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Kohli M, Ham L, Saloner R, Dung D, Iudicello J, Ellis RJ, Moore DJ. Latent Profile Analysis of Cognitive Performance and Depressive Symptoms Among People with HIV. AIDS Patient Care STDS 2024; 38:93-106. [PMID: 38381950 PMCID: PMC10890962 DOI: 10.1089/apc.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Depression and cognitive impairment are prevalent conditions among people with HIV (PWH), likely attributable to shared causes and common risk factors. Identifying subtypes of PWH with similar patterns of neurocognitive impairment (NCI) and depressive symptoms may inform development of patient-centered interventions that target-specific profiles. This study aimed to (1) classify PWH based on patterns of domain-specific NCI and depression; and (2) determine the relationship between latent class membership and pertinent clinical characteristics. PWH (N = 580, 86.2% male, 57.1% non-Hispanic White, 69.2% unemployed) completed a comprehensive neuropsychological test battery assessing global and domain-specific cognition. Domain-specific NCI was classified as deficit score >0.5. Participants completed the Beck Depression Inventory-II (BDI-II), and domain-specific BDI-II scores reflecting cognitive, affective, and somatic symptoms were computed. Latent profile analysis (LPA) was used to determine latent subgroups of NCI and depression. The optimal LPA solution consisted of five classes: minimal NCI and minimal depression (Class 1), amnestic and minimal depression (Class 2), severe multi-domain NCI and moderate depression (somatic and affective; Class 3), mild NCI and mild depression (Class 4), and moderate multi-domain NCI and severe depression (Class 5). Despite similar levels of functional impairment, Class 5 had a significant psychiatric profile, whereas Class 3 had a complex medical profile (i.e., higher frailty index, higher medications, greater proportion of AIDS diagnosis). In contrast, Class 1 had the lowest medication use and frailty index, with similar HIV disease characteristics to Classes 3 and 5. Our results suggest there are multiple pathways to cognitive and functional impairment among PWH with co-occurring depression and cognitive impairment, and these groups may respond differently to interventions. Of note, our sample was majority non-Hispanic White and male, which is nonrepresentative of the US population of PWH. Future interventions should consider a more integrated, person-centered approach that addresses cognitive and emotional health to optimize health outcomes in PWH.
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Affiliation(s)
- Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Lillian Ham
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Rowan Saloner
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Devin Dung
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Jennifer Iudicello
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
| | - Ronald J. Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
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McMahan C, Dietrich DK, Horne EF, Kelly E, Geannopoulos K, Siyahhan Julnes PS, Ham L, Santamaria U, Lau CY, Wu T, Hsieh HC, Ganesan A, Berjohn C, Kapetanovic S, Reich DS, Nair G, Snow J, Agan BK, Nath A, Smith BR. Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy. Neurology 2023:WNL.0000000000207339. [PMID: 37105760 DOI: 10.1212/wnl.0000000000207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BackgroundNeurologic outcomes in people with HIV (PWH) on long-duration antiretroviral therapy (ART) are not fully understood and the underlying pathophysiology is unclear. To address this, we established a cohort of such individuals and compared them to HIV-negative controls using a novel matching technique. Both groups underwent extensive cognitive testing, evaluation for psychiatric measures, and MRI and cerebrospinal fluid (CSF) analyses.MethodsParticipants underwent comprehensive neuropsychological (NP) testing and completed standardized questionnaires measuring depressive symptoms, perceptions of own functioning, and activities of daily living as part of an observational study. Brain MRI and lumbar puncture were optional. Coarsened Exact Matching (CEM) was used to reduce between-group differences in age and sex, and weighted linear/logistic regression models were used to assess the effect of HIV on outcomes.ResultsData were analyzed from 155 PWH on ART for at least 15 years and 100 HIV-negative controls. Compared to controls, PWH scored lower in the domains of attention/working memory (PWH Least Square Mean [LSM]=50.4 vs. controls LSM=53.1, p=0.008) and motor function (44.6 vs. 47.7, p=0.009), and a test of information processing speed (symbol search 30.3 vs. 32.2, p=0.003). They were more likely to self-report a higher number of cognitive difficulties in everyday life (p=0.011). PWH also reported more depressive symptoms, general anxiety, and use of psychiatric medications (all with p<0.05). PWH had reduced proportions of subcortical gray matter on MRI (β=-0.001, p<0.001) and CSF showed elevated levels of neurofilament-light chain (664 vs. 529 pg/mL, p=0.01) and TNF-α (0.229 vs. 0.156 ng/mL, p=0.0008).ConclusionsPWH, despite effective ART for over a decade, displayed neurocognitive deficits and mood abnormalities. MRI and CSF analyses revealed reduced brain volume and signs of ongoing neuronal injury and neuroinflammation. As the already large proportion of virologically controlled PWH continues to grow, longitudinal studies should be conducted to elucidate the implications of cognitive, psychiatric, MRI, and CSF abnormalities in this group.
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Affiliation(s)
- Cynthia McMahan
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Devon K Dietrich
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
| | - Elizabeth F Horne
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
- Duke University School of Medicine, Durham, NC
| | - Erin Kelly
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Katrina Geannopoulos
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
- Department of Neurology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Peter Selim Siyahhan Julnes
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Lillian Ham
- Office of the Clinical Director, NIMH, NIH, Bethesda, MD
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, NCI, NIH, Bethesda, MD
| | - Tianxia Wu
- Office of the Clinical Director, NINDS, NIH, Bethesda, MD
| | - Hsing-Chuan Hsieh
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Catherine Berjohn
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA
| | - Suad Kapetanovic
- Department of Psychiatry and the Behavioral Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Daniel S Reich
- Translational Neuroradiology Section, NINDS, NIH, Bethesda, MD
| | - Govind Nair
- Translational Neuroradiology Section, NINDS, NIH, Bethesda, MD
| | - Joseph Snow
- Office of the Clinical Director, NIMH, NIH, Bethesda, MD
| | - Brian K Agan
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Avindra Nath
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
| | - Bryan R Smith
- Section of Infections of the Nervous System, NINDS, NIH, Bethesda, MD
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Ham L, Montoya JL, Serrano V, Yeager S, Paltin D, Pasipanodya EC, Marquine MJ, Hoenigl M, Ramers CB, Kua J, Moore DJ. High Psychosocial Burden Relates to Poorer Antiretroviral Treatment Adherence Among Black/African American People with HIV. AIDS Patient Care STDS 2023; 37:103-113. [PMID: 36689195 PMCID: PMC9963477 DOI: 10.1089/apc.2022.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Black/African American communities continue to be disproportionately impacted by HIV with Black people with HIV (PWH) exhibiting poorer outcomes along the HIV treatment cascade. Psychosocial burden may, in part, explain these health disparities among PWH. We implemented a culturally adapted intervention [individualized Texting for Adherence Building (iTAB)] to improve ART adherence among 89 Black PWH in San Diego, CA. We aimed to (1) characterize psychosocial risk factors (depression, negative life events, discrimination, medical mistrust) hypothesized to be barriers to HIV outcomes among Black PWH and (2) determine if these factors influence intervention engagement, HIV outcomes, and self-reported physical and mental health. We identified three levels of psychosocial burden (low, moderate, high) through hierarchical cluster analysis. Participants in the high burden cluster (n = 25) experienced the highest levels of depression, negative life events, and discrimination, in addition to the poorest intervention outcomes, HIV outcomes, and physical and mental health compared to low and moderate burden clusters. Participants in the low (n = 29) burden cluster had less medical mistrust than the moderate (n = 34) and high burden clusters, but low and moderate clusters did not differ on any outcomes. Overall, self-reported ART adherence was 83%, which is above estimates of ART adherence in the Western region of the United States. The iTAB intervention shows promise in improving HIV-related outcomes among Black PWH with low to moderate psychosocial burden; however, additional supports may need to be identified for those with high psychosocial burden.
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Affiliation(s)
- Lillian Ham
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jessica L. Montoya
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Samantha Yeager
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dafna Paltin
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | | | - Maria J. Marquine
- Geriatrics Division, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Medical University of Graz, Graz, Austria
| | - Christian B. Ramers
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - John Kua
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
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Ham L, Zachary I. Use of Project Management Tool for Increased Efficiency and Project Management in the Missouri Cancer Registry. J Registry Manag 2023; 50:97. [PMID: 37941742 PMCID: PMC10629803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- L Ham
- Babette Langeneckert, CTR
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Ham L, Tang B, Kohli M, Jeste DV, Grant I, Moore DJ. Four-Year Trajectories of Internal Strengths and Socioemotional Support Among Middle-Aged and Older Adults with HIV. AIDS Behav 2023; 27:628-640. [PMID: 35908270 PMCID: PMC9908640 DOI: 10.1007/s10461-022-03798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/31/2023]
Abstract
Positive psychological attributes are associated with better health outcomes, yet few studies have identified their underlying constructs and none have examined their temporal trajectories in clinical vs. non-clinical samples. From data collected over 4 years from people with HIV (PWH) and HIV-uninfected (HIV-) participants, we identified two latent factors (internal strengths; socioemotional support) based on responses to seven positive psychological attributes. Internal strengths increased over 4 years for PWH, but not for HIV- comparisons. Socioemotional support did not change significantly in either group. Lower internal strengths and worse socioemotional support were related to greater depressive symptoms. We speculate that improvement in internal strengths in PWH could reflect their being in care, but this requires further study to include PWH not in care. Given the apparent malleability of internal strengths and their association with improved health outcomes, these attributes can serve as promising intervention targets for PWH.
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Affiliation(s)
- Lillian Ham
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 220 Dickinson Street, San Diego, CA, 92103, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 220 Dickinson Street, San Diego, CA, 92103, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA.
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Mina Y, Wu T, Hsieh HC, Hammoud DA, Shah S, Lau CY, Ham L, Snow J, Horne E, Ganesan A, Rapoport SI, Tramont EC, Reich DS, Agan BK, Nath A, Smith BR. Association of White Matter Hyperintensities With HIV Status and Vascular Risk Factors. Neurology 2021; 96:e1823-e1834. [PMID: 33637630 PMCID: PMC8105972 DOI: 10.1212/wnl.0000000000011702] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that brain white matter hyperintensities (WMH) are more common in people living with HIV (PLWH), even in the setting of well-controlled infection, and to identify clinical measures that correlate with these abnormalities. METHODS Research brain MRI scans, acquired within longitudinal studies evaluating neurocognitive outcomes, were reviewed to determine WMH load using the Fazekas visual rating scale in PLWH with well-controlled infection (antiretroviral therapy for at least 1 year and plasma viral load <200 copies/mL) and in sociodemographically matched controls without HIV (CWOH). The primary outcome measure of this cross-sectional analysis was increased WMH load, determined by total Fazekas score ≥2. Multiple logistic regression analysis was performed to evaluate the effect of HIV serostatus on WMH load and to identify MRI, CSF, and clinical variables that associate with WMH in the PLWH group. RESULTS The study included 203 PLWH and 58 CWOH who completed a brain MRI scan between April 2014 and March 2019. The multiple logistic regression analysis, with age and history of tobacco use as covariates, showed that the adjusted odds ratio of the PLWH group for increased WMH load is 3.7 (95% confidence interval 1.8-7.5; p = 0.0004). For the PLWH group, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus coinfection, and also with the presence of measurable tumor necrosis factor α in CSF. CONCLUSION Our results suggest that HIV serostatus affects the extent of brain WMH. This effect is mainly associated with aging and modifiable comorbidities.
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Affiliation(s)
- Yair Mina
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Tianxia Wu
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Hsing-Chuan Hsieh
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Dima A Hammoud
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Swati Shah
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Chuen-Yen Lau
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Lillian Ham
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Joseph Snow
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Elizabeth Horne
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Anuradha Ganesan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Stanley I Rapoport
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Edmund C Tramont
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Daniel S Reich
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Brian K Agan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Avindra Nath
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Bryan R Smith
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD.
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Dean O, Anjum S, Scott T, Ham L, Powers JH, Snow J, Williamson P. 1176. Quality of Life of Previously Healthy Subjects following Cryptococcal Meningoencephalitis. Open Forum Infect Dis 2020. [PMCID: PMC7777580 DOI: 10.1093/ofid/ofaa439.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in HIV-negative, previously healthy populations. This group has significant disease sequalae including a fronto-subcortical syndrome, hearing loss, vision loss, and spinal arachnoiditis. However, the health-related quality of life (HRQOL) of this group of patients following microbial recovery from infection has not been reported. Methods We cross-sectionally defined the HRQOL of previously healthy individuals with CM seen at the NIH Clinical Center since 2013 and at least one year past diagnosis using the Quality of Life in Neurological Disorders (Neuro-QoL) project short forms. These forms assess domains such as anxiety, fatigue, depression, dexterity and mobility in patients with chronic neurological disease. Form scores were calculated for each domain and centered to a general or clinical United States population reference. Impairment was considered a subject score of least one half a standard deviation (SD) lower than the population reference average. Results Of 43 subjects with CM (mean age 48 years, 56% male, mean time from diagnosis 5.7 years), 91% had evidence of impairment in at least one HRQOL domain. Notable findings included self-reported impaired cognitive function in 53% and sleep disturbance in 56%. Impaired satisfaction with social roles and activities was present in 44%. Mobility and dexterity were impaired in 30% respectively. The number of impaired HRQOL domains was not significantly different in subjects with a history of neurosurgical intervention during hospitalization (mean no. impaired domains 4.4 vs. 3.3, P=0.43) or methylprednisolone treatment for post-infectious inflammatory response syndrome (4.3 vs. 3.4, P=0.63). Cerebrospinal fluid glucose levels on admission were negatively correlated with the number of impaired functional domains (rs=-0.33, P=0.05, n=38). Patient reported quality of life domains following microbial recovery from cryptococcal meningoencephalitis. Box plots show median, 25th, and 75th percentiles.The gray dotted line represents the mean T-score (50) of the U.S. population reference for each Neuro-QoL domain. The yellow region designates mild symptoms or impairment (0.5-1.0 std below the population mean), orange, moderate (1.0-2.0), and red, severe (2.0-3.0). The asterisk* indicates measures that were centered to U.S. clinical reference population. All other domains were centered to a U.S. general population reference. Abbreviations: CNS, central nervous system, U.S., United States, ADL, activities of daily living, SRA, social roles and activities ![]()
Conclusion This is the first report of HRQOL deficits in previously healthy individuals following microbial recovery from CM. These data reinforce and quantify the long-term morbidity of this disease and identify patient-centered outcomes for future interventional trials. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Owen Dean
- University of Rochester School of Medicine and Dentistry, Marcellus, New York
| | | | - Terri Scott
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Lillian Ham
- National Institute of Mental Health, Bethesda, Maryland
| | - John H Powers
- Support to National Institute of Allergy and Infectious Disease, Bethesda, MD
| | - Joseph Snow
- National Institute of Mental Health, Bethesda, Maryland
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Snow J, Segalà L, Ham L, Traino KA, Summers AC, McGwier M, Page E, Kreisl WC. Medical Symptom Validity Test (MSVT) profiles in individuals being evaluated for Alzheimer's disease. Clin Neuropsychol 2020; 36:1328-1351. [PMID: 33043815 DOI: 10.1080/13854046.2020.1829067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Our purpose was to determine whether Medical Symptom Validity Test (MSVT) profiles could differentiate performance invalidity from true impairment in patients with varying levels of memory impairment and functional ability being evaluated for Alzheimer's disease (AD). Method: Seventy-three older adults (13 healthy controls, 25 mild cognitive impairment [MCI], 16 mild AD, 19 moderate AD) were evaluated with a neuropsychological battery including the MSVT and activities of daily living (ADL) measures. Using MSVT classification guidelines, examinees' MSVT profiles were categorized as: 1) valid, 2) invalid, 3) weak memory, or 4) genuine memory impairment (GMIP). Results: Eighty-four percent of moderate AD examinees produced a GMIP. Among MCI and mild AD examinees, who had only modestly affected ADLs, a substantial proportion manifested a GMIP (40% and 62.5%, respectively). An invalid profile was uncommon across patient groups (12.5% in mild AD, 5.3% in moderate AD, and 0% in MCI). Conclusions: The MSVT functions reasonably well in a dementia sample to determine if an examinee has an invalid profile, although for mild AD examinees, the false positive rate is slightly above the recommended 10% cut-off. However, even individuals with MCI, mild AD and relative preservation of ADLs may manifest a GMIP, demonstrating that such profile is found across patients with lower and higher degrees of functional impairment. Given this finding, the usefulness of the GMIP in differentiating performance invalidity from true impairment in patients being evaluated for AD appears limited.
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Affiliation(s)
- Joseph Snow
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Laura Segalà
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lillian Ham
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Katherine A Traino
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Angela C Summers
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychology, Fordham University, New York City, NY, USA
| | - Meghan McGwier
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Emily Page
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - William C Kreisl
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Columbia University, New York City, NY, USA
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Divers R, Ham L, Matchanova A, Hackett K, Mis R, Howard K, Rycroft SS, Roll E, Giovannetti T. When and how did you go wrong? Characterizing mild functional difficulties in older adults during an everyday task. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020; 28:308-326. [PMID: 32352347 DOI: 10.1080/13825585.2020.1756210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mild functional difficulties associated with cognitive aging may be reliably measured by coding "micro-errors" during everyday tasks, like meal preparation. Micro-errors made by 25 older adult and 48 younger adults were coded on four dimensions to evaluate the influence of: 1) poor error monitoring; 2) goal decay; 3) competition for response selection when switching to a new subtask; and 4) interference from distractor objects. Micro-errors made by young adults under a dual task load also were analyzed to determine the influence of overall performance level. Older adults' micro-errors were observed when switching to a new subtask and to unrelated distractors. Slowed error monitoring and goal decay also influenced micro-errors in older adults, but not significantly more so than younger adults under the dual task. Interventions to reduce interference from distractors and to increase attention at critical choice points during tasks may optimize everyday functioning and preclude decline in older adults.
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Affiliation(s)
- Ross Divers
- Department of Psychology, Temple University , Philadelphia, PA, USA
| | - Lillian Ham
- Department of Psychology, Temple University , Philadelphia, PA, USA
| | | | | | - Rachel Mis
- Department of Psychology, Temple University , Philadelphia, PA, USA
| | - Kia Howard
- Department of Psychology, Temple University , Philadelphia, PA, USA
| | | | - Emily Roll
- Department of Psychology, Temple University , Philadelphia, PA, USA
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Traino K, Snow J, Ham L, Summers A, Segalà L, Shirazi T, Biassou N, Panackal A, Anjum S, Marr KA, Kreisl WC, Bennett JE, Williamson PR. HIV-Negative Cryptococcal Meningoencephalitis Results in a Persistent Frontal-Subcortical Syndrome. Sci Rep 2019; 9:18442. [PMID: 31804566 PMCID: PMC6895107 DOI: 10.1038/s41598-019-54876-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Twenty-seven previously healthy (of 36 consecutive eligible patients), HIV-negative cryptococcal meningoencephalitis (CM) patients underwent comprehensive neuropsychological evaluation during the late post-treatment period (1.3-4 years post diagnosis), assessing attention, language, learning, memory, visuospatial, executive function, information processing, psychomotor functioning, as well as mood symptoms. Seven of eight domains (all except attention) showed increased percentages of CM patients scoring in the less than 16th percentile range compared to standardized normative test averages, adjusted for education level and age. Comparison with a matched archival dataset of mild cognitive impairment/Alzheimer's disease patients showed that CM patients exhibited relative deficits in psychomotor and executive function with fewer deficits in memory and learning, consistent with a frontal-subcortical syndrome. MRI evaluation at the time of testing demonstrated an association of lower neuropsychological functioning with ventriculomegaly. These studies suggest that CM should be included in the list of treatable causes of dementia in neurological work ups. Future studies are needed to identify diagnostic and treatment regimens that may enhance neurological function after therapy.
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Affiliation(s)
- Katherine Traino
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Joseph Snow
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Lillian Ham
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Angela Summers
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Laura Segalà
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Talia Shirazi
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nadia Biassou
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anil Panackal
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kieren A Marr
- Johns Hopkins University Department of Medicine, Baltimore, MD, USA
| | - William C Kreisl
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Columbia University, New York, NY, USA
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Shirazi TN, Snow J, Ham L, Raglan GB, Wiggs EA, Summers AC, Toro C, Introne WJ. The neuropsychological phenotype of Chediak-Higashi disease. Orphanet J Rare Dis 2019; 14:101. [PMID: 31060595 PMCID: PMC6503440 DOI: 10.1186/s13023-019-1049-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/19/2019] [Indexed: 01/23/2023] Open
Abstract
Background/objectives Chediak-Higashi Disease (CHD) is a rare autosomal disorder, purported to have cognitive and neurological impairments. Prior descriptions of cognitive impairment, however, are solely based on subjective, unstructured observations rather than on formal neuropsychological measures. Methods Four pediatric and 14 adult patients with diagnostically confirmed CHD were administered a neuropsychological battery assessing memory, attention, processing speed, psychomotor speed, language fluency, executive function, and general intelligence. Nine of the adult patients received follow-up evaluations to elucidate the longitudinal progression or stability of cognition over time. Results Pediatric CHD patients performed within the average range. Adult patients, however, performed below average on nearly all measures administered, and endorsed subjective reports of learning difficulties and poor academic performance in childhood. In particular, patients struggled with memory and psychomotor speed tasks, with 75% or more of patients scoring in the bottom 2.3 percentile in these two domains. No significant declines in cognition were observed among the patients who completed follow-up evaluations (M = 39.90, SD = 8.03 months between visits). Exploratory analyses suggested that adult patients who had classic CHD and previously received bone marrow transplants (BMTs; n = 3) exhibited moderately greater cognitive impairment than adult patients who had atypical CHD and had not received BMTs (n = 10). Conclusions Adult patients with CHD uniformly exhibit deficits in multiple domains, but in psychomotor speed and memory, in particular. Based on their neuropsychological profile, their ability to hold jobs and succeed in school may require support and special accommodations. The source of cognitive deficits is probably multifactorial including central nervous system involvement in CHD, and, for those transplanted, BMT-related side effects and complications. Absence of cognitive decline at three-year follow-up is encouraging but does not exclude progression at a slower time-scale. Future work should elucidate the possible effects and timing of BMT on cognition, as well as the mechanisms driving neuropsychological impairment in CHD.
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Affiliation(s)
- Talia N Shirazi
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Joseph Snow
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA.
| | - Lillian Ham
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Greta B Raglan
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Edythe A Wiggs
- National Human Genome Research Institute, Bethesda, MD, USA
| | - Angela C Summers
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Camilo Toro
- National Human Genome Research Institute, Bethesda, MD, USA
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Giovannetti T, Yamaguchi T, Roll E, Harada T, Rycroft SS, Divers R, Hulswit J, Tan CC, Matchanova A, Ham L, Hackett K, Mis R. The Virtual Kitchen Challenge: preliminary data from a novel virtual reality test of mild difficulties in everyday functioning. Aging, Neuropsychology, and Cognition 2018; 26:823-841. [DOI: 10.1080/13825585.2018.1536774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Takehiko Yamaguchi
- Department of Applied Information Engineering, Suwa University of Science, Nagano, Japan
| | - Emily Roll
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tetsuya Harada
- Department of Applied Electronics, Tokyo University of Science, Tokyo, Japan
| | | | - Ross Divers
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jacob Hulswit
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Chiu C. Tan
- Department of Computer and Information Science, Temple University, Philadelphia, PA, USA
| | | | - Lillian Ham
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Rachel Mis
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Dapena I, Dapena L, Dirisamer M, Ham L, Melles GRJ. [Visual acuity and endothelial cell density following Descemet membrane endothelial keratoplasty (DMEK)]. Arch Soc Esp Oftalmol 2011; 86:395-401. [PMID: 22117738 DOI: 10.1016/j.oftal.2011.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/21/2011] [Accepted: 05/25/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE To assess the clinical outcomes of DMEK in the first series of 120 eyes operated for the treatment of Fuchs endothelial dystrophy in terms of visual acuity and endothelial cell density. METHODS The first 120 consecutive eyes that underwent DMEK (i.e. transplantation of an isolated donor Descemet membrane with its endothelium) were evaluated. In all eyes, the best corrected visual acuity (BCVA) before and at 1, 3 and 6 months after surgery, as well as the endothelial cell density (ECD) before and at 6 months were measured. RESULTS In eyes with a functional DMEK graft and good visual potential (n=96), the BCVA was ≥ 20/40 (≥ 0.5) in 77% after 1 month, 92% after 3 months, and 95% after six months; ≥ 20/25 (≥ 0.8) in 50%, 63%, and 73% of the cases, and ≥ 20/20 (≥ 1.0) in 23%, 34%, and 45% of the cases at 1, 3, and 6 months respectively. In this group, ECD averaged 2610 (± 185) cells/mm(2) before, and 1770 (± 520) cells/mm(2) at six months after surgery (n=96). In 15 eyes, a secondary Descemet stripping endothelial keratoplasty (DSEK) was performed. In this group, 91% of patients reached a BCVA of ≥ 20/40 (≥ 0.5) and only one patient achieved a BCVA of 0.8 at 6 months after surgery (n=11). Furthermore, ECD averaged 2580 (± 185) cells/mm(2) before and 1310 (± 740) cells/mm(2) at six months (n=13). CONCLUSION DMEK provides a fast and high visual rehabilitation. Endothelial cell density loss may be similar to earlier types of endothelial keratoplasty.
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Affiliation(s)
- I Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Holanda.
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Dapena I, Ham L, Moutsouris K, Melles GRJ. Incidence of recipient Descemet membrane remnants at the donor-to-stromal interface after descemetorhexis in endothelial keratoplasty. Br J Ophthalmol 2010; 94:1689-90. [DOI: 10.1136/bjo.2010.186189] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moutsouris K, Ham L, Dapena I, van der Wees J, Melles GRJ. Radial graft contraction may relate to subnormal visual acuity in Descemet stripping (automated) endothelial keratoplasty. Br J Ophthalmol 2010; 94:951-3. [DOI: 10.1136/bjo.2009.167718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lie JT, Groeneveld-van Beek EA, Ham L, van der Wees J, Melles GRJ. More efficient use of donor corneal tissue with Descemet membrane endothelial keratoplasty (DMEK): two lamellar keratoplasty procedures with one donor cornea. Br J Ophthalmol 2010; 94:1265-6. [DOI: 10.1136/bjo.2009.171629] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Droutsas K, Ham L, Dapena I, Geerling G, Oellerich S, Melles G. Visus nach Descemet-Membran Endothelkeratoplastik (DMEK): Ergebnisse der ersten 100 Eingriffe bei Fuchs’scher Endotheldystrophie. Klin Monbl Augenheilkd 2010; 227:467-77. [DOI: 10.1055/s-0029-1245446] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dapena I, Ham L, van Luijk C, van der Wees J, Melles GRJ. Back-up procedure for graft failure in Descemet membrane endothelial keratoplasty (DMEK). Br J Ophthalmol 2009; 94:241-4. [DOI: 10.1136/bjo.2009.160945] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE To report the two-year results of Descemet membrane endothelial keratoplasty (DMEK) for managing corneal endothelial disorders. METHODS Non-randomized prospective clinical trial. A DMEK was performed in ten patients with Fuchs' endothelial dystrophy or bullous keratopathy. A 3.5 mm clear corneal incision was made and "under air" DM was stripped off from the posterior stroma. A 9.0 mm diameter, organ cultured donor DM roll was inserted into a recipient anterior chamber, positioned into the posterior stroma and secured by completely filling the anterior chamber with air for 30 minutes. RESULTS Three eyes showed complete detachment of the tissue; this was managed by a secondary Descemet stripping endothelial keratoplasty procedure. The remaining seven eyes had a best corrected visual acuity of >or=0.7 in three eyes (43%) at one month, in five eyes (71%) at six months, and in six eyes (86%) at one and two years. At six months, the endothelial cell density averaged 2039 (+/-373) cells/mm2 (n=7), at one year 1925 (+/-267) cells/mm2 (n=7) and at two years 1730 (+/-400) cells/mm2 (n=6). CONCLUSIONS DMEK may provide quick and nearly complete visual rehabilitation. Since the donor tissue can be stripped from donor corneo-scleral rims, the procedure may be readily accessible to most corneal surgeons.
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Affiliation(s)
- I Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
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Abstract
We present an unusual case in which a patient with asthma presented with acute respiratory distress of acute onset, secondary to marked atelectasis of the right middle and lower lobes, which resolved within 24 hr following administration of increased doses of intravenous steroids, inhalation therapy (beta-agonists and steroids), and pulmonary physiotherapy. This transient occurrence responding to basic therapeutic measures was considered consistent with the release of a mucous plug which had caused the above obstruction and associated symptomatology and radiographic findings. This case illustrates and supports the practice of chest imaging in patients with atypical presentations of asthma and stresses the importance of pulmonary physiotherapy and bronchodilatory therapy as primary therapeutic agents in cases of mucous plug-associated atelectasis.
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Affiliation(s)
- C I Onyeije
- Department of Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, New York, USA
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Tank AW, Ham L, Curella P. Induction of tyrosine hydroxylase by cyclic AMP and glucocorticoids in a rat pheochromocytoma cell line: effect of the inducing agents alone or in combination on the enzyme levels and rate of synthesis of tyrosine hydroxylase. Mol Pharmacol 1986; 30:486-96. [PMID: 2430169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The enzymatic activity of tyrosine hydroxylase (EC 1.14.16.2) increases in rat pheochromocytoma PC18 cells exposed to either elevated levels of cyclic AMP or glucocorticoids. The cyclic AMP-mediated increase in activity is elicited by cyclic AMP analogs or by compounds which activate adenylate cyclase or inhibit phosphodiesterase. The glucocorticoid-mediated increase is elicited only by glucocorticoid steroid hormones; nonglucocorticoid steroid hormones have no effect on tyrosine hydroxylase. In PC18 cells exposed simultaneously to both cyclic AMP-elevating agents and glucocorticoids, the increase in tyrosine hydroxylase activity is greater than that observed in cells treated with optimal concentrations of either inducing agent alone. Immunochemical titration experiments demonstrate that the increases in tyrosine hydroxylase activity observed in cells treated with the cyclic AMP analog, 8-bromocyclic AMP, and/or the synthetic glucocorticoid, dexamethasone, are due to increases in enzyme protein. Time course studies show that in cells treated with either 8-bromocyclic AMP or dexamethasone, the enzyme level increases slowly to a level 5-7-fold greater than that observed in untreated cells after 4 days of treatment. In cells treated with both of these inducing agents simultaneously, the enzyme level increases to a level 10-12-fold greater than that observed in control cells after 4 days of treatment. This additive increase in activity in cells treated with both inducing agents is observed at all time points. The rates of synthesis and degradation of tyrosine hydroxylase have also been measured in PC18 cells, using an antiserum to tyrosine hydroxylase to rapidly isolate radiolabeled enzyme from cells that have been incubated in the presence of [3H]leucine. The apparent half-life of tyrosine hydroxylase in the PC18 cells is approximately 30 hr. In PC18 cells incubated in the presence of radiolabeled leucine for 60 min, 0.2-0.3% of the total soluble protein synthesized is identified as tyrosine hydroxylase. In cells treated with either 8-bromocyclic AMP or dexamethasone for 24 hr, there is a 6-8-fold increase in the rate of synthesis of the enzyme. In cells treated with both inducing agents simultaneously, there is a 10-12-fold increase in the rate of synthesis; thus, the additive increase in enzyme level observed in cells treated with both inducing agents is paralleled by an additive increase in the rate of synthesis of the enzyme in these cells.(ABSTRACT TRUNCATED AT 400 WORDS)
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Tank AW, Curella P, Ham L. Induction of mRNA for tyrosine hydroxylase by cyclic AMP and glucocorticoids in a rat pheochromocytoma cell line: evidence for the regulation of tyrosine hydroxylase synthesis by multiple mechanisms in cells exposed to elevated levels of both inducing agents. Mol Pharmacol 1986; 30:497-503. [PMID: 2877392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
When rat pheochromocytoma PC18 cells are exposed to the cyclic AMP analog, 8-bromocyclic AMP, and/or the synthetic glucocorticoid, dexamethasone, there is a marked increase in the level of a single RNA species that hybridizes to the recombinant plasmid pTH.4, which contains sequences complementary to the RNA coding for tyrosine hydroxylase. This RNA species is 1800-1900 nucleotides in length and is presumably identical to an RNA species of similar size, isolated from rat pheochromocytoma PC8b cells and shown to code for tyrosine hydroxylase. Using RNA dot hybridization to quantitate the relative level of this tyrosine mRNA species, time course studies show that this mRNA increases relatively rapidly in PC18 cells treated with either 8-bromocyclic AMP or dexamethasone. A new steady state level of tyrosine hydroxylase mRNA is achieved after 6 hr or 12-24 hr of treatment with either 8-bromocyclic AMP or dexamethasone, respectively. The changes in the level of the mRNA slightly precede the changes in the rate of synthesis of tyrosine hydroxylase in cells treated with these inducing agents. After 24 hr of treatment with either 8-bromocyclic AMP or dexamethasone, the increases in the level of tyrosine hydroxylase mRNA are identical to the increases in the rate of synthesis of the enzyme in the cells. In cells treated simultaneously with both 8-bromocyclic AMP and dexamethasone, the increases in the enzyme level and rate of synthesis of tyrosine hydroxylase are approximately equal to the sum of the increases in these parameters observed in cells treated with either inducing agent alone. In contrast, there is not an additive increase in the level of tyrosine hydroxylase mRNA in cells treated with both inducing agents. This lack of an additive increase in mRNA for tyrosine hydroxylase is observed in total cellular RNA samples or in cytoplasmic RNA samples. Our results suggest that in cells exposed to elevated levels of either cyclic AMP or glucocorticoids, tyrosine hydroxylase is induced by a mechanism which increases the level of its mRNA, resulting in an increased rate of synthesis of the enzyme. However, in cells exposed to elevated levels of both cyclic AMP and dexamethasone, tyrosine hydroxylase enzyme levels are regulated by multiple mechanisms, one of which regulates the rate of synthesis of the enzyme without affecting the level of its mRNA.
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Gasper PW, Thrall MA, Wenger DA, Macy DW, Ham L, Dornsife RE, McBiles K, Quackenbush SL, Kesel ML, Gillette EL. Correction of feline arylsulphatase B deficiency (mucopolysaccharidosis VI) by bone marrow transplantation. Nature 1984; 312:467-9. [PMID: 6438532 DOI: 10.1038/312467a0] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Feline and human mucopolysaccharidosis VI (MPS VI or Maroteaux-Lamy syndrome) are inherited autosomal recessive deficiencies of lysosomal enzyme arylsulphatase B. Affected cats and children exhibit lesions caused by incompetent degradation, retinal atrophy and excessive urinary excretion of dermatan facial dysmorphia, corneal stromal opacities, leukocyte granulation, retinal atrophy and excessive urinary excretion of dermatan sulphate--and usually die before adulthood. Most attempts to treat humans affected with MPS VI or other mucopolysaccharidoses have been ineffective or logistically prohibitive, but allogeneic bone marrow transplantation (BMT) offers promise for cure of certain inborn errors of metabolism. Engraftment of normal donor marrow may endow the enzyme-deficient recipient with a continuous source of enzyme-competent blood cells and tissue macrophages to facilitate degradation of stored substrate and to prevent genesis of further malformations. To test this hypothesis, we performed allogeneic BMT in a 2-year-old male Siamese cat with advanced MPS VI. Here we describe BMT-induced correction of this hereditary enzyme deficiency.
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