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Brain Sciences Apr 2024Recent research suggests that cognitive deficits in individuals with psychotic disorders could be overestimated because poor cognitive test performance is partly...
Revisiting Cognitive Deficits in Outpatients with Psychotic Disorders: A Transdiagnostic Comparison of Cognitive Performance While Accounting for Putative Confounding Factors.
Recent research suggests that cognitive deficits in individuals with psychotic disorders could be overestimated because poor cognitive test performance is partly attributable to non-cognitive factors. To further test this, we included non-hospitalized individuals with psychotic disorders (PSY, = 38), individuals with attenuated psychotic symptoms ( = 40), individuals with obsessive-compulsive disorders ( = 39), and healthy controls ( = 38). Relevant cognitive domains were assessed using the MATRICS Consensus Cognitive Battery. Putative confounding non-cognitive factors-heart rate, self-reported stress, negative affect, performance-related beliefs, and actigraphy-derived sleep-were assessed before cognitive testing. A multivariate analysis of covariance was calculated to examine group differences in cognitive performance while controlling for non-cognitive factors. PSY showed decreased test performance in graphomotor speed, attention, and verbal tasks compared to the other groups, whereas non-verbal/visual-spatial tasks were unimpaired. After accounting for non-cognitive factors, group differences diminished in verbal learning, whereas differences in the other domains remained significant. Against our hypotheses, the present findings indicate that some cognitive deficits in PSY cannot be attributed to momentary confounding factors.
PubMed: 38790425
DOI: 10.3390/brainsci14050446 -
Brain Sciences Apr 2024Few randomized controlled trials have reported that repetitive transcranial magnetic stimulation (rTMS) has controversial results for managing multiple domains of...
Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive and Psychiatric Dysfunction in Patients with Fibromyalgia: A Double-Blinded, Randomized Clinical Trial.
Few randomized controlled trials have reported that repetitive transcranial magnetic stimulation (rTMS) has controversial results for managing multiple domains of fibromyalgia-related symptoms. This work aimed to evaluate the effect of low-frequency rTMS over the right dorsolateral prefrontal area (DLPFC) on the Fibromyalgia Impact Questionnaire (FIQ) concerning psychiatric and cognitive disorders. Forty-two eligible patients with fibromyalgia (FM) were randomized to have 20 sessions of active or sham rTMS (1 Hz, 120% of resting motor threshold with a total of 1200 pules/session) over the right DLPFC. All participants were evaluated at baseline, post sessions, and 3 months after sessions with the FIQ, Hamilton depression, and anxiety rating scales (HDRS and HARS), Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Tower of London test (TOL), the Trail Making, and Digit Span Tests. Both groups showed improvement in most rating scales at 1 and 3 months follow-up, with greater improvement in the active group, with significant correlation between FIQ cognitive rating scales, including RAVLT and TOL. Twenty sessions of low-frequency rTMS over the right DLPFC can improve FIQ scores regarding the psychiatric and cognitive symptoms of medicated patients with FM to a greater extent than sham. Changes in RAVLT and TOL correlated with changes in FIQ results.
PubMed: 38790395
DOI: 10.3390/brainsci14050416 -
Journal of Neuroimmune Pharmacology :... May 2024Based on emerging evidence on the role for specific single-nucleotide variants (SNVs) in EIF2AK3 encoding the integrated stress response kinase PERK, in...
Based on emerging evidence on the role for specific single-nucleotide variants (SNVs) in EIF2AK3 encoding the integrated stress response kinase PERK, in neurodegeneration, we assessed the association of EIF2AK3 SNVs with neurocognitive performance in people with HIV (PWH) using a candidate gene approach. This retrospective study included the CHARTER cohort participants, excluding those with severe neuropsychiatric comorbidities. Genome-wide data previously obtained for 1047 participants and targeted sequencing of 992 participants with available genomic DNA were utilized to interrogate the association of three noncoding and three coding EIF2AK3 SNVs with the continuous global deficit score (GDS) and global neurocognitive impairment (NCI; GDS ≥ 0.5) using univariable and multivariable methods, with demographic, disease-associated, and treatment characteristics as covariates. The cohort characteristics were as follows: median age, 43.1 years; females, 22.8%; European ancestry, 41%; median CD4 + T cell counts, 175/µL (nadir) and 428/µL (current). At first assessment, 70.5% used ART and 68.3% of these had plasma HIV RNA levels ≤ 200 copies/mL. All three noncoding EIF2AK3 SNVs were associated with GDS and NCI (all p < 0.05). Additionally, 30.9%, 30.9%, and 41.2% of participants had at least one risk allele for the coding SNVs rs1805165 (G), rs867529 (G), and rs13045 (A), respectively. Homozygosity for all three coding SNVs was associated with significantly worse GDS (p < 0.001) and more NCI (p < 0.001). By multivariable analysis, the rs13045 A risk allele, current ART use, and Beck Depression Inventory-II value > 13 were independently associated with GDS and NCI (p < 0.001) whereas the other two coding SNVs did not significantly correlate with GDS or NCI after including rs13045 in the model. The coding EIF2AK3 SNVs were associated with worse performance in executive functioning, motor functioning, learning, and verbal fluency. Coding and non-coding SNVs of EIF2AK3 were associated with global NC and domain-specific performance. The effects were small-to-medium in size but present in multivariable analyses, raising the possibility of specific SNVs in EIF2AK3 as an important component of genetic vulnerability to neurocognitive complications in PWH.
Topics: Adult; Female; Humans; Male; Middle Aged; Cognitive Dysfunction; Cohort Studies; eIF-2 Kinase; HIV Infections; Polymorphism, Single Nucleotide; Retrospective Studies
PubMed: 38789639
DOI: 10.1007/s11481-024-10125-x -
Archives of Gerontology and Geriatrics May 2024Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined...
Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.
PubMed: 38788370
DOI: 10.1016/j.archger.2024.105483 -
Behavioral Sciences (Basel, Switzerland) May 2024Phonological processing skills, such as phonological awareness, are known predictors of reading acquisition in alphabetic languages with varying degrees of orthographic...
Phonological processing skills, such as phonological awareness, are known predictors of reading acquisition in alphabetic languages with varying degrees of orthographic complexity. However, the role of multi-letter-sound knowledge, an important foundation for early reading development, in supporting reading fluency development remains to be determined. This study examined whether two core foundational skills, phonemic awareness and grapheme sounding, have a predictive role in reading fluency development in an intermediate-depth orthography. The participants were 62 children learning to read in European Portuguese, and they were longitudinally assessed on phonemic awareness, complex grapheme sounding, and reading fluency (decoding, word, and text) from Grade 2 to Grade 3. The results showed that grapheme sounding predicted reading fluency development controlled for nonverbal intelligence and vocabulary, short-term verbal memory, and phonemic awareness. Grapheme sounding plays a prominent role in predicting reading fluency outcomes, whereas phonemic awareness (both accuracy and time per correct item) did not contribute to any of the three types of reading fluency. The fact that grapheme-sounding predicted reading fluency is likely due to complex grapheme-phoneme correspondences being required to achieve proficient reading. These findings provide insights into the cognitive processes underlying reading development in intermediate-depth orthographies and have implications for early literacy instruction.
PubMed: 38785887
DOI: 10.3390/bs14050396 -
European Journal of Investigation in... May 2024In postoperative care, patient education and follow-up are pivotal for enhancing the quality of care and satisfaction. Artificial intelligence virtual assistants (AIVA)...
In postoperative care, patient education and follow-up are pivotal for enhancing the quality of care and satisfaction. Artificial intelligence virtual assistants (AIVA) and large language models (LLMs) like Google BARD and ChatGPT-4 offer avenues for addressing patient queries using natural language processing (NLP) techniques. However, the accuracy and appropriateness of the information vary across these platforms, necessitating a comparative study to evaluate their efficacy in this domain. We conducted a study comparing AIVA (using Google Dialogflow) with ChatGPT-4 and Google BARD, assessing the accuracy, knowledge gap, and response appropriateness. AIVA demonstrated superior performance, with significantly higher accuracy (mean: 0.9) and lower knowledge gap (mean: 0.1) compared to BARD and ChatGPT-4. Additionally, AIVA's responses received higher Likert scores for appropriateness. Our findings suggest that specialized AI tools like AIVA are more effective in delivering precise and contextually relevant information for postoperative care compared to general-purpose LLMs. While ChatGPT-4 shows promise, its performance varies, particularly in verbal interactions. This underscores the importance of tailored AI solutions in healthcare, where accuracy and clarity are paramount. Our study highlights the necessity for further research and the development of customized AI solutions to address specific medical contexts and improve patient outcomes.
PubMed: 38785591
DOI: 10.3390/ejihpe14050093 -
Acta Neurochirurgica May 2024In recent years there has been a re-evaluation regarding the clinical implications of temporal lobe arachnoid cysts (temporal arachnoid cysts) in children. These cysts...
BACKGROUND AND PURPOSE
In recent years there has been a re-evaluation regarding the clinical implications of temporal lobe arachnoid cysts (temporal arachnoid cysts) in children. These cysts have often been considered asymptomatic, or if symptomatic, only causing focal neurological symptoms or signs of increased intracranial pressure. However, several studies have more recently reported on cognitive symptoms improving after surgery. This study aimed to evaluate if reported cognitive improvement after surgery of temporal arachnoid cysts were stable after five years.
METHOD
Ten consecutive children (m = 14.65; range 12.1-19.415 were assessed cognitively five years after micro-neurosurgical fenestration of a temporal arachnoid cyst. Results were compared to results from their pre- and post-surgical evaluations. Evaluations included the Wechsler-scales, Boston Naming Test (BNT), Rey Auditory Verbal Learning Test (RAVLT), verbal fluency test (FAS) and Rey Complex Figure Test (RCFT).
RESULTS
The analysis revealed significant postsurgical improvement compared to baseline on the Wechsler-scales measures of general intelligence (FSIQ), verbal abilities (VCI) and processing speed (PSI). Mean differences after surgery were 8.3 for FSIQ, (p = 0.026), 8.5 for VI (p = < .01) and 9.9 for PSI (p = 0.03). There were no significant differences in mean test results when comparing postsurgical scores with scores five years after surgery, indicating long-term stability of improvements.
CONCLUSION
The results indicate that affected cognitive functions in children with temporal arachnoid cysts improve after surgery and that the improvements remain stable five years later. The improvements and long term stability were also consistent with the experience of both parents and children. The findings provide a strong argument for neurosurgical fenestration of temporal arachnoid cysts in children.
Topics: Humans; Arachnoid Cysts; Male; Female; Child; Follow-Up Studies; Adolescent; Cognition; Young Adult; Neurosurgical Procedures; Microsurgery; Neuropsychological Tests; Treatment Outcome; Temporal Lobe
PubMed: 38777952
DOI: 10.1007/s00701-024-06120-z -
Age and Ageing May 2024Post-operative delirium (POD) is a common complication in older patients, with an incidence of 14-56%. To implement preventative procedures, it is necessary to identify...
INTRODUCTION
Post-operative delirium (POD) is a common complication in older patients, with an incidence of 14-56%. To implement preventative procedures, it is necessary to identify patients at risk for POD. In the present study, we aimed to develop a machine learning (ML) model for POD prediction in older patients, in close cooperation with the PAWEL (patient safety, cost-effectiveness and quality of life in elective surgery) project.
METHODS
The model was trained on the PAWEL study's dataset of 878 patients (no intervention, age ≥ 70, 209 with POD). Presence of POD was determined by the Confusion Assessment Method and a chart review. We selected 15 features based on domain knowledge, ethical considerations and a recursive feature elimination. A logistic regression and a linear support vector machine (SVM) were trained, and evaluated using receiver operator characteristics (ROC).
RESULTS
The selected features were American Society of Anesthesiologists score, multimorbidity, cut-to-suture time, estimated glomerular filtration rate, polypharmacy, use of cardio-pulmonary bypass, the Montreal cognitive assessment subscores 'memory', 'orientation' and 'verbal fluency', pre-existing dementia, clinical frailty scale, age, recent falls, post-operative isolation and pre-operative benzodiazepines. The linear SVM performed best, with an ROC area under the curve of 0.82 [95% CI 0.78-0.85] in the training set, 0.81 [95% CI 0.71-0.88] in the test set and 0.76 [95% CI 0.71-0.79] in a cross-centre validation.
CONCLUSION
We present a clinically useful and explainable ML model for POD prediction. The model will be deployed in the Supporting SURgery with GEriatric Co-Management and AI project.
Topics: Humans; Aged; Female; Male; Machine Learning; Delirium; Aged, 80 and over; Geriatric Assessment; Postoperative Complications; Risk Assessment; Risk Factors; Predictive Value of Tests; Age Factors; Support Vector Machine; Algorithms
PubMed: 38776213
DOI: 10.1093/ageing/afae101 -
Medical Science Monitor : International... May 2024BACKGROUND Effective communication and patient education are important in geriatric dental care. Memory decline complicates patient adherence. This study aimed to... (Comparative Study)
Comparative Study
BACKGROUND Effective communication and patient education are important in geriatric dental care. Memory decline complicates patient adherence. This study aimed to compare verbal, audio, and video patient education material (PEM) and adherence to dental prosthetic management in edentulous patients. MATERIAL AND METHODS 90 completely/partially edentulous patients (aged 40 to 70 years), were divided (simple random) into three groups (Gp) of 30 each . A total of 68 instructions were organized into 9 learning categories. For GpVi, a 20 minute video was shot using a Sony camera (PD170), with two actors depicting related PEM information. Patients were recalled after 1 day and 7days, to recall the PEM instructions. A Denture plaque Index (DPI) determined the efficiency of the instructions at both time intervals. Frequencies, means and standard deviations were derived for each group and then compared using Chi square, paired and unpaired t test and a Neuman-Keul post hoc pairwise test. All significant differences were kept at probability t value of ≤0.05. RESULTS PEM instructions related to patient individuality, proper tongue position and miscellaneous showed poor patient recall. At 1 day interval, audio was found to have better recall than video and verbal in 5 PEM instruction categories. At 7 day interval, video showed better recall than other two groups (P≤0.05). Despite improvements in patients recall, DPI revealed better denture hygiene maintenance in patients receiving instructions through video format (P≤0.05). CONCLUSIONS For all categories, no single media was considered to be sufficient, audio produced early better recall while video influenced long term recall and better denture hygiene maintenance.
Topics: Humans; Middle Aged; Patient Education as Topic; Female; Male; Aged; Oral Hygiene; Adult; Mouth, Edentulous; Dentures; Treatment Adherence and Compliance; Patient Compliance
PubMed: 38773745
DOI: 10.12659/MSM.944175 -
The Journal of Clinical Psychiatry May 2024This study examined the effects of a multicomponent intervention program on cognitive function in community-dwelling older adults with mild cognitive impairment (MCI)... (Randomized Controlled Trial)
Randomized Controlled Trial
This study examined the effects of a multicomponent intervention program on cognitive function in community-dwelling older adults with mild cognitive impairment (MCI) and subjective cognitive decline (SCD). This was a 2-arm, randomized controlled trial in which a multicomponent intervention was applied. Participants were recruited from June 2020 to August 2020, randomization and intervention began in August 2020, and the entire program ended in January 2021. It included cognitive training (mnemonic strategy training) and lifestyle guidance (diet, sleep, and exercise guidance) for 7 weeks. A total of 123 Chinese community-dwelling older adults experiencing MCI or SCD were randomly divided into a multicomponent intervention group (n = 62) and a health education group (n = 61). The global cognitive function was measured using the Mini-Mental State Examination (MMSE). The cognitive domains outcomes included memory functions measured using the immediate and delayed tests of the Auditory Verbal Learning Test (AVLT) and Logical Memory Test (LMT), and executive function and attention measured using the Digital Symbol Substitution Test (DSST) and Digit Span Test (DST). Data were collected at baseline and postintervention. For cognitive outcome, the results of linear mixed-effect model showed significant time × group effects in the MMSE (Cohen =0.63 [95% CI, 0.27 to 1.00], = 10.25, = .002). This study found significant time × group effects in AVLT-immediate (Cohen = 0.47 [95% CI, 0.11 to 0.83], = 8.18, = .005), AVLT delayed (Cohen = 0.45 [95% CI, 0.10 to 0.81], = 4.59, = .034), LMT-delayed (Cohen = 0.71 [95% CI, 0.34 to 1.07], = 4.59, = .034), DSST (Cohen = 0.27 [95% CI, -0.08 to 0.63], = 4.83, = .030), and DST (Cohen =0.69 [95% CI, 0.33 to 1.05], = 8.58, = .004). The results support the feasibility and effectiveness of the multicomponent intervention program in improving cognitive function in community dwelling older adults at risk of dementia. The high adherence of this program shows its potential for promotion in the community and supports a larger and longer trial. Chinese Clinical Trial Registry (ChiCTR2200061420).
Topics: Humans; Male; Female; Aged; Cognitive Dysfunction; Dementia; Life Style; Independent Living; Middle Aged; Cognitive Behavioral Therapy; Executive Function; China; Cognitive Training
PubMed: 38767936
DOI: 10.4088/JCP.23m15112