1
|
Nolin SA, Cowart H, Merritt S, McInerney K, Bharadwaj PK, Franchetti MK, Raichlen DA, Jessup CJ, Hishaw GA, Van Etten EJ, Trouard TP, Geldmacher DS, Wadley VG, Porges ES, Woods AJ, Cohen RA, Levin BE, Rundek T, Alexander GE, Visscher KM. Validity of the NIH toolbox cognitive battery in a healthy oldest-old 85+ sample. J Int Neuropsychol Soc 2023; 29:605-614. [PMID: 36239453 DOI: 10.1017/s1355617722000443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the construct validity of the NIH Toolbox Cognitive Battery (NIH TB-CB) in the healthy oldest-old (85+ years old). METHOD Our sample from the McKnight Brain Aging Registry consists of 179 individuals, 85 to 99 years of age, screened for memory, neurological, and psychiatric disorders. Using previous research methods on a sample of 85 + y/o adults, we conducted confirmatory factor analyses on models of NIH TB-CB and same domain standard neuropsychological measures. We hypothesized the five-factor model (Reading, Vocabulary, Memory, Working Memory, and Executive/Speed) would have the best fit, consistent with younger populations. We assessed confirmatory and discriminant validity. We also evaluated demographic and computer use predictors of NIH TB-CB composite scores. RESULTS Findings suggest the six-factor model (Vocabulary, Reading, Memory, Working Memory, Executive, and Speed) had a better fit than alternative models. NIH TB-CB tests had good convergent and discriminant validity, though tests in the executive functioning domain had high inter-correlations with other cognitive domains. Computer use was strongly associated with higher NIH TB-CB overall and fluid cognition composite scores. CONCLUSION The NIH TB-CB is a valid assessment for the oldest-old samples, with relatively weak validity in the domain of executive functioning. Computer use's impact on composite scores could be due to the executive demands of learning to use a tablet. Strong relationships of executive function with other cognitive domains could be due to cognitive dedifferentiation. Overall, the NIH TB-CB could be useful for testing cognition in the oldest-old and the impact of aging on cognition in older populations.
Collapse
Affiliation(s)
- Sara A Nolin
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Hannah Cowart
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Stacy Merritt
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Katalina McInerney
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - P K Bharadwaj
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | | | | | - Cortney J Jessup
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - G Alex Hishaw
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Emily J Van Etten
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Theodore P Trouard
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - David S Geldmacher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Virginia G Wadley
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Eric S Porges
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Adam J Woods
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Ron A Cohen
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Bonnie E Levin
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Gene E Alexander
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Kristina M Visscher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| |
Collapse
|
2
|
Zhang HS, Choi DW, Kim HS, Kang HJ, Jhang H, Jeong W, Nam CM, Park S. Increasing disparities in the proportions of active treatment and 5-year overall survival over time by age groups among older patients with gastric cancer in Korea. Front Public Health 2023; 10:1030565. [PMID: 36699910 PMCID: PMC9869046 DOI: 10.3389/fpubh.2022.1030565] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose As older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters. Materials and methods A nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005-2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed. Results The mean age of patients was 76.4, and 60.4% were males. Most patients had 0-1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005-2006 to 69.6% in 2011-2012. The proportion of surgery-including active treatment increased to over 70% in the 70-74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70-84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing "chronological" age but varied quite randomly, especially among female patients. Conclusion Our study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, "functional" age rather than "chronological" age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.
Collapse
Affiliation(s)
- Hyun-Soo Zhang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,Department of Biomedical Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong-Woo Choi
- Data Link and Operations Team, Cancer Big-Data Center, National Cancer Center, National Cancer Control Institute, Goyang, Republic of Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hye Jung Kang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Hoyol Jhang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Wonjeong Jeong
- Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Chung Mo Nam
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,Department of Biomedical Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,*Correspondence: Sohee Park ✉
| |
Collapse
|
3
|
Gan EH, Jagger C, Yadegarfar ME, Duncan R, Pearce SH. Changes in Serum Thyroid Function Predict Cognitive Decline in the Very Old: Longitudinal Findings from the Newcastle 85+ Study. Thyroid 2021; 31:1182-1191. [PMID: 34074153 DOI: 10.1089/thy.2020.0596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Low serum thyrotropin (TSH) has been associated with an increased risk of cognitive impairment in observational studies of older individuals, but the mechanism underlying this is unclear. We investigated the association between changes in thyroid status and cognitive impairment in very old adults, using prospective data from the Newcastle 85+ study. Method: A cohort of 85-year-old individuals was assessed for health status and thyroid function. Complete data from a comprehensive multidimensional measure of health and repeat thyroid function were available for 642 participants with normal free thyroid hormones and TSH levels ranging between 0.1 and 10 mU/L. Cognitive performance, assessed using Mini-Mental State Examination (MMSE) and Cognitive Drug Research battery was examined by using linear mixed, logistic regression, and Cox proportional hazard models in relation to baseline and 3-year changes in serum TSH, free thyroxine (fT4), and free triiodothyronine (fT3). Results: Over 3 years, declining serum TSH was associated with reductions in fT4 and fT3, and an increased risk of incident cognitive impairment by 5 years (odds ratio1.77 [95% confidence interval: 1.19-2.61]; p = 0.004). A greater reduction in MMSE score was associated with larger TSH decline, at 3 (p = 0.001) and 5 years (p < 0.001), respectively. Steady fT4 concentrations were found in participants with rising TSH. Conclusions: In contrast to physiological expectation, in this group of 85-year-olds, a declining serum TSH was associated with reductions in free thyroid hormones over time. A decreasing serum TSH trajectory over time anticipated cognitive decline in later life. Declining TSH concentrations are a biomarker for cognitive impairment in later life.
Collapse
Affiliation(s)
- Earn H Gan
- Translational and Clinical Research Institute, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
- Endocrinology Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mohammad E Yadegarfar
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Rachel Duncan
- Endocrinology Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Simon H Pearce
- Translational and Clinical Research Institute, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
- Endocrinology Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
4
|
Abstract
BACKGROUND The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population. OBJECTIVE The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records. METHODS We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient's cognitive status and nursing care, and cognitive status and length of stay. RESULTS We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults' cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI. DISCUSSION Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap.
Collapse
Affiliation(s)
- Tamara G R Macieira
- Tamara G. R. Macieira, PhD, BSN, is Postdoctoral Fellow, University of Florida College of Nursing, Gainesville. Yingwei Yao, PhD, is Research Associate Professor, Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville. Madison B. Smith, PhD, BSN, RN, is Diabetes Nurse Clinician, Department of Pediatrics, University of Florida College of Medicine, Division of Endocrinology, Gainesville. Jiang Bian, PhD, MS, is Associate Professor, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville. Diana J. Wilkie, PhD, RN, FAAN, is Professor and Prairieview Trust-Earl and Margo Powers Endowed Professor, Department of Biobehavioral Nursing Science, University of Florida College of Nursing, and Director, Academic Center of Excellence in Palliative Care Research and Education, Gainesville, Florida. Gail M. Keenan, PhD, RN, FAAN, is Professor and Annabel Davis Jenks Endowed Chair for Teaching and Research in Clinical Nursing Excellence, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville
| | | | | | | | | | | |
Collapse
|
5
|
Krok-Schoen JL, Adams IK, Baltic RD, Fisher JL. Ethnic disparities in cancer incidence and survival among the oldest old in the United States. Ethn Health 2020; 25:79-92. [PMID: 29076352 DOI: 10.1080/13557858.2017.1395818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
Objective: To examine potential ethnic disparities in cancer incidence and survival rates among the oldest old using data from the SEER Program.Design: Cases diagnosed with one of the leading four cancer sites (lung and bronchus, colon and rectum, female breast, prostate) and four cancer sites (stomach, liver and intrahepatic bile duct, gallbladder, and cervical) that disproportionally affect Hispanics were reported to one of 18 SEER registries. Differences in cancer incidence were examined for cases aged ≥85 years diagnosed during the most recent 5-year time period (2009-2013) and, to examine changes over time, from 1992 to 2013. Five-year relative cancer survival probability was examined for Hispanics and non-Hispanics aged ≥85 years diagnosed 2006-2012.Results: From 2009 to 2013, non-Hispanics aged ≥85 years had higher incidence rates compared to Hispanics for colon and rectum, lung and bronchus, female breast, and prostate cancers. Five-year survival probability for cancers of all stages combined was higher for non-Hispanics than Hispanics in this age group. However, Hispanics had higher survival probability of colon and rectum and lung and bronchus cancers diagnosed at regional (colon and rectum: 67.2% vs. 60.5%; lung and bronchus: 15.9% vs. 12.7%) and distant (colon and rectum: 5.4% vs. 3.8%; lung and bronchus: 2.8% vs. 2.2%) stages than non-Hispanics, respectively.Conclusion: Ethnic differences in cancer incidence and survival probability exist for the ≥85 population. Continued efforts are needed to understand and reduce ethnic disparities in cancer prevention and treatment for this population.
Collapse
Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Ingrid K Adams
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio University, Columbus, OH, USA
- The Ohio State University Extension, College of Food, Agricultural, and Environmental Sciences, The Ohio University, Columbus, OH, USA
| | - Ryan D Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James L Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| |
Collapse
|