Predicting Interrelated Alzheimer's Disease Outcomes via New Self-Learned Structured Low-Rank Model

Alzheimer's disease (AD) is a progressive neurodegenerative disorder. As the prodromal stage of AD, Mild Cognitive Impairment (MCI) maintains a good chance of converting to AD. How to efficaciously detect this conversion from MCI to AD is significant in AD diagnosis. Different from standard classification problems where the distributions of classes are independent, the AD outcomes are usually interrelated (their distributions have certain overlaps). Most of existing methods failed to examine the interrelations among different classes, such as AD, MCI conversion and MCI non-conversion. In this paper, we proposed a novel self-learned low-rank structured learning model to automatically uncover the interrelations among different classes and utilized such interrelated structures to enhance classification. We conducted experiments on the ADNI cohort data. Empirical results demonstrated advantages of our model

Cognitive impairment in medical inpatients

Background: People aged over 80 years is the most rapidly growing segment of the population in Sweden. This group is susceptible to multimorbidity, disability and cognitive impairment. Managing these issues will be essential in order to obtain a sustainable healthcare system in the near future. Aim: To determine if increased acknowledgement of cognitive impairment could improve healthcare for elderly persons admitted to a general hospital Study population: Two hundred patients at the wards of general internal medicine at Skåne university hospital in Malmö. Results: I. Cognitive impairment was prevalent in 73% of medical inpatients, the majority of which were undetected by healthcare professionals. Cognitive impairment was independently associated with a three-fold risk of one-year mortality. II. A group of 99 patients received an intervention that focused on cognitive impairment. This group had fewer rehospitalisations after 12-months than the control group, receiving standard care. This effect was statistically significant for those patients who survived for 12-months, but not from an intention-to-treat perspective. III. In total, 94 patients had undergone a cranial computed tomography. Of these, 36% had an abnormal medial temporal lobe atrophy (MTA). None of these had been reported originally. Of the patients with abnormal MTA, 93% had cognitive impairment, with a test profile indicating a possible Alzheimer symptomatology. IV. An ADL (activities of daily living) measurement predicted mortality stronger than age, sex, body mass index, albumin, haemoglobin, kidney function and the Charlson comorbidity index. The ADL measurement entailed a substantial added value to these established risk factors. V. Lower quality of life was associated with cognitive impairment, ADL impairment, depression and social factors, but not with physical comorbidity. Conclusion: This thesis emphasises the need to acknowledge cognitive impairment in medical inpatients. The results suggest that increased acknowledgement of cognitive impairment could lead to fewer rehospitalisations, more accurate prognosis estimates and possibly better quality of life

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Not Getting Out While There Is Still Time? Behavioral Response to Threat as a Possible Mechanism of Sexual Revictimization

Sexual violence affects approximately one in four college women. Feminist sexual assault risk reduction programs attempt to empower women to cope with threats of sexual assault, yet there is no standardized way to assess behavioral responses to threat, the key behavior targeted in these interventions. In this study, we sought to compare the behavioral responses of two groups of college women, those without a history of any sexual victimization, n = 12 and those with a history of repeated sexual victimization, n = 45 in a standardized analog task in order to investigate possible group differences which may lead to increased risk for sexual assault and psychological factors which facilitate different styles of responding. Results indicate that women with a history of victimization were more likely to engage in less effective behavioral response styles. Hierarchical regression analyses found that interpersonal skills predicted assertive style responding. These findings indicate this analog task may be useful as a risk assessment to identify those in need of risk reduction intervention and that women with a history of sexual assault may require greater or different kinds of intervention in order to reduce risk. Finally, results indicate interpersonal skills as a possible target for increasing the efficacy of risk reduction interventions

Designing an intervention and plan its evaluation : development of a protocol of a randomised feasibility study for a multi-component intervention to improve instrumental activities of daily living in persons with mild cognitive impairment

Cumulative doctoral/PhD Thesis, University of LucerneBackground: Beside cognitive loss from a previously achieved level, persons with mild cognitive impairment (MCI) experience impairments in physical functions, and limitations in instrumental activities of daily living (IADL) are frequently reported. IADLs are complex tasks that are needed to live independently in society. Currently, there is no pharmacological treatment recommended to improve cognition or reduce the impact of cognitive loss on functioning in people with MCI. In contrary, evidence supports beneficial effects of multi-component interventions, e.g. a combination of physical exercise and cognitive training on specific aspects of cognitive and physical functioning. However, the pertinent components of such interventions are unknown, and whether these effects translate into improved IADL functioning. Aims: The objective of this doctoral thesis was to develop a study protocol of a randomised feasibility study for a multi-component intervention targeting IADL functioning in persons with MCI. The specific aims were to: 1) review the evidence for multi-component interventions in improving IADL performance, cognitive function and physical capacity in older adults, with or without MCI; 2) identify the most suitable measurement tool with good psychometric properties to assess IADL performance; and, 3) develop a multi-component intervention to improve IADL functioning in persons with MCI. Methods: The aims were addressed in four studies. Based on a systematic review, including Bayesian network meta-analyses, the evidence from randomised controlled trials on the effects of multi-component interventions on IADL performance, cognitive function, and physical capacity in elderly individuals with normal cognition (NC) and MCI were summarised. In an observational study, including a German-speaking sample of 96 elderly individuals with NC, MCI and mild dementia (MD) the Amsterdam IADL questionnaire short (A-IADL-Q-SV), was adapted, validated and relevant psychometric properties were evaluated. The first step to develop a multi-component intervention was to form the theoretical base by developing a model of IADL functioning using a four-round online Delphi study in 69 international IADL experts. The second step of the development of the intervention included the description of a draft of the planned intervention, that was elaborated using a patient and public involvement approach (PPI). Based on the findings of the preceding studies, the fourth study outlined the protocol of a randomised feasibility study to evaluate the feasibility, acceptability, and preliminary efficacy of the newly-developed multi-component intervention in persons with MCI. Results: The findings of the first study demonstrated the effectiveness and superiority of multi-component interventions on cognitive functions and physical capacity, while their effectiveness on IADL performance remained inconclusive. The results of the second study affirmed the successful adaptation and validation of the German version of the A-IADL-Q-SV and the determination of psychometric properties. The findings from the Delphi study depicted a comprehensive IADL functioning model encompassing relevant influencing factors and covering various aspects of human functioning, these factors were used to determine the components of the multi-component intervention. International guidelines and current literature were used to specify how the determined intervention components should be trained. The PPI resulted in design adaptations of the intervention. The developed multi-component intervention – the F.I.T.AL. (Function - Information - Training - therapy for everyday life) consists of three main components: cognitive training, physical training, and information and support. Discussion/Conclusion: This thesis outlines a research protocol of a randomised feasibility study to evaluate the feasibility, acceptability, and adherence of a multi-component intervention that has been designed to improve IADL in persons with MCI. The development process aligns with the British Medical Research Council framework and includes the current evidence on multi-component interventions in persons with MCI, and the newly developed IADL functioning model in persons with MCI. The selected outcome measure for the planned study to assess IADL performance, the A-IADL-Q-SV, was successfully adapted and validated. This thesis may have implications for clinical practice through the provision of a potential non-pharmacological treatment strategy for persons with MCI and a valuable measure for the assessment of IADL performance. This thesis may also stimulate future research in the field of IADL functioning in persons with MCI and multi-component interventions as treatment options for persons with MCI

The Moderating Effect of Physical Activity on the Association between White Matter Hyperintensities and Gait Characteristics

The objectives of this thesis were; 1) to assess the effect of white matter hyperintensities (WMH) burden on motor outcomes among older individuals in presence and absence of overt neurological conditions and 2) to evaluate whether physical activity (PA) moderated the association between WMH and gait velocity and stride time variability (STV), under single and dual-task conditions, in a geriatric clinic sample. Study 1 systematically reviewed the literature demonstrating that greater WMH burden was associated with predefined motor outcomes. Notably, gait velocity emerged as a well-studied characteristic. Study 2 confirmed that WMH negatively affected gait velocity. STV and dual-task gait conditions did not reveal significance. Additionally, PA did not moderate the association between WMH and gait velocity, although conditional effects showed significance for low and moderate levels of PA. This finding extends support for the efficacy of physical activity in attenuating the effects of WMH on mobility

The importance of "scaffolding" in clinical approach to deafness across the lifespan

Throughout the present work of thesis, the concept of scaffolding will be used as a fil rouge through the chapters. What I mean for “scaffolding approach”, therefore, is an integrated and multidisciplinary clinical and research methodology to hearing impairments that could take into account persons as a whole; an approach that needs to be continuously adapted and harmonized with the individuals, pursuant to their progress, their limits and resources, in consideration of their audiological, cognitive, emotional, personal, and social characteristics. The following studies of our research group will be presented: A study (2020) designed to assess the effects of parent training (PT) on enhancing children’s communication development (chapter two); Two studies of our research group (2016; 2020) concerning variables influencing comprehension of emotions and nuclear executive functions in deaf children with cochlear implant (chapter three and chapter four) In chapter five a presentation and description of our Mind-Active Communication program, main topics and aims, multidisciplinary organizations of group and individual sessions with a description of used materials and methodology is given. Finally, a preliminary evaluation to explore the use of this multidisciplinary rehabilitative program on quality of life, psychological wellbeing, and hearing abilities in a sample of cochlear implanted elderly persons is reported

Parsing neurocognitive heterogeneity in pediatric traumatic brain injury

Traumatic brain injuries (TBI) occur quite frequently in children and adolescents. One difficulty in understanding and treating TBI lies in the heterogeneous nature of its acquisition and mechanism of injury, and the resulting neurocognitive impairment. While there are instruments that exist to identify such impairment, they typically are divided into very broad domains of academic performance. Tests such as the Wechsler Intelligence Scale for Children (WISC) and the Woodcock Johnson are helpful in identifying impairment within the realm of academic aptitude, but have thus far not provided specific enough information as to the impairment of the underlying neurocognitive process that may be causing the degraded performance. In recent years, however, there has been an increase in tests specifically to assess neurocognitive functioning in children. One such test, the Test of Memory and Learning (Reynolds & Bigler, 1994), includes both nonverbal and verbal components, similar to the WISC, as well as indices of performance that measure broader underlying neurocognitive processes such as memory, learning, and attention/concentration factors. The purpose of the current study was to investigate the heterogeneity in neurocognitive function demonstrated by children who have sustained a TBI. Understanding the profiles of neurocognitive impairment that occur in child TBI may assist in predicting outcomes and treatment planning. From a theoretical perspective, patterns of performance on neuropsychological tests may provide unique insights into the type of injury sustained and the brain structures that are most susceptible to injury. In the present investigation, heterogeneity in neurocognitive function was investigated using cluster analysis of neuropsychological domains assessed by the Test of Memory and Learning (TOMAL). A five-cluster solution for the TOMAL, data was selected as the optimal cluster solution. It best exhibited differences in level and pattern of performance, as well as differences on important clinical and behavioral variables. Empirical support for the identification of clusters based upon TOMAL scores, Intelligence scores (IQ) and behaviors reported on the Behavior Assessment System for Children (BASC) further supported the selected cluster solution, and should assist clinicians in providing both a more informed prognosis and a more prescriptive treatment intervention

The Relationship Between Leadership Styles and Organizational Culture withinSchools of Nursing

The purpose of this study was to investigate the relationship between leadership styles and organizational culture within schools of nursing. A non-probability convenience sample (N=149) of subjects was obtained from BSN schools of nursing within the Southern Regional Education Board geographical area. Three data collection tools were utilized including a demographic questionnaire; the Multi-factor Leadership Questionnaire (Bass & Avolio) which measures transformational, transactional, and laissez-faire leadership styles; and the Organizational Culture Assessment Inventory (Cameron & Quinn) which measures four culture types including clan, market, adhocracy and hierarchy cultures. A descriptive – correlational design was used. Inferential statistics utilized included multiple regressions using analysis of variance and Pearson’s correlations. Significant relationships were evidenced as follows: the main research questions demonstrated that there were statistically significant relationships between the three leadership styles (transformational, transactional, and laissez-faire) and school organizational culture. With each regression analysis, based on the significance of the beta coefficient parameter estimate, the results showed that measures for transformational leadership had a predictive value for Clan, Adhocracy, and Market Cultures. Transactional leadership was found to have significantly predictive value for Adhocracy and Hierarchy cultures. Laissez-faire leadership was found to have significantly predictive value for the Adhocracy and Market Cultures