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Arias F, Dufour AB, Jones RN, Alegria M, Fong TG, Inouye SK. Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study. J Am Geriatr Soc 2024; 72:369-381. [PMID: 37933703 PMCID: PMC10922227 DOI: 10.1111/jgs.18662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. METHODS A retrospective study of a prospective cohort of patients enrolled from June 18, 2010, to August 8, 2013, across two academic medical centers in Boston, Massachusetts. Overall, 560 older adults age ≥70 years undergoing major elective non-cardiac surgery were included in this analysis. Exposure variables included income, lack of private insurance, and neighborhood disadvantage. Our main outcome was incident postoperative delirium, measured using the Confusion Assessment Method long form. RESULTS Older age (odds ratio, OR: 1.01, 95% confidence interval, CI: 1.00, 1.02), income <20,000 a year (OR: 1.12, 95% CI: 1.00, 1.26), lack of private insurance (OR: 1.19, 95% CI: 1.04, 1.38), higher depressive symptomatology (OR: 1.02, 95% CI: 1.01, 1.04), and the Area Deprivation Index (OR: 1.02, 95% CI: 1.01, 1.04) were significantly associated with increased risk of postoperative delirium in bivariable analyses. In a multivariable model, explaining 27% of the variance in postoperative delirium, significant independent variables were older age (OR 1.01, 95% CI 1.00, 1.02), lack of private insurance (OR 1.18, 95% CI 1.02, 1.36), and depressive symptoms (OR 1.02, 95% CI 1.00, 1.03). Household income was no longer a significant independent predictor of delirium in the multivariable model (OR:1.02, 95% CI: 0.90, 1.15). The type of medical insurance significantly mediated the association between household income and incident delirium. CONCLUSIONS Lack of private insurance, a social determinant of health reflecting socioeconomic status, emerged as a novel and important independent risk factor for delirium. Future efforts should consider targeting SDOH factors to prevent postoperative delirium in older adults.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32608, USA
| | - Alyssa B. Dufour
- Harvard Medical School, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02131, USA
- Department of Medicine and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
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Asken BM, Wang W, McFarland K, Arias F, Fiala J, Velez‐Uribe I, Mayrand RP, Sawada LO, Freytes C, Adeyosoye M, Marsiske M, Rosselli M, Barker WW, Curiel Cid R, Loewenstein DA, DeKosky ST, Armstrong MJ, Smith GE, Adjouadi M, Vaillancourt DE, Duara R. Plasma Alzheimer's biomarkers and brain amyloid in Hispanic and non-Hispanic older adults. Alzheimers Dement 2024; 20:437-446. [PMID: 37671801 PMCID: PMC10865106 DOI: 10.1002/alz.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Alzheimer's disease studies often lack ethnic diversity. METHODS We evaluated associations between plasma biomarkers commonly studied in Alzheimer's (p-tau181, GFAP, and NfL), clinical diagnosis (clinically normal, amnestic MCI, amnestic dementia, or non-amnestic MCI/dementia), and Aβ-PET in Hispanic and non-Hispanic older adults. Hispanics were predominantly of Cuban or South American ancestry. RESULTS Three-hundred seventy nine participants underwent blood draw (71.9 ± 7.8 years old, 60.2% female, 57% Hispanic of which 88% were Cuban or South American) and 240 completed Aβ-PET. P-tau181 was higher in amnestic MCI (p = 0.004, d = 0.53) and dementia (p < 0.001, d = 0.97) than in clinically normal participants and discriminated Aβ-PET[+] and Aβ-PET[-] (AUC = 0.86). P-tau181 outperformed GFAP and NfL. There were no significant interactions with ethnicity. Among amnestic MCI, Hispanics had lower odds of elevated p-tau181 than non-Hispanic (OR = 0.41, p = 0.006). DISCUSSION Plasma p-tau181 informs etiological diagnosis of cognitively impaired Hispanic and non-Hispanic older adults. Hispanic ethnicity may relate to greater likelihood of non-Alzheimer's contributions to memory loss. HIGHLIGHTS Alzheimer's biomarkers were measured in Hispanic and non-Hispanic older adults. Plasma p-tau181 related to amnestic cognitive decline and brain amyloid burden. AD biomarker associations did not differ between Hispanic and non-Hispanic ethnicity. Hispanic individuals may be more likely to have non-Alzheimer causes of memory loss.
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Liu J, Gou RY, Jones RN, Schmitt EM, Metzger E, Tabloski PA, Arias F, Hshieh TT, Travison TG, Marcantonio ER, Fong T, Inouye SK. Association of Loneliness With Change in Physical and Emotional Health of Older Adults During the COVID-19 Shutdown. Am J Geriatr Psychiatry 2023; 31:1102-1113. [PMID: 37940227 PMCID: PMC10797604 DOI: 10.1016/j.jagp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To examine factors influencing loneliness and the effect of loneliness on physical and emotional health, in the context of the COVID-19 pandemic. DESIGN Prospective, observational cohort. SETTING Community-dwelling participants. PARTICIPANTS Older adults (n = 238) enrolled in a longitudinal study. MEASUREMENTS Interviews were completed July-December 2020. Loneliness was measured with the UCLA 3-item loneliness scale. Data including age, marriage, education, cognitive functioning, functional impairment, vision or hearing impairment, depression, anxiety, medical comorbidity, social network size, technology use, and activity engagement were collected. Health outcomes included self-rated health, and physical and mental composites from the 12-item Short Form Survey. Physical function was measured by a PROMIS-scaled composite score. RESULTS Thirty-nine (16.4%) participants reported loneliness. Vulnerability factors for loneliness included age (RR = 1.08, 95% CI 1.02-1.14); impairment with instrumental activities of daily living (RR = 2.08, 95% CI 1.14-3.80); vision impairment (RR = 2.09, 95% CI 1.10-3.97); depression (RR = 1.34, 95% CI 1.25-1.43); and anxiety (RR = 1.92, 95% CI 1.55-2.39). Significant resilience factors included high cognitive functioning (RR = 0.88, 95% CI 0.83-0.94); large social network size (RR = 0.92, 95% CI 0.88-0.96); technology use (RR = 0.81, 95% CI 0.73-0.90); and social and physical activity engagement (RR = 0.91, 95% CI 0.85-0.98). Interaction analyses showed that larger social network size moderated the effect of loneliness on physical function (protective interaction effect, RR = 0.64, 95% CI 0.15-1.13, p <.01), and activity engagement moderated the effect of loneliness on mental health (protective interaction effect, RR = 0.65, 95% CI 0.25-1.05, p <.001). CONCLUSIONS Resilience factors may mitigate the adverse health outcomes associated with loneliness. Interventions to enhance resilience may help to diminish the detrimental effects of loneliness and hold great importance for vulnerable older adults.
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Affiliation(s)
- Julianna Liu
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Ray Yun Gou
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior (RNJ), Brown University, Providence, RI
| | - Eva M Schmitt
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Eran Metzger
- Department of Psychiatry (EM), Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Franchesca Arias
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (FA, TTH), Brigham and Women's Hospital, Boston, MA
| | - Tammy T Hshieh
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (FA, TTH), Brigham and Women's Hospital, Boston, MA
| | - Thomas G Travison
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA
| | - Edward R Marcantonio
- Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Divisions of General Medicine and Gerontology (ERM), Beth Israel Deaconess Medical Center, Boston, MA
| | - Tamara Fong
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Neurology (TF), Beth Israel Deaconess Medical Center, Boston, MA.
| | - Sharon K Inouye
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (SKI), Beth Israel Deaconess Medical Center, Boston, MA
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Perez-Lao A, Arias F, Levy SA, Smith G, Ying G. H - 66 A Systematic Review of Available Normative Data of Neuropsychological Tests for Latinx and Hispanic Samples. Arch Clin Neuropsychol 2023; 38:1550. [PMID: 37807549 DOI: 10.1093/arclin/acad067.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE This review aimed to examine and compare norm stratification of available normative data of neuropsychological tests for Spanish-speakers in the United States, Latin America, the Caribbean, and Spain. DATA SELECTION English and Spanish studies focused on acquiring normative data for Latinx/Hispanics in Latin America, the Caribbean, the United States, and Spain, were searched from Embase, PubMed, PsycINFO APA, ClinicalTrials.gov, Science Direct, and ProQuest with the date before August 31st, 2022. We used the terms "Neuropsychological testing", "Cognitive assessment", "Hispanic", "Latinx" and "Latinos". Studies were imported to COVIDENCE, and reviewed by two Spanish-English bilingual reviewers, and one proficient English-only reviewer. Out of 345 records identified, 55 met inclusion and exclusion criteria and were not two standard deviations below the quality criteria index. DATA SYNTHESIS Age, education, and sex were the most common variables included in the stratification of normative data. Age was a predictor of lower performance in adults, and higher education was a predictor of better performance. With children and adolescents, increased age was related to better cognitive performance. Most of the studies were written in English and included a cognitively intact sample that was assessed either with the Mini-Mental State Examination, health history, or other clinical interviews or exams. CONCLUSION There is an evident improvement in the availability of measures for Spanish speakers. However, there is a need for better-developed tests for this population. Future studies in this area should consider adding variables such as acculturation and bilingualism into research, as well as developing novel measures for Spanish speakers.
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Gomez J, Miranda M, Arias F. H - 58 Medical Competency and Translational Fallouts: a Need for Advocacy for Ethnic Minorities. Arch Clin Neuropsychol 2023; 38:1542. [PMID: 37807597 DOI: 10.1093/arclin/acad067.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Despite a growing ethnically and linguistically diverse population, the medical system in the U.S. continues to lack the cultural sensitivity needed to provide patients from underrepresented groups with culturally relevant care. This case study of a 32-year-old Mexican woman, by the pseudo name of Ella, will be reviewed to describe her family's journey through the medical system. Ella was referred for neuropsychological testing to determine medical capacity for kidney transplant. She's an example of how our health care system has inadequately adapted to our diversification and how lower literacy and disempowerment has led to misinformed ideas about illness and higher risk of health complications. METHOD This case study will review Ella's medical, developmental, and psychosocial history, will illustrate the important considerations relevant to providing culturally, ethically, and linguistically informed neuropsychological and medical evaluations. RESULTS Through neuropsychological testing, Ella was diagnosed with a severe intellectual disability, solidifying that she doesn't have the capacity to make medical decisions. Her mother, a monolingual Spanish speaker, bringing another daughter as she's the only fluent English speaker in the family. After having her kidney transplant surgery halted due to an allergic reaction, Ella's life is at risk due to translational fallouts in communication between Ella's providers and family, and misinformation regarding her medical diagnoses and treatments. CONCLUSIONS Advocacy for a healthcare system that adapts to language, lower health literacy, socioeconomic/legal statuses will ensure that our ethnic minorities are informed of their medical conditions and management, and receive the lifesaving care they need, when the need it.
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Picanso N, Arias F. H - 26 Cognitive Functioning Following Bariatric Surgery in a Bilingual, Spanish, and English - Speaking, Patient: a Case Study. Arch Clin Neuropsychol 2023; 38:1509. [PMID: 37807553 DOI: 10.1093/arclin/acad067.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Overall, 256,000 bariatric surgeries were completed in the United States in 2019 (ASMBS, 2023). Bariatric surgeries are effective in reducing morbidity, prolonging life, and improving cognition, particularly among patients with BMI >40 and those with BMI >35 and obesity-related complications (Handley et al., 2016; Cornejo-Pareja et al., 2021). Nevertheless, up to 16% of patients undergoing bariatric procedures experience neurological sequelae (Thaisetthawatku et al., 2004) that is likely secondary to surgery-related nutritional deficiencies (Gasmi et al., 2022). Although neuropsychological assessments may help to identify postsurgical cognitive changes, cultural and linguistic differences may preclude reliable and valid assessment of non-native English-speaking persons. METHOD A Spanish-dominant 38-year-old, right-handed, female reported diminished attention, reduced thinking speed, and memory difficulties that were interfering with her daily functioning. She completed a thorough Clinical Interview (both individually and with collaterals), Record Review, and a comprehensive neuropsychological workup. RESULTS She demonstrated multi-domain impairment (>1.5 S.D. below the normative mean), suggesting a possible dementia or encephalopathy. When her cognitive profile was interpreted in the context of her medical history, further testing was recommended to rule out reversible etiologies. Interdisciplinary collaborations with primary care and gastroenterology revealed nutritional deficiencies that had persisted for over 18 months after bariatric surgery and that were not fully resolved with regular oral vitamin consumption. CONCLUSIONS Cultural and linguistic differences were relevant when assessing cognitive changes in non-native English-speaking persons, and in helping to determine whether pharmacological and behavioral interventions are ameliorating these complications. Practical considerations of these high-stakes assessments will be discussed from neuropsychological, psychosocial, and ethical perspectives.
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Rivera ZR, Arias F, Guzmán Y, Vega M. H - 12 Bienestar Psicológico Y Aflicción en Cuidadores Informales de Adultos Mayores Con Demencia en Puerto Rico, Durante Tiempos de Pandemia. Arch Clin Neuropsychol 2023; 38:1493. [PMID: 37807521 DOI: 10.1093/arclin/acad067.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJETIVO Los objetivos del estudio fueron describir los niveles de aflicción y bienestar psicológico en cuidadores informales (CI) de personas diagnosticadas con demencia en Puerto Rico, así como determinar la relación entre estos, durante el periodo de pandemia por COVID-19. MÉTODO En este estudio descriptivo y correlacional participaron 84 adultos puertorriqueños entre las edades de 21 y 65 años. El 92.9% se identificó con el género femenino. Se administró un cuestionario sociodemográfico, la Escala de Bienestar Psicológico de Ryff (EBPR) y el Inventario de Aflicción del Cuidador Marwit y Meuser (IACMM), formulario corto, a través de Psychdata. RESULTADOS Un 70.0% de la muestra (n = 59) reportó presentar niveles de aflicción promedio, un 19.0% (n = 16) bajos, y 11.0% (n = 9) altos. El promedio de aflicción reportada en la IACMM fue de 63.89 (DE = 13.31). Un 61.0% (n = 51) de los participantes reportó niveles bajos de bienestar psicológico. La EBPR reflejó un promedio de 70.39 (DE = 13.09). Se llevó a cabo un análisis de correlación Pearson para evaluar la relación entre puntuaciones en la IACMM y la EBPR. Los resultados reflejaron una correlación negativa, moderada baja y estadísticamente significativa, r = -0.374 (p < 0.01). CONCLUSIÓN La muestra reportó niveles de aflicción comparables con los reportados por muestras de CI en tiempos pre-pandemia. También reportaron niveles de bienestar psicológico por debajo de lo esperado para la población puertorriqueña en general. Los resultados apoyaron la correlación inversa entre aflicción y bienestar psicológico documentada previamente en la literatura. Se discutirán implicaciones de estos hallazgos para la población puertorriqueña de CI.
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Azar M, Arias F, Stelmokas J. H - 05 Non-Pharmacological Treatment for Older Adults with Mild Cognitive Impairment: Expanding Diversity into Clinical Practice and Research. Arch Clin Neuropsychol 2023; 38:1486. [PMID: 37807560 DOI: 10.1093/arclin/acad067.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Numerous non-pharmacological treatments (NPT) have been developed for older adults with mild cognitive impairment (MCI) (Bahar-Fuchs, Mowszowski, Lautenschlager, & Cox, 2021). Two forms of NPTs, namely cognitive rehabilitation (CR) and cognitive training (CT) may demonstrate cognitive benefit, but there remain significant methodological challenges in the field (Barban et al., 2016; McPhee, Downey & Stough, 2019; Sherman et al., 2020). One such limitation is the contribution of cultural and demographic factors to study outcome heterogeneity. Our goal was to highlight examples of select culturally informed NPTs and provide recommendations to expand diversity into clinical practice and research. DATA SELECTION Discussed results and limitations of recent meta-analyses and systematic reviews that focused on NPTs for MCI in older adults. We completed a review of culturally informed NPTs from the past two years. Clinician experiences informed the inclusion of additional diversity variables (e.g., methodological, demographic, social, systemic) that could be integrated into clinical practice and research. DATA SYNTHESIS There is a paucity of research considering cultural and demographic factors when delivering NPTs. Results of culturally informed CR or CT highlighted themes in the adaptation of language, cognition, function, diet, and physical activity. Additional provider, patient, and systemic factors can be considered to promote diversity, equity, and inclusion (DEI). CONCLUSIONS Culturally informed NPTs are understudied. Practical recommendations for US-based clinicians and researchers are provided that could increase access/recruitment, retention, and outcome in CT and CR for diverse populations.
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Valentine KD, Vo H, Mancini B, Urman RD, Arias F, Barry MJ, Sepucha KR. Shared Decision Making for Elective Surgical Procedures in Older Adults with and without Cognitive Insufficiencies. Med Decis Making 2023; 43:656-666. [PMID: 37427547 PMCID: PMC10526885 DOI: 10.1177/0272989x231182436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE Older adults are prone to cognitive impairment, which may affect their ability to engage in aspects of shared decision making (SDM) and their ability to complete surveys about the SDM process. This study examined the surgical decision-making processes of older adults with and without cognitive insufficiencies and evaluated the psychometric properties of the SDM Process scale. METHODS Eligible patients were 65 y or older and scheduled for a preoperative appointment before elective surgery (e.g., arthroplasty). One week before the visit, staff contacted patients via phone to administer the baseline survey, including the SDM Process scale (range 0-4), SURE scale (top scored), and the Montreal Cognitive Assessment Test version 8.1 BLIND English (MoCA-blind; score range 0-22; scores < 19 indicate cognitive insufficiency). Patients completed a follow-up survey 3 mo after their visit to assess decision regret (top scored) and retest reliability for the SDM Process scale. RESULTS Twenty-six percent (127/488) of eligible patients completed the survey; 121 were included in the analytic data set, and 85 provided sufficient follow-up data. Forty percent of patients (n = 49/121) had MoCA-blind scores indicating cognitive insufficiencies. Overall SDM Process scores did not differ by cognitive status (intact cognition x ¯ = 2.5, s = 1.0 v. cognitive insufficiencies x ¯ = 2.5, s = 1.0; P = 0.80). SURE top scores were similar across groups (83% intact cognition v. 90% cognitive insufficiencies; P = 0.43). While patients with intact cognition had less regret, the difference was not statistically significant (92% intact cognition v. 79% cognitive insufficiencies; P = 0.10). SDM Process scores had low missing data and good retest reliability (intraclass correlation coefficient = 0.7). CONCLUSIONS Reported SDM, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The SDM Process scale was an acceptable, reliable, and valid measure of SDM in patients with and without cognitive insufficiencies. HIGHLIGHTS Forty percent of patients 65 y or older who were scheduled for elective surgery had scores indicative of cognitive insufficiencies.Patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies.The Shared Decision Making Process scale was an acceptable, reliable, and valid measure of shared decision making in patients with and without cognitive insufficiencies.
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Affiliation(s)
- K D Valentine
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ha Vo
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael J Barry
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Strutt AM, Armendariz V, Arias F, Diaz Santos AL, Zink D, Vuong KD, Rossetti MA. Culturally and Linguistically Informed Neuropsychological Evaluation Protocol for Primarily Spanish-Speaking Adults. Arch Clin Neuropsychol 2023; 38:408-432. [PMID: 36988491 DOI: 10.1093/arclin/acad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. METHOD Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. RESULTS A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. CONCLUSION Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.
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Affiliation(s)
- Adriana M Strutt
- BCM Cerebro, Neuropsychology Section, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Victoria Armendariz
- BCM Cerebro, Neuropsychology Section, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL and Center for Health Equity and Engagement Research (CHEER), UF College of Medicine- Jacksonville, Jacksonville, FL 32209, USA
- Department of Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ana L Diaz Santos
- BCM Cerebro, Neuropsychology Section, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Davor Zink
- Department of Neurology, Renown Health, Reno, NV, USA
| | - Kevin Dat Vuong
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Maria Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Abstract
OBJECTIVES Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. METHODS An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization. RESULTS Higher paternal education was associated with significantly lower incidence of delirium (X2(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=-.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient's education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X2(2, N =547)=31.22, p <.001). CONCLUSIONS Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium. CLINICAL IMPLICATIONS Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
| | - Eran Metzger
- Department of Medicine, Hebrew SeniorLife, Boston, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Harvard Medical School, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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12
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Fong TG, Hshieh TT, Tabloski PA, Metzger ED, Arias F, Heintz HL, Patrick RE, Lapid MI, Schmitt EM, Harper DG, Forester BP, Inouye SK. Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach. Am J Geriatr Psychiatry 2022; 30:1067-1078. [PMID: 35581117 PMCID: PMC10413471 DOI: 10.1016/j.jagp.2022.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023]
Abstract
Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia. Because DSD is associated with poorer clinical outcomes than dementia alone, detecting delirium is important for reducing morbidity and mortality in this population. We review a number of delirium screening instruments that have shown promise for use in DSD, including the 4-DSD, combined Six Item Cognitive Impairment Test (6-CIT) and 4 'A's Test (4AT), Confusion Assessment Method (CAM), and the combined UB2 and 3D-CAM (UB-CAM). Each has advantages and disadvantages. We then describe the operationalization of a CAM-based approach in a current ECT in dementia project as an example of modifying an existing instrument for patients with moderate to severe dementia. Ultimately, any instrument modified will need to be validated against a standard clinical reference, in order to fully establish its sensitivity and specificity in the moderate to severe dementia population. Future work is greatly needed to advance the challenging area of accurate identification of delirium in moderate or severe dementia.
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Affiliation(s)
- Tamara G Fong
- Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA.
| | - Tammy T Hshieh
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA; Department of Medicine (TTH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Eran D Metzger
- Departments of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Franchesca Arias
- Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
| | - Hannah L Heintz
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Regan E Patrick
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | | | - Eva M Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
| | - David G Harper
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Brent P Forester
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Sharon K Inouye
- Departments of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
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13
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Ubeda C, Vano E, Perez MD, Jímenez P, Ramirez R, Nader A, Miranda P, Azcurra P, Damsky J, Capdevila S, Oliveira M, Albuquerque J, Bocamino R, Schelin H, Yagui A, Aguirre D, Riquelme N, Cardenas L, Álvarez A, Mosquera W, Arias F, Gutierrez R, De la Mora R, Rivera T, Zapata J, Araujo P, Chiesa P. Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges. J Radiol Prot 2022; 42:031513. [PMID: 35940166 DOI: 10.1088/1361-6498/ac87b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.
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Affiliation(s)
- C Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - E Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - M D Perez
- World Health Organization (WHO), Geneva, Switzerland
| | - P Jímenez
- Pan American Health Organization (PAHO), Washington, DC, United States of America
| | - R Ramirez
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - A Nader
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - P Miranda
- Luis Calvo Mackenna's Hospital, AntonioVaras 360, Santiago, Chile
| | - P Azcurra
- Hemodynamic Service, Italian Hospital, Buenos Aires, Argentina
| | - J Damsky
- Hemodynamic Service, Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina
| | - S Capdevila
- Hemodynamic Service, Santísima Trinidad Children's Hospital, Córdova, Argentina
| | - M Oliveira
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, Brazil
| | - J Albuquerque
- University Hospital of the Federal University of Maranhão, San Luis, Brasil
| | - R Bocamino
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brasil
| | - H Schelin
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - A Yagui
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - D Aguirre
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - N Riquelme
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - L Cardenas
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - A Álvarez
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - W Mosquera
- Valle del Lili Foundation University Hospital ICESI, Cali, Colombia
| | - F Arias
- National Children's Hospital, San José, Costa Rica
| | - R Gutierrez
- National Children's Hospital, San José, Costa Rica
| | - R De la Mora
- National Directorate of Environmental Health, Ministry of Public Health, Havana, Cuba
| | - T Rivera
- Center for Research in Applied Sciences and Advanced Technology Legaria, IPN, Ciudad de México, Mexico
| | - J Zapata
- National Institute of Child Health St. Borja, Lima, Peru
| | - P Araujo
- National Cardiovascular Institute, Lima, Peru
| | - P Chiesa
- Children's Cardiology Institute, Montevideo, Uruguay
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14
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Shiff HM, Arias F, Dufour AB, Carr D, Chen F, Gou Y, Jones R, Schmitt E, Travison TG, Kunicki ZJ, Okereke OI, Inouye SK. Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures. Innov Aging 2022; 6:igac050. [PMID: 36128514 PMCID: PMC9478553 DOI: 10.1093/geroni/igac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk.
Research Design and Methods
A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay.
Results
Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units.
Discussion and Implications
Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
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Affiliation(s)
- Haley M Shiff
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Alyssa B Dufour
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Deborah Carr
- Department of Sociology, Boston University , Boston, Massachusetts , USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Yun Gou
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Eva Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Thomas G Travison
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Olivia I Okereke
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Sharon K Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
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15
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Ibáñez P, Valladolid V, Villa-Abaunza A, Espinosa A, Arias F, Galve P, Sánchez-Parcerisa D, Udías J. PO-1730 Real-time hybrid Monte Carlo for dose calculation in proton therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Miranda M, Arias F, Arain A, Newman B, Rolston J, Richards S, Peters A, Pick LH. Neuropsychological evaluation in American Sign Language: A case study of a deaf patient with epilepsy. Epilepsy Behav Rep 2022; 19:100558. [PMID: 35856041 PMCID: PMC9287772 DOI: 10.1016/j.ebr.2022.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/23/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michelle Miranda
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
- Corresponding author at: University of Utah, Center for Alzheimer’s Care, Imaging, and Research (CACIR), 650 Komas Dr. Suite 106A, Salt Lake City, UT 84108, USA.
| | - Franchesca Arias
- Hinda & Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Department of Cognitive Neurology, Boston, 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Amir Arain
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
| | - Blake Newman
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
| | - John Rolston
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
- University of Utah, Department of Neurosurgery, Salt Lake City, UT 84132, USA
| | - Sindhu Richards
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
| | - Angela Peters
- University of Utah, Department of Neurology, Salt Lake City, UT 84132, USA
| | - Lawrence H. Pick
- Gallaudet University, Department of Psychology, Washington, DC, 20002, USA
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17
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Arias F, Alegria M, Kind AJ, Jones RN, Travison TG, Marcantonio ER, Schmitt EM, Fong TG, Inouye SK. A framework of social determinants of health for delirium tailored to older adults. J Am Geriatr Soc 2022; 70:235-242. [PMID: 34693992 PMCID: PMC8742772 DOI: 10.1111/jgs.17465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
Delirium is a debilitating medical condition that disproportionately affects hospitalized older adults and is associated with adverse health outcomes, increased mortality, and high medical costs. Efforts to understand delirium risk in hospitalized older adults have focused on examining medical comorbidities, pre-existing cognitive deficits, and other clinical and demographic factors present in the period proximate to the hospitalization. The contribution of social determinants of health (SDOH), including social circumstances, environmental characteristics, and early-life exposures, referred as the social exposome, to delirium risk is poorly understood. Increased knowledge about the influence of SDOH will offer a more comprehensive understanding of factors that may increase vulnerability to delirium and poor outcomes. Clinically, these efforts can guide the development and implementation of holistic preventive strategies to improve clinical outcomes. We propose a SDOH framework for delirium adapted for older adults. We provide the definition, description, and rationale for the domains and variables in our proposed model.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA,Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
| | - Amy J. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI,Madison VA Geriatrics Research Education and Clinical Center (GRECC), Middleton VA Hospital, Madison, WI
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI
| | - Thomas G. Travison
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA,Harvard Medical School, Boston, MA,Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA,Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA,Harvard Medical School, Boston, MA,Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
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18
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Arias F, Chen F, Shiff H, Marcantonio ER, Jones RN, Travison TG, Schmitt EM, Fong TG, Inouye SK. Parental education and delirium risk after surgery in older adults: A lifecourse analysis. Alzheimers Dement 2021. [DOI: 10.1002/alz.056049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Franchesca Arias
- Marcus Institute for Aging Research at Hebrew SeniorLife Boston MA USA
| | - Fan Chen
- Marcus Institute for Aging Research at Hebrew SeniorLife Boston MA USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health Boston MA USA
| | | | | | - Thomas G Travison
- Marcus Institute for Aging Research, Hebrew SeniorLife Boston MA USA
| | - Eva M Schmitt
- Marcus Institute for Aging Research, Hebrew SeniorLife Boston MA USA
| | - Tamara G Fong
- Marcus Institute for Aging Research, Hebrew SeniorLife Boston MA USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research, Hebrew SeniorLife Boston MA USA
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19
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Scott TM, Arnsten J, Olsen JP, Arias F, Cunningham CO, Rivera Mindt M. Neurocognitive, psychiatric, and substance use characteristics in a diverse sample of persons with OUD who are starting methadone or buprenorphine/naloxone in opioid treatment programs. Addict Sci Clin Pract 2021; 16:64. [PMID: 34689841 PMCID: PMC8543954 DOI: 10.1186/s13722-021-00272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). Persons with OUD have high rates of neurocognitive impairment and psychiatric and substance use disorders, but few studies have examined these characteristics in diverse patients initiating OAT in opioid treatment programs (OTPs). Additionally, in these individuals, poor neurocognitive functioning and psychiatric/other substance use disorders are associated with poor OUD treatment outcomes. Given rapid changes in the opioid epidemic, we sought to replicate findings from our pilot study by examining these characteristics in a large diverse sample of persons with OUD starting OTP-based OAT. METHODS Ninety-seven adults with OUD (M age = 42.2 years [SD = 10.3]; M education = 11.4 years [SD = 2.3]; 27% female; 22% non-Hispanic white) were enrolled in a randomized longitudinal trial evaluating methadone versus buprenorphine/naloxone on neurocognitive functioning. All participants completed a comprehensive neurocognitive, psychiatric, and substance use evaluation within one week of initiating OAT. RESULTS Most of the sample met criteria for learning (79%) or memory (69%) impairment. Half exhibited symptoms of current depression, and comorbid substance use was highly prevalent. Lifetime cannabis and cocaine use disorders were associated with better neurocognitive functioning, while depression was associated with worse neurocognitive functioning. CONCLUSIONS Learning and memory impairment are highly prevalent in persons with OUD starting treatment with either methadone or buprenorphine/naloxone in OTPs. Depression and comorbid substance use are prevalent among these individuals, but neither impact learning or memory. However, depression is associated with neurocognitive impairment in other domains. These findings might allow clinicians to help persons with OUD starting OAT to develop compensatory strategies for learning and memory, while providing adjunctive treatment for depression. Trial Registration NCT, NCT01733693. Registered November 4, 2012, https://clinicaltrials.gov/ct2/show/NCT01733693 .
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Affiliation(s)
- Travis M Scott
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, 3801 Miranda Ave, Palo Alto, CA, 94304, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA.
| | - Julia Arnsten
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - James Patrick Olsen
- Department of Neurology, North Shore University Hospital, Manhasset, NY, USA
| | - Franchesca Arias
- The Aging Brain Center, Hebrew SeniorLife, Boston, MA, USA.,Department of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin America and Latino Studies Institute, Fordham University, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Mindt MR, Coulehan K, Aghvinian M, Scott TM, Olsen JP, Cunningham CO, Arias F, Arnsten JH. Underrepresentation of diverse populations and clinical characterization in opioid agonist treatment research: A systematic review of the neurocognitive effects of buprenorphine and methadone treatment. J Subst Abuse Treat 2021; 135:108644. [PMID: 34857427 DOI: 10.1016/j.jsat.2021.108644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The relative neurocognitive effects of the two most common opioid agonist treatments (OAT; buprenorphine and methadone) for opioid use disorder (OUD) are poorly understood. The aim of this systematic review is to examine the neurocognitive effects of OAT (buprenorphine and methadone) and the clinical and sociodemographic characteristics of study samples. METHODS The research team queried PubMed, PsycINFO and Cochrane Reviews for articles (01/1980-01/2020) with terms related to neurocognitive testing in adults (age ≥ 18) prescribed OAT. The team extracted neurocognitive data and grouped them by domain (e.g., executive functioning, learning/memory), and assessed study quality. RESULTS The search retrieved 2341 abstracts, the team reviewed 278 full articles, and 32 met inclusion criteria. Of these, 31 were observational designs and one was an experimental design. Healthy controls performed better across neurocognitive domains than OAT-treated persons (buprenorphine or methadone). Compared to those with active OUD, OAT-treated persons had better neurocognition in various domains. However, in seven studies comparing buprenorphine- and methadone-treated persons, buprenorphine was associated with better neurocognition than was methadone, with moderate to large effect sizes in executive functioning, attention/working memory, and learning/memory. Additionally, OAT research underreports clinical characteristics and underrepresents Black and Latinx adults, as well as women. CONCLUSIONS Findings suggest that compared to active opioid use, both buprenorphine and methadone treatment are associated with better neurocognitive functioning, but buprenorphine is associated with better executive functioning, attention/working memory, and learning/memory. These findings should be interpreted with caution given widespread methodological heterogeneity, and limited representation of ethnoracially diverse adults and women. Rigorous longitudinal comparisons with more diverse, better characterized samples will help to inform treatment and policy recommendations for persons with OUD.
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Affiliation(s)
- Monica Rivera Mindt
- Fordham University, Department of Psychology, USA; Icahn School of Medicine at Mount Sinai, Department of Neurology, USA.
| | | | - Maral Aghvinian
- Fordham University, Department of Psychology, USA; Icahn School of Medicine at Mount Sinai, Department of Neurology, USA.
| | - Travis M Scott
- VA Palo Alto Health Care System, Sierra Pacific Mental Illness Research Education Clinical Center, USA; Stanford School of Medicine, Department of Psychiatry and Behavioral Sciences, USA.
| | | | - Chinazo O Cunningham
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Medicine, USA.
| | - Franchesca Arias
- The Aging Brain Center, Hebrew SeniorLife, USA; Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Cognitive Neurology, USA.
| | - Julia H Arnsten
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Medicine, USA.
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Tabloski PA, Arias F, Flanagan N, Webb M, Gregas M, Schmitt EM, Travison TG, Jones RN, Inouye SK, Fong TG. Predictors of Caregiver Burden in Delirium: Patient and Caregiver Factors. J Gerontol Nurs 2021; 47:32-38. [PMID: 34432572 DOI: 10.3928/00989134-20210803-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study examined the association of patient factors, patient/caregiver relationships, and living arrangements with caregiver burden due to delirium. The sample included a subset (N = 207) of hospitalized medical and surgical patients (aged >70 years) enrolled in the Better Assessment of Illness Study and their care-givers. The majority of caregivers were female (57%) and married (43%), and 47% reported living with the patient. Delirium occurred in 22% of the sample, and delirium severity, pre-existing cognitive impairment, and impairment of any activities of daily living (ADL) were associated with higher caregiver burden. However, only the ADL impairment of needing assistance with transfers was independently significantly associated with higher burden (p < 0.01). Child, child-in-law, and other relatives living with or apart from the patient reported significantly higher caregiver burden compared to spouse/partners (p < 0.01), indicating caregiver relationship and living arrangement are associated with burden. Future studies should examine additional factors contributing to delirium burden. [Journal of Gerontological Nursing, 47(9), 32-39.].
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Rubio Rodríguez M, Arias F, Chen-Zhao X, Flamarique S, Fernández-Letón P, Campo M, López M, Rodríguez M, Zucca D, Martínez D, Sánchez-Saugar E, Mañeru F, García Ruiz-Zorrilla J, García de Acilu P, Valero J, Montero A, Ciérvide R, Alvarez B, García-Aranda M, Alonso R, de la Casa M, Alonso L, Nuñez M, Martí J, Hernando O. OC-0416 Results of SBRT-SG-01, a prospective multicentric-study of SBRT for liver metastases. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Avila JF, Rentería MA, Jones RN, Vonk JMJ, Turney I, Sol K, Seblova D, Arias F, Hill-Jarrett T, Levy SA, Meyer O, Racine AM, Tom SE, Melrose RJ, Deters K, Medina LD, Carrión CI, Díaz-Santos M, Byrd DR, Chesebro A, Colon J, Igwe KC, Maas B, Brickman AM, Schupf N, Mayeux R, Manly JJ. Education differentially contributes to cognitive reserve across racial/ethnic groups. Alzheimers Dement 2021; 17:70-80. [PMID: 32827354 PMCID: PMC8376080 DOI: 10.1002/alz.12176] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We examined whether educational attainment differentially contributes to cognitive reserve (CR) across race/ethnicity. METHODS A total of 1553 non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and Hispanics in the Washington Heights-Inwood Columbia Aging Project (WHICAP) completed structural magnetic resonance imaging. Mixture growth curve modeling was used to examine whether the effect of brain integrity indicators (hippocampal volume, cortical thickness, and white matter hyperintensity [WMH] volumes) on memory and language trajectories was modified by education across racial/ethnic groups. RESULTS Higher educational attainment attenuated the negative impact of WMH burden on memory (β = -0.03; 99% CI: -0.071, -0.002) and language decline (β = -0.024; 99% CI:- 0.044, -0.004), as well as the impact of cortical thinning on level of language performance for Whites, but not for Blacks or Hispanics. DISCUSSION Educational attainment does not contribute to CR similarly across racial/ethnic groups.
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Affiliation(s)
- Justina F. Avila
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Richard N. Jones
- Department of Neurology, Warren Alpert Medical School, Brown University, Butler Hospital, Providence, Rhode Island, USA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Indira Turney
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Ketlyne Sol
- Department of Psychology, University of Michigan, Michigan, Ann Arbor, USA
| | - Dominika Seblova
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Franchesca Arias
- Aging Brain Center, Hebrew Senior Life, Harvard Medical School Affiliate, Boston, Massachusetts, USA
| | | | - Shellie-Anne Levy
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Oanh Meyer
- Department of Neurology, University of California Davis School of Medicine, Sacramento, California, USA
| | | | - Sarah E. Tom
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Kacie Deters
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Carmen I. Carrión
- Department of Neurology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Mirella Díaz-Santos
- Department of Psychiatry & Biobehavioral Sciences, University of California Los, Angeles, California, USA
| | - DeAnnah R. Byrd
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Anthony Chesebro
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Juliet Colon
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kay C. Igwe
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Benjamin Maas
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Tabloski P, Arias F, Flanagan N, Fong T, Schmitt E, Jones R, Travison T, Inouye S. Predictors of Caregiver Burden in Delirium: Patient and Caregiver Factors. Innov Aging 2020. [PMCID: PMC7741870 DOI: 10.1093/geroni/igaa057.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Delirium — an acute disorder of attention and cognition — is a common, life-threatening and costly syndrome occurring frequently in older hospitalized persons. The unexpected, rapid, and volatile nature of delirium can be difficult for family caregivers to experience and may contribute to subjective feelings of distress (i.e. “delirium burden”). The aim of this study was to examine whether pre-admission patient characteristics or patient-caregiver relationship and living arrangements were associated with caregiver burden as measured by the delirium burden scale for caregivers (DEL-B-C; score 0-40, higher score is more burden). Our sample consisted of 208 older adults and their caregivers from the Better Assessment of Illness (BASIL) study, an ongoing prospective, observational study of surgical and medical patients ≥70 years old; 22% of patients experienced delirium by the Confusion Assessment Method (CAM) and the average DEL-B-C score was 7.9, 95% CI(6.95-8.88). Results indicated that neither patient-caregiver relationship and living arrangement or patient factors including pre-admission pain, sleep disturbance, or new onset incontinence were significantly correlated with delirium-related caregiver burden. However, DEL-B-C scores were significantly higher in caregivers of patients with any ADL impairment (mean 8.5 vs. 5.2, p = .016) during hospitalization although none of the individual functional deficits alone were statistically significant. This finding suggests that the association of ADL impairment and DEL-B-C scores is not driven by a single functional domain. Future studies are needed to further understand how caregiver characteristics and patient factors occurring before and during hospitalization contribute to caregiver burden after the occurrence of delirium.
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Affiliation(s)
| | - Franchesca Arias
- Marcus Institue for Aging Rsearch, Hebrew Senior Life, Boston, Massachusetts, United States
| | - Nina Flanagan
- Binghamton University, Vestal, New York, United States
| | - Tamara Fong
- Institute for Aging Research / Hebrew SeniorLife, Boston, Massachusetts, United States
| | - Eva Schmitt
- Harvard Medical School, Boston, Massachusetts, United States
| | - Richard Jones
- Brown University, Providence, Rhode Island, United States
| | - Thomas Travison
- Harvard Medical School, Boston, Massachusetts, United States
| | - Sharon Inouye
- Harvard University, Boston, Massachusetts, United States
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25
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Arias F, Chen F, Fong TG, Shiff H, Alegria M, Marcantonio ER, Gou Y, Jones RN, Travison TG, Schmitt EM, Kind AJ, Inouye SK. Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery. J Am Geriatr Soc 2020; 68:2863-2871. [PMID: 32865254 PMCID: PMC7744425 DOI: 10.1111/jgs.16782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compared neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence. DESIGN A prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status. SETTING Two academic medical centers in Boston, MA. PARTICIPANTS A total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery. INTERVENTION The Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage. MEASUREMENTS Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM-S) occurring during daily hospital assessments (CAM-S Peak). RESULTS Residing in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3-3.1). The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P = .009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual-level markers of socioeconomic status and cultural background were: 1.2 (0.9-1.7) for education of 12 years or less; 1.3 (0.8-2.1) for non-White race; and 1.7 (1.1-2.6) for annual household income of less than $20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk. CONCLUSIONS Neighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA 02115
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA 02115, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Yun Gou
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, MA 02115, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA 02131, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
| | - Amy J.H. Kind
- Health Services and Care Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI 53705, USA
- Madison VA Geriatrics Research Education and Clinical Center (GRECC), Middleton VA Hospital, Madison WI 53705, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Arias F, Safi DE, Miranda M, Carrión CI, Diaz Santos AL, Armendariz V, Jose IE, Vuong KD, Suarez P, Strutt AM. Teleneuropsychology for Monolingual and Bilingual Spanish-Speaking Adults in the Time of COVID-19: Rationale, Professional Considerations, and Resources. Arch Clin Neuropsychol 2020; 35:1249-1265. [PMID: 33150414 PMCID: PMC7665473 DOI: 10.1093/arclin/acaa100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Neuropsychological assessments with monolingual Spanish and bilingual Spanish/English-speaking adults present unique challenges. Barriers include, but are not limited to, the paucity of test norms, uncertainty about the equivalence of translated neuropsychological tests, and limited proficiency in the provision of culturally competent services. Similar issues generalize to telephone- and video-based administration of neuropsychological tests or teleneuropsychology (TeleNP) with Hispanics/Latinos (as), and few studies have examined its feasibility and validity in this group. The sudden onset of the COVID-19 pandemic prompted neuropsychologists to identify alternative ways to provide equitable care. Clinicians providing TeleNP to this population during (and after) the pandemic must consider safety, professional factors, and systemic barriers to accessing and benefitting from virtual modalities. METHOD This clinical process manuscript describes how cross-cultural neuropsychologists across five U.S. academic institutions serving Hispanics/Latinos (as) developed TeleNP models of care during the pandemic. RESULTS Workflows, test batteries, and resources for TeleNP assessment with monolingual and bilingual Spanish-speaking patients are included. Factors guiding model development and informing decisions to incorporate virtual administration of neuropsychological tests into their practice are also discussed. CONCLUSIONS Provision of TeleNP is a promising modality. Additional research in this area is warranted with focus on cultural and contextual factors that support or limit the use of TeleNP with this community.
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Affiliation(s)
- Franchesca Arias
- Hinda & Arthur Marcus Institute for Aging Research, The Aging Brain Center, Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Diomaris E Safi
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Michelle Miranda
- Department of Cognitive Neurology, University of Utah, Salt Lake City, UT 84112, USA
| | - Carmen I Carrión
- Department of Neurology, Yale School of Medicine, New Haven, CT 06519, USA
| | | | | | - Irene E Jose
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
| | - Kevin D Vuong
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Adriana M Strutt
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Wiggins M, Arias F, Urman RD, Richman DC, Sweitzer BJ, Edwards AF, Armstrong MJ, Chopra A, Libon DJ, Price C. Common neurodegenerative disorders in the perioperative setting: Recommendations for screening from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Perioper Care Oper Room Manag 2020; 20:100092. [PMID: 32577538 PMCID: PMC7311090 DOI: 10.1016/j.pcorm.2020.100092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aging is associated with normal and abnormal brain and cognitive changes. Due to the expected increase in older adults requiring surgery, perioperative clinicians will be increasingly encountering patients with neurodegenerative disease. To help perioperative clinicians understand signs of abnormal behaviors that may mark an undiagnosed neurodegenerative disorder and alert additional patient monitoring, The Society for Perioperative Assessment and Quality Improvement (SPAQI) worked with experts in dementia, neuropsychology, geriatric medicine, neurology, and anesthesiology to provide a summary of cognitive and behavioral considerations for patients with common neurodegenerative disorders being evaluated at preoperative centers. Patients with neurodegenerative disorders are at high risk for delirium due to known neurochemical disruptions, medication interactions, associated frailty, or vascular risk profiles presenting risk for repeat strokes. We provide basic information on the expected cognitive changes with aging, most common neurodegenerative disorders, a list of behavioral features and considerations to help differentiate neurodegenerative disorders. Finally, we propose screening recommendations intended for a multidisciplinary team in the perioperative setting.
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Affiliation(s)
- Margaret Wiggins
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, Gainesville, FL 32610
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Deborah C Richman
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480
| | - Bobbie Jean Sweitzer
- Northwestern University Feinberg School of Medicine, 251 East Huron, Chicago, IL 60611
| | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Melissa J Armstrong
- Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 Williston Road, Gainesville, Florida 32608
- Neurology Department, University of Florida, 101 S Newell Drive, Gainesville, FL 32610
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
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Flamarique S, Campo M, Asín G, Pellejero S, Viúdez A, Arias F. Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters. Clin Transl Oncol 2020; 22:2350-2356. [PMID: 32488803 DOI: 10.1007/s12094-020-02375-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE We analysed our initial experience with SBRT in liver metastasis from colorectal cancer at our institution. MATERIALS AND METHODS Between January/2014 and December/2017, 22 patients with 31 LMCCR were treated. Local control (LC) was assessed using the Kaplan-Meier and log-rank tests. We analysed potential prognostic factors for LC: sex, PTV size, number of LM and the radiation scheme. RESULTS Median age: 69 years. Prior chemotherapy or local liver treatments: 81.8% and 63.6% of patients, respectively. SBRT consisted of 3 × 20 Gy (42.9%) and 3 × 15 Gy (31.4%). There were 88.5% responses (57.1% CR and 31.4% PR). Median follow-up was 30 months. LC per lesion at 12 and 24 months was 85.3% and 61.8%, respectively. Tumour volumes > 30 cc correlated with worsened 2-year-control rates (90% vs 34.5%) (p = 0.005). There was only a patient with CTC-grade 3 toxicity. CONCLUSIONS Liver SBRT is a safe and effective treatment that achieves high local control rates. We found a significant correlation between larger LMCRC and worse local control.
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Affiliation(s)
- S Flamarique
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
| | - M Campo
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
| | - G Asín
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
| | - S Pellejero
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
| | - A Viúdez
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain.,Medical Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
| | - F Arias
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain.
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Irazusta A, Rodríguez-Camejo C, Jorcin S, Puyol A, Fazio L, Arias F, Castro M, Hernández A, López-Pedemonte T. High-pressure homogenization and high hydrostatic pressure processing of human milk: Preservation of immunological components for human milk banks. J Dairy Sci 2020; 103:5978-5991. [PMID: 32418693 DOI: 10.3168/jds.2019-17569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
Abstract
Human milk (HM) constitutes the first immunological barrier and the main source of nutrients and bioactive components for newborns. Immune factors comprise up to 10% of the protein content in HM, where antibodies are the major components (mainly IgA, IgG, and IgM). In addition, antibacterial enzymes such as lysozyme and immunoregulatory factors such as soluble cluster of differentiation 14 (sCD14) and transforming growth factor β2 (TGF-β2) are also present and play important roles in the protection of the infant's health. Donor milk processed in HM banks by Holder pasteurization (HoP; 62.5°C, 30 min) is a safe and valuable resource for preterm newborns that are hospitalized, but is reduced in major immunological components due to thermal inactivation. We hypothesized that high hydrostatic pressure (HHP) and high-pressure homogenization (HPH) are 2 processes that can be used on HM to reduce total bacteria counts while retaining immunological components. We studied the effects of HHP (400, 450, and 500 MPa for 5 min applied at 20°C) and HPH (200, 250, and 300 MPa, milk inlet temperature of 20°C) applied to mature HM, on microbiological and immunological markers (IgA, IgG, IgM, sCD14, and TGF-β2), and compared them with those of traditional HoP in HM samples from healthy donors. The HHP processing between 400 and 500 MPa at 20°C reduced counts of coliform and total aerobic bacteria to undetectable levels (<1.0 log cfu/mL) while achieving approximately 100% of immunological component retention. In particular, comparing median percentages of retention of immunological components for 450 MPa versus HoP, we found 101.5 versus 50.5% for IgA, 89.5 versus 26.0% for IgM, 104.5 versus 75.5% for IgG, 125.0 versus 72.5% for lysozyme, 50.6 versus 0.1% for sCD14, and 88.5 versus 61.1% for TGF-β2, respectively. Regarding HPH processing, at a pressure of 250 MPa and inlet temperature of 20°C, the process showed good potential to reduce coliforms to undetectable levels and total aerobic bacteria to levels slightly above those obtained by HoP. The median percentages of retention of immunological markers for HPH versus HoP were 71.5 versus 52.0%, 71.0 versus 27.0%, 104.0 versus 66.5%, and 30.9 versus 0.2%, for IgA, IgM, IgG, and sCD14, respectively; results did not significantly differ for lysozyme and TGF-β2. The HPH at 300 MPa produced higher inactivation of immunological components, similar to values achieved with HoP.
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Affiliation(s)
- A Irazusta
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800
| | - C Rodríguez-Camejo
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - S Jorcin
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800
| | - A Puyol
- Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - L Fazio
- Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - F Arias
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - M Castro
- Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - A Hernández
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - T López-Pedemonte
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800.
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Campeny E, López-Pelayo H, Nutt D, Blithikioti C, Oliveras C, Nuño L, Maldonado R, Florez G, Arias F, Fernández-Artamendi S, Villalbí JR, Sellarès J, Ballbè M, Rehm J, Balcells-Olivero MM, Gual A. The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. Eur Neuropsychopharmacol 2020; 33:1-35. [PMID: 32165103 DOI: 10.1016/j.euroneuro.2020.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.
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Affiliation(s)
- E Campeny
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain.
| | - H López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - C Blithikioti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - C Oliveras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - L Nuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - R Maldonado
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - G Florez
- Hospital Universitario de Ourense, Ourense, Spain
| | - F Arias
- Hospital Doce de Octubre, Madrid, Spain
| | | | - J R Villalbí
- Public Health Agency of Barcelona, Barcelona, Spain
| | - J Sellarès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - M Ballbè
- Catalan Institute of Oncology, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - J Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, (CAMH), Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Canada; Department of Psychiatry, Faculty of Medicine, UofT, Canada; Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M M Balcells-Olivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Gual
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
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Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth 2020; 62:109724. [PMID: 32018131 DOI: 10.1016/j.jclinane.2020.109724] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/08/2019] [Accepted: 01/11/2020] [Indexed: 02/01/2023]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America.
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
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Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid In-Person Cognitive Screening in the Preoperative Setting: Test Considerations and Recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). ACTA ACUST UNITED AC 2020; 19. [PMID: 32342018 DOI: 10.1016/j.pcorm.2020.100089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
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Dion C, Arias F, Amini S, Davis R, Penney D, Libon DJ, Price CC. Cognitive Correlates of Digital Clock Drawing Metrics in Older Adults with and without Mild Cognitive Impairment. J Alzheimers Dis 2020; 75:73-83. [PMID: 32250300 PMCID: PMC7217723 DOI: 10.3233/jad-191089] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A digital version of the clock drawing test (dCDT) provides new latency and graphomotor behavioral measurements. These variables have yet to be validated with external neuropsychological domains in non-demented adults. OBJECTIVE The current investigation reports on cognitive constructs associated with selected dCDT latency and graphomotor variables and compares performances between individuals with mild cognitive impairment (MCI) and non-MCI peers. METHODS 202 non-demented older adults (age 68.79 ± 6.18, 46% female, education years 16.02 ± 2.70) completed the dCDT and a comprehensive neuropsychological protocol. dCDT variables of interest included: total completion time (TCT), pre-first hand latency (PFHL), post-clock face latency (PCFL), and clock face area (CFA). We also explored variables of percent time drawing (i.e., 'ink time') versus percent time not drawing (i.e., 'think time'). Neuropsychological domains of interest included processing speed, working memory, language, and declarative memory. RESULTS Adjusting for age and premorbid cognitive reserve metrics, command TCT positively correlated with multiple cognitive domains; PFHL and PCFL negatively associated with worse performance on working memory and processing speed tests. For Copy, TCT, PCFL, and PFHL negatively correlated with processing speed, and CFA negatively correlated with language. Between-group analyses show MCI participants generated slower command TCT, produced smaller CFA, and required more command 'think' (% Think) than 'ink' (% Ink) time. CONCLUSION Command dCDT variables of interest were primarily processing speed and working memory dependent. MCI participants showed dCDT differences relative to non-MCI peers, suggesting the dCDT may assist with classification. Results document cognitive construct validation to digital metrics of clock drawing.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Franchesca Arias
- Aging Brain Center at Hebrew Senior Life, Harvard University, Boston, MA, USA
| | - Shawna Amini
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dana Penney
- Department of Neurology, Lahey Clinic Medical Center, Burlington, MA, USA
| | - David J. Libon
- Department of Geriatrics, Gerontology, and Psychology, Rowan University, Glassboro, NJ, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Flamarique S, Campo M, Asín G, Zubimendi C, Arias F. [Re-irradiation with SBRT (Stereotactic Body Radiation Therapy) for locoregional unresectable relapse of head and neck cancer: a case report]. An Sist Sanit Navar 2019; 42:339-343. [PMID: 31343640 DOI: 10.23938/assn.0715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with an unresectable recurrence of head and neck carcinoma (HNC) have a poor prognosis, with limited treatment options. Recent technical advances allow radiotherapy (RT) to be handled with great precision, making it possible to re-irradiate recurrent tumors by means of stereotactic body radiotherapy (SBRT) with high doses of RT while protecting healthy tissues near the tumor. Although this technique has been used to irradiate different primary tumors and their metastases, SBRT in HNC has had a much slower evolution than in the mentioned locations. This is due to the difficulties in re-irradiating the HNC, because of the expected toxicity as it is a relatively small area with dense vascularization and innervation, and where several senses are located. We present the first case of a HNC re-irradiated with SBRT in the Complejo Hospitalario de Navarra; the patient showed a complete response and continues to be disease-free sixteen months after the irradiation.
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Affiliation(s)
- S Flamarique
- Servicio de Oncología Radioterápica. Complejo Hospitalario de Navarra. Pamplona..
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Amofa Sr. P, Arias F, Trifilio E, Belser-Ehrlich J, Rohl B, Lopez F, Levy SA. Free Neurocognitive Screening Initiative: An Opportunity to Address Health Disparities and Promote Cultural Competence in Northcentral Florida. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The risk for cognitive impairment is greater in individuals with low SES and limited education. In rural areas, distance and economic concerns preclude individuals from accessing care. In Alachua County, 23% of residents live below poverty and 16% are uninsured. The Neurocognitive Screening Initiative (NSI) attempts to reduce disparities in Alachua by offering free neurocognitive screening. NSI also aspires to promote cultural competence through unique training opportunities for clinical neuropsychology doctoral students.
Method
Patients learned about NSI through flyers, word of mouth, or referrals. Appointments include a clinical interview, cognitive testing, and mood questionnaires. Patients receive feedback, brain health recommendations, and referrals to community resources. Phase 1 began in November 2017 and involved selection of appropriate cognitive measures, development and dissemination of advertising materials, identification of resources, and trainee recruitment. From February 2018 to August 2018, phase 2 involved administration of cognitive screeners. Phase 3 involved continued provision of clinical services, expansion of the NSI team and increased culturally relevant outreach.
Outcomes
NSI’s greatest challenge is recruitment of the appropriate demographic. Since phase 2, we have evaluated 10 patients with diverse racial, socioeconomic, and clinical characteristics. NSI has recruited an ethnoracially diverse cohort of trainees comprised of 4 graduate students and 2 postdoctoral fellows supervised by a clinical neuropsychologist.
Discussion
Efforts to provide services to marginalized individuals have uncovered challenges in attracting patients who might benefit from these services. NSI is forging community partnerships with churches, libraries, and local organizations to reach the targeted audience. Via weekly meetings, participation in community events/outreach, and clinical work, NSI provides unique training for emerging neuropsychologists.
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Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, Giordano C, Garvan CW, Enneking FK, Price CC. Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic. Anesth Analg 2019; 129:830-838. [PMID: 31425227 PMCID: PMC6927245 DOI: 10.1213/ane.0000000000004190] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
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Affiliation(s)
- Shawna Amini
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Samuel Crowley
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Loren Hizel
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - David J. Libon
- Department of Geriatrics, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Gerontology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Psychology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Chris Giordano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - F. Kayser Enneking
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
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Abstract
In a preoperative anesthesia setting with integrated neuropsychology for individuals >64 years of age, we completed a pilot study examining the association between neurocognitive disorders with frequency of missed colonoscopies and quality of bowel preparation (prep). Gastroenterologists completed the Boston Bowel Preparation Scale (BBPS) for each patient. Of 47 older adults seen in our service, 68% met criteria for neurocognitive disorders. All individuals failing to attend the colonoscopy procedure had met criteria for major neurocognitive disorder. Poor bowel prep was also identified in 100% of individuals with major neurocognitive disorder and 28% of individuals with mild neurocognitive disorder. Our pilot data suggest that, in high-risk individuals, the presence of neurocognitive disorders is risk factors for missed appointments and inadequate bowel prep. These pilot data provide reference statistics for future intervention protocols.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, Gainesville, FL
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Michael Riverso
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Shellie-Anne Levy
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Rebecca Armstrong
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - David S. Estores
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | - Catherine C. Price
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
- Department of Anesthesiology, University of Florida, Gainesville, FL
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Carrión CI, Arias F, Diaz-Santos M, Levy SA, Hill-Jarrett TG, Avila J, Jones R, Rivera Mindt M, Arce M, Schupf N, Mayeux R, Manly J. Does Literacy Moderate the Relationship between Age of Migration and Cognitive Change: Results from the Washington Heights-Inwood Community Aging Project (WHICAP). Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The “healthy immigrant effect” pertains to findings that Hispanics/Latinos born outside of the US tend to be physically and emotionally healthier than individuals born in the US. However, immigrant Latino groups residing in the US have higher incidences of dementia (Tang et al., 2001). Sex/gender and years of education have been found to moderate the relationship between age of migration and cognitive functioning among immigrants born in Mexico (Garcia et al., 2017; Hill et al., 2012). While years of education has been the focus of many studies, literacy (ability to read/write) has been less frequently explored as a moderator of age of migration and cognitive change. We investigated the effect of age of migration on cognitive trajectory in a diverse Latino population and explored whether literacy influences the association between age of immigration and cognitive change. We hypothesize that literacy (ability to read/write) will buffer the effects of age of migration on cognitive (memory, language, motor speed, visuospatial) trajectory.
Participants and Method
Age at baseline, English fluency, country of birth, sex/gender, and years of education were included as time-invariant covariates and literacy was tested as a moderator via multiple group modeling.
Results
Results show that age of migration is marginally and inversely associated with baseline cognitive performance (p < .01). Thus, individuals who immigrated at an older age had lower baseline cognitive scores than their counterparts. Age of migration was not associated with cognitive change. Independent of covariates, literacy did not buffer the negative effects of later age at migration on cognitive function.
Conclusions
Results suggest that literacy confers a small advantage in premorbid cognition, but does not protect against cognitive decline over time. These findings also suggest that adults who immigrate at an older age present with lower cognitive scores at baseline, but do not experience faster rates of cognitive change.
References
Tang, M. X., Cross, P., Andrews, H., Jacobs, D. M., Small, S., Bell, K., ... & Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49-56. Garcia, M. A., Reyes, A. M., Downer, B., Saenz, J. L., Samper-Ternent, R. A., & Raji, M. (2018). Age of migration and the incidence of cognitive impairment: A cohort study of elder Mexican-Americans. Innovation in aging, 1, igx037. https://doi.org/10.1093/geroni/igx037. Hill, T. D., Angel, J. L., Balistreri, K. S., & Herrera, A. P. (2012). Immigrant Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine (1982), 75, 2076–2084. http://doi.org/10.1016/j.socscimed.2012.04.005.
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Olsen J, Arnsten J, Scott T, Arias F, Zhang C, Rivera Mindt M. The Role of Quality of Education in Neurocognitive Functioning in a Diverse Sample with Chronic Opioid Use Disorder. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Literacy is a proxy for quality of education (QoE) and mediates ethnicity-related differences in neurocognitive (NC) performance in some populations (Manly et al., 2002; Rivera Mindt et al., 2008). However, it is unknown whether this relationship exists in the context of chronic opioid use disorder (OUD). This study examined the role of ethnicity, QoE, opioid use severity, and depression in predicting NC performance in a diverse sample of persons with OUD.
Participants and Method
This cross-sectional study included 74 adults with OUD (Age M = 40.3 [SD = 10.5]; Education M = 11.3 [2.5]; 24% female; 68% Latinx and 32% Non-Latinx White [NLW]). All participants completed comprehensive NC testing and psychiatric/substance use questionnaires. Variables included ethnicity (Latinx vs. Non-Latinx White), years of education, QoE (Wide Range Achievement Test, Third Edition; WRAT-3 Reading Standard Scores), opioid use severity (high vs. low OAT dose), current depression (Beck Depression Inventory, Second Edition; BDI-II Total Score), and demographically-corrected NC T-scores were computed and used for average domain T-scores (e.g., learning, memory, verbal fluency, executive function). Bivariate and ANCOVA analyses were used to compare ethnic groups.
Results
There were no significant group differences on opioid use severity or current depression (p’s > .05). However, compared to the NLW group, the Latinx group had lower years of education (M = 10.9 [SD = 1.7] vs. M = 12.2 [SD = 3.5]; t[72)] = 2.1, p < .05), QoE (M = 83.1 [SD = 13.6] vs. M = 94.8 [SD = 9.4]; t[72] = 3.8, p < .001), executive functioning (M = 42.0 [SD = 6.5] vs. M = 45.8 [SD = 8.5]; t[72) = 2.1, p < .05), and learning (M = 32.2 [SD = 8.2] vs. M = 37.8 [SD = 8.7]; t[72)] = 2.7, p < .05), with medium to large effect sizes (Cohen’s d > .50). The overall effect of ethnicity became non-significant for executive functioning after accounting for QoE (F[2,70] = 10.0, p = .002) and years of education (F[2,70)] = 16.8, p < .001).
Conclusions
The current study found that accounting for years of education and QoE attenuates some differences in NC performance between Latinx and Non-Latinx participants.
References
Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341-348. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., ... & Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychology review, 18(3), 255-268.
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Arias F, Asín G, Flamarique S, Hernández I, Suarez J. In favor of total neoadjuvant therapy (TNT) for locally advanced rectal carcinoma. Clin Transl Oncol 2019; 22:793-794. [PMID: 31309436 DOI: 10.1007/s12094-019-02177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Affiliation(s)
- F Arias
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain.
| | - G Asín
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S Flamarique
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - I Hernández
- Services of Medical Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Suarez
- Services of Surgery, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
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Bakuła Z, Arias F, Bachiyska E, Borroni E, Cirillo DM, Coulter C, Giske C, Humięcka J, Van Ingen J, Ioannidis P, Kranzer K, Kuzmič U, Levina K, Lillebæk T, Mokrousov I, Morimoto K, Nikolayevskyy V, Norman A, Papaventsis D, Peuchant O, Safianowska A, Ulmann V, Vasiliauskiene E, Won-Jung K, Zhuravlev V, Žolnir-Dovč M, Krenke R, Jagielski T. MOLECULAR TYPING OF MYCOBACTERIUM KANSASII — A GLOBAL PERSPECTIVE. ACTA ACUST UNITED AC 2019. [DOI: 10.15789/2220-7619-2018-4-6.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Z. Bakuła
- Department of Applied Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw
| | - F. Arias
- Mycobacteria Laboratory, Public Health Institute of Chile, Santiago
| | - E. Bachiyska
- National Reference Laboratory for Tuberculosis, Sofia
| | - E. Borroni
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milano
| | - D. M. Cirillo
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milano
| | - C. Coulter
- Queensland Mycobacterial Reference Laboratory, Queensland, Brisbane
| | - C. Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Solna
| | - J. Humięcka
- Hospital of Infectious Diseases in Warsaw, Warsaw
| | - J. Van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen
| | - P. Ioannidis
- National Reference Laboratory for Mycobacteria, “Sotiria” Chest Diseases Hospital of Athens
| | - K. Kranzer
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Borstel
| | - U. Kuzmič
- Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik
| | - K. Levina
- Mycobacteriology Section Laboratory, North Estonia Medical Centre, Tallinn
| | - T. Lillebæk
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - I. Mokrousov
- Laboratory of Molecular Microbiology, St. Petersburg Pasteur Institute, St. Petersburg
| | - K. Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
| | | | - A. Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - D. Papaventsis
- National Reference Laboratory for Mycobacteria, “Sotiria” Chest Diseases Hospital of Athens
| | - O. Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - A. Safianowska
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Warsaw Medical University, Warsaw
| | | | - E. Vasiliauskiene
- Infectious Diseases and Tuberculosis Hospital, Vilnius University Hospital Santariskiu Klinikos
| | - K. Won-Jung
- Division of Pulmonary and Critical Care Medicine; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - V. Zhuravlev
- Research Institute of Phthisiopulmonology, St. Petersburg
| | - M. Žolnir-Dovč
- Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik
| | - R. Krenke
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Warsaw Medical University, Warsaw
| | - T. Jagielski
- Department of Applied Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw
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Arias F, Bursian AC, Sappenfield JW, Price CE. Delirium History and Preoperative Mild Neurocognitive Disorder: An Opportunity for Multidisciplinary Patient-Centered Care. Am J Case Rep 2018; 19:1324-1328. [PMID: 30397190 PMCID: PMC6232917 DOI: 10.12659/ajcr.911437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient: Male, 75 Final Diagnosis: Mild neurocognitive disorder Symptoms: Apathy • irritability • reduced concentration worsening visual disturbances Medication: — Clinical Procedure: Preoperative workup Specialty: Anesthesiology
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA
| | - Alberto C Bursian
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joshua W Sappenfield
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Catherine E Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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Arias F, Londoño-Schimmer E, Otero J, Cétares C, Herrera G, Mora M, Rodriguez P, Mejía M, Guerra J, Ruiz-Patiño A, Cardona Zorrilla A. Long-term outcomes with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis: 10-year experience in a developing country. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Campo M, Flamarique S, Asin G, Visus I, Lacalle A, Maneru F, Zubimendi C, Resano M, Saenz J, Arias F. Multidisciplinary approach of a locally advanced adult alveolar rhabdomyosarcoma of paranasal sinuses: a case report and literature review. RHINOL 2018. [DOI: 10.4193/rhinol/18.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Scott TM, Rivera Mindt M, Cunningham CO, Arias F, Coulehan K, Mangalonzo A, Olsen P, Arnsten JH. Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study. Subst Abuse Treat Prev Policy 2017; 12:48. [PMID: 29141650 PMCID: PMC5688712 DOI: 10.1186/s13011-017-0133-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time. METHODS We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age = 45.2 years [SD = 8.1]; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence. RESULTS Depressive symptomatology was not significantly related to neuropsychological change (p's > .05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r's = .52-60; p's < .05). CONCLUSIONS Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD. TRIAL REGISTRATION NCT01108679 . Registered 21 April 2010.
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Affiliation(s)
- Travis M Scott
- Department of Psychology, Fordham University, Bronx, NY, 10458, USA.
| | | | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Franchesca Arias
- Department of Psychology, University of Florida, Gainesville, FL, 32611, USA
| | - Kelly Coulehan
- Department of Psychology, Fordham University, Bronx, NY, 10458, USA
| | - Aprille Mangalonzo
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Pat Olsen
- Department of Psychology, Fordham University, Bronx, NY, 10458, USA
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10467, USA
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Barrado M, Escors D, Arias F, Blanco I, Arteta V, Visus I, Campo M, Flamarique S, Navarrete P, Martínez E. Enzalutamide as a Radiosensitizer in Prostate Cancer Cell Lines. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mañós M, Giralt J, Rueda A, Cabrera J, Martinez-Trufero J, Marruecos J, Lopez-Pousa A, Rodrigo J, Castelo B, Martínez-Galán J, Arias F, Chaves M, Herranz J, Arrazubi V, Baste N, Castro A, Mesía R. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1). Oral Oncol 2017; 70:58-64. [DOI: 10.1016/j.oraloncology.2017.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 01/15/2023]
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Petracca M, Saiote C, Bender HA, Arias F, Farrell C, Magioncalda P, Martino M, Miller A, Northoff G, Lublin F, Inglese M. Synchronization and variability imbalance underlie cognitive impairment in primary-progressive multiple sclerosis. Sci Rep 2017; 7:46411. [PMID: 28429774 PMCID: PMC5399449 DOI: 10.1038/srep46411] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/15/2017] [Indexed: 12/03/2022] Open
Abstract
We aimed to investigate functional connectivity and variability across multiple frequency bands in brain networks underlying cognitive deficits in primary-progressive multiple sclerosis (PP-MS) and to explore how they are affected by the presence of cortical lesions (CLs). We analyzed functional connectivity and variability (measured as the standard deviation of BOLD signal amplitude) in resting state networks (RSNs) associated with cognitive deficits in different frequency bands in 25 PP-MS patients (12 M, mean age 50.9 ± 10.5 years) and 20 healthy subjects (9 M, mean age 51.0 ± 9.8 years). We confirmed the presence of a widespread cognitive deterioration in PP-MS patients, with main involvement of visuo-spatial and executive domains. Cognitively impaired patients showed increased variability, reduced synchronicity between networks involved in the control of cognitive macro-domains and hyper-synchronicity limited to the connections between networks functionally more segregated. CL volume was higher in patients with cognitive impairment and was correlated with functional connectivity and variability. We demonstrate, for the first time, that a functional reorganization characterized by hypo-synchronicity of functionally-related/hyper-synchronicity of functionally-segregated large scale networks and an abnormal pattern of neural activity underlie cognitive dysfunction in PP-MS, and that CLs possibly play a role in variability and functional connectivity abnormalities.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, 80131, Italy
| | - Catarina Saiote
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Heidi A. Bender
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Franchesca Arias
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Colleen Farrell
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Paola Magioncalda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health, University of Genoa, Genoa, 16132, Italy
| | - Matteo Martino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health, University of Genoa, Genoa, 16132, Italy
| | - Aaron Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, K1Z 7K4, Canada
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health, University of Genoa, Genoa, 16132, Italy
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, 10029, NY, USA
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Arias F, Eito C, Asín G, Mora I, Cambra K, Mañeru F, Ibáñez B, Arbea L, Viudez A, Hernández I, Arrarás JI, Errasti M, Barrado M, Campo M, Visus I, Flamarique S, Ciga MA. Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study. Clin Transl Oncol 2017; 19:969-975. [DOI: 10.1007/s12094-017-1627-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/02/2017] [Indexed: 01/13/2023]
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50
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Ureña I, Arias F, Castro M, León E, Masís M, Reyes L. Development of a methodology to quantify bromacil in hair using an animal model. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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