Persistent fatigue in post-acute COVID syndrome is associated with altered T1 MRI texture in subcortical structures: a preliminary investigation

Post-acute COVID syndrome (PACS) is a global health concern and is often associated with debilitating symptoms. Post-COVID fatigue is a particularly frequent and troubling issue, and its underlying mechanisms remain incompletely understood. One potential contributor is micropathological injury of subcortical and brainstem structures, as has been identified in other patient populations. Texture-based analysis (TA) may be used to measure such changes in anatomical MRI data. The present study develops a methodology of voxel-wise TA mapping in subcortical and brainstem regions, which is then applied to T1-weighted MRI data from a cohort of 48 individuals who had PACS (32 with and 16 without ongoing fatigue symptoms) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19. Both groups were assessed an average of 4-5 months post-infection. There were no significant differences between PACS and control groups, but significant differences were observed between those with and without fatigue symptoms in the PACS group. This included reduced texture energy and increased entropy, along with reduced texture correlation, cluster shade and profile in the putamen, pallidum, thalamus and brainstem. These findings provide new insights into the neurophysiological mechanisms that underlie PACS, with altered tissue texture as a potential biomarker of this debilitating condition.

Persistent post-COVID headache is associated with suppression of scale-free functional brain dynamics in non-hospitalized individuals

INTRODUCTION

Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is a growing concern, with headache being a particularly debilitating symptom with high prevalence. The long-term effects of COVID-19 and post-COVID headache on brain function remain poorly understood, particularly among non-hospitalized individuals. This study focused on the power-law scaling behavior of functional brain dynamics, indexed by the Hurst exponent (H). This measure is suppressed during physiological and psychological distress and was thus hypothesized to be reduced in individuals with post-COVID syndrome, with greatest reductions among those with persistent headache.

METHODS

Resting-state blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging data were collected for 57 individuals who had COVID-19 (32 with no headache, 14 with ongoing headache, 11 recovered) and 17 controls who had cold and flu-like symptoms but  tested negative for COVID-19. Individuals were assessed an average of 4-5 months after COVID testing, in a cross-sectional, observational study design.

RESULTS

No significant differences in H values were found between non-headache COVID-19 and control groups., while those with ongoing headache had significantly reduced H values, and those who had recovered from headache had elevated H values, relative to non-headache groups. Effects were greatest in temporal, sensorimotor, and insular brain regions. Reduced H in these regions was also associated with decreased BOLD activity and local functional connectivity.

CONCLUSIONS

These findings provide new insights into the neurophysiological mechanisms that underlie persistent post-COVID headache, with reduced BOLD scaling as a potential biomarker that is specific to this debilitating condition.

Feasibility of diffusion-tensor and correlated diffusion imaging for studying white-matter microstructural abnormalities: Application in COVID-19

There has been growing attention on the effect of COVID-19 on white-matter microstructure, especially among those that self-isolated after being infected. There is also immense scientific interest and potential clinical utility to evaluate the sensitivity of single-shell diffusion magnetic resonance imaging (MRI) methods for detecting such effects. In this work, the performances of three single-shell-compatible diffusion MRI modeling methods are compared for detecting the effect of COVID-19, including diffusion-tensor imaging, diffusion-tensor decomposition of orthogonal moments and correlated diffusion imaging. Imaging was performed on self-isolated patients at the study initiation and 3-month follow-up, along with age- and sex-matched controls. We demonstrate through simulations and experimental data that correlated diffusion imaging is associated with far greater sensitivity, being the only one of the three single-shell methods to demonstrate COVID-19-related brain effects. Results suggest less restricted diffusion in the frontal lobe in COVID-19 patients, but also more restricted diffusion in the cerebellar white matter, in agreement with several existing studies highlighting the vulnerability of the cerebellum to COVID-19 infection. These results, taken together with the simulation results, suggest that a significant proportion of COVID-19 related white-matter microstructural pathology manifests as a change in tissue diffusivity. Interestingly, different b-values also confer different sensitivities to the effects. No significant difference was observed in patients at the 3-month follow-up, likely due to the limited size of the follow-up cohort. To summarize, correlated diffusion imaging is shown to be a viable single-shell diffusion analysis approach that allows us to uncover opposing patterns of diffusion changes in the frontal and cerebellar regions of COVID-19 patients, suggesting the two regions react differently to viral infection.

Effects of post-acute COVID-19 syndrome on the functional brain networks of non-hospitalized individuals

Introduction

The long-term impact of COVID-19 on brain function remains poorly understood, despite growing concern surrounding post-acute COVID-19 syndrome (PACS). The goal of this cross-sectional, observational study was to determine whether there are significant alterations in resting brain function among non-hospitalized individuals with PACS, compared to symptomatic individuals with non-COVID infection.

Methods

Data were collected for 51 individuals who tested positive for COVID-19 (mean age 41±12 yrs., 34 female) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19 (mean age 41±14 yrs., 9 female), with both groups assessed an average of 4-5 months after COVID testing. None of the participants had prior neurologic, psychiatric, or cardiovascular illness. Resting brain function was assessed via functional magnetic resonance imaging (fMRI), and self-reported symptoms were recorded.

Results

Individuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions.

Discussion

These results provide preliminary evidence that patterns of functional connectivity distinguish PACS from non-COVID infection and correlate with the severity of clinical outcome, providing novel insights into this highly prevalent disorder.

MRI Assessment of Cerebral Blood Flow in Nonhospitalized Adults Who Self-Isolated Due to COVID-19

BACKGROUND

Neurological symptoms associated with coronavirus disease 2019 (COVID-19), such as fatigue and smell/taste changes, persist beyond infection. However, little is known of brain physiology in the post-COVID-19 timeframe.

PURPOSE

To determine whether adults who experienced flu-like symptoms due to COVID-19 would exhibit cerebral blood flow (CBF) alterations in the weeks/months beyond infection, relative to controls who experienced flu-like symptoms but tested negative for COVID-19.

STUDY TYPE

Prospective observational.

POPULATION

A total of 39 adults who previously self-isolated at home due to COVID-19 (41.9 ± 12.6 years of age, 59% female, 116.5 ± 62.2 days since positive diagnosis) and 11 controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (41.5 ± 13.4 years of age, 55% female, 112.1 ± 59.5 since negative diagnosis).

FIELD STRENGTH AND SEQUENCES

A 3.0 T; T1-weighted magnetization-prepared rapid gradient and echo-planar turbo gradient-spin echo arterial spin labeling sequences.

ASSESSMENT

Arterial spin labeling was used to estimate CBF. A self-reported questionnaire assessed symptoms, including ongoing fatigue. CBF was compared between COVID-19 and control groups and between those with (n = 11) and without self-reported ongoing fatigue (n = 28) within the COVID-19 group.

STATISTICAL TESTS

Between-group and within-group comparisons of CBF were performed in a voxel-wise manner, controlling for age and sex, at a family-wise error rate of 0.05.

RESULTS

Relative to controls, the COVID-19 group exhibited significantly decreased CBF in subcortical regions including the thalamus, orbitofrontal cortex, and basal ganglia (maximum cluster size = 6012 voxels and maximum t-statistic = 5.21). Within the COVID-19 group, significant CBF differences in occipital and parietal regions were observed between those with and without self-reported on-going fatigue.

DATA CONCLUSION

These cross-sectional data revealed regional CBF decreases in the COVID-19 group, suggesting the relevance of brain physiology in the post-COVID-19 timeframe. This research may help elucidate the heterogeneous symptoms of the post-COVID-19 condition.

EVIDENCE LEVEL

2.

TECHNICAL EFFICACY

Stage 3.

“CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults

Spatial cognition is known to decline with aging. However, little is known about whether training can reduce or eliminate age-related deficits in spatial memory. We investigated whether a custom-designed video game involving spatial navigation, obstacle avoidance, and balance control would improve spatial memory in older adults. Specifically, 56 healthy adults aged 65 to 84 years received 10 sessions of multicomponent video game training, based on a virtual cityscape, over 5 weeks. Participants were allocated to one of three training conditions: the main intervention, the “CityQuest” group (n = 19), and two control groups, spatial navigation without obstacle avoidance (“Spatial Navigation-only” group, n = 21) and obstacle avoidance without spatial navigation (“Obstacles-only” group, n = 15). Performance on object recognition, egocentric and allocentric spatial memory (incorporating direction judgment tasks and landmark location tasks, respectively), navigation strategy preference, and executive functioning was assessed in pre- and post-intervention sessions. The results showed an overall benefit on performance in a number of spatial memory measures and executive function for participants who received spatial navigation training, particularly the CityQuest group, who also showed significant improvement on the landmark location task. However, there was no evidence of a shift from egocentric to allocentric strategy preference. We conclude that spatial memory in healthy older participants is amenable to improvement with training over a short term. Moreover, technology based on age-appropriate, multicomponent video games may play a key role in cognitive training in older adults.

Brain structure and function in people recovering from COVID-19 after hospital discharge or self-isolation: a longitudinal observational study protocol

BACKGROUND

The detailed extent of neuroinvasion or deleterious brain changes resulting from COVID-19 and their time courses remain to be determined in relation to "long-haul" COVID-19 symptoms. Our objective is to determine whether there are alterations in functional brain imaging measures among people with COVID-19 after hospital discharge or self-isolation.

METHODS

This paper describes a protocol for NeuroCOVID-19, a longitudinal observational study of adults aged 20-75 years at Sunnybrook Health Sciences Centre in Toronto, Ontario, that began in April 2020. We aim to recruit 240 adults, 60 per group: people who contracted COVID-19 and were admitted to hospital (group 1), people who contracted COVID-19 and self-isolated (group 2), people who experienced influenza-like symptoms at acute presentation but tested negative for COVID-19 and self-isolated (group 3, control) and healthy people (group 4, control). Participants are excluded based on premorbid neurologic or severe psychiatric illness, unstable cardiovascular disease, and magnetic resonance imaging (MRI) contraindications. Initial and 3-month follow-up assessments include multiparametric brain MRI and electroencephalography. Sensation and cognition are assessed alongside neuropsychiatric assessments and symptom self-reports. We will test the data from the initial and follow-up assessments for group differences based on 3 outcome measures: MRI cerebral blood flow, MRI resting state fractional amplitude of low-frequency fluctuation and electroencephalography spectral power.

INTERPRETATION

If neurophysiologic alterations are detected in the COVID-19 groups in our NeuroCOVID-19 study, this information could inform future research regarding interventions for long-haul COVID-19. The study results will be disseminated to scientists, clinicians and COVID-19 survivors, as well as the public and private sectors to provide context on how brain measures relate to lingering symptoms.

The neuropsychological profile of professional action video game players

In the past 20 years, there has been growing research interest in the association between video games and cognition. Although many studies have found that video game players are better than non-players in multiple cognitive domains, other studies failed to replicate these results. Until now, the vast majority of studies defined video game players based on the number of hours an individual spent playing video games, with relatively few studies focusing on video game expertise using performance criteria. In the current study, we sought to examine whether individuals who play video games at a professional level in the esports industry differ from amateur video game players in their cognitive and learning abilities. We assessed 14 video game players who play in a competitive league (Professional) and 16 casual video game players (Amateur) on set of standard neuropsychological tests evaluating processing speed, attention, memory, executive functions, and manual dexterity. We also examined participants' ability to improve performance on a dynamic visual attention task that required tracking multiple objects in three-dimensions (3D-MOT) over five sessions. Professional players showed the largest performance advantage relative to Amateur players in a test of visual spatial memory (Spatial Span), with more modest benefits in a test of selective and sustained attention (d2 Test of Attention), and test of auditory working memory (Digit Span). Professional players also showed better speed thresholds in the 3D-MOT task overall, but the rate of improvement with training did not differ in the two groups. Future longitudinal studies of elite video game experts are required to determine whether the observed performance benefits of professional gamers may be due to their greater engagement in video game play, or due to pre-existing differences that promote achievement of high performance in action video games.

Aging Impairs Audiovisual Facilitation of Object Motion Within Self-Motion

The presence of a moving sound has been shown to facilitate the detection of an independently moving visual target embedded among an array of identical moving objects simulating forward self-motion (Calabro et al., Proc. R. Soc. B, 2011). Given that the perception of object motion within self-motion declines with aging, we investigated whether older adults can also benefit from the presence of a congruent dynamic sound when detecting object motion within self-motion. Visual stimuli consisted of nine identical spheres randomly distributed inside a virtual rectangular prism. For 1 s, all the spheres expanded outward simulating forward observer translation at a constant speed. One of the spheres (the target) had independent motion either approaching or moving away from the observer at three different speeds. In the visual condition, stimuli contained no sound. In the audiovisual condition, the visual stimulus was accompanied by a broadband noise sound co-localized with the target, whose loudness increased or decreased congruent with the target’s direction. Participants reported which of the spheres had independent motion. Younger participants showed higher target detection accuracy in the audiovisual compared to the visual condition at the slowest speed level. Older participants showed overall poorer target detection accuracy than the younger participants, but the presence of the sound had no effect on older participants’ target detection accuracy at either speed level. These results indicate that aging may impair cross-modal integration in some contexts. Potential reasons for the absence of auditory facilitation in older adults are discussed.

Changes in Regional Brain Grey-Matter Volume Following Successful Completion of a Sensori-Motor Intervention Targeted at Healthy and Fall-Prone Older Adults

Previous studies have suggested that discrete cross-sensory events could be incorrectly combined in the brain of older adults with a history of falls, possibly undermining motor and balance control. Based on previous findings that multisensory integration is modifiable with practice, even in an ageing population, we designed a serious game, named CityQuest, to train typical, everyday multisensory processes including sensori-motor control, spatial navigation, obstacle avoidance and balance control. Played over several sessions, this game was shown to improve these functions in older adults with and without a history of falls, depending on the specific condition of the game on which they were trained. Here, using voxel-based morphometry analysis of anatomical magnetic resonance imaging (MRI) data, we investigated structural changes in the brain of a smaller group of older adults from those who successfully completed this five-week intervention. A grey-matter (GM) volume increase in the precentral gyrus, and GM volume reduction in the inferior temporal and orbitofrontal gyri, was found for all participants. Changes in GM volume within regions of the cerebellum were differentially associated with fall-prone and healthy older adults. Furthermore, a greater GM volume increase in the precentral gyrus was observed in participants who performed the full CityQuest intervention relative to those required to avoid obstacles only. Our results support previous evidence that multisensory training can affect structural changes in the older brain and have implications for programmes designed for the successful rehabilitation of perceptual and cognitive functions.

Different effects of aging and gender on the temporal resolution in attentional tracking

The current study examined the role of temporal resolution of attention in the decline in multiple object tracking abilities with healthy aging. The temporal resolution of attention is known to limit attentional tracking of one and multiple targets (Holcombe & Chen, 2013). Here, we examined whether aging is associated with a lower temporal resolution of attention when tracking one target, the efficiency of splitting attention across multiple targets, or both. Stimuli comprised three concentric rings containing five or 10 equally spaced dots. While maintaining central fixation, younger and older participants tracked a target dot on one, two, or three rings while the rings rotated around fixation in random directions for 5 s. Rotational speed was varied to estimate speed or temporal frequency thresholds in six conditions. Results showed that younger and older participants had similar temporal frequency thresholds for tracking one target, but the addition of one and two more targets reduced thresholds more in the older group compared to the younger group. Gender also affected performance, with men having higher temporal frequency thresholds than women, independently of the number of targets. These findings indicate that the temporal resolution of attention for a single target depends on gender but is not affected by aging, whereas aging specifically affects the efficiency of dividing attention across multiple targets.

Familiar environments enhance object and spatial memory in both younger and older adults

Recent evidence suggests that familiarity with an environment may protect against spatial memory decline for familiar objects in older adults. We investigated whether a familiar context also reduces age-related decline in spatial memory for novel objects. Twenty-four younger and 23 older participants viewed a virtual rendering of a local environment along two different routes, each through a well-known (West) or lesser-known (East) area within the environment. Older and younger participants reported being more familiar with one (i.e. West) area than the other. In each trial, participants were presented with one route and were instructed to learn ten novel objects and their locations along the route. Following learning, participants immediately completed five test blocks: an object recognition task, an egocentric spatial processing (direction judgement) task, an allocentric spatial processing (proximity judgement) task and two pen-and-paper tests to measure cognitive mapping abilities. First we found an age effect with worse performance by older than younger adults in all spatial tasks, particularly in allocentric spatial processing. However, our results suggested better memory for objects and directions, but not proximity judgements, when the task was associated with more familiar than unfamiliar contexts, in both age groups. There was no benefit of context when a separate young adult group (N = 24) was tested, who reported being equally familiar with both areas. These results suggest an important facilitatory role of context familiarity on object recognition, and in particular egocentric spatial memory, and have implications for enhancing spatial memory in older adults.

The sound-induced flash illusion reveals dissociable age-related effects in multisensory integration

While aging can lead to significant declines in perceptual and cognitive function, the effects of age on multisensory integration, the process in which the brain combines information across the senses, are less clear. Recent reports suggest that older adults are susceptible to the sound-induced flash illusion (Shams et al., 2000) across a much wider range of temporal asynchronies than younger adults (Setti et al., 2011). To assess whether this cost for multisensory integration is a general phenomenon of combining asynchronous audiovisual input, we compared the time courses of two variants of the sound-induced flash illusion in young and older adults: the fission illusion, where one flash accompanied by two beeps appears as two flashes, and the fusion illusion, where two flashes accompanied by one beep appear as one flash. Twenty-five younger (18–30 years) and older (65+ years) adults were required to report whether they perceived one or two flashes, whilst ignoring irrelevant auditory beeps, in bimodal trials where auditory and visual stimuli were separated by one of six stimulus onset asynchronies (SOAs). There was a marked difference in the pattern of results for the two variants of the illusion. In conditions known to produce the fission illusion, older adults were significantly more susceptible to the illusion at longer SOAs compared to younger participants. In contrast, the performance of the younger and older groups was almost identical in conditions known to produce the fusion illusion. This surprising difference between sound-induced fission and fusion in older adults suggests dissociable age-related effects in multisensory integration, consistent with the idea that these illusions are mediated by distinct neural mechanisms.

Aging and the integration of orientation and position in shape perception

The current experiments examined the effect of healthy aging on the integration of orientation and position information in shape perception. Following Day and Loffler (2009), conflicting contours were created by sampling the orientations of one shape (e.g., a rounded pentagon) with Gabors, and positioning them on the circumference of a different shape (e.g., a circle). In Experiment 1, subjects judged whether the conflicting contour looked more circular than a rounded pentagon of varying amplitude, which allowed us to estimate the perceived shape of the conflicting contour. The relative amount of position and orientation information was manipulated by varying the number of Gabors comprising the target contour. Orientation information dominated the percept for contours sampled with 15-40 elements, producing a strong shape illusion, but position information determined the shape with denser sampling. The magnitude of this orientation dominance effect was equal in younger and older subjects across all sampling levels. In Experiment 2, subjects discriminated five contours that differed in orientation and/or position information. Both groups showed poor discrimination between conflicting contours and their perceptually equivalent radial frequency patterns, confirming the main finding of Experiment 1. In addition, older subjects showed worse discrimination between two noncircular radial frequency patterns than younger subjects. In sum, integration of orientation and position information in shape perception is preserved with aging; however, older adults are less able to make fine shape discriminations between noncircular sampled contours.

Does that look heavy to you? Perceived weight judgment in lifting actions in younger and older adults

When interpreting other people's movements or actions, observers may not only rely on the visual cues available in the observed movement, but they may also be able to "put themselves in the other person's shoes" by engaging brain systems involved in both "mentalizing" and motor simulation. The ageing process brings changes in both perceptual and motor abilities, yet little is known about how these changes may affect the ability to accurately interpret other people's actions. Here we investigated the effect of ageing on the ability to discriminate the weight of objects based on the movements of actors lifting these objects. Stimuli consisted of videos of an actor lifting a small box weighing 0.05-0.9 kg or a large box weighting 3-18 kg. In a four-alternative forced-choice task, younger and older participants reported the perceived weight of the box in each video. Overall, older participants were less sensitive than younger participants in discriminating the perceived weight of lifted boxes, an effect that was especially pronounced in the small box condition. Weight discrimination performance was better for the large box compared to the small box in both groups, due to greater saliency of the visual cues in this condition. These results suggest that older adults may require more salient visual cues to interpret the actions of others accurately. We discuss the potential contribution of age-related changes in visual and motor function on the observed effects and suggest that older adults' decline in the sensitivity to subtle visual cues may lead to greater reliance on visual analysis of the observed scene and its semantic context.

Contour integration and aging: the effects of element spacing, orientation alignment and stimulus duration

The ability to extract contours in cluttered visual scenes, which is a crucial step in visual processing, declines with healthy aging, but the reasons for this decline are not well understood. In three experiments, we examined how the effect of aging on contour discrimination varies as a function of contour and distracter inter-element spacing, collinearity, and stimulus duration. Spiral-shaped contours composed of Gabors were embedded within a field of distracter Gabors of uniform density. In a four alternative forced-choice task, younger and older subjects were required to report the global orientation of the contour. In Experiment 1, the absolute contour element spacing varied from two to eight times the Gabor wavelength and contour element collinearity was disrupted with five levels of orientation jitter. Contour discrimination accuracy was lower in older subjects, but the effect of aging did not vary with contour spacing or orientation jitter. Experiment 2 found that decreasing stimulus durations from 0.8 to 0.04 s had a greater effect on older subjects' performance, but only for less salient contours. Experiment 3 examined the effect of the background on contour discrimination by varying the spacing and orientation of the distracter elements for contours with small and large absolute spacing. As in Experiment, the effect of aging did not vary with absolute contour spacing. Decreasing the distracter spacing, however, had a greater detrimental effect on accuracy in older subjects compared to younger subjects. Finally, both groups showed equally high accuracy when all distracters were iso-oriented. In sum, these findings suggest that aging does not affect the sensitivity of contour integration to proximity or collinearity. However, contour integration in older adults is slower and is especially vulnerable when distracters are denser than contour elements.

Aging and audio-visual and multi-cue integration in motion

The perception of naturalistic events relies on the ability to integrate information from multiple sensory systems, an ability that may change with healthy aging. When two objects move toward and then past one another, their trajectories are perceptually ambiguous: the objects may seem to stream past one another or bounce off one another. Previous research showed that auditory or visual events that occur at the time of disks' coincidence could bias the percept toward bouncing or streaming. We exploited this malleable percept to assay age-related changes in the integration of multiple inter- and intra-modal cues. The disks' relative luminances were manipulated to produce stimuli strongly favoring either bouncing or streaming, or to produce ambiguous motion (equal luminances). A sharp sound coincident with the disks' overlap increased both groups' perception of bouncing, but did so significantly less for older subjects. An occluder's impact on motion perception varied with its duration: a long duration occluder promoted streaming in both groups; a brief occluder promoted bouncing in younger subjects, but not older ones. Control experiments demonstrated that the observed differences between younger and older subjects resulted from neither age-related changes in retinal illuminance nor age-related changes in hearing, pointing to weakened inter- and intra-modal integration with aging. These changes could contribute to previously demonstrated age-related perceptual and memory deficits.

Spatiotemporal properties of apparent motion perception and aging

We used a random-dot two-frame apparent motion paradigm to investigate whether age-related declines in motion perception are caused by deficits in integrating spatial information, temporal information, or both. Two random-dot patterns were presented sequentially on a black screen, separated by a blank inter-stimulus interval ranging from 0.01 s to 0.240 s. From the first to the second pattern, all the dots were shifted to the left or right by an equal displacement ranging from 0.03 deg to 1.64 deg. The spatiotemporal range yielding good direction discrimination performance was greatly reduced with age. For ISIs longer than 0.04 s, older subjects performed less accurately than younger subjects across a wide range of spatial displacements. Older subjects also showed poorer performance for large spatial displacements across a wide range of ISIs. Age-related differences in performance were also found with small displacements; however, these were largely accounted for by age-related declines in visual acuity. Overall, the results show that the maximum temporal interval and maximum spatial displacement over which two frames can be integrated are reduced in older age.

Benefits of cognitive dual-task training on balance performance in healthy older adults

BACKGROUND

There is growing evidence of the involvement of executive control in the maintenance of balance in old age. We examined whether healthy older adults who completed five sessions of nonmotor cognitive dual-task training would show significant improvements on measures of dual-task standing balance and mobility, compared with an untrained control group.

METHODS

Twenty healthy older adults were assigned to either training or control groups. In the pre- and post-training sessions, all participants performed tests of cognition, balance, and mobility (single-support balance, dynamic posturography, sit-to-stand, 40-foot walk) under single- and dual-task conditions. The training group completed five sessions of cognitive dual-task training spaced at least 2 days apart. The two tasks involved making two-choice decisions to visually presented stimuli. Participants completed multiple blocks of single-task (task A or B, blockwise) and mixed (A, B, or A + B) trials in each training session.

RESULTS

The training group showed significant improvements in body sway during single-support balance and center of gravity alignment during double-support dynamic balance. The control group showed no appreciable improvements.

CONCLUSIONS

This study is the first to demonstrate training-related benefits to gross motor performance stemming from cognitive dual-task training. The results support the view that motor control in aging is influenced by executive control and have implications for theories of cognitive training and transfer.

Exercise in patients with advanced non-small cell lung cancer (NSCLC): Compliance and population characteristics of patients referred to the McGill Cancer Nutrition-Rehabilitation Program (CNRP)

8631

Background: Few studies focus on exercise in advanced NSCLC. We evaluated compliance with exercise prescription in stages 3/4 NSCLC. Methods: Patients (pts) referred to the CNRP, a multidisciplinary clinic, for weight/functional loss were evaluated for participation in a supervised exercise program. Compliance with exercise was scored as 0 (refused/home exercise), 1 (<6 sessions in 2 mo), and 2 (≥ 6 sessions in 2 mo). Gender, age, PS, stage, CRP, weight loss, and quality of life [Edmonton Syptom Assessment Scale (ESAS)] were assessed by univariate and multivariate analyses. Survival from the time of exercise prescription was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: 168 pts were referred to the CNRP from April 2002 to September 2005. 92/168 (54%) were prescribed exercise. Of the 76 remaining pts, 3 (4%) refused, and 6 (8%) were on an exercise trial. Others were excluded due to bone metastasis/severe pain (50 pts, 66%), cardiovascular instability (13 pts, 17%) or poor PS (4 pts, 5%). Of the 92 who were prescribed exercise, the compliance score was 0 in 38 (41%), 1 in 37 (40%) and 2 in 17(19%). There were no significant differences in gender, age, PS, stage, ESAS, and weight loss at the time of referral among the three compliance groups. Most pts (15/17) with a compliance score of 2 were referred prior to or during initial treatment, whereas those with compliance scores of 0 and 1 were referred later in the course of treatment. Compliance with exercise correlated with survival (p<0.001). The median survival from time of exercise prescription for pts with a compliance score of 2 was 22 mo (95%CI 13.4,30.2); compared with 5 mo (95%CI 3.7,5.6) and 7 mo (95%CI 2.5,11.5) for those with compliance scores of 0 and 1 respectively. No serious adverse events occurred. Conclusion: A select group of advanced NSCLC pts can exercise safely at a moderate-high level. Those referred earlier tended to be more compliant, and their longer survival may reflect a lead time bias. Clinical trials are needed to evaluate efficacy of exercise in newly diagnosed NSCLC.

No significant financial relationships to disclose.