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | | | - Alexandra König
- National Institute for Research in Computer Science and Automation (INRIA), Sophie Antipolis, France
- ki elements, Saarbrücken, Germany
| | | | | | - Kai Langel
- Janssen Clinical Innovation, Beerse, Belgium
| | - Frans Verhey
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Inez Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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22
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Henneghan AM, Van Dyk KM, Ackerman RA, Paolillo EW, Moore RC. Assessing cancer-related cognitive function in the context of everyday life using ecological mobile cognitive testing: A protocol for a prospective quantitative study. Digit Health 2023; 9:20552076231194944. [PMID: 37588154 PMCID: PMC10426293 DOI: 10.1177/20552076231194944] [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: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Millions of cancer survivors are at risk for cancer-related cognitive impairment (CRCI), yet accurate and accessible assessments of cognitive functioning remain limited. Ecological mobile cognitive testing (EMCT) could offer a solution. This paper presents the protocol for a study that aims to (1) establish the reliability and validity of EMCT to assess CRCI in breast cancer survivors, and (2) prospectively evaluate within-person processes (and interactions) among context, mood, and behavior that explain cognitive variability, everyday functioning, and quality of life of cancer survivors. Methods Participants will include breast cancer survivors (>21 years old) who are within 5 years of completing chemotherapy treatment. Participants will complete two virtual visits (baseline, follow-up) 2 months apart to assess self-reported cognitive symptoms and cognitive performance, sociodemographic characteristics, clinical history, everyday functioning, and quality of life. Between virtual visits, EMCT will be used to sample cognitive functioning every other day (28 times total). We will use linear mixed-effect regressions and single-level multiple regression models to analyze the data. Results We anticipate a minimum of 124 breast cancer survivors enrolling and completing data collection. Study results will be published in peer-reviewed scientific journals. Conclusions Our findings will have broad implications for assessing CRCI in an ecologically valid and person-centered way using EMCT. We aim to provide this protocol to aid researchers who would like to apply this approach to their studies.
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Affiliation(s)
| | - Kathleen M Van Dyk
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, CA, USA
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23
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Loveland PM, Watson R, Yassi N. Diagnostic challenges for dementia in Australia: are blood-based biomarkers the solution? Intern Med J 2022; 52:2181-2185. [PMID: 37133369 PMCID: PMC10946735 DOI: 10.1111/imj.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/24/2022] [Indexed: 12/23/2022]
Abstract
The burden of dementia will increase as the Australian population ages and grows in coming decades. Early and accurate diagnosis remains challenging, and disproportionately so for particular groups, including rural communities. Recent advances in technology, however, now allow reliable measurement of blood biomarkers that could improve diagnosis in a range of settings. We discuss the most promising biomarker candidates for translation into clinical practice and research in the near future.
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Affiliation(s)
- Paula M. Loveland
- Population Health and Immunity DivisionThe Walter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of Medicine, The Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rosie Watson
- Population Health and Immunity DivisionThe Walter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of Medicine, The Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Nawaf Yassi
- Population Health and Immunity DivisionThe Walter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of Medicine, The Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Neurology, Melbourne Brain Centre at The Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
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24
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Rombauts A, Infante C, de Lagos MDÁM, Alba J, Valiente A, Donado-Mazarrón C, Carretero-Ledesma M, Rodríguez-Álvarez R, Omatos S, Palacios-Baena ZR, Abelenda-Alonso G, Silva-Sánchez MDM, Goikoetxea-Agirre AJ, Oteo JA, Rodríguez-Baño J, Cordero E, Gudiol C, Sánchez-Céspedes J, Carratalà J. Impact of SARS-CoV-2 RNAemia and other risk factors on long-COVID: A prospective observational multicentre cohort study. J Infect 2022; 86:154-225. [PMID: 36403699 PMCID: PMC9671615 DOI: 10.1016/j.jinf.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Alexander Rombauts
- Department of Infectious Diseases, Hospital Universitari de Bellvitge – Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Infante
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain,Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jorge Alba
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Adoración Valiente
- Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
| | - Carla Donado-Mazarrón
- Department of Infectious Diseases, Hospital Universitari de Bellvitge – Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Carretero-Ledesma
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain,Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | | | - Sonia Omatos
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Zaira R. Palacios-Baena
- Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Hospital Universitari de Bellvitge – Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - María del Mar Silva-Sánchez
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain,Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | | | - José A. Oteo
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Jesús Rodríguez-Baño
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain,Department of Medicine, School of Medicine, University of Seville, Seville, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain,Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Department of Medicine, School of Medicine, University of Seville, Seville, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge – Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Javier Sánchez-Céspedes
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge – Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Universitat de Barcelona, Barcelona, Spain
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25
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Byrne KA, Ghaiumy Anaraky R. Identifying Racial and Rural Disparities of Cognitive Functioning Among Older Adults: The Role of Social Isolation and Social Technology Use. J Gerontol B Psychol Sci Soc Sci 2022; 77:1779-1790. [PMID: 35312775 PMCID: PMC9535781 DOI: 10.1093/geronb/gbac055] [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: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Social isolation is associated with poorer cognitive outcomes among older adults. The use of online social technology platforms may provide a means to reduce social isolation. However, research examining whether social technology can mitigate the negative effects of social isolation on cognitive functioning is limited. This study investigates the interaction between social isolation and social technology use on cognitive functioning among older adults and seeks to identify racial and rural-urban differences in this relationship. METHOD Data were obtained from the Health and Retirement Study 2014-2018 waves (N = 5,358). Participants (aged 50-102) completed self-report measures of social isolation, loneliness, and frequency of online social communication and completed the modified Telephone Interview for Cognitive Status, which assesses cognitive functioning. Examinations of race focused on differences between Black/African American and White/Caucasian groups; rurality was operationalized using Beale Rural-Urban Continuum Codes. Data were analyzed using structural equation models. RESULTS Social technology use moderated the negative relationship between social isolation and cognitive functioning, controlling for age, education, gender, wealth, and general computer usage. Greater social technology use was associated with better cognitive functioning among socially isolated older adults. Results showed evidence of racial, but not rural-urban, differences in the relationship between social technology use and cognitive functioning. Regardless of the degree of social isolation, frequent social technology use was associated with improved cognitive functioning in Black/African American older adults but not White/Caucasians older adults. DISCUSSION Social technology may represent a way to mitigate cognitive decline, particularly among Black/African American older adults.
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Affiliation(s)
- Kaileigh A Byrne
- Address correspondence to: Clemson University, 418 Brackett Hall, Clemson, SC 29634, USA. E-mail:
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26
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Ayers E, Wang C, Verghese J. Validation of a "subjective motoric cognitive risk syndrome" screening tool for motoric cognitive risk syndrome-A prospective cohort study. Eur J Neurol 2022; 29:2925-2933. [PMID: 35748730 PMCID: PMC9875832 DOI: 10.1111/ene.15476] [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: 04/07/2022] [Revised: 06/02/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a gait-based pre-dementia syndrome associated with risk of dementia. Ascertaining subjective cognitive and motoric complaints may facilitate early and remote identification of individuals with MCR as they are reported to precede and predict objective cognitive and motoric impairments in aging. METHODS The validity of five subjective motoric complaint (SMC) questions and 10 subjective cognitive complaint (SCC) questions was examined for discriminating MCR in 538 non-demented community-dwelling adults. Backward logistic regression was used to identify questions to develop a weighted score to define subjective MCR (MCR-S). Receiver operating characteristic analysis was applied to determine the discriminative ability of MCR-S for the objective MCR (MCR-O) definition based on SCCs and objectively measured gait. Cox proportional hazard models adjusted for potential confounders were used to examine the predictive validity of MCR-S for incident dementia. RESULTS Five subjective complaint questions (three SCC and two SMC) were associated with MCR-O. They were combined to define an MCR-S score (range 0-7) which yielded an area under the curve of 0.89 for discriminating MCR-O from receiver operating characteristic analysis. An optimal cut-score of 2 on the MCR-S score was determined to have good sensitivity (84%) and specificity (82%) for MCR-O. Over a median follow-up of 2.5 years, 29 participants developed dementia. Both MCR-S (adjusted hazard ratio 2.39) and MCR-O at baseline (adjusted hazard ratio 3.16) predicted risk of incident dementia. CONCLUSIONS Subjective MCR had high concordance with MCR-O and can provide a remote screening assessment for MCR-O, which can identify those at high risk for dementia.
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Affiliation(s)
- Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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27
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Lai Y, Zhao M, Jiang C, Du X, Wang Z, Zhang J, Bai Y, Xu B, Zhang W, Tang R, Sang C, Long D, Dong J, Ma C. Validation of T-MoCA in the Screening of Mild Cognitive Impairment in Chinese Patients With Atrial Fibrillation. Front Cardiovasc Med 2022; 9:896846. [PMID: 35811734 PMCID: PMC9257241 DOI: 10.3389/fcvm.2022.896846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is associated with a high risk of mild cognitive impairment (MCI) and dementia. However, feasible and simple instruments that facilitate the regular assessment of cognitive status in patients with AF remain underdeveloped.MethodsCognitive function was first evaluated using telephone Montreal cognitive assessment (T-MoCA), and then patients were invited for an in-person interview for cognitive assessment using both Clinical Dementia Rating (CDR) and mini-mental status evaluation (MMSE). Using CDR = 0.5 as a reference standard, the ability of T-MoCA and MMSE to discriminate cognitive dysfunction, stratified by education level, was tested by receiver–operating curve (ROC) analysis. The net reclassification index was calculated for comparison between the performance of T-MoCA and MMSE.ResultsOne hundred and one patients completed both telephone and in-person interview. Thirty-five MCI patients were identified as MCI using the criteria of CDR = 0.5. The areas under the ROC curve of T-MoCA were 0.80 (0.71–0.89), 0.83 (0.71–0.95), and 0.85 (0.64–0.92) for all patients, patients with high educational level, and patients with low education level, respectively. The optimal threshold was achieved at 16/17 with a sensitivity of 85.7% and a specificity of 69.7% in overall patients, 15/16 with a sensitivity of 88.2% and a specificity of 64.5% in the low educational level patients, and 16/17 with a sensitivity of 77.8% and a specificity of 87.9% in the high educational level patients. Compared to the criterion MMSE ≤ 27 and MMSE norms for the elderly Chinese community, the stratified T-MoCA threshold improves correct classification by 23.7% (p = 0.033) and 30.3% (p = 0.020), respectively.ConclusionT-MoCA is a feasible and effective instrument for MCI screening in patients with AF.
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Affiliation(s)
- Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Manlin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
- *Correspondence: Chao Jiang
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Zhiyan Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Jingrui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Yu Bai
- School of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Baolei Xu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiwei Zhang
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
- Changsheng Ma
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28
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Aiello EN, Pucci V, Diana L, Niang A, Preti AN, Delli Ponti A, Sangalli G, Scarano S, Tesio L, Zago S, Difonzo T, Appollonio I, Mondini S, Bolognini N. Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases. Aging Clin Exp Res 2022; 34:1635-1644. [PMID: 35699839 PMCID: PMC9194888 DOI: 10.1007/s40520-022-02155-3] [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: 02/23/2022] [Accepted: 05/13/2022] [Indexed: 12/18/2022]
Abstract
Background Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). Methods The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. Results In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC = .78–.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). Discussion The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02155-3.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Veronica Pucci
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy.,Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Lorenzo Diana
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Aida Niang
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alice Naomi Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Adriana Delli Ponti
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Gaia Sangalli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Zago
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Teresa Difonzo
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy.,Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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29
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Shi C, Babiker N, Urbanek JK, Grossman RL, Huisingh-Scheetz M, Rzhetsky A. Free-living wrist and hip accelerometry forecast cognitive decline among older adults without dementia over 1- or 5-years in two distinct observational cohorts. NPJ AGING 2022; 8:7. [PMID: 35927250 PMCID: PMC9170733 DOI: 10.1038/s41514-022-00087-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/28/2022] [Indexed: 11/09/2022]
Abstract
The prevalence of major neurocognitive disorders is expected to rise over the next 3 decades as the number of adults ≥65 years old increases. Noninvasive screening capable of flagging individuals most at risk of subsequent cognitive decline could trigger closer monitoring and preventive strategies. In this study, we used free-living accelerometry data to forecast cognitive decline within 1- or 5-years in older adults without dementia using two cohorts. The first cohort, recruited in the south side of Chicago, wore hip accelerometers for 7 continuous days. The second cohort, nationally recruited, wore wrist accelerometers continuously for 72 h. Separate classifier models forecasted 1-year cognitive decline with over 85% accuracy using hip data and forecasted 5-year cognitive decline with nearly 70% accuracy using wrist data, significant improvements compared to demographics and comorbidities alone. The proposed models are readily translatable to clinical practices serving ageing populations.
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Affiliation(s)
- Chengjian Shi
- grid.170205.10000 0004 1936 7822Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL 60637 USA ,grid.170205.10000 0004 1936 7822Department of Medicine, University of Chicago, Chicago, IL 60637 USA
| | - Niser Babiker
- grid.170205.10000 0004 1936 7822Department of Medicine, University of Chicago, Chicago, IL 60637 USA
| | - Jacek K. Urbanek
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University, Baltimore, MD 21287 USA
| | - Robert L. Grossman
- grid.170205.10000 0004 1936 7822Department of Medicine, University of Chicago, Chicago, IL 60637 USA ,grid.170205.10000 0004 1936 7822Department of Computer Science, University of Chicago, Chicago, IL 60637 USA
| | | | - Andrey Rzhetsky
- Department of Medicine, University of Chicago, Chicago, IL, 60637, USA. .,Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA.
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30
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Aiello EN, Esposito A, Pucci V, Mondini S, Bolognini N, Appollonio I. Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties. Aging Clin Exp Res 2022; 34:1259-1265. [PMID: 34997544 PMCID: PMC8741569 DOI: 10.1007/s40520-021-02041-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/20/2021] [Indexed: 12/03/2022]
Abstract
Background The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02041-4.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | | | - Veronica Pucci
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Aiello EN, Esposito A, Giannone I, Diana L, Appollonio I, Bolognini N. Telephone Interview for Cognitive Status (TICS): Italian adaptation, psychometrics and diagnostics. Neurol Sci 2022; 43:3071-3077. [PMID: 34792669 PMCID: PMC8600494 DOI: 10.1007/s10072-021-05729-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Telephone-based cognitive screening (TBCS) is crucial to telehealth care of neurological patients, prevention campaigns, and epidemiological studies on cognitive impairment. The Telephone Interview for Cognitive Status (TICS) is one of the most widespread and psychometrically/diagnostically sound TBCS test, with several versions developed worldwide (e.g., with and without a delayed recall item). In Italy, only attempts of adaptation and preliminary evidence of its statistical features have been provided so far. This study thus aimed at (1) developing an Italian version of the TICS and assessing its (2) psychometric and (3) diagnostic properties. METHODS A back-translated and culturally adapted version of the TICS was developed. Three-hundred and sixty-five healthy individuals from different regions of Italy (147 males, 216 females; age: 53.2 ± 16 years; education: 13 ± 4.5 years) were administered the TICS and the Italian telephone-based Mini-Mental State Examination (Itel-MMSE). Validity was tested by convergence and at the structure level, whereas reliability as internal consistency, test-retest, and inter-rater. Diagnostic accuracy, item difficulty, and discrimination were also examined. RESULTS The TICS featured a single component and its score converged with that of the Itel-MMSE (rs = .37). Reliability was excellent as inter-rater (ICC = .94), good as test-retest (ICC = .78), and acceptable as internal consistency (Cronbach's α = .63). Accuracy was high as tested against the Itel-MMSE (AUC = .83) and did not improve when adding the delayed recall. Backward subtraction was the most difficult and discriminative task. DISCUSSION The Italian TICS is a valid, reliable, and diagnostically accurate TBCS test. The original format of the TICS can be thus adopted in both clinical and research settings.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Ilaria Giannone
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Lorenzo Diana
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Jiang J, Yao K, Huang X, Zhang Y, Shen F, Weng S. Longitudinal white matter hyperintensity changes and cognitive decline in patients with minor stroke. Aging Clin Exp Res 2022; 34:1047-1054. [PMID: 35084664 PMCID: PMC9135882 DOI: 10.1007/s40520-021-02024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Background and objective As reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke. Methods A group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline. Results Finally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001). Conclusions The longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kanmin Yao
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Suiqing Weng
- Department of Neurology, Shanghai Minhang Hospital, Shanghai Fu Dan University, Shanghai, China.
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Abdulrahman H, Jansen E, Hoevenaar-Blom M, van Dalen JW, van Wanrooij LL, van Bussel E, van Gool WA, Richard E, Moll van Charante EP. Diagnostic Accuracy of the Telephone Interview for Cognitive Status for the Detection of Dementia in Primary Care. Ann Fam Med 2022; 20:130-136. [PMID: 35346928 PMCID: PMC8959747 DOI: 10.1370/afm.2768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Cognitive diagnostic work-up in primary care is not always physically feasible, owing to chronic disabilities and/or travel restrictions. The identification of dementia might be facilitated with diagnostic instruments that are time efficient and easy to perform, as well as useful in the remote setting. We assessed whether the Telephone Interview for Cognitive Status (TICS) might be a simple and accurate alternative for remote diagnostic cognitive screening in primary care. METHODS We administered the TICS (range, 0-41) for 810 of 1,473 older people aged 84.5 (SD, 2.4) years. We scrutinized electronic health records for participants with TICS scores ≤30 and for a random sample of participants with TICS scores >30 for a dementia diagnosis using all data from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial for 8-12 years of follow-up. We used multiple imputation to correct for verification bias. RESULTS Of the 810 participants, 155 (19.1%) had a TICS score ≤30, and 655 (80.9%) had a TICS score >30. Electronic health records yielded 8.4% (13/154) dementia diagnoses for participants with TICS ≤30 vs none with TICS >30. Multiple imputation for TICS >30 yielded a median of 7/655 (1.1%; interquartile range, 5-8) estimated dementia cases. After multiple imputation, the optimal cutoff score was ≤29, with mean sensitivity 65.4%, specificity 87.8%, positive predictive value 11.9%, negative predictive value 99.0%, and area under the curve 77.4% (95% CI, 56.3%-90.0%). CONCLUSIONS In the present older population, the TICS performed well as a diagnostic screening instrument for excluding dementia and might be particularly useful when face-to-face diagnostic screening is not feasible in family practice or research settings. The potential reach to large numbers of people at low cost could contribute to more efficient medical management in primary care.
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Affiliation(s)
- Herrer Abdulrahman
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands .,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Reinier Postlaan 4, Nijmegen, The Netherlands
| | - Eva Jansen
- Amsterdam University Medical Center, University of Amsterdam, Department of General Practice/Family Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke Hoevenaar-Blom
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jan Willem van Dalen
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lennard L van Wanrooij
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Emma van Bussel
- Amsterdam University Medical Center, University of Amsterdam, Department of General Practice/Family Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Willem A van Gool
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam University Medical Center, University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Edo Richard
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Reinier Postlaan 4, Nijmegen, The Netherlands.,Amsterdam University Medical Center, University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Amsterdam University Medical Center, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam University Medical Center, University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
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Vannorsdall TD, Brigham E, Fawzy A, Raju S, Gorgone A, Pletnikova A, Lyketsos CG, Parker AM, Oh ES. Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19. J Acad Consult Liaison Psychiatry 2022; 63:133-143. [PMID: 34793996 PMCID: PMC8591857 DOI: 10.1016/j.jaclp.2021.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. OBJECTIVE We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients. METHODS Approximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function. RESULTS Most Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%-32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores. CONCLUSIONS At approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.
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Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Emily Brigham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarath Raju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alesandra Gorgone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra Pletnikova
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann M Parker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing, Baltimore, MD
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35
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LoBuono DL, Shea KS, Tovar A, Leedahl SN, Mahler L, Xu F, Lofgren IE. Diet Quality and Nutrition Concerns of People with Parkinson's Disease and Their Informal Caregivers: A Mixed Methods Study. J Nutr Gerontol Geriatr 2022; 41:1-21. [PMID: 35048783 DOI: 10.1080/21551197.2021.2024478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research exists regarding the diet quality and nutritional concerns of people with Parkinson's disease (PwPD) and their informal caregivers. The study's purpose was to assess diet quality via the Healthy Eating Index-2015 (HEI-2015) and self-reported nutrition concerns via semi-structured, dyadic interviews of 20 PwPD (69.7 ± 9.2 yrs) and their caregivers (66.7 ± 13.0 yrs). HEI-2015 scores were 58.3 ± 12.4 and 58.1 ± 10.6 for PwPD and caregivers, respectively. Reported dietary concerns related to PD included: change in appetite or amount eaten, gastrointestinal issues, food-medication management, chewing/swallowing issues, and change in taste/smell. The poor diet quality and nutrition concerns identified suggest nutrition professionals and caregivers are critical on the healthcare team to promote optimal health among PwPD. Future research should address overall and specific aspects of diet quality, and nutritional concerns identified by dyads in this study, such as gastrointestinal issues and food-medication management.
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Affiliation(s)
- Dara L LoBuono
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kyla S Shea
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Skye N Leedahl
- Department of Human Development and Family Science, University of Rhode Island, Kingston, RI, USA
| | - Leslie Mahler
- Department of Communicative Disorders, University of Rhode Island, Kingston, RI, USA
| | - Furong Xu
- School of Education, University of Rhode Island, Kingston, RI, USA
| | - Ingrid E Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
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Keins S, Abramson JR, Castello JP, Pasi M, Charidimou A, Kourkoulis C, DiPucchio Z, Schwab K, Anderson CD, Gurol ME, Greenberg SM, Rosand J, Viswanathan A, Biffi A. Latent profile analysis of cognitive decline and depressive symptoms after intracerebral hemorrhage. BMC Neurol 2021; 21:481. [PMID: 34893031 PMCID: PMC8662844 DOI: 10.1186/s12883-021-02508-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cognitive impairment and depressive symptoms are highly prevalent after Intracerebral Hemorrhage (ICH). We leveraged Latent Profile Analysis (LPA) to identify profiles for cognitive decline and depression onset after ICH. We also investigated differences in clinical, genetic and neuroimaging characteristics across patients' profiles. METHODS We analyzed data from the ICH study conducted at Massachusetts General Hospital between January 1998 and December 2019. We collected information from electronical health records, follow-up interviews, CT and MRI imaging, and APOE genotype. We conducted LPA and multinomial logistic regression analyses to: 1) identify distinct profiles for cognitive decline and depression onset after ICH; 2) identify clinical, neuroimaging and genetic factors predicting individuals' likelihood to express a specific profile. RESULTS We followed 784 ICH survivors for a median of 45.8 months. We identified four distinct profiles in cognitive and depressive symptoms after ICH: low depression and dementia risk, early-onset depression and dementia, late-onset depression and dementia, high depression with low dementia risk. Cerebral small vessel disease severity and APOE genotype were specifically associated with the late-onset profile (both p < 0.05). Acute hematoma characteristics (size, intraventricular extension) and functional disability were specifically associated with the early-onset profile (all p < 0.05). CONCLUSION We identified four distinct profiles for cognitive and depressive symptoms after ICH, each displaying specific associations with individual patients' clinical, genetic and neuroimaging data. These associations reflect separate biological mechanisms influencing dementia and depression risk after ICH. Our findings support employing LPA in future ICH studies, and is likely applicable to stroke survivors at large.
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Affiliation(s)
- Sophia Keins
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica R Abramson
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Juan Pablo Castello
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Marco Pasi
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Univ.Lille, Inserm, CHU Lille, U 1172 - LilNCog - Lille Neuroscience and Cognition, F-59000, Lille, France
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Kourkoulis
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zora DiPucchio
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D Anderson
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA.,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street - Room 2064, Boston, MA, 02114, USA. .,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA. .,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA. .,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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Online assessment of cognitive functioning across the adult lifespan using the eCOGTEL: a reliable alternative to laboratory testing. Eur J Ageing 2021; 19:609-619. [PMID: 34903960 PMCID: PMC8655327 DOI: 10.1007/s10433-021-00667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
As the population ages, risks for cognitive decline threaten independence and quality of life of older adults. Classically, psychological assessment tools that evaluate cognitive functioning are administered in face-to-face laboratory sessions, which are time- and resource-consuming. The present study set out to examine whether the eCOGTEL—an online adaptation of the Cognitive Telephone Screening Instrument (COGTEL; Kliegel et al. in J Psychol 141(2):147–170, 2007)—represents a reliable measure of cognitive performance in adulthood. Therefore, an age-stratified adult lifespan sample of 253 participants (aged 19–86 years) completed a face-to-face assessment in the laboratory and a self-administered online version, at their homes. A second, independent sample of 176 younger adults (aged 19–30 years) performed a test–retest assessment of the eCOGTEL. Results showed strong correlations between overall cognitive scores assessed online and in the laboratory, as well as a high test–retest reliability. Further, comparable data distributions between both assessment modes underline the feasibility of the eCOGTEL across the adult lifespan and particularly in older age. Our findings thereby indicate that the eCOGTEL can reliably measure cognitive performance across the lifespan at reduced costs, which may help detecting individuals at risk of developing age-related cognitive decline. Due to these strengths, the eCOGTEL represents a valuable contemporary approach for the resource-efficient online assessment of cognition, which may benefit a broad array of fundamental and applied research fields, such as clinical and organizational psychology.
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LoBuono DL, Shea KS, Tovar A, Leedahl SN, Mahler L, Xu F, Lofgren IE. Acceptance and perception of digital health for managing nutrition in people with Parkinson's disease and their caregivers and their digital competence in the United States: A mixed-methods study. Health Sci Rep 2021; 4:e412. [PMID: 34796282 PMCID: PMC8581626 DOI: 10.1002/hsr2.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND AIMS This mixed-methods study examined participants' acceptance and perception of using digital health for managing nutrition and participants' digital competence. The results will be formative for making digital nutrition education more effective and acceptable for people with Parkinson's disease (PwPD) and their informal caregivers. METHODS Qualitative data were collected through in-person semi-structured, dyadic interviews, and questionnaires from 20 dyads (20 PwPD and their caregivers) in the Northeastern United States and analyzed throughout the 2018 to 2019 academic year. Interview transcripts were deductively coded using the framework analysis method. Phrases related to acceptance of digital health were sub-coded into accept, neutral, or reject and those related to perceptions of digital health were sub-coded into perceived usefulness, perceived ease of use, and awareness of digital health. Quantitative data were analyzed using independent samples t tests and Fisher's exact tests. Qualitative codes were transformed into variables and compared to digital competence scores to integrate the data. An average acceptance rate for digital health was calculated through examining the mean percent of phrases coded as accept from interview transcripts. RESULTS Twenty-five of 40 (62.5%) participants used the internet for at least 5 health-related purposes and the average acceptance rate was 54.4%. Dyads rejected digital health devices if they did not see the added benefit. The majority of participants reported digital health to be useful, but hard to use, and about half felt they needed education about existing digital health platforms. There was no difference in digital competence scores between PwPD and their caregivers (28.6 ± 12.6). CONCLUSION Findings suggest that dyads accept and use technology but not to its full potential as technology can be perceived as hard to use. This finding, combined with digital competence scores, revealed that education is warranted prior to providing a digital nutrition intervention.
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Affiliation(s)
- Dara L. LoBuono
- Department of Health and Exercise ScienceRowan UniversityGlassboroNew JerseyUSA
| | - Kyla S. Shea
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
| | - Alison Tovar
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
| | - Skye N. Leedahl
- Department of Human Development and Family ScienceUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Leslie Mahler
- Department of Communicative DisordersUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Furong Xu
- School of EducationUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Ingrid E. Lofgren
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
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Collins JT, Mohamed B, Bayer A. Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle. Age Ageing 2021; 50:2259-2263. [PMID: 34510177 PMCID: PMC8499871 DOI: 10.1093/ageing/afab173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.
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Affiliation(s)
- Jemima T Collins
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
| | - Biju Mohamed
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
| | - Antony Bayer
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
- Cardiff University School of Medicine, Heath Park, University Hospital of Wales, CF14 4XW, UK
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Zanin E, Aiello EN, Diana L, Fusi G, Bonato M, Niang A, Ognibene F, Corvaglia A, De Caro C, Cintoli S, Marchetti G, Vestri A. Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability. Neurol Sci 2021; 43:125-138. [PMID: 34751849 PMCID: PMC8576086 DOI: 10.1007/s10072-021-05719-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 02/06/2023]
Abstract
Background The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales. Results Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings — the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status. Discussion Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05719-9.
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Affiliation(s)
- Elia Zanin
- Ospedale Riabilitativo di Alta Specializzazione (ORAS)-ULSS 2 TV, Motta di Livenza, Italy
| | - Edoardo Nicolò Aiello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. .,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy.
| | - Lorenzo Diana
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Giulia Fusi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mario Bonato
- Department of General Psychology, University of Padua, Padova, Italy
| | - Aida Niang
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Alessia Corvaglia
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Simona Cintoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Marchetti
- Department of General Psychology, University of Padua, Padova, Italy
| | - Alec Vestri
- Unit for the Rehabilitation of Acquired Neuropsychological Disorders, IRCCS E. Medea, Pieve di Soligo, Italy
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Aiello EN, Esposito A, Giannone I, Diana L, Woolley S, Murphy J, Christodoulou G, Tremolizzo L, Bolognini N, Appollonio I. ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV): norms, psychometrics, and diagnostics in an Italian population sample. Neurol Sci 2021; 43:2571-2578. [PMID: 34601697 PMCID: PMC8487338 DOI: 10.1007/s10072-021-05636-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Up to 50% of motor neuron disease (MND) patients show neuropsychological deficits which negatively affect prognosis and care. However, disability-related logistical issues and uneven geographical coverage of healthcare services may prevent MND patients from accessing neuropsychological evaluations. This study thus aimed to standardize for the Italian population the ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV), an MND-specific, telephone-based screening for frontotemporal dysfunction. METHODS The cognitive section of the ALS-CBS™-PhV, the Italian telephone-based Mini-Mental State Examination (Itel-MMSE), and the Telephone Interview for Cognitive Status (TICS) was administered to 359 healthy individuals (143 males, 216 females; age, 52.7 ± 15.8; education, 13.1 ± 4.4). Norms were derived through equivalent scores. Validity, factorial structure, reliability, diagnostic accuracy, and item difficulty and discrimination were examined. Statistical equivalence between the telephone-based and in-person versions was tested. RESULTS ALS-CBS™-PhV measures were predicted by age and education. The ALS-CBS™-PhV reflected a mono-component structure, converged with Itel-MMSE and TICS scores (rs = .23-.51) and was equivalent to its in-person format (t = .37; p = .72). Good internal (Cronbach's α = .61), test-retest (ICC = .69), and inter-rater (ICC = .96) reliability was detected. High accuracy was found when tested against both the Itel-MMSE and the TICS (AUC = .82-89). Backward digit span items were the most discriminative. DISCUSSION The ALS-CBS™-PhV is a statistically solid screening test for frontotemporal disorders featuring MND. Its standardization allows for (1) improvements in tele-healthcare for MND patients, (2) epidemiological applications, and (3) effective assessments in decentralized clinical trials. The ALS-CBS™-PhV can be also suitable for assessing bedridden and visually impaired patients with motor disorders.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | | | - Ilaria Giannone
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Lorenzo Diana
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susan Woolley
- Sutter Pacific Medical Foundation, San Francisco, CA, USA
| | | | - Georgia Christodoulou
- Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lucio Tremolizzo
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Chitnis S, Mullane D, Brohan J, Noronha A, Paje H, Grey R, Bhalla RK, Sidhu J, Klein R. Dexmedetomidine Use in Intensive Care Unit Sedation and Postoperative Recovery in Elderly Patients Post-Cardiac Surgery (DIRECT). J Cardiothorac Vasc Anesth 2021; 36:880-892. [PMID: 34887180 DOI: 10.1053/j.jvca.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study examined recovery, delirium, and neurocognitive outcome in elderly patients receiving dexmedetomidine or propofol sedation after undergoing cardiac surgery. DESIGN Open-label randomized trial. SETTING Single center. PARTICIPANTS A total of 70 patients older than 75 years without English language limitations and Mini Mental State Examination scores >20. INTERVENTIONS Patients received either propofol (group P) or dexmedetomidine (group D) postoperatively until normothermic and hemodynamically stable. MEASUREMENTS AND MAIN RESULTS Quality of recovery (QoR) was measured by the QoR-40 questionnaire on postoperative day (POD) three. Secondary outcomes were incidence and duration of delirium, time to extubation, length of hospital stay, hospital mortality rate, postoperative quality of life (QoL; measured by SF-36 performed at baseline and six months postoperatively), and neurocognitive disorder (measured by Minnesota Cognitive Acuity Screen [MCAS] performed at baseline, POD5, and six months postoperatively). A total of sixty-seven patients completed the trial. There was no significant difference in QoR-40 scores (95% confidence interval [CI], -7.6081-to-10.9781; p = 1.000), incidence of delirium (group P, 42%; group D, 24%; p = 0.191), mean hospital stay (95% CI, -5.4838-to-1.5444; p = 0.297), mean time to extubation (95% CI, -19.2513-to-7.5561; p = 0.866), or mean duration of delirium (95% CI, -4.3065-to-1.067; p = 0.206) between groups. No patients died in the hospital. There were no significant differences in changes in SF-36 or MCAS scores over time between groups. There was a decline in MCAS score from preoperatively to POD5 in group P (95% CI, -8.95725-to- -2.61775; p = 0.0005), which was greater than that observed in group D. CONCLUSIONS The authors' findings demonstrated that the use of dexmedetomidine compared with propofol in elderly patients undergoing cardiac surgery was unlikely to improve QoR/postoperative QoL. Although the study was underpowered to detect secondary outcomes, the results suggested no reductions in delirium, time to extubation, and hospital stay, but a potential decrease in delayed neurocognitive recovery.
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Affiliation(s)
- Shruti Chitnis
- Department of Anesthesiology and Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, British Columbia, Canada; Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.
| | - Darren Mullane
- Department of Anesthesiology and Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, British Columbia, Canada
| | - Janette Brohan
- Department of Anesthesiology and Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, British Columbia, Canada; Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Republic of Ireland
| | - Andrea Noronha
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Howard Paje
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Rebecca Grey
- Department of Anesthesiology and Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, British Columbia, Canada
| | - Rishi K Bhalla
- Neuropsychology Service, Vancouver General Hospital, 899 W 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada; Division of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Jesse Sidhu
- Department of Psychiatry, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rael Klein
- Department of Anesthesiology and Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, British Columbia, Canada
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Yu NC, Zhu D, Watts KL, Abraham N, Choice C. Implementation of the telephone montreal cognitive assessment in a telemedicine based pre-admission testing clinic during COVID-19. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2021; 24:100191. [PMID: 36568726 PMCID: PMC9764502 DOI: 10.1016/j.pcorm.2021.100191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/27/2022]
Abstract
Introduction Postoperative delirium (POD) affects 10-70% of patients 60 years or older and has been linked to increasing length of hospitalization, mortality, and morbidity. Pre-existing cognitive impairment is a predictor of POD. COVID-19 restricted use of in-person cognitive screens. The Telephone Montreal Cognitive Assessment (T-MoCA) can screen for cognitive dysfunction remotely. We evaluated the feasibility of administering T-MoCA in a multiethnic population during pre-operative testing televisits. Methods Patients scheduled for surgery between July 2020 and August 2020 were asked to participate in the T-MoCA at the end of their preadmission testing (PAT) televisit. A retrospective chart review was conducted to collect patient comorbidities and demographics. Patients were stratified by negative (T-MoCA≥19) or positive (T-MoCA<19) for mild cognitive impairment (MCI) and compared using 2-tailed χ2-tests. Univariate logistic regression was used to identify associations between patient characteristics and positive T-MoCA result. Results Fifty out of 65 (77%) patients who consented to the T-MoCA completed the test. The average time to complete the assessment was 10.5 mins. Twenty two (44%) had a negative score and 28 (56%) had a positive score. Patients who had a positive T-MoCA were older (70.04±7.61 yrs) compared to those with a negative T-MoCA (67.68±4.69 yrs, p=0.007), although the distribution of patients above and below age 65 was not different (p=0.243). The two groups did not vary by gender, race/ethnicity, obesity, surgery type, or medical co-morbidities. When we examined our population for predictors of a positive T-MoCA, we found a trend toward men being less likely to score positive on T-MoCA (OR=0.33, 95% CI: 0.10-1.10, p=0.07) compared to women; and that patients with Hispanic race/ethnicity were more likely to test positive on the T-MoCA (OR=4.13, 95% CI: 0.84-20.28, p=0.08) compared to Non-Hispanic Whites. Conclusions Implementation of the T-MoCA in a telemedicine-based PAT setting is feasible. In our cohort, most people who consented to the assessment completed it, and more than half scored positively, which may have important implications on the surgical plan and post-operative recovery. There may be limitations in using T-MoCA in certain populations, such as non-English preferred language, hearing difficulties, lack of focus, and use of external aids, which would need to be explored in a larger sample size.
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Affiliation(s)
- Nick C Yu
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Urology, Montefiore Medical Center, Bronx, NY, United States
| | - Nitya Abraham
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Urology, Montefiore Medical Center, Bronx, NY, United States
| | - Curtis Choice
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, United States
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Kanser R, O'Rourke J, Silva MA. Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study. NeuroRehabilitation 2021; 49:169-177. [PMID: 34397429 DOI: 10.3233/nre-218019] [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: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephoneMETHOD:Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs maintained adequate specificity (i.e., > 90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS < 7 or 21-item test forced choice total correct < 11 led to < 10%false positive classification errors. CONCLUSIONS Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to-severe TBI. Future investigations including clinical or experimental "feigners" in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended.
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Affiliation(s)
- Robert Kanser
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Justin O'Rourke
- Polytrauma Section, Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX, USA
| | - Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
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45
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Underwood BR, Thompsell A, Sidhom E, Burns A. Providing memory assessment services during COVID-19. Aging Ment Health 2021; 25:1373-1375. [PMID: 33030025 DOI: 10.1080/13607863.2020.1830946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Benjamin R Underwood
- Fulbourn Hospital, Gnodde Goldman Sachs Translational Neuroscience Unit, Cambridge, UK
| | - Amanda Thompsell
- South London and Maudsley NHS Foundation Trust, London, UKConsultant Old Age Psychiatrist
| | - Emad Sidhom
- Fulbourn Hospital, Gnodde Goldman Sachs Translational Neuroscience Unit, Cambridge, UK.,Department of Clinical Neurosciences, University of CambridgeClinical Research Associate
| | - Alistair Burns
- Professor of Old Age Psychiatry, University of Manchester, UK
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Beresford T, Ronan PJ, Hipp D. A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series. JMIR Form Res 2021; 5:e26417. [PMID: 34010137 PMCID: PMC8204938 DOI: 10.2196/26417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/30/2021] [Accepted: 05/16/2021] [Indexed: 01/05/2023] Open
Abstract
Background Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus.
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Affiliation(s)
- Thomas Beresford
- Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Patrick J Ronan
- Research and Development Service, Sioux Falls Veterans Affairs Medical Center, Sioux Falls, SD, United States.,Department of Psychiatry and Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | - Daniel Hipp
- Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
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Gosse PJ, Kassardjian CD, Masellis M, Mitchell SB. Soins virtuels pour les patients atteints de la maladie d’Alzheimer et de démences connexes à l’ère de la COVID-19 et au-delà. CMAJ 2021; 193:E878-E885. [PMID: 34099476 PMCID: PMC8203262 DOI: 10.1503/cmaj.201938-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Paula J Gosse
- Faculté de médecine (Gosse, Kassardjian, Masellis, Mitchell) et Département de médecine, Division de neurologie ( Kassardjian, Masellis, Mitchell), Université de Toronto; Centre des sciences de la santé Sunnybrooke, Service de médecine, Division de neurologie (Masellis, Mitchell); Service de médecine, Division de neurologie (Kassardjian), Hôpital St. Michael; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), Université de Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Institut de recherche Sunnybrook; Institut du savoir Li Ka Shing (Kassardjian), Hôpital St. Michael, Toronto, Ont
| | - Charles D Kassardjian
- Faculté de médecine (Gosse, Kassardjian, Masellis, Mitchell) et Département de médecine, Division de neurologie ( Kassardjian, Masellis, Mitchell), Université de Toronto; Centre des sciences de la santé Sunnybrooke, Service de médecine, Division de neurologie (Masellis, Mitchell); Service de médecine, Division de neurologie (Kassardjian), Hôpital St. Michael; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), Université de Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Institut de recherche Sunnybrook; Institut du savoir Li Ka Shing (Kassardjian), Hôpital St. Michael, Toronto, Ont
| | - Mario Masellis
- Faculté de médecine (Gosse, Kassardjian, Masellis, Mitchell) et Département de médecine, Division de neurologie ( Kassardjian, Masellis, Mitchell), Université de Toronto; Centre des sciences de la santé Sunnybrooke, Service de médecine, Division de neurologie (Masellis, Mitchell); Service de médecine, Division de neurologie (Kassardjian), Hôpital St. Michael; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), Université de Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Institut de recherche Sunnybrook; Institut du savoir Li Ka Shing (Kassardjian), Hôpital St. Michael, Toronto, Ont
| | - Sara B Mitchell
- Faculté de médecine (Gosse, Kassardjian, Masellis, Mitchell) et Département de médecine, Division de neurologie ( Kassardjian, Masellis, Mitchell), Université de Toronto; Centre des sciences de la santé Sunnybrooke, Service de médecine, Division de neurologie (Masellis, Mitchell); Service de médecine, Division de neurologie (Kassardjian), Hôpital St. Michael; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), Université de Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Institut de recherche Sunnybrook; Institut du savoir Li Ka Shing (Kassardjian), Hôpital St. Michael, Toronto, Ont.
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48
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Hunter MB, Jenkins N, Dolan C, Pullen H, Ritchie C, Muniz-Terrera G. Reliability of Telephone and Videoconference Methods of Cognitive Assessment in Older Adults with and without Dementia. J Alzheimers Dis 2021; 81:1625-1647. [PMID: 33967052 DOI: 10.3233/jad-210088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Telephone and videoconference administration of cognitive tests introduce additional sources of variance compared to in-person testing. Reviews of test-retest reliability have included mixed neurocognitive and psychiatric populations with limited consideration of methodological and statistical contributions. OBJECTIVE We reviewed reliability estimates from comparison studies of older adults with and without dementia, considering test-retest analyses and study methods. METHODS Medline, Embase, PsycINFO, and Web of Science were systematically searched from 1 January 2000 to 9 June 2020 for original articles comparing telephone or videoconference administered cognitive instruments to in-person administration in older adults with and without dementia or mild cognitive impairment. RESULTS Of 4,125 articles, 23 were included: 11 telephone (N = 2 dementia cohorts) and 12 videoconference (N = 4 dementia cohorts). Telephone administered subtest scores trended in the same direction as in-person with comparable means. Person-level data were scarce. Data on dementia was only available for MMSE, with resulting subtle modality bias. MMSE, SMMSE, Letter Fluency, and HVLT-R in healthy to mild-moderate Alzheimer's disease were particularly reliable for videoconference administration. Other tests show promise but require more observations and comprehensive analyses. Most studies used high-speed stable videoconferencing hardware resulting in a lack of ecological validity for home administration. CONCLUSION Remote administration is often consistent with in-person administration but variable and limited at the person/test level. Improved statistical design and inclusion of dementia related cohorts in telephone studies is recommended. Reliability evidence is stronger for videoconferencing but with limited applicability to home administration and severe dementia. Improved reporting of administrative procedures is recommended.
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Affiliation(s)
- Matthew B Hunter
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Natalie Jenkins
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Clare Dolan
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Hannah Pullen
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
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49
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Gosse PJ, Kassardjian CD, Masellis M, Mitchell SB. Virtual care for patients with Alzheimer disease and related dementias during the COVID-19 era and beyond. CMAJ 2021; 193:E371-E377. [PMID: 33722828 PMCID: PMC8096398 DOI: 10.1503/cmaj.201938] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Paula J Gosse
- Faculty of Medicine (Gosse, Kassardjian, Masellis, Mitchell) and Department of Medicine, Division of Neurology ( Kassardjian, Masellis, Mitchell), University of Toronto; Sunnybrook Health Sciences Centre, Department of Medicine, Division of Neurology (Masellis, Mitchell); Department of Medicine, Division of Neurology (Kassardjian), St. Michael's Hospital; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), University of Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Sunnybrook Research Institute; Li Ka Shing Knowledge Institute (Kassardjian), St. Michael's Hospital, Toronto, Ont
| | - Charles D Kassardjian
- Faculty of Medicine (Gosse, Kassardjian, Masellis, Mitchell) and Department of Medicine, Division of Neurology ( Kassardjian, Masellis, Mitchell), University of Toronto; Sunnybrook Health Sciences Centre, Department of Medicine, Division of Neurology (Masellis, Mitchell); Department of Medicine, Division of Neurology (Kassardjian), St. Michael's Hospital; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), University of Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Sunnybrook Research Institute; Li Ka Shing Knowledge Institute (Kassardjian), St. Michael's Hospital, Toronto, Ont
| | - Mario Masellis
- Faculty of Medicine (Gosse, Kassardjian, Masellis, Mitchell) and Department of Medicine, Division of Neurology ( Kassardjian, Masellis, Mitchell), University of Toronto; Sunnybrook Health Sciences Centre, Department of Medicine, Division of Neurology (Masellis, Mitchell); Department of Medicine, Division of Neurology (Kassardjian), St. Michael's Hospital; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), University of Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Sunnybrook Research Institute; Li Ka Shing Knowledge Institute (Kassardjian), St. Michael's Hospital, Toronto, Ont
| | - Sara B Mitchell
- Faculty of Medicine (Gosse, Kassardjian, Masellis, Mitchell) and Department of Medicine, Division of Neurology ( Kassardjian, Masellis, Mitchell), University of Toronto; Sunnybrook Health Sciences Centre, Department of Medicine, Division of Neurology (Masellis, Mitchell); Department of Medicine, Division of Neurology (Kassardjian), St. Michael's Hospital; Neurology Quality and Innovation Lab (NQIL) (Kassardjian, Mitchell), University of Toronto; Hurvitz Brain Sciences Research Program (Masellis, Mitchell), Sunnybrook Research Institute; Li Ka Shing Knowledge Institute (Kassardjian), St. Michael's Hospital, Toronto, Ont.
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50
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Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley KL, Ferris K, Moses A, Willard J, Williamson JD. Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:361-369. [PMID: 33427851 PMCID: PMC7802005 DOI: 10.1001/jamainternmed.2020.5950] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation. OBJECTIVE To determine whether a nurse navigator-led ACP pathway combined with a health care professional-facing EHR interface improves the occurrence of ACP discussions and their documentation within the EHR. DESIGN, SETTING, AND PARTICIPANTS This was a randomized effectiveness trial using the Zelen design, in which patients are randomized prior to informed consent, with only those randomized to the intervention subsequently approached to provide informed consent. Randomization began November 1, 2018, and follow-up concluded November 1, 2019. The study population included patients 65 years or older with multimorbidity combined with either cognitive or physical impairments, and/or frailty, assessed from 8 primary care practices in North Carolina. INTERVENTIONS Participants were randomized to either a nurse navigator-led ACP pathway (n = 379) or usual care (n = 380). MAIN OUTCOMES AND MEASURES The primary outcome was documentation of a new ACP discussion within the EHR. Secondary outcomes included the usage of ACP billing codes, designation of a surrogate decision maker, and ACP legal form documentation. Exploratory outcomes included incident health care use. RESULTS Among 759 randomized patients (mean age 77.7 years, 455 women [59.9%]), the nurse navigator-led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, P < .001) as compared with usual care. The ACP billing codes were used more frequently for patients randomized to the nurse navigator-led ACP pathway (25.3% vs 1.3%, P < .001). Patients randomized to the nurse navigator-led ACP pathway more frequently designated a surrogate decision maker (64% vs 35%, P < .001) and completed ACP legal forms (24.3% vs 10.0%, P < .001). During follow-up, the incidence of emergency department visits and inpatient hospitalizations was similar between the randomized groups (hazard ratio, 1.17; 95% CI, 0.92-1.50). CONCLUSIONS AND RELEVANCE A nurse navigator-led ACP pathway integrated with a health care professional-facing EHR interface increased the frequency of ACP discussions and their documentation. Additional research will be required to evaluate whether increased EHR documentation leads to improvements in goal-concordant care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03609658.
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Affiliation(s)
- Jennifer Gabbard
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Pajewski
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ajay Dharod
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Section on General Internal Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L Foley
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Keren Ferris
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adam Moses
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Willard
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
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