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Akkoyun M, Koçoğlu K, Eraslan Boz H, Keskinoğlu P, Akdal G. Saccadic Eye Movements in Patients with Mild Cognitive Impairment: A Longitudinal Study. J Mot Behav 2023; 55:354-372. [PMID: 37080551 DOI: 10.1080/00222895.2023.2202620] [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: 01/09/2023] [Revised: 02/28/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Saccadic eye movements are one of the sensitive and noninvasive methods to help monitor the cognitive course of mild cognitive impairment (MCI). The study aimed to evaluate both pro and anti-saccade longitudinally and the relationship between cognitive functions and eye movements in MCI subgroups and healthy controls (HCs) at a two-year follow-up. This study revealed that the anti-saccade anticipatory responses decreased in amnestic MCI (aMCI). Correct vertical pro-saccades increased in non-amnestic MCI (naMCI), while the express saccades decreased. Our study demonstrated that longer than two years of follow-up is necessary to monitor the course of MCI. Findings of the relationships between longitudinal changes of saccades and cognitive measurements demonstrated the usability of eye movements in evaluating the process of MCI.
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Affiliation(s)
- Müge Akkoyun
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
| | - Koray Koçoğlu
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
| | - Hatice Eraslan Boz
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Pembe Keskinoğlu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Gülden Akdal
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
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Cohen S, Cummings J, Knox S, Potashman M, Harrison J. Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer's Disease. J Prev Alzheimers Dis 2022; 9:507-522. [PMID: 35841252 PMCID: PMC9843702 DOI: 10.14283/jpad.2022.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As the focus of Alzheimer's disease (AD) therapeutic development shifts to the early stages of the disease, the clinical endpoints used in drug trials, and how these might translate into clinical practice, are of increasing importance. The clinical meaningfulness of trial outcome measures is often unclear, with a lack of conclusive evidence as to how these measures correlate to changes in disease progression and treatment response. Clarifying this would benefit all, including patients, care partners, primary care providers, regulators, and payers, and would enhance our understanding of the relationship between clinical trial endpoints and assessments used in everyday practice. At present, there is a wide range of assessment tools used in clinical trials for AD and substantial variability in measures selected as endpoints across these trials. The aim of this review is to summarize the most commonly used assessment tools for early stages of AD, describe their use in clinical trials and clinical practice, and discuss what might constitute clinically meaningful change in these measures in relation to disease progression and treatment response.
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Affiliation(s)
- S. Cohen
- Toronto Memory Program, Toronto, ON, Canada
| | - J. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), NV, USA
| | - S. Knox
- Biogen International GmbH, Baar, Switzerland
| | | | - J. Harrison
- Metis Cognition Ltd, Wiltshire, UK,Alzheimer Center, AU Medical Center, Amsterdam, the Netherlands,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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Validation of a social deprivation index and association with cognitive function and decline in older adults. Int Psychogeriatr 2021; 33:1309-1320. [PMID: 34494514 DOI: 10.1017/s1041610221000995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous work using a US sample has shown that an index of social deprivation (SoDep Index) is associated with cognitive functioning and decline in older adults. This study aimed to replicate these findings using a European sample (Survey of Health, Ageing and Retirement in Europe, SHARE). DESIGN We analyzed data of 51,630 respondents aged 50 years and older (M: 63.5 years, standard deviation [SD]: 9.1) with at least two cognitive assessments (follow-up M: 6.06 years, SD: 3.86). Cognitive scores were transformed to Z-scores. Multiple growth curve modeling was used to model cognitive status and decline as predicted by the SoDep Index. In a sensitivity analysis, we constructed a new SoDep Index (SoDep Indexnew) including further social deprivation domains. RESULTS Adjusting for covariates, a unit increase in SoDep Index was associated with a cognitive score of 0.037 SDs smaller (p < .001) and a decline 0.003 SDs per year faster (p < .001). Of the covariates, depressive symptoms, chronic disease burden, male gender, and widowhood were also associated with poorer cognition. Being divorced was associated with better cognition. Sensitivity analysis confirmed findings. Compared to the SoDep Index, the SoDep Indexnew showed a more pronounced association with both cognition and cognitive decline. CONCLUSIONS We were able to replicate results showing an association between SoDep Index and cognitive function and decline. The sensitivity analysis further emphasizes the relevance of financial security. This strengthens the implication that preventing social deprivation can contribute to reducing the dementia burden by raising cognitive functioning in the older population. The findings are relevant to policy-makers and health care practitioners.
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Takechi H, Yoshino H. Usefulness of CogEvo, a computerized cognitive assessment and training tool, for distinguishing patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people. Geriatr Gerontol Int 2021; 21:192-196. [PMID: 33336432 PMCID: PMC7898622 DOI: 10.1111/ggi.14110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 01/02/2023]
Abstract
AIM This study aimed to assess whether CogEvo, a computerized cognitive assessment and training tool, could distinguish patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people. METHODS This cross-sectional study enrolled 166 participants with Alzheimer's disease, mild cognitive impairment and cognitively normal older people. In CogEvo, five types of cognitive tasks were carried out, and the z-scores were used as a composite score. Logistic regression and receiver operating characteristics analyses were then carried out to evaluate the usefulness of CogEvo in distinguishing between the three groups. RESULTS CogEvo and Mini-Mental State Examination scores showed excellent correlation, and could significantly differentiate between the Alzheimer's disease, mild cognitive impairment and cognitively normal older people groups (Mini-Mental State Examination 20.4 ± 3.5, 25.5 ± 1.6 and 27.6 ± 2.0, respectively; CogEvo: -1.9 ± 0.9, -0.8 ± 0.8 and 0.0 ± 1.0, respectively; both P < 0.001 by analysis of variance). Logistic regression analysis adjusted for age, sex and years of education significantly differentiated the mild cognitive dysfunction group (mild cognitive impairment plus mild Alzheimer's disease; n = 78) from the cognitively normal group (n = 88) (P < 0.001), whereas receiver operating characteristics analysis showed moderate accuracy (area under the receiver operating characteristic curve 0.830). CONCLUSIONS These results suggest that CogEvo, a computerized cognitive assessment tool, is useful for evaluating early-stage cognitive impairment. Further studies are required to assess its effectiveness as a combination assessment and training tool. Geriatr Gerontol Int 2021; 21: 192-196.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive DisordersFujita Health University School of MedicineToyoakeJapan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive DisordersFujita Health University School of MedicineToyoakeJapan
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Huang ST, Tange C, Otsuka R, Nishita Y, Peng LN, Hsiao FY, Tomida M, Shimokata H, Arai H, Chen LK. Subtypes of physical frailty and their long-term outcomes: a longitudinal cohort study. J Cachexia Sarcopenia Muscle 2020; 11:1223-1231. [PMID: 32558267 PMCID: PMC7567152 DOI: 10.1002/jcsm.12577] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Components of physical frailty cluster into subtypes, but it remains unknown how these might be associated with age-related functional declines and multimorbidities. This study aims to investigated associations of physical frailty subtypes with functional declines and multimorbidity in a 10 year longitudinal cohort survey. METHODS Complementary longitudinal cohort study used group-based multitrajectory modelling to verify whether frailty subtypes discovered in Taiwan are presented in another aging cohort, then investigated associations of these subtypes with cognitive decline and multimorbidity. Participants aged ≥50 years were recruited from the third to sixth waves (May 2002 to July 2010) of the National Institute for Longevity Sciences-Longitudinal Study of Aging, in Japan. People with incomplete data, pre-frail/frail status before their index wave, and those with incomplete data or who died during follow-up, were excluded. Group-based trajectory analysis denoted five established physical frailty criteria as time-varying binary variables in each wave during follow-up. Incident frailty was classified as mobility subtype (weakness/slowness), non-mobility subtype (weight loss/exhaustion), or low physical activity subtype. General linear modelling investigated associations of these frailty subtypes with activities of daily living, digit symbol substitution test (DSST) and Charlson Comorbidity Index (CCI) at 2 year follow-up. RESULTS We identified four longitudinal trajectories of physical frailty, which corroborated the distinct subtypes we discovered previously. Among 940 eligible participants, 38.0% were robust, 18.4% had mobility subtype frailty, 20.7% non-mobility subtype, and 20.1% low physical activity subtype. People with mobility subtype frailty were older than those with other frailty subtypes or robust status and had higher prevalence of hypertension, diabetes, and heart failure. In the multivariable-adjusted general linear models, mobility-subtype frailty was associated with a significantly lower DSST score (point estimate -2.28, P = 0.03) and higher CCI (point estimate 0.82, P < 0.01) than the other groups. CONCLUSIONS Mobility-subtype frailty was associated with functional declines and progression of multimorbidity; the long-term effects of physical frailty subtypes deserve further investigation.
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Affiliation(s)
- Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chikako Tange
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Rei Otsuka
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Li-Ning Peng
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.,School of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Makiko Tomida
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroshi Shimokata
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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Papunen S, Mustakallio-Könönen A, Auvinen J, Timonen M, Keinänen-Kiukaanniemi S, Sebert S. The association between diabetes and cognitive changes during aging. Scand J Prim Health Care 2020; 38:281-290. [PMID: 32777967 PMCID: PMC7470088 DOI: 10.1080/02813432.2020.1802140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide, we are observing a rising prevalence of dementia and mild cognitive impairments that often co-occur with the heightened incidence of non-communicable diseases in the elderly. It is suggested that type 2 diabetes and defects in glucose metabolism might predispose to poorer cognitive performances and more rapid decline in old age. METHODS to address existing knowledge gaps in this area, we systematically reviewed the literature to identify whether patients with type 2 diabetes (T2DM) and pre-diabetes are at a higher risk of poorer cognitive performance, and whether the risk (if any) might affect specific cognitive abilities. We concentrated the review on elderly individuals (65 years or older) at intake. In total, 3251 original articles were retrieved, of which 17 met our inclusion and quality control criteria, which comprised 12 structured questions used to define the articles. RESULTS 11 of 17 studies found a statistically significant decline in cognition among individuals who had T2DM or pre-diabetes compared to their non-diabetic counterparts. The association between diabetes and cognitive decline was not always clear, and the extent of the cognitive tests used seemed to have the greatest effect on the results. CONCLUSION Focusing on a population age 65 years and over, we found insufficient evidence to support an association between pre-diabetes stages and mild cognitive impairment. However, there is consistent evidence to support diabetes as an independent risk factor for low cognitive ability in the elderly. Finally, we found insufficient evidence to support effect of T2DM on distinct cognitive ability due to the scarcity of comparable findings.
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Affiliation(s)
- Sanna Papunen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- CONTACT Sanna Papunen Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, OuluFI-90014, Finland
| | | | - Juha Auvinen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Markku Timonen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Sylvain Sebert
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Genomics of Complex Diseases, School of Public Health, Imperial College London, London, UK
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Fuentes M, Klostermann A, Kleineidam L, Bauer C, Schuchhardt J, Maier W, Jessen F, Frölich L, Wiltfang J, Kornhuber J, Klöppel S, Schieting V, Teipel SJ, Wagner M, Peters O. Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer's Disease Dementia via Lead-Lag Analysis. J Alzheimers Dis 2020; 76:1005-1015. [PMID: 32597807 PMCID: PMC7504993 DOI: 10.3233/jad-200230] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive functions and activities of daily living (ADL) become increasingly impaired with progressing Alzheimer's disease. However, the temporal dynamics of this decline are inconsistent. OBJECTIVE To gain insight into the classical temporal cascade of specific cognitive and ADL changes, which may aid in improving detection of an impending clinical deterioration in patients, and to select ADL items and tests most sensitive to change in a specific disease stage. METHODS Patients with mild Alzheimer's dementia (AD; MMSE = 23.9±2.88) were followed at 12 and 24 months. Lead-lag analysis of changes in cognitive and functional outcome measures (CDR-SOB, 12 neuropsychological subtest scores from the CERAD + test battery, 25 Bayer-ADL items) was applied to rank the temporal sequence of changes on an ordinal scale. RESULTS Of 164 patients with mild AD, moderate disease progression was identified in 84 patients over 24 months (ΔMMSE 5.8±8.64; ΔCDR-SOB 4.32±4.03). Ten Bayer-ADL item measures were altered early in moderate progressors and included in a new ADL composite score. Accordingly, the new ADL score surpassed all neuropsychological measures in repeated lead-lag analysis. The Bayer-ADL total score, TMT-A, and MMSE were lagging variables in all lead-lag analyses. CONCLUSION Short-term clinical deterioration in mild AD is initially preceded by changes (i.e., decline) in a well-defined set of ADL and not in classical cognitive measures.
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Affiliation(s)
- Manuel Fuentes
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry, Berlin, Germany.,DZNE, German Center for Neurodegenerative Diseases, Charité-CBF, Berlin, Germany
| | - Arne Klostermann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry, Berlin, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | | | | | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,DZNE, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.,Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany.,University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Vera Schieting
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Oliver Peters
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry, Berlin, Germany.,DZNE, German Center for Neurodegenerative Diseases, Charité-CBF, Berlin, Germany
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Rosselli M, Tappen RM, Newman D. Semantic Interference Test: Evidence for Culture and Education Fairness from an Ethnically Diverse Sample in the USA. Arch Clin Neuropsychol 2019; 34:337-349. [PMID: 29688251 DOI: 10.1093/arclin/acy037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/01/2018] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Tests of cognitive abilities are particularly susceptible to culture-based bias because these abilities are culturally bound. The specific purpose of this study was to examine the Semantic Interference Test, a clinical neuropsychological test, for culture bias. METHOD The sample included 415 community-dwelling participants (mean age 74, SD = 8.32; 308 were females) living in South Florida (USA). The sample included 72 African Americans, 93 Afro-Caribbeans, 77 Hispanic Americans, and 173 European Americans. An Item Response Theory analysis of bias was employed using the Differential Item Functioning (DIF) procedure. RESULTS Overall, the items appear to be invariant across gender, ethnicity, and education levels. Although the DIF identified several items that appear to differ across the two latter groupings, the multiple group confirmatory factor analysis (MG-CFA) suggests that these items have low impact on the overall measure. There were however, meaningful differences across age groups in the MG-CFA, suggesting that an age adjustment might be required. CONCLUSION The SIT can be considered a cognitive test that is not significantly affected by the participants' cultural background, at least within the culture range included in this study.
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Affiliation(s)
- Mónica Rosselli
- Department of Psychology, Charles E. Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | - Ruth M Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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