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Cukierman-Yaffe T, Ramasundarahettige C, Bosch J, Gerstein HC. Effect of basal insulin and omega 3 fatty acids on cognitive impairment in dysglycaemia: An exploratory analysis of the ORIGIN trial. Diabetes Obes Metab 2024; 26:1180-1187. [PMID: 38204215 DOI: 10.1111/dom.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
AIM The outcomes reduction with an initial glargine intervention (ORIGIN) trial reported that, allocation to insulin glargine-mediated normoglycaemia versus standard care, and to omega 3 fatty acids versus placebo had a neutral effect on cognitive test scores when analysed as continuous variables. Analyses of these scores as standardized categorical variables using a previously validated strategy may yield different results. MATERIALS AND METHODS The ORIGIN trial recruited participants with dysglycaemia and additional cardiovascular risk factors from 573 sites in 40 countries. They completed a mini mental state examination and a subset completed the digit symbol substitution test at baseline and up to three subsequent visits. The effect of the interventions on country-standardized substantive cognitive impairment, defined as the first occurrence of a baseline-adjusted follow-up mini mental state examination or digit symbol substitution test score ≥1.5 standard deviations below the baseline mean score in each participant's country was assessed using Cox proportional hazards models. RESULTS During a median follow-up of 6.2 years, 2627 of 11 682 people (22.5%) developed country-standardized substantive cognitive impairment. The hazard of this outcome was reduced by 9% (hazard ratio 0.91, 95% confidence interval 0.85, 0.99; p = .023) in participants assigned to insulin glargine (21.6%) versus standard care (23.3%). Conversely, the hazard of this outcome was not affected by assignment to omega 3 fatty acid versus placebo (hazard ratio 0.93, 95% confidence interval 0.86, 1.01; p = .074). CONCLUSIONS In this post hoc exploratory analysis, insulin glargine-mediated normoglycaemia but not omega 3 fatty acids reduced the hazard of substantive cognitive impairment in people with dysglycaemia and additional cardiovascular risk factors.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Division of Endocrinology & Metabolism, Sheba Medical Center, Ramat Gan, Israel
- Epidemiology Department, School of Public Health, Faculty of Medicine, Herczeg Institute of Aging, Tel-Aviv University, Tel Aviv, Israel
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Bernal-Robledano A, Perez-Carpena P, Kikidis D, Mazurek B, Schoisswohl S, Staudinger S, Langguth B, Schlee W, Lopez-Escamez JA. Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus. Clin Exp Otorhinolaryngol 2024; 17:15-25. [PMID: 37974057 PMCID: PMC10933812 DOI: 10.21053/ceo.2023.00808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool. METHODS This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire. RESULTS MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean). CONCLUSION Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.
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Affiliation(s)
- Alberto Bernal-Robledano
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Patricia Perez-Carpena
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Dimitris Kikidis
- Department of Otolaryngology-Head and Neck Surgery, Hippocrateion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Birgit Mazurek
- Charité‒Universitätsmedizin Berlin, Tinnitus Center, Berlin, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Meniere’s Disease Neuroscience Research Program, Faculty of Medicine and Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, Australia
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Tengelmann C, Joos S, Kaußner Y, Malzahn U, Lunden L, Klug A, Häusler KG, Escales C, Maetzler W, Hügen K, Zolk O, Heuschmann PU, Förster C, Kaduszkiewicz H, Gágyor I. Feasibility, safety and effectiveness of prednisolone and vitamin B1, B6, and B12 in patients with post-COVID-19-syndrome (PreVitaCOV) - protocol of a randomised, double-blind, placebo-controlled multicentre trial in primary care (phase IIIb). BMC Infect Dis 2024; 24:56. [PMID: 38184567 PMCID: PMC10771676 DOI: 10.1186/s12879-023-08925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND After infection with SARS-CoV-2 a relevant proportion of patients complains about persisting symptoms, a condition termed Post-COVID-19-syndrome (PC19S). So far, possible treatments are under investigation. Among others, neurotropic vitamins and anti-inflammatory substances are potential options. Thus, the PreVitaCOV trial aims to assess feasibility, safety, and effectiveness of treating patients in primary care with prednisolone and/or vitamin B1, B6 and B12. METHODS The phase IIIb, multi-centre randomised, double-blind, and placebo-controlled PreVitaCOV trial has a factorial design and is planned as a two-phase approach. The pilot phase assessed feasibility and safety and was transformed into a confirmatory phase to evaluate effectiveness since feasibility was proven. Adult patients with PC19S after a documented SARS-CoV-2 infection at least 12 weeks ago are randomly assigned to 4 parallel treatments: prednisolone 20 mg for five days followed by 5 mg for 23 days (trial drug 1), B vitamins (B1 (100 mg OD), B6 (50 mg OD), and B12 (500 µg OD)) for 28 days (trial drug 2), trial drugs 1 and 2, or placebo. The primary outcome of the pilot phase was defined as the retention rate of the first 100 patients. Values of ≥ 85% were considered as confirmation of feasibility, this criterion was even surpassed by a retention rate of 98%. After transformation, the confirmatory phase proceeds by enrolling 240 additional patients. The primary outcome for the study is the change of symptom severity from baseline to day 28 as assessed by a tailored Patient Reported Outcomes Measurement Information System (PROMIS) total score referring to five symptom domains known to be typical for PC19S (fatigue, dyspnoea, cognition, anxiety, depression). The confirmatory trial is considered positive if superiority of any treatment is demonstrated over placebo operationalised by an improvement of at least 3 points on the PROMIS total score (t-score). DISCUSSION The PreVitaCOV trial may contribute to the understanding of therapeutic approaches in PC19S in a primary care context. TRIAL REGISTRATION EudraCT: 2022-001041-20. DRKS: DRKS00029617. CLINICALTRIALS gov: F001AM02222_1 (registered: 05 Dec 2022).
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Affiliation(s)
- Caroline Tengelmann
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany
| | - Yvonne Kaußner
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Uwe Malzahn
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Laura Lunden
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Andreas Klug
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Karl Georg Häusler
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 2, Building B1, 97080, Würzburg, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller- Str. 3, Haus D, 24105, Kiel, Germany
| | - Klemens Hügen
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Immanuel Klinik Rüdersdorf, Seebad82/83, 15562, Rüdersdorf, Germany
| | - Peter U Heuschmann
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany.
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
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Butz M, Gerriets T, Sammer G, El-Shazly J, Tschernatsch M, Braun T, Meyer R, Schramm P, Doeppner TR, Böning A, Mengden T, Choi YH, Schönburg M, Juenemann M. Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial. Open Heart 2023; 10:e002411. [PMID: 38011994 PMCID: PMC10685926 DOI: 10.1136/openhrt-2023-002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results. METHODS This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery. The training consisted of paper-and-pencil-based exercises practising multiple cognitive functions for 36 min/day 6 days/week over a period of 3 weeks. Neuropsychological tests and questionnaires assessing HQL (36-Item Short Form Health Survey (SF-36)) and cognitive failures in daily living (Cognitive Failures Questionnaire) were performed presurgery and 12 months after training. RESULTS Twelve months post training, the training group (n=30) showed improvements in HQL compared with the control group (n=28), especially in role limitations due to physical health (U=-2.447, p=0.015, η2=0.109), role limitations due to emotional problems (U=-2.245, p=0.025, η2=0.092), pain (U=-1.979, p=0.049, η2=0.068), average of all SF-36 factors (U=-3.237, p<0.001, η2=0.181), health change from the past year to the present time (U=-2.091, p=0.037, η2=0.075), physical component summary (U=-2.803, p=0.005, η2=0.138), and mental component summary (U=-2.350, p=0.018, η2=0.095). Furthermore, the training group (n=19) showed an improvement compared with the control group (n=27) in visual recognition memory (U=-2.137, p=0.034, η2=0.099). POCD frequency was 22% (n=6) in the control group and 11% (n=2) in the training group (χ²(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61). CONCLUSION In conclusion, postoperative cognitive training shows enhancing effects on HQL in cardiac surgery patients after 12 months.
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Affiliation(s)
- Marius Butz
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tibo Gerriets
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Gebhard Sammer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Jasmin El-Shazly
- Department of Psychocardiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tobias Braun
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Rolf Meyer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Patrick Schramm
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Markus Schönburg
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Martin Juenemann
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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5
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Balloff C, Bandlow C, Bernhard M, Brandenburger T, Bludau P, Elben S, Feldt T, Hartmann CJ, Heinen E, Ingwersen J, Jansen C, Jensen BEO, Kindgen-Milles D, Luedde T, Penner IK, Slink I, Stramm K, Telke AK, Timm J, Vetterkind L, Vollmer C, Wolff G, Schnitzler A, Meuth SG, Groiss SJ, Albrecht P. Prevalence and prognostic value of neurological affections in hospitalized patients with moderate to severe COVID-19 based on objective assessments. Sci Rep 2023; 13:19619. [PMID: 37949882 PMCID: PMC10638293 DOI: 10.1038/s41598-023-46124-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
Neurological manifestations of coronavirus disease 2019 (COVID-19) have been frequently described. In this prospective study of hospitalized COVID-19 patients without a history of neurological conditions, we aimed to analyze their prevalence and prognostic value based on established, standardized and objective methods. Patients were investigated using a multimodal electrophysiological approach, accompanied by neuropsychological and neurological examinations. Prevalence rates of central (CNS) and peripheral (PNS) nervous system affections were calculated and the relationship between neurological affections and mortality was analyzed using Firth logistic regression models. 184 patients without a history of neurological diseases could be enrolled. High rates of PNS affections were observed (66% of 138 patients receiving electrophysiological PNS examination). CNS affections were less common but still highly prevalent (33% of 139 examined patients). 63% of patients who underwent neuropsychological testing (n = 155) presented cognitive impairment. Logistic regression models revealed pathology in somatosensory evoked potentials as an independent risk factor of mortality (Odds Ratio: 6.10 [1.01-65.13], p = 0.049). We conclude that hospitalized patients with moderate to severe COVID-19 display high rates of PNS and CNS affection, which can be objectively assessed by electrophysiological examination. Electrophysiological assessment may have a prognostic value and could thus be helpful to identify patients at risk for deterioration.
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Affiliation(s)
- Carolin Balloff
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Department of Neurology, Kliniken Maria Hilf GmbH, 41063, Moenchengladbach, Germany
| | - Carolina Bandlow
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Michael Bernhard
- Emergency Department, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Timo Brandenburger
- Department of Anesthesiology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Patricia Bludau
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Saskia Elben
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Christian J Hartmann
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Elisa Heinen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Corinna Jansen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Isabel Slink
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Kim Stramm
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Ann-Kathrin Telke
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Jörg Timm
- Department of Virology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Lana Vetterkind
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Christian Vollmer
- Department of Anesthesiology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
| | - Stefan J Groiss
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany
- Neurocenter Duesseldorf, 40211, Duesseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Duesseldorf, Germany.
- Department of Neurology, Kliniken Maria Hilf GmbH, 41063, Moenchengladbach, Germany.
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Oz M, Ozel Asliyuce Y, Demirel A, Cetin H, Ulger O. Determination of cognitive status and influencing variables in patients with chronic neck pain: A cross-sectional study. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:764-771. [PMID: 34597197 DOI: 10.1080/23279095.2021.1980795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to evaluate cognitive function in individuals with chronic neck pain (CNP) and investigate the effects of different variables on cognition. METHODS The sociodemographic characteristics of the individuals who participated in this study were recorded. Pain intensity of the individuals was evaluated using the Visual Analog Scale, pain-related disability was evaluated with the Neck Disability Index and cognitive function was evaluated using Montreal Cognitive Assessment (MoCA). RESULTS For this study, 95 patients with CNP were recruited. The mean age was 45.61 ± 11.14, and the median MoCA score was 24 (20-26), and 64.2% of the patients scored below the original cutoff (<26/30 points). The regression analysis showed that higher age and lower education levels were associated with lower MoCA scores. Education appeared to be the most influential variable. Younger participants (18-45) performed systematically better on naming, attention and language domains than their older counterparts (over 45). CONCLUSIONS The findings suggest that age and education play an important role in MoCA total and domain scores in these patients. While treating these patients, assessment of cognitive function can be useful for effective pain management.
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Affiliation(s)
- Muzeyyen Oz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozel Asliyuce
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aynur Demirel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hatice Cetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozlem Ulger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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7
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Lorenzo-Mora AM, López-Sobaler AM, Bermejo LM, González-Rodríguez LG, Cuadrado-Soto E, Peral-Suárez Á, Salas-González MD, Delgado-Losada ML, Rodríguez-Rojo IC, Barabash A, Maestú-Unturbe F, Aparicio A. Association between Mineral Intake and Cognition Evaluated by Montreal Cognitive Assessment (MoCA): A Cross-Sectional Study. Nutrients 2023; 15:4505. [PMID: 37960158 PMCID: PMC10648921 DOI: 10.3390/nu15214505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mineral intake may protect against cognitive impairment (CI) and all-cause dementia, which affects a large number of adults worldwide. The aim of this study was to investigate the association between mineral intake and Montreal Cognitive Assessment (MoCA), which is a sensitive and specific test. METHODS In total, 201 adults were included in a cross-sectional study. They completed a three-day dietary record to estimate their average daily intake of minerals. Contributions to dietary reference intakes (DRIs) were also calculated. The participants were divided into tertiles according to their mineral intake. CI classifications were determined via the MoCA (score < 26). Apolipoprotein E (APOE) genotyping was carried out, and the patients' anthropometric measurements and physical activity, health and personal data were collected. RESULTS The prevalence of CI in this selective sample was 54.2% (34.3% females and 19.9% males). In women, being in the third tertiles of iron and manganese intake was associated with lower odds of having CI (OR [95% CI]: 0.32 [0.11 ± 0.93]; 0.33 [0.12 ± 0.93], p < 0.05). No significant differences were observed for any of the nutrients studied in men. CONCLUSIONS These findings suggest that a low mineral intake, especially low iron and manganese intake in women, is associated with a worse cognition as assessed by MoCA.
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Affiliation(s)
- Ana M. Lorenzo-Mora
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
| | - Ana M. López-Sobaler
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain;
| | - Laura M. Bermejo
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain;
| | - Liliana G. González-Rodríguez
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Esther Cuadrado-Soto
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
| | - África Peral-Suárez
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- School of Sport, Exercise and Health Sciences, Loughborough LE11 3TU, UK
| | - María Dolores Salas-González
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
| | - María Luisa Delgado-Losada
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain;
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | - Inmaculada C. Rodríguez-Rojo
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, 28223 Madrid, Spain;
- Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, Universidad de Alcalá, 28871 Madrid, Spain
| | - Ana Barabash
- Faculty of Medicine, Department of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Fernando Maestú-Unturbe
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain;
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, 28223 Madrid, Spain;
| | - Aránzazu Aparicio
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain; (A.M.L.-M.); (A.M.L.-S.); (L.M.B.); (E.C.-S.); (Á.P.-S.); (M.D.S.-G.); (A.A.)
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain;
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain;
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8
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Guenther SPW, Cheaban R, Hoepner L, Weinrautner N, Kirschning T, Al-Khalil R, Bruenger F, Serrano MR, Barndt I, Wiemer M, Niedermeyer J, Rudloff M, Helms S, Schramm R, Gummert JF. Functional Status and Quality of Life 6 Months After Extracorporeal Membrane Oxygenation Therapy for COVID-19-Related Pulmonary Failure. ASAIO J 2023; 69:942-949. [PMID: 37256794 DOI: 10.1097/mat.0000000000001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used in COVID-19-related pulmonary failure and the number of patients recovering from COVID-19 is growing. Here, we assess survival and recovery 6 months after ECMO for COVID-19. From April 2020 to September 2021, n = 60 (60.5 [51.0-65.0] years, 23.3% female) were treated with venovenous/venoarterial ECMO for COVID-19. 41.7% were weaned off ECMO, survival-to-discharge was 40.0% (n = 24). Age (63.0 [60.0-66.8] vs. 55.0 [43.8-60.0] years, p < 0.001), vasoactive support (97.2% vs . 75.0%, p = 0.013), and pre-ECMO SOFA scores (13.0 [12.0-14.8] vs. 12.0 [10.0-13.8] p = 0.036) correlated with nonsurvival. All patients aged >65 years, with histories of neoplasia, immunocompromise, chronic renal failure, or frailty died. After 6 months, 20 were alive (6-month survival 33.3%, survival conditioned on survival-to-discharge 83.3%), with follow-up in 19. 57.9% showed no relevant, 26.3% moderate, 15.8% severe deficits. Cardiopulmonary status was satisfactory (mMRC level: 84.2% ≤2). 73.7% were independent in daily life. Cognitive impairments were frequent (52.6%). 26.3% showed moderate depression, 15.8% posttraumatic stress disorder. Social and work life were considerably affected. Extracorporeal membrane oxygenation thus can serve as salvage therapy in COVID-19, but advanced age, immunocompromise, histories of neoplasia, and frailty must be considered as relative contraindications. Age, vasoactive support, and SOFA scores assist discriminating in daily practice. Deficits after 6 months are substantial, and efforts need to focus on long-term recovery.
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Affiliation(s)
- Sabina P W Guenther
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Rayan Cheaban
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Lisa Hoepner
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Nicole Weinrautner
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Thomas Kirschning
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Riad Al-Khalil
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Frank Bruenger
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Maria R Serrano
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Iris Barndt
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Minden, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Minden, Germany
| | - Jost Niedermeyer
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Markus Rudloff
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Sven Helms
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- From the Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
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9
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Goettel N, Wueest AS. Diagnosing delirium in perioperative and intensive care medicine. Curr Opin Anaesthesiol 2023; 36:491-499. [PMID: 37427443 DOI: 10.1097/aco.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current literature on instruments used for screening and diagnosing delirium in perioperative and intensive care medicine. It summarizes recent findings to guide clinicians and researchers in choosing the most appropriate tools. RECENT FINDINGS The incidence of delirium in hospitalized patients ranges from 5% to over 50%, depending on the population of patients studied. Failure to diagnose delirium in a timely manner is associated with serious adverse outcomes, including death and institutionalization. Valid assessment tests are needed for delirium detection, as early identification and treatment of delirium may help to prevent complications. Currently, there are more than 30 available instruments, which have been developed to assist with the screening and diagnosis of delirium. However, these tools vary greatly in sensitivity, specificity, and administration time, and their overabundance challenges the selection of specific tool as well as direct comparisons and interpretation of results across studies. SUMMARY Overlooking or misdiagnosing delirium may result in poor patient outcomes. Familiarizing healthcare workers with the variety of delirium assessments and selecting the most appropriate tool to their needs is an important step toward improving awareness and recognition of delirium.
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Affiliation(s)
- Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Research, University of Basel
| | - Alexandra S Wueest
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
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10
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Sun R, Ge B, Wu S, Li H, Lin L. Optimal cut-off MoCA score for screening for mild cognitive impairment in elderly individuals in China: A systematic review and meta-analysis. Asian J Psychiatr 2023; 87:103691. [PMID: 37499366 DOI: 10.1016/j.ajp.2023.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/16/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
AIM To evaluate the optimal cut-off MoCA score for elderly individuals with MCI. DESIGN A systematic review and meta-analysis. METHOD Articles were retrieved from PubMed, Ovid, Embase, The Cochrane Library, PsycINFO, CBM, CNKI, WanFang and CQVIP and were assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Figures of the assessment were made by using Review Manager 5.3, and a meta-analysis of the data was conducted by using Bivariate Random-effects Meta-Analysis (BRMA) via Stata 14.0. RESULTS Seventeen articles were retrieved from the database, and when the cut-offs were 24/25 and 25/26, they represented the same diagnostic value; in addition, the AUC was 0.96, which demonstrated high predictive validity for mild cognitive impairment screening. However, the sensitivity was higher with 25/26 (se=0.95, sp=0.80), whereas the specificity was higher with 24/25 (se=0.92, sp=0.89).
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Affiliation(s)
- Rui Sun
- International Medical Services, Peking Union Medical College Hospital, Beijing, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Shiyu Wu
- International Medical Services, Peking Union Medical College Hospital, Beijing, China
| | - Huiling Li
- School of Nursing, Soochow University and The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, China.
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11
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Guimarães V, Sousa I, de Bruin ED, Pais J, Correia MV. Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations. BMC Geriatr 2023; 23:329. [PMID: 37237278 DOI: 10.1186/s12877-023-04042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments. METHODS We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance. RESULTS The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups. CONCLUSIONS Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT04587895).
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Affiliation(s)
- Vânia Guimarães
- Fraunhofer Portugal AICOS, Porto, Portugal.
- Faculty of Engineering, University of Porto, Porto, Portugal.
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- OST - Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
| | - Joana Pais
- Neuroinova, Lda., Vila Nova de Gaia, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Miguel Velhote Correia
- Faculty of Engineering, University of Porto, Porto, Portugal
- INESC TEC (Institute for Systems and Computer Engineering, Technology and Science), Porto, Portugal
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12
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Li C, Hong Y, Yang X, Zeng X, Ocepek-Welikson K, Eimicke JP, Kong J, Sano M, Zhu C, Neugroschl J, Aloysi A, Cai D, Martin J, Loizos M, Sewell M, Akrivos J, Evans K, Sheppard F, Greenberg J, Ardolino A, Teresi JA. The use of subjective cognitive complaints for detecting mild cognitive impairment in older adults across cultural and linguistic groups: A comparison of the Cognitive Function Instrument to the Montreal Cognitive Assessment. Alzheimers Dement 2023; 19:1764-1774. [PMID: 36222321 PMCID: PMC10090224 DOI: 10.1002/alz.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This pilot study aims to explore the psychometric properties of the Cognitive Function Instrument (CFI) as a measure of subjective cognitive complaints (SCC) and its performance in distinguishing mild cognitive impairment (MCI) from normal control (NC) compared to an objective cognitive screen (Montreal Cognitive Assessment [MoCA]). METHODS One hundred ninety-four community-dwelling non-demented older adults with racial/ethnic diversity were included. Unidimensionality and internal consistency of the CFI were examined using factor analysis, Cronbach's alpha, and McDonald's omega. Logistic regression models and receiver operating characteristic (ROC) analysis were used to examine the performance of CFI. RESULTS The CFI demonstrated adequate internal consistency; however, the fit for a unidimensional model was suboptimal. The CFI distinguished MCI from NC alone or in combination with MoCA. ROC analysis showed comparable performance of the CFI and the MoCA. DISCUSSION Our findings support the use of CFI as a brief and easy-to-use screen to detect MCI in culturally/linguistically diverse older adults. HIGHLIGHT What is the key scientific question or problem of central interest of the paper? Subjective cognitive complaints (SCCs) are considered the earliest sign of dementia in older adults. However, it is unclear if SCC are equivalent in different cultures. The Cognitive Function Instrument (CFI) is a 14-item measure of SCC. This study provides pilot data suggesting that CFI is sensitive for detecting mild cognitive impairment in a cohort of older adults with racial/ethnic diversity. Comparing performance, CFI demonstrates comparable sensitivity to the Montreal Cognitive Assessment, an objective cognitive screening test. Overall, SCC may provide a non-invasive, easy-to-use method to flag possible cognitive impairment in both research and clinical settings.
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Affiliation(s)
- Clara Li
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yue Hong
- Salem Hospital, Mass General Brigham, Salem, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Xiao Yang
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyi Zeng
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katja Ocepek-Welikson
- Columbia University Stroud Center, New York State Psychiatric Institute, New York, NY, USA
| | | | - Jian Kong
- Research Division, The Hebrew Home at Riverdale, Riverdale, NY, USA
| | - Mary Sano
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, New York, NY, USA
| | - Carolyn Zhu
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, New York, NY, USA
| | - Judith Neugroschl
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Aloysi
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dongming Cai
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, New York, NY, USA
| | - Jane Martin
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Loizos
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Sewell
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jimmy Akrivos
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kirsten Evans
- James J. Peters VA Medical Center, New York, NY, USA
| | - Faye Sheppard
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Greenberg
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allison Ardolino
- Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeanne A. Teresi
- Columbia University Stroud Center, New York State Psychiatric Institute, New York, NY, USA
- Research Division, The Hebrew Home at Riverdale, Riverdale, NY, USA
- Mount Sinai Pepper Older Americans Independence Center, Department of Geriatrics and Palliative Medicine, Mount Sinai Medical Center, New York, NY, USA
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13
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Jarsch M, Piguet O, Berres M, Sluka C, Semenkova A, Kressig RW, Monsch AU, McDonald S, Sollberger M. Development of the Basel Version of the Awareness of Social Inference Test - Theory of Mind (BASIT-ToM) in healthy adults. J Neuropsychol 2023; 17:125-145. [PMID: 36129703 PMCID: PMC10947008 DOI: 10.1111/jnp.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 08/13/2022] [Indexed: 11/27/2022]
Abstract
Impairments of Theory of Mind (ToM) abilities occur in a wide range of brain disorders. Therefore, reliable and ecologically valid examination of these abilities is a crucial part of any comprehensive neuropsychological assessment. An established and ecologically valid, English-language test identifying deficits in ToM abilities is "The Awareness of Social Inference Test - Social Inference Minimal (TASIT-SIM)". However, no comparable German-language ToM test currently exists. In this study, we aimed to develop the first German-language adaption of TASIT-SIM in healthy adults. We selected 13 scenes [four scenes per message type (i.e., honesty, simple sarcasm, paradoxical sarcasm) and one practice scene] out of the 30 TASIT-SIM scenes. In collaboration with a film institute, we filmed each scene at three different intensities. These intensity version scenes were then administered to 240 healthy adults, equally distributed in sex and age, ranging from 35 to 92 years. By applying Rasch analysis, we selected intensity versions that showed neither floor nor ceiling effects in the majority of ToM questions in participants whose ToM abilities were in the medium range. In conclusion, we have developed the first German-language adaption of TASIT-SIM, i.e., the "Basel Version of the Awareness of Social Inference Test - Theory of Mind (BASIT-ToM)". The BASIT-ToM incorporates the strengths of TASIT-SIM, while overcoming its limitations such as inconsistencies in cinematic realization and ceiling effects in healthy participants. Next, the BASIT-ToM needs to be validated in healthy people and clinical populations.
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Affiliation(s)
- Marianne Jarsch
- Memory ClinicUniversity Department of Geriatric Medicine Felix PlatterBaselSwitzerland
- Faculty of PsychologyUniversity of BaselBaselSwitzerland
| | - Olivier Piguet
- School of Psychology and Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Manfred Berres
- Faculty of Mathematics and TechnologyUniversity of Applied Sciences KoblenzKoblenzGermany
| | - Constantin Sluka
- Department of Clinical ResearchUniversity of Basel and University Hospital BaselBaselSwitzerland
| | - Anna Semenkova
- Memory ClinicUniversity Department of Geriatric Medicine Felix PlatterBaselSwitzerland
- Faculty of PsychologyUniversity of BaselBaselSwitzerland
| | - Reto W. Kressig
- Memory ClinicUniversity Department of Geriatric Medicine Felix PlatterBaselSwitzerland
| | - Andreas U. Monsch
- Memory ClinicUniversity Department of Geriatric Medicine Felix PlatterBaselSwitzerland
- Faculty of PsychologyUniversity of BaselBaselSwitzerland
| | - Skye McDonald
- University of New South Wales PsychologySydneyNew South WalesAustralia
| | - Marc Sollberger
- Memory ClinicUniversity Department of Geriatric Medicine Felix PlatterBaselSwitzerland
- Department of NeurologyUniversity Hospital Basel and University of BaselBaselSwitzerland
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14
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Engedal K, Benth JŠ, Gjøra L, Skjellegrind HK, Nåvik M, Selbæk G. Normative Scores on the Norwegian Version of the Mini-Mental State Examination. J Alzheimers Dis 2023; 92:831-842. [PMID: 36847004 DOI: 10.3233/jad-221068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND The Mini-Mental State Examination (MMSE), a simple test for measuring global cognitive function, is frequently used to evaluate cognition in older adults. To decide whether a score on the test indicates a significant deviation from the mean score, normative scores should be defined. Moreover, because the test may vary depending on its translation and cultural differences, normative scores should be established for national versions of the MMSE. OBJECTIVE We aimed to examine normative scores for the third Norwegian version of the MMSE. METHODS We used data from two sources: the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) and the Trøndelag Health Study (HUNT). After persons with dementia, mild cognitive impairment, and disorders that may cause cognitive impairment were excluded, the sample contained 1,050 cognitively healthy persons, 860 from NorCog, and 190 from HUNT, whose data we subjected to regression analyses. RESULTS The normative MMSE score varied from 25 to 29, depending on years of education and age. More years of education and younger age were associated with higher MMSE scores, and years of education was the strongest predictor. CONCLUSION Mean normative MMSE scores depend on test takers' years of education and age, with level of education being the strongest predictor.
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Affiliation(s)
- Knut Engedal
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.,Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Linda Gjøra
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Marit Nåvik
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Telemark Hospital Trust, Skien, Norway
| | - Geir Selbæk
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
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15
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Wagle J, Selbæk G, Benth JŠ, Gjøra L, Rønqvist TK, Bekkhus-Wetterberg P, Persson K, Engedal K. The CERAD Word List Memory Test: Normative Data Based on a Norwegian Population-Based Sample of Healthy Older Adults 70 Years and Above. The HUNT Study. J Alzheimers Dis 2023; 91:321-343. [PMID: 36404547 DOI: 10.3233/jad-220672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking. OBJECTIVE To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education. METHODS A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample. RESULTS Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education. CONCLUSION Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).
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Affiliation(s)
- Jørgen Wagle
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Thale Kinne Rønqvist
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Karin Persson
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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16
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Guimarães V, Sousa I, de Bruin ED, Pais J, Correia MV. Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study. Digit Health 2023; 9:20552076231167001. [PMID: 37009304 PMCID: PMC10061638 DOI: 10.1177/20552076231167001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games’ scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.
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Affiliation(s)
- Vânia Guimarães
- Fraunhofer Portugal AICOS, Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
- Vânia Guimarães, Fraunhofer Portugal AICOS, 4200-135 Porto, Portugal.
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Joana Pais
- Neuroinova, Lda., Vila Nova de Gaia, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Miguel Velhote Correia
- Faculty of Engineering, University of Porto, Porto, Portugal
- INESC TEC (Institute for Systems and Computer Engineering, Technology and Science), Porto, Portugal
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17
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Ilardi CR, Menichelli A, Michelutti M, Cattaruzza T, Manganotti P. Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia. Neurol Sci 2023; 44:159-170. [PMID: 36169756 PMCID: PMC9816212 DOI: 10.1007/s10072-022-06422-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In this phase II psychometric study on the Montreal cognitive assessment (MoCA), we tested the clinicometric properties of Italian norms for patients with mild cognitive impairment (PwMCI) and early dementia (PwD) and provided optimal cutoffs for diagnostic purposes. METHODS Retrospective data collection was performed for consecutive patients with clinically and biologically defined MCI and early dementia. Forty-five patients (24 PwMCI and 21 PwD) and 25 healthy controls were included. Raw MoCA scores were adjusted according to the conventional 1-point correction (Nasreddine) and Italian norms (Conti, Santangelo, Aiello). The diagnostic properties of the original cutoff (< 26) and normative cutoffs, namely, the upper limits (uLs) of equivalent scores (ES) 1, 2, and 3, were evaluated. ROC curve analysis was performed to obtain optimal cutoffs. RESULTS The original cutoff demonstrated high sensitivity (0.93 [95% CI 0.84-0.98]) but low specificity (0.44 [0.32-0.56]) in discriminating between patients and controls. Nominal normative cutoffs (ES0 uLs) showed excellent specificity (SP range = 0.96-1.00 [0.88-1.00]) but poor sensitivity (SE range = 0.09-0.24 [0.04-0.36]). The optimal cutoff for Nasreddine's method was 23.50 (SE = 0.82 [0.71-0.90]; SP = 0.72 [0.60-0.82]). Optimal cutoffs were 20.97, 22.85, and 22.29 (SE range = 0.69-0.73 [0.57-0.83], SP range = 0.88-0.92 [0.77-0.97]) for Conti's, Santangelo's, and Aiello's methods, respectively. CONCLUSION Using the 1-point correction, combined with a cutoff of 23.50, might be useful in ambulatory settings with a large turnout. Our optimal cutoffs can offset the poor sensitivity of Italian cutoffs.
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Affiliation(s)
- Ciro Rosario Ilardi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
| | - Alina Menichelli
- Neuropsychology Service, Rehabilitation Unit, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Marco Michelutti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Tatiana Cattaruzza
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
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18
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Gaudreau AS, Macoir J, Hudon C. Normative data for the Color Trails Test in middle-aged and elderly Quebec-French people. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36548473 DOI: 10.1080/23279095.2022.2156291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Despite the widespread use of the Color Trails Test (CTT) in clinical and research settings, information regarding the impact of sociodemographic variables on test performance in Quebec-French adults and elderly people is non-existent. This study aimed to establish French-Quebec normative data for error scores and completion time on all test trials (CTT1 and CTT2) taking into account the impact of age, education, and sex on test performance. METHOD The sample consisted of 169 community-dwelling and healthy Quebec-French individuals aged between 50 and 90 years and having between 6 and 21 years of formal education. RESULTS Regression analyses indicated that age was associated with completion time on CTT1 and CTT2. Spearman correlations also revealed that age was positively associated with error scores (CTT1 errors, CTT2 number errors, CTT2 near-misses) and index interference. Education was marginally associated with CTT1 but was not associated with CTT2 completion time or interference index. Education was only associated with the number of errors in the CTT2. Finally, sex was not associated with any variables. Equations to calculate Z scores and percentiles are presented. CONCLUSIONS Norms for the CTT will ease the interpretation of executive functioning in Quebec-French adults and the elderly and favor accurate discrimination between normal and pathological cognitive states.
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Affiliation(s)
- Anne-Sophie Gaudreau
- CERVO Brain Research Centre, Quebec, Canada
- School of Psychology, Laval University, Quebec, Canada
| | - Joël Macoir
- CERVO Brain Research Centre, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Carol Hudon
- CERVO Brain Research Centre, Quebec, Canada
- School of Psychology, Laval University, Quebec, Canada
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19
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Völter C, Fricke H, Götze L, Labrenz F, Tokic M, Wirth R, Nasreddine ZS, Dawes P. Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired. Front Neurol 2022; 13:1022292. [PMID: 36582608 PMCID: PMC9792785 DOI: 10.3389/fneur.2022.1022292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Background Since hearing loss and cognitive decline often co-occur among older adults, a cognitive screening test suitable for hearing-impaired people is of high clinical relevance. We report the first evaluation of a German language version of the Montreal Cognitive Assessment-Hearing Impaired version (MoCA-HI). Objective The aim of the present study was to compare cognitively healthy participants with and without hearing loss, to examine the impact of age, sex, educational level and degree of hearing impairment on the German MoCA-HI performance, and to develop normative data. Material and methods The German MoCA-HI was tested in 94 participants with normal or mild hearing impairment (group 1: 4PTA ≤ 40 dB on the better hearing ear) and 81 participants with moderate to profound hearing loss (group 2: 4PTA > 40 dB on the better hearing ear). Additionally, all participants performed the standard MoCA (version 8.2). Results No significant group difference between group 1 and 2 was found in the MoCA-HI total score (p = 0.05). In contrast, group 1 performed significantly better than group 2 on the standard MoCA (p < 0.001). There was no difference between the MoCA and the MoCA-HI performance in group 1 (p = 0.12), whereas individuals of group 2 performed significantly better on the MoCA-HI than on the standard MoCA (p < 0.001). Test-retest reliability of the MoCA-HI was high (p < 0.001). Higher age (p < 0.001), male sex (p = 0.009) and lower education (p < 0.001) were associated with a lower overall MoCA-HI score. Based on the demographic data normative data were developed by a regression-based approach. Conclusion The MoCA-HI is a cognitive screening test which is suitable for people with hearing impairment.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany,*Correspondence: Christiane Völter
| | - Hannah Fricke
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Marianne Tokic
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Piers Dawes
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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20
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Butz M, Meyer R, Gerriets T, Sammer G, Doerr JM, El-Shazly J, Doeppner TR, Choi YH, Schoenburg M, Juenemann M. Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training. Front Neurol 2022; 13:1040733. [PMID: 36578306 PMCID: PMC9791586 DOI: 10.3389/fneur.2022.1040733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Postoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training. Methods The planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2-3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2-3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery. Discussion Should it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.
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Affiliation(s)
- Marius Butz
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany,*Correspondence: Marius Butz
| | - Rolf Meyer
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tibo Gerriets
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Gebhard Sammer
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Cognitive Neuroscience at the Centre of Psychiatry, University Giessen, Giessen, Germany,Department of Psychology, Justus-Liebig University, Giessen, Germany
| | - Johanna M. Doerr
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Jasmin El-Shazly
- Department of Psychocardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Thorsten R. Doeppner
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Markus Schoenburg
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Martin Juenemann
- Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
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21
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King L, Deda E, Ketcheson F, Levine AR, Cyr KS, Carr JA. Montreal Cognitive Assessment scores of Veterans and Canadian Armed Forces personnel seeking mental health treatment. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY SUMMARY The Montreal Cognitive Assessment (MoCA) is a test of mild cognitive impairment that is commonly administered to military personnel seeking mental health treatment. However, there is little research on the average MoCA score for military Veterans. This study looked at MoCA scores provided by Canadian Armed Forces members and Veterans receiving services for an operational-related mental health condition. Scores below the cut-off for mild cognitive impairment were not uncommon and were related to education level, as well as to severity of posttraumatic stress disorder and depression. These findings will help clinicians better contextualize score variation among clients.
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Affiliation(s)
- Lisa King
- St. Joseph’s Healthcare, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Erisa Deda
- St. Joseph’s Healthcare, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Felicia Ketcheson
- St. Joseph’s Healthcare, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Amanda R. Levine
- St. Joseph’s Healthcare, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Kate St. Cyr
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Jason A. Carr
- St. Joseph’s Healthcare, Operational Stress Injury Clinic, London, Ontario, Canada
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22
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Kouzuki M, Miyamoto M, Tanaka N, Urakami K. Validation of a novel computerized cognitive function test for the rapid detection of mild cognitive impairment. BMC Neurol 2022; 22:457. [PMID: 36476188 PMCID: PMC9727980 DOI: 10.1186/s12883-022-02997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the present study, we examined the distinguishing ability of a mild cognitive impairment (MCI) assessment tool for rapid screening using a computer (MARC) for Alzheimer's disease dementia (ADD), MCI, and non-demented controls (NDC) with no cognitive impairment, as well as its validity and reliability, as part of a preliminary trial for the development of the tool. METHODS A total of 64 participants (23 in the ADD group, 17 in the MCI group, and 24 in the NDC group) were analyzed. The participants were administered MARC and a pre-existing computerized Alzheimer's dementia screening test (MSP), and 31 participants (14 in the MCI group, 17 in the NDC group) were readministered MARC within 4 months from the first test. RESULTS The median (interquartile range) test time for MARC was 401 (350-453) s. Total MARC scores were significantly worse in the MCI and ADD groups than in the NDC group (p < 0.05 and p < 0.01, respectively). In the receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) when comparing the NDC and MCI groups was 0.866 (95% CI, 0.759-0.974), when comparing the NDC and AD groups was 0.989 (95% CI, 0.970-1.000), and when comparing the MCI and AD groups was 0.889 (95% CI, 0.790-0.988). Furthermore, there was a significant correlation with the results of the existing test, MSP (r = 0.839, p < 0.001). In addition, the intraclass correlation coefficient (ICC) (1,1) when the first and second MARC scores were compared was 0.740 (95% CI, 0.529-0.865; p < 0.001). CONCLUSIONS MARC is considered capable of distinguishing MCI with high accuracy. The tool has good validity and reliability, and it can be administered in a short period of time without the need for a specialist.
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Affiliation(s)
- Minoru Kouzuki
- grid.265107.70000 0001 0663 5064Department of Biological Regulation, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503 Japan
| | - Madoka Miyamoto
- grid.265107.70000 0001 0663 5064Department of Dementia Prevention, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503 Japan
| | - Nobuto Tanaka
- grid.265107.70000 0001 0663 5064Department of Dementia Prevention, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503 Japan
| | - Katsuya Urakami
- grid.265107.70000 0001 0663 5064Department of Dementia Prevention, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503 Japan
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23
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Hartung TJ, Neumann C, Bahmer T, Chaplinskaya-Sobol I, Endres M, Geritz J, Haeusler KG, Heuschmann PU, Hildesheim H, Hinz A, Hopff S, Horn A, Krawczak M, Krist L, Kudelka J, Lieb W, Maetzler C, Mehnert-Theuerkauf A, Montellano FA, Morbach C, Schmidt S, Schreiber S, Steigerwald F, Störk S, Maetzler W, Finke C. Fatigue and cognitive impairment after COVID-19: A prospective multicentre study. EClinicalMedicine 2022; 53:101651. [PMID: 36133318 PMCID: PMC9482331 DOI: 10.1016/j.eclinm.2022.101651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reliable estimates of frequency, severity and associated factors of both fatigue and cognitive impairment after COVID-19 are needed. Also, it is not clear whether the two are distinct sequelae of COVID-19 or part of the same syndrome." METHODS In this prospective multicentre study, frequency of post-COVID fatigue and cognitive impairment were assessed in n = 969 patients (535 [55%] female) ≥6 months after SARS-CoV-2 infection with the FACIT-Fatigue scale (cut-off ≤30) and Montreal Cognitive Assessment (≤25 mild, ≤17 moderate impairment) between November 15, 2020 and September 29, 2021 at University Medical Center Schleswig-Holstein, Campus Kiel and University Hospital Würzburg in Germany. 969 matched non-COVID controls were drawn from a pre-pandemic, randomised, Germany-wide population survey which also included the FACIT-Fatigue scale. Associated sociodemographic, comorbid, clinical, psychosocial factors and laboratory markers were identified with univariate and multivariable linear regression models. FINDINGS On average 9 months after infection, 19% of patients had clinically relevant fatigue, compared to 8% of matched non-COVID controls (p < 0.001). Factors associated with fatigue were female gender, younger age, history of depression and the number of acute COVID symptoms. Among acute COVID symptoms, altered consciousness, dizziness and myalgia were most strongly associated with long-term fatigue. Moreover, 26% of patients had mild and 1% had moderate cognitive impairment. Factors associated with cognitive impairment were older age, male gender, shorter education and a history of neuropsychiatric disease. There was no significant correlation between fatigue and cognitive impairment and only 5% of patients suffered from both conditions. INTERPRETATION Fatigue and cognitive impairment are two common, but distinct sequelae of COVID-19 with potentially separate pathophysiological pathways. FUNDING German Federal Ministry of Education and Research (BMBF).
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Key Words
- CI, confidence interval
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CRP, C-reactive protein
- CSF, cerebrospinal fluid
- Cognitive dysfunction
- Fatigue
- GAD-7, 7-item anxiety screening questionnaire
- MoCA, Montreal Cognitive Assessment
- NAPKON, National Pandemic Cohort Network
- PCR, polymerase chain reaction
- PHQ-8, 8-item depression module of the Patient Health Questionnaire
- PSQI, Pittsburgh Sleep Quality Index
- Post-acute COVID-19 syndrome
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Distress Syndrome caused by Corona Virus 2
- VIF, variance inflation factor
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Affiliation(s)
- Tim J. Hartung
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Christian Neumann
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Johanna Geritz
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Hildesheim
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Sina Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Duesseldorf, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kudelka
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Felipe A. Montellano
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Berlin, Germany
| | - Stefan Schreiber
- Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Klinik für Innere Medizin I, Kiel, Germany
| | - Flo Steigerwald
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carsten Finke
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Corresponding author at: Department of Neurology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
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Imaoka Y, Flury A, Hauri L, de Bruin ED. Effects of different virtual reality technology driven dual-tasking paradigms on posture and saccadic eye movements in healthy older adults. Sci Rep 2022; 12:18059. [PMID: 36302813 PMCID: PMC9613688 DOI: 10.1038/s41598-022-21346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
Postural sway and eye movements are potential biomarkers for dementia screening. Assessing the two movements comprehensively could improve the understanding of complicated syndrome for more accurate screening. The purpose of this research is to evaluate the effects of comprehensive assessment in healthy older adults (OA), using a novel concurrent comprehensive assessment system consisting of stabilometer and virtual reality headset. 20 healthy OA (70.4 ± 4.9 years) were recruited. Using a cross-sectional study design, this study investigated the effects of various dual-tasking paradigms with integrated tasks of visuospatial memory (VM), spatial orientation (SO), and visual challenge on posture and saccades. Dual-task paradigms with VM and SO affected the saccadic eye movements significantly. Two highly intensive tests of anti-saccade with VM task and pro-saccade with SO task also influenced postural sway significantly. Strong associations were seen between postural sway and eye movements for the conditions where the two movements theoretically shared common neural pathways in the brain, and vice versa. This study suggests that assessing posture and saccades with the integrated tasks comprehensively and simultaneously could be useful to explain different functions of the brain. The results warrant a cross-sectional study in OA with and without dementia to explore differences between these groups.
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Affiliation(s)
- Yu Imaoka
- grid.5801.c0000 0001 2156 2780Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Andri Flury
- grid.5801.c0000 0001 2156 2780Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Laura Hauri
- grid.5801.c0000 0001 2156 2780Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Eling D. de Bruin
- grid.5801.c0000 0001 2156 2780Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland ,grid.4714.60000 0004 1937 0626Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 141 83 Stockholm, Sweden ,grid.510272.3School of Health Professions, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
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25
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Lo CKF, Yung EA, Tsang KT. Investigation of Play Intervention for Dementia (PID) Activities in Addressing Cognitive Domains Reflected in Hong Kong Montreal Cognitive Assessment (HK-MoCA). Gerontol Geriatr Med 2022; 8:23337214221130161. [PMID: 36275408 PMCID: PMC9580081 DOI: 10.1177/23337214221130161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Objectives: Yee Hong Play Intervention for Dementia (PID) is a community program strengthening East Asians >65 years with dementia in their daily functional activities. We analyzed how PID activities align with Hong Kong Montreal Cognitive Assessment. Methods: Utilizing observation sheets procured from documentation notes from the twice-weekly PID sessions, cognitive domains were identified. Mean time duration and activity frequencies were compared between high and low competency client groups. Results: Independent of competency group, activities predominantly targeted attention/concentration (23.8% HC, 16.4% LC), and hand-eye coordination (19.1% HC, 28.7% LC). Less focused domains were delayed recall (3.1-4.7%) and naming (1.3-1.5%). Conclusions: Yee Hong PID tested innovative cognitive domains not currently covered in HK-MoCA screening assessment, emphasizing attention/concentration-oriented activities and none assessing orientation and language domains. Additionally, presence of new domains such as hand-eye coordination and fine motor dexterity suggested that strict adherence with standardized screening tools (e.g., MoCA) may not be ideal. Likely, facilitators have developed innovative measures to assess individual competency to strengthen resilience in our geriatric population.
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Affiliation(s)
- Calvin Ka-Fung Lo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada,Calvin Ka-Fung Lo, Department of Pathology and Laboratory Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Eric Andrew Yung
- School of Public Health Sciences, University of Waterloo, ON, Canada
| | - Ka Tat Tsang
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
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Imaoka Y, Hauri L, Flury A, de Bruin ED. Linking cognitive functioning and postural balance control through virtual reality environmental manipulations. Front Aging Neurosci 2022; 14:954050. [PMID: 36118684 PMCID: PMC9476829 DOI: 10.3389/fnagi.2022.954050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dementia is becoming a relevant problem worldwide. A simple screening at an early stage will be important to detect the risk of developing dementia. Vestibular dysfunction is likely to be associated with cognitive impairment. Since head-mounted display (HMD) virtual reality (VR) technology has the potential to activate the vestibular function, assessing postural sway with visual stimulation using HMD VR technology could be potentially useful for dementia screening. Objective The purpose of this study is to evaluate the effect of HMD-based VR visual stimuli on posture in older adults and the relationship between the stimulated body sway behaviors and cognitive performance. Method Using a cross-sectional study design, we investigated the effect of an optokinetic design-based room with stripes (OKR) VR environment oscillating forwards and backwards at 23/60Hz. Center of pressure (COP) displacement was measured in older adults aged 65 years and over in the OKR VR environment. The frequency response of COP was compared to the cognitive performance of the Montreal Cognitive Assessment (MoCA). Results 20 healthy older adults (70.4 ± 4.9 years; 27.2 ± 1.6 MoCA score) and 3 people with mild cognitive impairment (74.7 ± 4.0 years; 20.3 ± 2.1 MoCA score) were assessed. The results reveal that the oscillating OKR VR environment induced different postural sway in the anterior-posterior direction in the real world. Correlation analysis shows that the cognitive test score was associated with the frequency response of stimulated postural sway in the anterior-posterior direction (frequency Band 1 of 0−0.5Hz related to the visual and vestibular systems: rs = 0.45, P = 0.03). Conclusion Outcomes would suggest that a potential link may emerge between cognition and posture when the HMD-based VR visual stimuli are applied. The simple screening of stimulated postural sway could explain cognitive functioning. Further studies are warranted to clarify the vestibular system and spatial cognitive function more specifically in the proposed assessment system.
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Affiliation(s)
- Yu Imaoka
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- *Correspondence: Yu Imaoka
| | - Laura Hauri
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andri Flury
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- School of Health Professions, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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27
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Sobczak A, Kudelka J, Stiel C, Hieke J, Alpes A, Bunzeck N, Maetzler W. Does Executive Function Influence Walking in Acutely Hospitalized Patients With Advanced Parkinson's Disease: A Quantitative Analysis. Front Neurol 2022; 13:852725. [PMID: 35928127 PMCID: PMC9344922 DOI: 10.3389/fneur.2022.852725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIt is well-known that, in Parkinson's disease (PD), executive function (EF) and motor deficits lead to reduced walking performance. As previous studies investigated mainly patients during the compensated phases of the disease, the aim of this study was to investigate the above associations in acutely hospitalized patients with PD.MethodsA total of seventy-four acutely hospitalized patients with PD were assessed with the delta Trail Making Test (ΔTMT, TMT-B minus TMT-A) and the Movement Disorder Society-revised version of the motor part of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III). Walking performance was assessed with wearable sensors under single (ST; fast and normal pace) and dual-task (DT; walking and checking boxes as the motor secondary task and walking and subtracting seven consecutively from a given three-digit number as the cognitive secondary task) conditions over 20 m. Multiple linear regression and Bayes factor BF10 were performed for each walking parameter and their dual-task costs while walking (DTC) as dependent variables and also included ΔTMT, MDS-UPDRS III, age, and gender.ResultsUnder ST, significant negative effects of the use of a walking aid and MDS-UPDRS III on gait speed and at a fast pace on the number of steps were observed. Moreover, depending on the pace, the use of a walking aid, age, and gender affected step time variability. Under walking-cognitive DT, a resolved variance of 23% was observed in the overall model for step time variability DTC, driven mainly by age (β = 0.26, p = 0.09). Under DT, no other significant effects could be observed. ΔTMT showed no significant associations with any of the walking conditions.DiscussionThe results of this study suggest that, in acutely hospitalized patients with PD, reduced walking performance is mainly explained by the use of a walking aid, motor symptoms, age, and gender, and EF deficits surprisingly do not seem to play a significant role. However, these patients with PD should avoid walking-cognitive DT situations, as under this condition, especially step time variability, a parameter associated with the risk of falling in PD worsens.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- *Correspondence: Johanna Geritz
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Alexandra Sobczak
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christopher Stiel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johanne Hieke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Annekathrin Alpes
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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28
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Kessels RPC, de Vent NR, Bruijnen CJWH, Jansen MG, de Jonghe JFM, Dijkstra BAG, Oosterman JM. Regression-Based Normative Data for the Montreal Cognitive Assessment (MoCA) and Its Memory Index Score (MoCA-MIS) for Individuals Aged 18–91. J Clin Med 2022; 11:jcm11144059. [PMID: 35887823 PMCID: PMC9318507 DOI: 10.3390/jcm11144059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023] Open
Abstract
(1) Background: There is a need for a brief assessment of cognitive function, both in patient care and scientific research, for which the Montreal Cognitive Assessment (MoCA) is a psychometrically reliable and valid tool. However, fine-grained normative data allowing for adjustment for age, education, and/or sex are lacking, especially for its Memory Index Score (MIS). (2) Methods: A total of 820 healthy individuals aged 18–91 (366 men) completed the Dutch MoCA (version 7.1), of whom 182 also completed the cued recall and recognition memory subtests enabling calculation of the MIS. Regression-based normative data were computed for the MoCA Total Score and MIS, following the data-handling procedure of the Advanced Neuropsychological Diagnostics Infrastructure (ANDI). (3) Results: Age, education level, and sex were significant predictors of the MoCA Total Score (Conditional R2 = 0.4, Marginal R2 = 0.12, restricted maximum likelihood (REML) criterion at convergence: 3470.1) and MIS (Marginal R2 = 0.14, REML criterion at convergence: 682.8). Percentile distributions are presented that allow for age, education and sex adjustment for the MoCA Total Score and the MIS. (4) Conclusions: We present normative data covering the full adult life span that can be used for the screening for overall cognitive deficits and memory impairment, not only in older people with or people at risk of neurodegenerative disease, but also in younger individuals with acquired brain injury, neurological disease, or non-neurological medical conditions.
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Affiliation(s)
- Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
- Vincent van Gogh Institute for Psychiatry, Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, 5803 DN Venray, The Netherlands;
- Klimmendaal Rehabilitation Specialists, 6813 GG Arnhem, The Netherlands
- Tactus Addiction Care, 7400 AD Deventer, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-3612-541
| | - Nathalie R. de Vent
- Department of Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands;
| | - Carolien J. W. H. Bruijnen
- Vincent van Gogh Institute for Psychiatry, Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, 5803 DN Venray, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6525 GD Nijmegen, The Netherlands;
| | - Michelle G. Jansen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
| | | | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6525 GD Nijmegen, The Netherlands;
- Novadic-Kentron, Addiction Care Center, 5261 LX Vught, The Netherlands
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
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Kovaltcova RS, Petrova NN, Zadvorev SF. Post-Coronary Artery Bypass Grafting Cognitive Decline: Risk Modification And Implications For Screening In Low-Risk Population. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background — Postoperative cognitive dysfunction (POCD) is an important complication of coronary artery bypass grafting (CABG). Large amount of data points to the problem of POCD in patients with high surgical risk of CABG. Low-risk patients are not safe from these complications either. Assessment of the severity, duration of POCD, degree of recovery and risk factors in off- and on-pump patients with stable coronary artery disease is crucial in minimization of the POCD risk in patients with low surgical risk. Objective — to analyze incidence, severity, reversibility and risk factors of POCD in patients undergoing elective low-risk CABG. Methods and Results — The retrospective cohort study included 79 patients who underwent on-pump (N=44) or off-pump (N=35) elective CABG with low surgical risk (mean EuroSCORE II death risk 1.08±0.71%), with observation period of 6 months. Pre-CABG markers of cognitive impairment were found in 50% of patients, with 44% of patients demonstrating POCD. Patients who underwent off-pump CABG demonstrated more pronounced decline in MoCA score compared to on-pump (-3.9±2.0 vs. -2.2±2.0 at 8 days point, p=0.018), with regress to pre-CABG results after 3 weeks. Baseline MoCA score <25 was found to be a predictor for more pronounced cognitive decline at 8 days point. MMSE demonstrated less predictive value compared to MoCA. Conclusion — POCD risk differs in off-pump and on-pump CABG cohorts, with significantly higher prevalence in the former group, whether assessed using MMSE or MoCA tests. Differences are observed within 3 weeks post-CABG. Pre-CABG MoCA score <25 is associated with more pronounced POCD in low-risk elective CABG cohort.
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30
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Opitz L, Wagner F, Rogenz J, Maas J, Schmidt A, Brodoehl S, Klingner CM. Still Wanting to Win: Reward System Stability in Healthy Aging. Front Aging Neurosci 2022; 14:863580. [PMID: 35707701 PMCID: PMC9190761 DOI: 10.3389/fnagi.2022.863580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Healthy aging is accompanied by multi-faceted changes. Especially within the brain, healthy aging exerts substantial impetus on core parts of cognitive and motivational networks. Rewards comprise basic needs, such as food, sleep, and social contact. Thus, a functionally intact reward system remains indispensable for elderly people to cope with everyday life and adapt to their changing environment. Research shows that reward system function is better preserved in the elderly than most cognitive functions. To investigate the compensatory mechanisms providing reward system stability in aging, we employed a well-established reward paradigm (Monetary Incentive Delay Task) in groups of young and old participants while undergoing EEG measurement. As a new approach, we applied EEG connectivity analyses to assess cortical reward-related network connectivity. At the behavioral level, our results confirm that the function of the reward system is preserved in old age. The mechanisms identified for maintaining reward system function in old age do not fit into previously described models of cognitive aging. Overall, older adults exhibit lower reward-related connectivity modulation, higher reliance on posterior and right-lateralized brain areas than younger adults, and connectivity modulation in the opposite direction than younger adults, with usually greater connectivity during non-reward compared to reward conditions. We believe that the reward system has unique compensatory mechanisms distinct from other cognitive functions, probably due to its etymologically very early origin. In summary, this study provides important new insights into cortical reward network connectivity in healthy aging.
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Affiliation(s)
- Laura Opitz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Franziska Wagner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
- Clinician Scientist Program OrganAge, Jena University Hospital, Jena, Germany
- *Correspondence: Franziska Wagner,
| | - Jenny Rogenz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Johanna Maas
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Alexander Schmidt
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Stefan Brodoehl
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Carsten M. Klingner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
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31
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Stienen MN, Germans MR, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Velz J, Sebök M, Eggenberger N, May A, Haemmerli J, Bijlenga P, Schaller K, Guerra-Lopez U, Maduri R, Beaud V, Al-Taha K, Daniel RT, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Maradan-Gachet ME, Gutbrod K, Maldaner N, Neidert MC, Früh S, Schwind M, Bozinov O, Brugger P, Keller E, Marr A, Roux S, Regli L. Longitudinal neuropsychological assessment after aneurysmal subarachnoid hemorrhage and its relationship with delayed cerebral ischemia: a prospective Swiss multicenter study. J Neurosurg 2022; 137:1742-1750. [PMID: 35535839 DOI: 10.3171/2022.2.jns212595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While prior retrospective studies have suggested that delayed cerebral ischemia (DCI) is a predictor of neuropsychological deficits after aneurysmal subarachnoid hemorrhage (aSAH), all studies to date have shown a high risk of bias. This study was designed to determine the impact of DCI on the longitudinal neuropsychological outcome after aSAH, and importantly, it includes a baseline examination after aSAH but before DCI onset to reduce the risk of bias. METHODS In a prospective, multicenter study (8 Swiss centers), 112 consecutive alert patients underwent serial neuropsychological assessments (Montreal Cognitive Assessment [MoCA]) before and after the DCI period (first assessment, < 72 hours after aSAH; second, 14 days after aSAH; third, 3 months after aSAH). The authors compared standardized MoCA scores and determined the likelihood for a clinically meaningful decline of ≥ 2 points from baseline in patients with DCI versus those without. RESULTS The authors screened 519 patients, enrolled 128, and obtained complete data in 112 (87.5%; mean [± SD] age 53.9 ± 13.9 years; 66.1% female; 73% World Federation of Neurosurgical Societies [WFNS] grade I, 17% WFNS grade II, 10% WFNS grades III-V), of whom 30 (26.8%) developed DCI. MoCA z-scores were worse in the DCI group at baseline (-2.6 vs -1.4, p = 0.013) and 14 days (-3.4 vs -0.9, p < 0.001), and 3 months (-0.8 vs 0.0, p = 0.037) after aSAH. Patients with DCI were more likely to experience a decline of ≥ 2 points in MoCA score at 14 days after aSAH (adjusted OR [aOR] 3.02, 95% CI 1.07-8.54; p = 0.037), but the likelihood was similar to that in patients without DCI at 3 months after aSAH (aOR 1.58, 95% CI 0.28-8.89; p = 0.606). CONCLUSIONS Aneurysmal SAH patients experiencing DCI have worse neuropsychological function before and until 3 months after the DCI period. DCI itself is responsible for a temporary and clinically meaningful decline in neuropsychological function, but its effect on the MoCA score could not be measured at the time of the 3-month follow-up in patients with low-grade aSAH with little or no impairment of consciousness. Whether these findings can be extrapolated to patients with high-grade aSAH remains unclear. Clinical trial registration no.: NCT03032471 (ClinicalTrials.gov).
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | - Noemi Dannecker
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Julia Velz
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 4Department of Neurosurgery, University Hospital Geneva
| | | | | | - Karl Schaller
- 4Department of Neurosurgery, University Hospital Geneva
| | | | - Rodolfo Maduri
- 6Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier
| | - Valérie Beaud
- 7Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | - Khalid Al-Taha
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | - Roy Thomas Daniel
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | | | - Stefania Rossi
- 10Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Johannes Goldberg
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 11Department of Neurosurgery, University Hospital Berne, Switzerland.,12Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | | | - Klemens Gutbrod
- 13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | | | | | - Severin Früh
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Marc Schwind
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,14Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Peter Brugger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich.,16Neuropsychology Unit, Rehabilitation Clinic Valens; and
| | - Emanuela Keller
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Angelina Marr
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sébastien Roux
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
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Eichler T, Rötz W, Kayser C, Bröhl F, Römer M, Witteborg AH, Kummert F, Sandmeier T, Schulte C, Stolz P, Meyer K, Sudhoff H, Todt I. Algorithm-Based Hearing and Speech Therapy Rehabilitation after Cochlear Implantation. Brain Sci 2022; 12:580. [PMID: 35624970 PMCID: PMC9139523 DOI: 10.3390/brainsci12050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Due to the changes in the indication range for cochlear implants and the demographic development towards an aging society, more and more people are in receipt of cochlear implants. An implantation requires a close-meshed audiological and logopedic aftercare. Hearing therapy rehabilitation currently requires great personnel effort and is time consuming. Hearing and speech therapy rehabilitation can be supported by digital hearing training programs. However, the apps currently on the market are to a limited degree personalized and structured. Increasing digitalization makes it possible, especially in times of pandemics, to decouple hearing therapy treatment from everyday clinical practice. MATERIAL AND METHODS For this purpose, an app is in development that provides hearing therapy tailored to the patient. The individual factors that influence hearing outcome are considered. Using intelligent algorithms, the app determines the selection of exercises, the level of difficulty and the speed at which the difficulty is increased. RESULTS The app works autonomously without being connected to local speech therapists. In addition, the app is able to analyze patient difficulties within the exercises and provides conclusions about the need for technical adjustments. CONCLUSIONS The presented newly developed app represents a possibility to support, replace, expand and improve the classic outpatient hearing and speech therapy after CI implantation. The way the application works allows it to reach more people and provide a time- and cost-saving alternative to traditional therapy.
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Affiliation(s)
- Theda Eichler
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Wiebke Rötz
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Christoph Kayser
- Faculty of Biology, Cognitive Neuroscience, Bielefeld University, 33615 Bielefeld, Germany; (C.K.); (F.B.)
| | - Felix Bröhl
- Faculty of Biology, Cognitive Neuroscience, Bielefeld University, 33615 Bielefeld, Germany; (C.K.); (F.B.)
| | - Michael Römer
- Faculty of Economics, Decision Analytics, Bielefeld University, 33615 Bielefeld, Germany; (M.R.); (A.H.W.)
| | - Arne Henning Witteborg
- Faculty of Economics, Decision Analytics, Bielefeld University, 33615 Bielefeld, Germany; (M.R.); (A.H.W.)
| | - Franz Kummert
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Tobias Sandmeier
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Christoph Schulte
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Patricia Stolz
- Department of Design, University of Applied Science, 33619 Bielefeld, Germany; (P.S.); (K.M.)
| | - Katharina Meyer
- Department of Design, University of Applied Science, 33619 Bielefeld, Germany; (P.S.); (K.M.)
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
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Classon E, van den Hurk W, Lyth J, Johansson MM. Montreal Cognitive Assessment: Normative Data for Cognitively Healthy Swedish 80- to 94-Year-Olds. J Alzheimers Dis 2022; 87:1335-1344. [PMID: 35431248 PMCID: PMC9198733 DOI: 10.3233/jad-215629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The Montreal Cognitive Assessment (MoCA) is sensitive to cognitive impairment; however, it is also sensitive to demographic and socio-cultural factors. This necessitates reliable sub-population norms, but these are often lacking for older adults. Objective: To present demographically adjusted regression-based MoCA norms for cognitively healthy Swedish older adults. Methods: A pseudo-random sample of community-dwelling 80- to 94-year-olds, stratified by age and gender, was invited to the study. Initial telephone interviews and medical records searches (n = 218) were conducted to screen for cognitive impairment. N = 181 eligible participants were administered a protocol including the Swedish version of the MoCA and assessment of global cognition (Mini-Mental State Examination, MMSE) and depression (Patient Health Questionnaire-9, PHQ-9). Individuals scoring in the range of possible cognitive impairment on the MMSE or more than mild depression on the PHQ-9 were excluded (n = 23); three discontinued the test-session. Results: Norms were derived from the remaining n = 158. They were evenly distributed by gender, on average 85 years old, and with a mean education of 11 years. MoCA scores were independently influenced by age and education, together explaining 17.2% of the total variance. Higher age and lower education were associated with lower performance and 46% performed below the original cut-off (< 26/30). Conclusion: The negative impact of increasing age on MoCA performance continues linearly into the nineties in normal aging. Demographic factors should be considered when interpreting MoCA performance and a tool for computing demographically corrected standard scores is provided.
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Affiliation(s)
- Elisabet Classon
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Wobbie van den Hurk
- Mindmore AB, Stockholm, Sweden, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Maria M. Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
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Engedal K, Gjra L, Benth JŠ, Wagle J, Rønqvist TK, Selbæk G. The Montreal Cognitive Assessment: Normative Data from a Large, Population-Based Sample of Cognitive Healthy Older Adults in Norway—The HUNT Study. J Alzheimers Dis 2022; 86:589-599. [DOI: 10.3233/jad-215442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Several studies have found that normative scores on the Montreal Cognitive Assessment Scale (MoCA) vary depending on the person’s education and age. The evidence for different normative scores between sexes is poor. Objective: The main aim of the study was to determine normative scores on the MoCA for Norwegian older adults stratified by educational level, age, and sex. In addition, we aimed to explore sex differences in greater detail. Methods: From two population-based studies in Norway, we included 4,780 people age 70 years and older. People with a diagnosis of dementia or mild cognitive impairment, a history of stroke, and depression were excluded. Trained health personnel tested the participants with the MoCA. Results: The mean MoCA score varied between 22 and 27 and was highest among women 70–74 years with education >13 years and lowest among men age 85 and older with education ≤10 years. Education, age, and sex were significant predictors of MoCA scores. Conclusion: In the present study of cognitively healthy Norwegian adults 70 years and older, we found that the normative score on the MoCA varied between 22 and 27 depending on a person’s education, age, and sex. We suggest that normative scores should be determined taking these three variables into consideration.
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Affiliation(s)
- Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Gjra
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jørgen Wagle
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Thale Kinne Rønqvist
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Thalmann M, Ringli L, Adcock M, Swinnen N, de Jong J, Dumoulin C, Guimarães V, de Bruin ED. Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413422. [PMID: 34949028 PMCID: PMC8705921 DOI: 10.3390/ijerph182413422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.
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Affiliation(s)
- Melanie Thalmann
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Lisa Ringli
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Manuela Adcock
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Nathalie Swinnen
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium;
- University Psychiatric Centre, KU Leuven, 3070 Kortenberg, Belgium
| | | | - Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | | | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 171 77 Stockholm, Sweden
- Department of Health, OST—Eastern Swiss University of Applied Sciences, 9001 St. Gallen, Switzerland
- Correspondence: ; Tel.: +41-44-632-40-18
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36
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Utne I, Løyland B, Grov EK, Rasmussen HL, Torstveit AH, Paul SM, Ritchie C, Lindemann K, Vistad I, Rodríguez-Aranda C, Miaskowski C. Age-related differences in self-report and objective measures of cognitive function in older patients prior to chemotherapy. Nurs Open 2021; 9:1040-1051. [PMID: 34878233 PMCID: PMC8859071 DOI: 10.1002/nop2.1141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 12/27/2022] Open
Abstract
Aim Evaluate for differences in demographic and clinical characteristics and subjective and objective measures of cognitive function (CF) between younger older adults (YOA, 60–69 years) and older adults (OA, ≥70 years). Design Cross‐sectional. Methods Older oncology patients (n = 139) completed subjective (Attentional Function Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) CF scale) and objective (Montreal Cognitive Assessment, Trail Making Test (TMT) A & B) measures of CF prior to chemotherapy. Data were analyzed using parametric and nonparametric tests. Results No differences were found between the two groups for any of the subjective or objective CF measures, except that OA patients had higher TMT B scores. Compared with the general population, OAs had significantly higher EORTC CF scores and YOAs had significantly worse scores for all of the objective tests. Clinically meaningful difference between group differences was found for the TMT B test.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hege Lund Rasmussen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, Massachusetts, USA
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Hospital of Southern Norway, Kristiansand, Norway.,Clinical Institute II, Medical department, University of Bergen, Bergen, Norway
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Torstveit AH, Miaskowski C, Løyland B, Grov EK, Guren MG, Ritchie CS, Paul SM, Kleven AG, Utne I. Common and distinct characteristics associated with self-reported functional status in older patients with cancer receiving chemotherapy. Eur J Oncol Nurs 2021; 54:102033. [PMID: 34537538 DOI: 10.1016/j.ejon.2021.102033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/04/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate for inter-individual differences in two subjective measures of functional status in older patients (n = 112), as well as to determine which demographic, clinical, and symptom characteristics, and levels of cognitive function, were associated with initial levels and with the trajectory of the two measures. METHODS Functional status was assessed using self-report measures of physical function (PF) and role function (RF) from the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess inter-individual differences in and characteristics associated with initial levels and changes in PF and RF. RESULTS Characteristics associated with decreases in PF at the initiation of chemotherapy were higher numbers of comorbidities and higher depression, pain, and dyspnea scores. For initial levels of poorer RF, lower Karnofsky Performance Status scores and higher pain and fatigue scores were the associated characteristics. Characteristic associated with worse trajectories of PF was not having had surgery. For RF, worse trajectories were associated with lower cognitive function and higher RF at enrollment. Characteristic associated with both lower initial levels and improved trajectories of PF was having lower performance status at enrollment. CONCLUSIONS Older patients undergoing chemotherapy experience reduced functional performance. Characteristics associated with decrements in PF and RF need to be assessed and interventions implemented to maintain and increase functional status in older oncology patients.
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Affiliation(s)
- Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | | | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Marianne Grønlie Guren
- Department of Oncology and K G Jebsen Colorectal Cancer Research Center, Oslo University Hospital, Oslo, Norway
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anne Grethe Kleven
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway.
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Kizina K, Akkaya Y, Jokisch D, Stolte B, Totzeck A, Munoz-Rosales J, Thimm A, Bolz S, Brakemeier S, Pul R, Aslan D, Hackert J, Kleinschnitz C, Hagenacker T. Cognitive Impairment in Adult Patients with 5q-Associated Spinal Muscular Atrophy. Brain Sci 2021; 11:brainsci11091184. [PMID: 34573206 PMCID: PMC8471736 DOI: 10.3390/brainsci11091184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
In previous studies, a below-average, average, or above-average intelligence quotient (IQ) in children with SMA was detected but, aside from a severe physical disability, the cognitive performance of adult SMA patients has not yet been evaluated. The intelligence test used in this study, the Wechsler Adult Intelligence Scale, fourth edition (WAIS-IV), was used to measure major intelligence components of adult SMA patients. The WAIS-IV determines four index scores representing verbal comprehension, perceptual reasoning, working memory, and processing speed. Due to time-dependent demands on motor function, the processing speed index score was excluded. IQ index scores of 33 adult SMA patients did not differ from IQ index scores of the normal population. In SMA type-3 patients, the index scores for verbal comprehension, perceptual reasoning, and working memory did not differ from the normal population but showed a trend of IQ scores towards lower points. Patients with SMA type 2 had lower IQ index scores for working memory (90.33 ± 12.95; p = 0.012) and perceptual reasoning (90.73 ± 12.58; p = 0.013) than the normal population. This study provided further evidence that SMA is a multi-systemic disease and may refute the widespread hypothesis that SMA patients might improve their cognitive skills to compensate for their physical impairment.
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Mueller C, Langenbruch LM, Rau JMH, Brix T, Strippel C, Dik A, Golombeck KS, Moenig C, Raeuber SJ, Kovac S, Wiendl H, Meuth SG, Bölte J, Johnen A, Melzer N. Determinants of cognition in autoimmune limbic encephalitis-A retrospective cohort study. Hippocampus 2021; 31:1092-1103. [PMID: 34270832 DOI: 10.1002/hipo.23375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022]
Abstract
Autoimmune limbic encephalitis (ALE) is the most common type of autoimmune encephalitis (AIE). Subacute memory disturbance, temporal lobe seizures, and psychiatric symptoms are clinical hallmarks of the disease. However, little is known on the factors contributing to cognitive functioning in ALE. Hence, we here investigate major determinants of cognitive functioning in ALE. In a retrospective analysis of 102 patients with ALE, we first compared verbal learning capacity, nonverbal learning capacity, and attentional and executive functioning by absence or presence of different types of neural autoantibodies (AABs). Subsequently we established three linear regression models including 63, 38, and 61 patients, respectively to investigate how cognitive functioning in these domains may depend on common markers of ALE such as intrathecal inflammation, blood-cerebrospinal fluid (CSF)-barrier function, mesiotemporal epileptiform discharges and slowing, determined by electroencephalography (EEG) and structural mesiotemporal changes, measured with magnetic resonance imaging (MRI). We also accounted for possible effects of cancer- and immunotherapy and other centrally effective medication. There was no effect of AAB status on cognitive functioning. Although the regression models could not predict verbal and nonverbal learning capacity, structural mesiotemporal neural network alterations on T2-/fluid attenuated inversion recovery (FLAIR)-signal-weighted MRI and mesiotemporal epileptiform discharges or slowing on EEG exerted a significant impact on memory functions. In contrast, the regression model significantly predicted attentional and executive functioning with CSF white blood cell count and centrally effective medication being significant determinants. In this cohort, cognitive functioning in ALE does not depend on the AAB status. Common markers of ALE cannot predict memory functioning that only partially depends on structural and functional alterations of mesiotemporal neural networks. Common markers of ALE significantly predict attentional and executive functioning that is significantly related to centrally effective medication and CSF white blood cell count, which may point toward inflammation affecting brain regions beyond the limbic system.
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Affiliation(s)
- Christoph Mueller
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Lisa M Langenbruch
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Johanna M H Rau
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Tobias Brix
- Institute of Medical Informatics, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Christine Strippel
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Andre Dik
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Kristin S Golombeck
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Constanze Moenig
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Saskia J Raeuber
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany.,Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany.,Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Jens Bölte
- Institute of Psychology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Andreas Johnen
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Münster, Germany.,Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
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Loenneker HD, Artemenko C, Willmes K, Liepelt-Scarfone I, Nuerk HC. Deficits in or preservation of basic number processing in Parkinson's disease? A registered report. J Neurosci Res 2021; 99:2390-2405. [PMID: 34184307 DOI: 10.1002/jnr.24907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022]
Abstract
Neurodegenerative diseases such as Parkinson's disease (PD) have a huge impact on patients, caregivers, and the health-care system. To date, the diagnosis of mild cognitive impairments in PD has been established based on domain-general functions such as executive functions, attention, or working memory. However, specific numerical deficits observed in clinical practice have not yet been systematically investigated. PD-immanent deterioration of domain-general functions and domain-specific numerical areas suggests the mechanisms of both primary and secondary dyscalculia. The current study will systematically investigate basic number processing performance in PD patients for the first time, targeting domain-specific cognitive representations of numerosity and the influence of domain-general factors. The overall sample consists of patients with a diagnosis of PD, according to consensus guidelines, and healthy controls. PD patients will be stratified into patients with normal cognition or mild cognitive impairment (level I-PD-MCI based on cognitive screening). Basic number processing will be assessed using transcoding, number line estimation, and (non)symbolic number magnitude comparison tasks. Discriminant analysis will be employed to assess whether basic number processing tasks can differentiate between a healthy control group and both PD groups. All participants will be subjected to a comprehensive numerical and a neuropsychological test battery, as well as sociodemographic and clinical measures. Study results will give the first broad insight into the extent of basic numerical deficits in different PD patient groups and will help us to understand the underlying mechanisms of the numerical deficits faced by PD patients in daily life.
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Affiliation(s)
| | - Christina Artemenko
- Department of Psychology, University of Tuebingen, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Klaus Willmes
- Department of Neurology, RWTH Aachen University, University Hospital, Aachen, Germany
| | - Inga Liepelt-Scarfone
- Department of Clinical Neurodegeneration, Hertie Institute for Clinical Brain Research, Tuebingen, Germany.,German Centre for Neurodegenerative Diseases, Tuebingen, Germany.,IB-Hochschule für Gesundheit und Soziales, Stuttgart, Germany
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Effects of Sociodemographic Variables and Depressive Symptoms on MoCA Test Performance in Native Germans and Turkish Migrants in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126335. [PMID: 34208085 PMCID: PMC8296159 DOI: 10.3390/ijerph18126335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
The validity of the Montreal Cognitive Assessment (MoCA) in migrants is questionable, as sociodemographic factors and the migration process may influence performance. Our aim was to evaluate possible predictors (age, education, sex, depression, and migration) of MoCA results in Turkish migrants and Germans living in Germany. Linear regression models were conducted with a German (n = 419), a Turkish (n = 133), and an overall sample. All predictor analyses reached statistical significance. For the German sample, age, sex, education, and depression were significant predictors, whereas education was the only predictor for Turkish migrants. For the overall sample, having no migration background and higher education were significant predictors. Migration background and education had an impact on MoCA performance in a sample of German and Turkish individuals living in Germany. Thus, culture-specific normative data for the MoCA are needed, and the development of culture-sensitive cognitive screening tools is encouraged.
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Tsiakiri A, Vadikolias K, Tripsianis G, Vlotinou P, Serdari A, Terzoudi A, Heliopoulos I. Influence of Social and Demographic Factors on the Montreal Cognitive Assessment (MoCA) Test in Rural Population of North-Eastern Greece. Geriatrics (Basel) 2021; 6:geriatrics6020043. [PMID: 33920668 PMCID: PMC8167640 DOI: 10.3390/geriatrics6020043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
The current study aims to investigate the influence of socio-demographic factors on the Montreal Cognitive Assessment (MoCA) test results in a Greek-speaking population consisting of a sample of healthy older adults, individuals with mild cognitive impairment (MCI), and dementia patients in rural areas. In addition, the current research focuses on determining optimal cut-off scores for the clinical diagnoses of MCI and dementia. The data originated from 283 participants in an ongoing registry of the Neurology Department of Alexandroupolis University Hospital, recruited in different rural districts of north-eastern Greece, across a broad range of educational and occupational categories. Total and sub-domain scores for the MoCA varied significantly, according to sex, age, and education, among the three study groups. The optimal cut-off points of 25/26 for the MoCA total score was determined to classify healthy subjects from individuals with MCI, 24 to discriminate healthy participants from demented, and 21/22 to discriminate subjects with MCI from dementia. Overall, the clinical use of the MoCA test can be supported by demographically adjusted standard scores in a Greek-speaking rural population. These findings serve to improve the diagnostic accuracy and utility of the MoCA test.
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Affiliation(s)
- Anna Tsiakiri
- Department of Neurology, Medical School, Democritus University of Thrace, Univeristy Hospital of Alexandroupolis, 68100 Dragana, Greece; (K.V.); (P.V.); (A.T.); (I.H.)
- Correspondence: ; Tel.: +30-6941582772
| | - Konstantinos Vadikolias
- Department of Neurology, Medical School, Democritus University of Thrace, Univeristy Hospital of Alexandroupolis, 68100 Dragana, Greece; (K.V.); (P.V.); (A.T.); (I.H.)
| | - Grigorios Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Pinelopi Vlotinou
- Department of Neurology, Medical School, Democritus University of Thrace, Univeristy Hospital of Alexandroupolis, 68100 Dragana, Greece; (K.V.); (P.V.); (A.T.); (I.H.)
| | - Aspasia Serdari
- Department of Child & Adolescent Psychiatry, Medical School, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Dragana, Greece;
| | - Aikaterini Terzoudi
- Department of Neurology, Medical School, Democritus University of Thrace, Univeristy Hospital of Alexandroupolis, 68100 Dragana, Greece; (K.V.); (P.V.); (A.T.); (I.H.)
| | - Ioannis Heliopoulos
- Department of Neurology, Medical School, Democritus University of Thrace, Univeristy Hospital of Alexandroupolis, 68100 Dragana, Greece; (K.V.); (P.V.); (A.T.); (I.H.)
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Krebs C, Falkner M, Niklaus J, Persello L, Klöppel S, Nef T, Urwyler P. Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults. JMIR Serious Games 2021; 9:e24151. [PMID: 33749607 PMCID: PMC8078028 DOI: 10.2196/24151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/23/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies suggest that computerized puzzle games are enjoyable, easy to play, and engage attentional, visuospatial, and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behavior. OBJECTIVE The goal of the research was to test the feasibility of eye tracking during a puzzle game and develop adjunct markers for cognitive performance using eye-tracking metrics. METHODS A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D (Unity Technologies). The goal of the Match-3 puzzle was to find configurations (target patterns) that could be turned into a row of 3 identical game objects (tiles) by swapping 2 adjacent tiles. Difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of 4 boards (ie, target patterns to match) with one target pattern each. In this study, the desktop version was presented on a laptop computer setup with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil-based assessment battery was administered prior to the Match-3 game. The gaze behavior of all participants was recorded during the game. Correlation analyses were performed on eye-tracking data correcting for age to examine if gaze behavior pertains to target patterns and distractor patterns and changes with puzzle board size (set size). Additionally, correlations between cognitive performance and eye movement metrics were calculated. RESULTS A total of 13 healthy older subjects (mean age 70.67 [SD 4.75] years; range 63 to 80 years) participated in this study. In total, 3 training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions (Trail Making Test B) and number of fixations on distractor patterns (P=.01) and average fixations (P=.005). CONCLUSIONS Overall, this study shows that eye tracking in puzzle games can act as a supplemental source of data for cognitive performance. The relationship between a paper-pencil test for executive functions and fixations confirms that both are related to the same cognitive processes. Therefore, eye movement metrics might be used as an adjunct marker for cognitive abilities like executive functions. However, further research is needed to evaluate the potential of the various eye movement metrics in combination with puzzle games as visual search and attentional marker.
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Affiliation(s)
- Christine Krebs
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Falkner
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Gerontechnology & Rehabilitation group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Joel Niklaus
- Gerontechnology & Rehabilitation group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Luca Persello
- Gerontechnology & Rehabilitation group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Prabitha Urwyler
- Gerontechnology & Rehabilitation group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, University Neurorehabilitation unit, Inselspital, Bern, Switzerland
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Margot-Cattin I, Ludwig C, Kühne N, Eriksson G, Berchtold A, Nygard L, Kottorp A. Visiting Out-of-Home Places When Living With Dementia: A Cross-Sectional Observational Study: Visiter des lieux hors du domicile lorsque l'on vit avec une démence: étude transversale observationnelle. The Canadian Journal of Occupational Therapy 2021; 88:131-141. [PMID: 33745342 PMCID: PMC8240000 DOI: 10.1177/00084174211000595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Persons living with dementia face a reduction of their life space outside home and disengagement from participation, linked to places visited. PURPOSE. This study explored stability and change in perceived participation in places visited outside home and its relationship with occupational gaps among older adults. METHOD. Older adults living with (n = 35) or without (n = 35) dementia were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire and the Occupational Gaps Questionnaire (OGQ). Data analysis used descriptive and inferential statistics. FINDINGS. The group of people living with dementia reported significantly fewer places (p < .001) visited than the comparison group and having abandoned more places visited (p < .001) than the comparison group. The number of occupational gaps was significantly different between groups (p < .001). IMPLICATIONS. Participation outside home is not influenced in a uniform and straightforward way for persons living with dementia; the shrinking world effect appears differently in relation to types of places.
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Affiliation(s)
- Isabel Margot-Cattin
- Isabel Margot-Cattin, Haute Ecole Specialisee de Suisse Occidentale (HES-SO), HETSL, ch.des Abeilles 14, 1010 Lausanne, Switzerland. E-mail:
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Tigchelaar C, Atmosoerodjo SD, van Faassen M, Wardenaar KJ, De Deyn PP, Schoevers RA, Kema IP, Absalom AR. The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:455. [PMID: 33850852 PMCID: PMC8039635 DOI: 10.21037/atm-20-4498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The pathophysiology of numerous central nervous system disorders remains poorly understood. Biomarker research using cerebrospinal fluid (CSF) is a promising way to illuminate the neurobiology of neuropsychiatric disorders. CSF biomarker studies performed so far generally included patients with neurodegenerative diseases without an adequate control group. The Anaesthetic Biobank of Cerebrospinal fluid (ABC) was established to address this. The aims are to (I) provide healthy-control reference values for CSF-based biomarkers, and (II) to investigate associations between CSF-based candidate biomarkers and neuropsychiatric symptoms. Methods In this cross-sectional study, we collect and store CSF and blood from adult patients undergoing spinal anaesthesia for elective surgery. Blood (20.5 mL) is collected during intravenous cannulation and CSF (10 mL) is aspirated prior to intrathecal local anaesthetic injection. A portion of the blood and CSF is sent for routine laboratory analyses, the remaining material is stored at -80 °C. Relevant clinical, surgical and anaesthetic data are registered. A neurological examination and Montreal Cognitive Assessment (MoCA) are performed pre-operatively and a subset of patients fill in questionnaires on somatic and mental health (depression, anxiety and stress). Results Four-hundred-fifty patients (58% male; median age: 56 years) have been enrolled in the ABC. The planned spinal anaesthetic procedure was not attempted for various reasons in eleven patients, in fourteen patients the spinal puncture failed and in twelve patients CSF aspiration was unsuccessful. A mean of 9.3 mL CSF was obtained in the remaining 413 of patients. Most patients had a minor medical history and 60% scored in the normal range on the MoCA (median score: 26). Conclusions The ABC is an ongoing biobanking project that can contribute to CSF-based biomarker research. The large sample size with constant sampling methods and extensive patient phenotyping provide excellent conditions for future neuroscientific research.
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Affiliation(s)
- Celien Tigchelaar
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sawal D Atmosoerodjo
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martijn van Faassen
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaas J Wardenaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behavior, Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.,Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Röhr S, Zülke A, Luppa M, Brettschneider C, Weißenborn M, Kühne F, Zöllinger I, Samos FAZ, Bauer A, Döhring J, Krebs-Hein K, Oey A, Czock D, Frese T, Gensichen J, Haefeli WE, Hoffmann W, Kaduszkiewicz H, König HH, Thyrian JR, Wiese B, Riedel-Heller SG. Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study-A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020408. [PMID: 33430189 PMCID: PMC7825589 DOI: 10.3390/ijerph18020408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60–77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
- Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: ; Tel.: +49-341-9724568; Fax: +49-341-9724569
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Flora Kühne
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Franziska-Antonia Zora Samos
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Kerstin Krebs-Hein
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Anke Oey
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (B.W.)
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (W.H.); (J.R.T.)
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (W.H.); (J.R.T.)
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (B.W.)
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
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Guenther SPW, Hornung R, Joskowiak D, Vlachea P, Feil K, Orban M, Peterss S, Born F, Hausleiter J, Massberg S, Hagl C. Extracorporeal life support in therapy-refractory cardiocirculatory failure: looking beyond 30 days. Interact Cardiovasc Thorac Surg 2020; 32:607-615. [PMID: 33347585 DOI: 10.1093/icvts/ivaa312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Venoarterial extracorporeal life support (ECLS) has emerged as a potentially life-saving treatment option in therapy-refractory cardiocirculatory failure, but longer-term outcome is poorly defined. Here, we present a comprehensive follow-up analysis covering all major organ systems. METHODS From February 2012 to December 2016, 180 patients were treated with ECLS for therapy-refractory cardiogenic shock or cardiac arrest. The 30-day survival was 43.9%, and 30-day survivors (n = 79) underwent follow-up analysis with the assessment of medium-term survival, quality of life, neuropsychological, cardiopulmonary and end-organ status. RESULTS After a median of 1.9 (1.1-3.6) years (182.4 patient years), 45 of the 79 patients (57.0%) were alive, 35.4% had died and 7.6% were lost to follow-up. Follow-up survival estimates were 78.0% at 1, 61.2% at 3 and 55.1% at 5 years. NYHA class at follow-up was ≤II for 83.3%. The median creatinine was 1.1 (1.0-1.4) mg/dl, and the median bilirubin was 0.8 (0.5-1.0) mg/dl. No patient required dialysis. Overall, 94.4% were free from moderate or severe disability, although 11.1% needed care. Full re-integration into social life was reported by 58.3%, and 39.4% were working. Quality of life was favourable for mental components, but a subset showed deficits in physical aspects. While age was the only peri-implantation parameter significantly predicting medium-term survival, adverse events and functional status at discharge or 30 days were strong predictors. CONCLUSIONS This study demonstrates positive medium-term outcome with high rates of independence in daily life and self-care but a subset of 10-20% suffered from sustained impairments. Our results indicate that peri-implantation parameters lack predictive power but downstream morbidity and functional status at discharge or 30 days can help identify patients at risk for poor recovery.
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Affiliation(s)
- Sabina P W Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Roman Hornung
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian-University, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Martin Orban
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Jörg Hausleiter
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Steffen Massberg
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
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Jekel K, Wagner P. [Neuropsychological diagnostics of cognitive deficits : Focus on dementia]. Z Gerontol Geriatr 2020; 53:797-806. [PMID: 33146740 DOI: 10.1007/s00391-020-01800-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
Older people often report a decline in their cognitive functions - memory problems and difficulty finding words are frequently mentioned. In this context it is essential to differentiate between age-related cognitive decline and pathological processes as they occur in the context of dementia. Neuropsychological diagnostics make an important contribution to this distinction. Using cognitive tests, the quality and quantity of cognitive deficits can be determined. Moreover, the cognitive profile can be used to generate hypotheses about the etiology of the cognitive impairment. In order to avoid a misdiagnosis, factors such as drug side effects, loss of vision and hearing, the presence of depressive symptoms or states of delirium should be taken into account.
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Affiliation(s)
- Katrin Jekel
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
| | - Peter Wagner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
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Iwaki H, Blauwendraat C, Leonard HL, Makarious MB, Kim JJ, Liu G, Maple-Grødem J, Corvol JC, Pihlstrøm L, van Nimwegen M, Smolensky L, Amondikar N, Hutten SJ, Frasier M, Nguyen KDH, Rick J, Eberly S, Faghri F, Auinger P, Scott KM, Wijeyekoon R, Van Deerlin VM, Hernandez DG, Gibbs RJ, Day-Williams AG, Brice A, Alves G, Noyce AJ, Tysnes OB, Evans JR, Breen DP, Estrada K, Wegel CE, Danjou F, Simon DK, Andreassen OA, Ravina B, Toft M, Heutink P, Bloem BR, Weintraub D, Barker RA, Williams-Gray CH, van de Warrenburg BP, Van Hilten JJ, Scherzer CR, Singleton AB, Nalls MA. Differences in the Presentation and Progression of Parkinson's Disease by Sex. Mov Disord 2020; 36:106-117. [PMID: 33002231 DOI: 10.1002/mds.28312] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies reported various symptoms of Parkinson's disease (PD) associated with sex. Some were conflicting or confirmed in only one study. OBJECTIVES We examined sex associations to PD phenotypes cross-sectionally and longitudinally in large-scale data. METHODS We tested 40 clinical phenotypes, using longitudinal, clinic-based patient cohorts, consisting of 5946 patients, with a median follow-up of 3.1 years. For continuous outcomes, we used linear regressions at baseline to test sex-associated differences in presentation, and linear mixed-effects models to test sex-associated differences in progression. For binomial outcomes, we used logistic regression models at baseline and Cox regression models for survival analyses. We adjusted for age, disease duration, and medication use. In the secondary analyses, data from 17 719 PD patients and 7588 non-PD participants from an online-only, self-assessment PD cohort were cross-sectionally evaluated to determine whether the sex-associated differences identified in the primary analyses were consistent and unique to PD. RESULTS Female PD patients had a higher risk of developing dyskinesia early during the follow-up period, with a slower progression in activities of daily living difficulties, and a lower risk of developing cognitive impairments compared with male patients. The findings in the longitudinal, clinic-based cohorts were mostly consistent with the results of the online-only cohort. CONCLUSIONS We observed sex-associated contributions to PD heterogeneity. These results highlight the necessity of future research to determine the underlying mechanisms and importance of personalized clinical management. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hirotaka Iwaki
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.,Data Tecnica International, Glen Echo, Maryland, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Hampton L Leonard
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.,Data Tecnica International, Glen Echo, Maryland, USA
| | - Mary B Makarious
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonggeol J Kim
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Ganqiang Liu
- School of Medicine, Sun Yat-sen University, Guangzhou, China.,Advanced Center for Parkinson's Disease Research, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Precision Neurology Program, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University in Stavanger, Stavanger, Norway
| | - Jean-Christophe Corvol
- Assistance-Publique Hôpitaux de Paris, ICM, INSERM UMRS 1127, CNRS 7225, ICM, Department of Neurology and CIC Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Marlies van Nimwegen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Luba Smolensky
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Jacqueline Rick
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Faraz Faghri
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Peggy Auinger
- Department of Neurology, Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Kirsten M Scott
- Department of Clinical Neurosciences, University of Cambridge, John van Geest Centre for Brain Repair, Cambridge, UK
| | - Ruwani Wijeyekoon
- Department of Clinical Neurosciences, University of Cambridge, John van Geest Centre for Brain Repair, Cambridge, UK
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dena G Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Raphael J Gibbs
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron G Day-Williams
- Flagship Labs 60 Inc, Cambridge, Massachusetts, USA.,Statistical Genetics, Biogen, Cambridge, Massachusetts, USA
| | - Alexis Brice
- Institut du cerveau et de la moelle épinière ICM, Paris, France.,Sorbonne Université SU, Paris, France.,INSERM UMR1127, Paris, France
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University in Stavanger, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jonathan R Evans
- Department of Neurology, Nottingham University NHS Trust, Nottingham, UK
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Karol Estrada
- Translational Genome Sciences, Biogen, Cambridge, Massachusetts, USA
| | - Claire E Wegel
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Fabrice Danjou
- Institut du cerveau et de la moelle épinière ICM, Paris, France
| | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Ole A Andreassen
- NORMENT; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bernard Ravina
- Voyager Therapeutics, Cambridge, Massachusetts, USA.,Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Heutink
- German Center for Neurodegenerative Diseases-Tubingen, Tuebingen, Germany.,HIH Tuebingen, Tuebingen, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
| | - Roger A Barker
- Department of Clinical Neurosciences and WT-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | | | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jacobus J Van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Clemens R Scherzer
- Advanced Center for Parkinson's Disease Research, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Precision Neurology Program, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.,Data Tecnica International, Glen Echo, Maryland, USA
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50
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Cukierman-Yaffe T, Gerstein HC, Colhoun HM, Diaz R, García-Pérez LE, Lakshmanan M, Bethel A, Xavier D, Probstfield J, Riddle MC, Rydén L, Atisso CM, Hall S, Rao-Melacini P, Basile J, Cushman WC, Franek E, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pirags V, Pogosova N, Raubenheimer PJ, Shaw JE, Sheu WHH, Temelkova-Kurktschiev T. Effect of dulaglutide on cognitive impairment in type 2 diabetes: an exploratory analysis of the REWIND trial. Lancet Neurol 2020; 19:582-590. [PMID: 32562683 DOI: 10.1016/s1474-4422(20)30173-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes is an independent risk factor for cognitive impairment. We aimed to investigate the association between the glucagon-like peptide-1 (GLP-1) receptor agonist dulaglutide and cognitive impairment as an exploratory analysis within the Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial. METHODS REWIND is a randomised, double-blind placebo-controlled trial at 371 sites in 24 countries. We included men and women (aged ≥50 years) with either established or newly diagnosed type 2 diabetes and additional cardiovascular risk factors, glycated haemoglobin of up to 9·5% (80 mmol/mol) on a maximum of two oral glucose-lowering drugs with or without basal insulin, and a body-mass index of at least 23 kg/m2. Participants were randomly assigned (1:1) subcutaneous injections once a week of either dulaglutide (1·5 mg) or an equal volume of matching placebo. Randomisation was done using a computer-generated code with stratification by site. Participants and all study personnel were masked to treatment allocation until the database was locked. Participants were followed up at least every 6 months for the composite primary outcome of stroke, myocardial infarction, or death from cardiovascular or unknown causes. Cognitive function was assessed at baseline and during follow-up using the Montreal Cognitive Assessment (MoCA) and Digit Symbol Substitution Test (DSST). We present here the exploratory primary cognitive outcome, which was the first occurrence of a follow-up score on MoCA or DSST that was 1·5 SDs or more below the baseline mean score in the participant's country. All analyses were done using an intention-to-treat approach. The REWIND trial is registered with ClinicalTrials.gov, NCT01394952. FINDINGS Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were randomly assigned to either dulaglutide (n=4949) or placebo (n=4952). During median follow-up of 5·4 (IQR 5·1-5·9) years, 8828 participants provided a baseline and one or more follow-up MoCA or DSST scores, of whom 4456 were assigned dulaglutide and 4372 were assigned placebo. The cognitive outcome occurred in 4·05 per 100 patient-years in participants assigned dulaglutide and 4·35 per 100 patient-years in people assigned placebo (hazard ratio [HR] 0·93, 95% CI 0·85-1·02; p=0·11). After post-hoc adjustment for individual standardised baseline scores, the hazard of substantive cognitive impairment was reduced by 14% in those assigned dulaglutide (HR 0·86, 95% CI 0·79-0·95; p=0·0018). INTERPRETATION Long-term treatment with dulaglutide might reduce cognitive impairment in people with type 2 diabetes. Further studies of this drug focused on brain health and cognitive function are clearly indicated. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Endocrinology Institute, Gertner Institute, Sheba Medical Center, Ramat-Gan, Israel; Epidemiology Department, Sackler School of Medicine, Herceg Institute of Aging, Tel Aviv University, Tel Aviv, Israel
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | | | | | | | | | | | - Matthew C Riddle
- Department of Medicine, Oregon Health and Science University Portland, OR, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | - Stephanie Hall
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jan Basile
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences and Central Clinical Hospital, Warsaw, Poland
| | - Matyas Keltai
- Semmelweis University, Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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