The effects of age and language on paragraph recall performance: Findings from a preliminary cross-sctional study

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Altered Resting Functional Connectivity Is Related to Cognitive Outcome in Males With Moderate-Severe Traumatic Brain Injury

TBI results in significant cognitive impairments and in altered brain functional connectivity. However, no studies explored so far, the relationship between global functional connectivity and cognitive outcome in chronic moderate-severe TBI. This proof of principle study employed the intrinsic connectivity contrast, an objective voxel-based metric of global functional connectivity, in a small sample of chronic moderate-severe TBI participants and a group of healthy controls matched on gender (males), age, and education. Cognitive tests assessing executive functions, verbal memory, visual memory, attention/organization, and cognitive reserve were administered. Group differences in terms of global functional connectivity maps were assessed and the association between performance on the cognitive measures and global functional connectivity was examined. Next, we investigated the spatial extent of functional connectivity in the brain regions found to be associated with cognitive performance, using traditional seed-based analyses. Global functional connectivity of the TBI group was altered, compared to the controls. Moreover, the strength of global functional connectivity in affected brain areas was associated with cognitive outcome. These findings indicate that impaired global functional connectivity is a significant consequence of TBI suggesting that cognitive impairments following TBI may be partly attributed to altered functional connectivity between brain areas involved in the specific cognitive functions

The Effects of Age, Sex and Education on HVLT-R Performance Across the Lifespan: Data from the NEUROAGE Cohort

Η μελέτη επιδιώκει να διερευνήσει την επίδραση της ηλικίας, της εκπαίδευσης και του φύλου στη μνήμη μιας ποικίλης ομάδας συμμετεχόντων που καλύπτει το ενήλικο εύρος, χρησιμοποιώντας το G-HVLT-R. Συμμετείχαν 1,055 Έλληνοκύπριοι ενήλικες, άνδρες και γυναίκες, ηλικίας 18 έως 80 ετών, από τη διαχρονική μελέτη NEUROAGE. Οι συμμετέχοντες υποβλήθηκαν σε μια σειρά από νευροψυχολογικά τεστ για την αξιολόγηση της γνωστικής και ψυχολογικής λειτουργίας, συμπεριλαμβανομένου του G-HVLT-R για την μέτρηση της συνολικής μάθησης και καθυστερημένης ανάκλησης, καθώς και των έργων Λογικής Μνήμης για την καθυστερημένη ανάκληση κατά την ανάκληση ιστορίας. Τα αποτελέσματα απέδειξαν διαφορές στην επίδοση μεταξύ τηςΦόρμας 1 και 2 και μεταξύ της Φόρμας 1 και 3 του G-HVLT-R. Οι αναλύσεις παλινδρόμησης αποκάλυψαν ότι η ηλικία είχε τους υψηλότερους συντελεστές, ακολουθούμενη από την εκπαίδευση και το φύλο. Ιδιαίτερα σημαντικό είναι το γεγονός ότι το G-HVLT-R έδειξε ισχυρή ταυτόχρονη εγκυρότητα, όπως αποδεικνύεται από υψηλούς συντελεστές συσχέτισης με τα έργα καθυστερημένης ανάκλησης Λογικής Μνήμης. Τα ευρήματα υπογραμμίζουν ότι, ενώ η ηλικία αποτελεί τον κυρίαρχο παράγοντα πρόβλεψης της απόδοσης, η εκπαίδευση και το φύλο σχετίζονται με την απόδοση σε όλη τη διάρκεια της ζωής. Επομένως, η δημιουργία νορμών που λαμβάνουν υπόψη τα δημογραφικά χαρακτηριστικά είναι ζωτικής σημασίας για την ακριβή αξιολόγηση νευροψυχολογικών παραμέτρων, ιδίως για άτομα με χαμηλή εκπαίδευση και σε μεγαλύτερες ηλικιακές ομάδες. Τέτοιες πληροφορίες προάγουν την ακριβή ανίχνευση των συνθηκών σε διάφορους πληθυσμούς και βοηθούν στον εντοπισμό ατόμων με ανάγκες για συγκεκριμένες θεραπευτικές παρεμβάσεις.The study investigates the impact of age, education, and sex on memory within a diverse cohort of participants spanning the adult lifespan, utilizing the G-HVLT-R. A total of 1,055 Greek Cypriot individuals, both males and females aged 18 to 80, were recruited from the NEUROAGE longitudinal project. Participants underwent a comprehensive battery of neuropsychological tests, including the G-HVLT-R for assessing total learning and delayed recall, alongside the Logical Memory test measuring delayed recall performance in story recall. Significant performance disparities emerged between Forms 1 and 2 and Forms 1 and 3 of the G-HVLT-R. Regression analyses revealed age as the predominant predictor, with the highest coefficients, followed by education and sex. Notably, the G-HVLT-R demonstrated robust concurrent validity, evidenced by high correlation coefficients with Logical Memory delayed recall tasks. The findings underscore age as the primary determinant of performance, while also emphasizing the influence of education and sex across the lifespan. Consequently, establishing norms that account for demographic characteristics is imperative for refining the precision of neuropsychological assessment, particularly among those with lower education levels and in older age groups. This information enhances accurate clinical assessment across diverse populations and aids in identifying individuals necessitating specific treatment interventions

Altered Resting Functional Connectivity Is Related to Cognitive Outcome in Males With Moderate-Severe Traumatic Brain Injury.

TBI results in significant cognitive impairments and in altered brain functional connectivity. However, no studies explored so far, the relationship between global functional connectivity and cognitive outcome in chronic moderate-severe TBI. This proof of principle study employed the intrinsic connectivity contrast, an objective voxel-based metric of global functional connectivity, in a small sample of chronic moderate-severe TBI participants and a group of healthy controls matched on gender (males), age, and education. Cognitive tests assessing executive functions, verbal memory, visual memory, attention/organization, and cognitive reserve were administered. Group differences in terms of global functional connectivity maps were assessed and the association between performance on the cognitive measures and global functional connectivity was examined. Next, we investigated the spatial extent of functional connectivity in the brain regions found to be associated with cognitive performance, using traditional seed-based analyses. Global functional connectivity of the TBI group was altered, compared to the controls. Moreover, the strength of global functional connectivity in affected brain areas was associated with cognitive outcome. These findings indicate that impaired global functional connectivity is a significant consequence of TBI suggesting that cognitive impairments following TBI may be partly attributed to altered functional connectivity between brain areas involved in the specific cognitive functions

Neural correlates of pain acceptance and the role of the cerebellum:Functional connectivity and anatomical differences in individuals with headaches versus matched controls

Background: Despite functional connectivity network dysfunction among indi-viduals with headaches, no studies have examined functional connectivity neuralcorrelates and anatomical differences in coping with headaches.Methods: This study investigated inter-individual variability in whole-brainfunctional connectivity and anatomical differences among 37 individuals withprimary headaches and 24 age- and gender-matched controls, and neural cor-relates of psychological flexibility (PF) that was previously found to contributeto headache adjustment. Participants (84% women; M headache severity = 4/10;M age = 43 years) underwent functional magnetic resonance imaging scans andcompleted questionnaires to examine global and subnetwork brain areas, andtheir relations with PF components, controlling for age, gender, education, andhead- motion.Results: Seed and voxel-based contrast analyses between groups showed atypicalfunctional connectivity of regions involved in pain matrix and core resting-statenetworks. Pain acceptance was the sole PF component that correlated with thecerebellum (x, y, z: 28, −72, −34, p-false discovery rate <0.001), where individualswith headaches showed higher grey matter density compared to controls.Conclusions: The cerebellum, recently implicated in modulating emotional andcognitive processes, was indicated to process information resembling what indi-viduals do when practicing pain acceptance. Our findings establish for the firsttime this connection of the cerebellum and its role in pain acceptance. We pro-pose that pain acceptance might be a behavioural biomarker target that couldmodulate problematic headache perceptions and brain networks abnormalities

Feasibility of an Intervention to Support Hearing and Vision in Dementia:The SENSE-Cog Field Trial

OBJECTIVES: People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD. DESIGN: An international single-arm open-label feasibility, acceptability, and tolerability study. SETTING: Home-based setting in the United Kingdom, France, and Cyprus. PARTICIPANTS: Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads). INTERVENTION: A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion. MEASUREMENTS: Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews. RESULTS: We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified. CONCLUSION: This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable

Hearing and vision rehabilitation for people with dementia in five European countries (SENSE-Cog): a randomised controlled trial

Background: The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties. Methods: We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-based sensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211. Findings: Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2–39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI –2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures. Interpretation: This study showed no improvement in quality in life in participants who received the intervention in the longer term. Sensory difficulties are common in people with dementia and interventions aimed at improving sensory-cognitive health should be explored further

Individualised sensory intervention to improve quality of life in people with dementia and their companions (SENSE-Cog trial): study protocol for a randomised controlled trial

Background: Hearing and vision impairments are highly prevalent in people with dementia and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimise sensory impairment and support sensory function may be a means of improving dementia-related outcomes. The SENSE-Cog trial will test whether a home-based multi-part sensory intervention is effective in improving quality of life and other key outcomes in people with dementia and hearing or vision problems (or both) and their companions. Methods: This is an European, multi-centre, observer-blind, pragmatic, randomised controlled trial. Three hundred fifty four people with dementia and hearing or vision impairment (or both) and their companions will be randomly assigned to receive either "care as usual" or a multi-component sensory intervention including assessment and correction of hearing or vision impairments (or both), home-based (maximum 10 visits over 18 weeks), therapist-delivered sensory support (that is, adherence to devices; improving the sensory environment (that is, lighting), communication training, and sign-posting to other support agencies). Change from baseline to intervention end (18 weeks) and post-intervention (36 weeks) will be compared between the two arms in the following outcomes: quality of life (primary endpoint), sensory and cognitive functional ability, relationships, mental well-being, health resource utilisation and cost-effectiveness. Discussion: This is one of two articles outlining the SENSE-Cog trial. Here, we describe the protocol for the effectiveness of the SENSE-Cog intervention. A parallel and complementary process evaluation will be described elsewhere. If the SENSE-Cog trial demonstrates that the sensory intervention improves outcomes in dementia, we will make a toolkit of training materials, resources and information available to health and social care providers to implement the intervention in routine practice. This will be a significant contribution to the therapeutic management of people with dementia and sensory impairment. Trial registration: ISRCTN (Trial ID: ISRCTN17056211) on 19 February 2018

Trials

Background Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. Methods/design We will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. Discussion This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment