Psychometric testing of a Swedish version of the Apathy Evaluation Scale

Background: Apathy, a prevalent and clinically relevant symptom in neurodegenerative disease, is often evaluated by the instrument Apathy Evaluation Scale (AES). However, this instrument has not been translated into Swedish, halting clinical and research efforts. Furthermore, previous studies lack analyses of some basic properties, such as the legitimacy of a total score, or have analysed dimensionality by questionable methods.Aim: To translate and psychometrically evaluate a Swedish version of the AES.Method: The AES was translated, and its psychometric properties were tested in the Swedish BioFINDER study, including cognitively well elderly, and subjects with mild cognitive or parkinsonian symptoms. Psychometric analyses were conducted according to classical test theory (CTT) and aimed to resemble those performed in the English original study by Marin et al. in 1991. Dimensionality was additionally analysed on a matrix of polychoric correlations and parallel analyses.Results: Data indicate that the Swedish AES performs satisfactorily regarding data completeness, scaling assumptions, targeting, and reliability. Principal component analyses (with parallel analysis) of polychoric correlation matrices identified a single component. Convergent and discriminative validity correlations accorded with a priori expectations.Conclusions: The study provides initial support that this Swedish AES performs similarly to the English original, and exhibits acceptable psychometric properties according to CTT, including supported unidimensionality, and may be adopted for use in clinical and research settings.Keywords: Apathy, Apathy Evaluation Scale (AES), neurodegenerative disease, neuropsychiatric assessment, psychometric

Воздействие менталитета белорусов на интеграционные процессы Беларуси на культурно-цивилизационной оси "Восток-Запад"

BACKGROUND: Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. METHODS: An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test. RESULTS: 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes. CONCLUSIONS: A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected

Textanalys och Maskininlärning: En jämförelse av maskininlärningsalgoritmer för klassificering av fakturor och kvitton i e-postmeddelanden.

Enligt Skatteverket (Skatteverket, 2018-05-29) skall varje händelse som påverkar ekonomin i ett företag bokföras. Bokföringen skall grunda sig på skriftlig handling, också kallat verifikation. Bland typer av verifikationer kan en sådan vara ett kvitto eller en faktura. I ett företag där anställda gör köp åt företagets vägnar är det alltid nödvändigt att sammanställa verifikationer. Processen av att samla och sammanställa fakturor och kvitton sker oftast manuellt. Från detta kom idén att utveckla en mobilapplikation vars syfte är att samla fakturor och kvitton från en användares e-post och spara tid för användaren. För att idén för mobilapplikationen skall vara möjlig måste det finnas ett sätt att effektivt klassificera rätt dokument i ett e-postmeddelande. Ur detta kom idén till detta examensarbete. En möjlig användare till applikationen kan vara en anställd på ett företag som måste rapportera till företagets ekonomiavdelning. Syftet med examensarbetet är att hitta en lämplig lösning med hjälp av maskininlärning och språkbehandlingstekniker, som ordstam och Bag of Words, för att automatiskt kunna identifiera vad som är ett kvitto eller faktura från ett godtyckligt textdokument. Arbetet utfördes genom att jämföra tre olika maskininlärningsalgoritmer tillsammans med en modul för språkbehandling, Natural Language Toolkit, samt Bag of Words metoder. Två av algoritmerna är baserade på Naive Bayes teorem, multinomial naive bayes samt multivariate bernoulli naive bayes algoritm. Den tredje maskininlärningsmetoden är ett neuronnät. Resultatet i detta examensarbete visar att neuronnät med minst 80% framgång kan identifiera fakturor och kvitton korrekt. Naive bayes baserade maskininlärningsalgoritmer visar fluktuerande resultat. Klassificeringen av fakturor i multinomial naive bayes visar 100% framgång i klassificering av fakturor och i bästa fall 70% framgång i klassificering av kvitton. Multivariate bernoulli naive bayes algoritm visar i bästa fall 87% framgång i klassificering av fakturor och 13% framgång i klassificering av kvitton. Vid ökning av datamängden för träning av de naive bayes baserade algoritmerna försämrades det sammanställda resultatet för de båda algoritmerna. Neuronnätet visar konsekvent framgång av minst 80% oberoende av datamängden använd för träning i detta examensarbete. Sammanfattningsvis är metoder som liknar det sätt neuronnät behandlar och tolkar information bättre lämpat för denna typ av klassificeringsproblem. Anledningen till varför naive bayes algoritmerna presterar sämre är på grund av svårigheter att konsekvent formatera data av olika ursprung. Med ursprung menas olika filformat av de dokument som utgör data samt huruvida dokumentet ursprungligen har skapats genom användning av ett program, såsom Microsoft Word, eller ifall det är ett fotografi. Då data, orden i ett textdokument, inte konsekvent formateras med samma resultat är användningen av ett neuronnät fördelaktigt. Anledningen till detta är att neuronnätet inte har samma strikta riktlinjer att förhålla sig till. Nätet kommer genom många och återigen många iterationer försöka anpassa sig så att felen blir så minimala som möjligt. Ger vi nätet inkonsekvent data kommer det därav anpassa sig till det och producera bästa möjlig gissning givet den inkonsekventa träningsdatan. Naive Bayes har inte samma anpassning och måste förhålla sig till Bayes sats

Apathy in Alzheimer's disease : A neurocircuitry based perspective

In addition to memory deficits and other cognitive disturbances, patients with Alzheimer's disease (AD) experience neuropsychiatric symptoms, notably apathy, which is a state of impaired motivation observed by deficits in goal directed behavior. Apathy is a multifaceted neuropsychiatric condition and appears to be a prognostic indicator, correlating with the progression of AD. Strikingly, recent studies point out that the neurodegenerative pathology of AD may drive apathy independent of cognitive decline. These studies also highlight that neuropsychiatric symptoms, in particular apathy, might manifest early in AD. Here, we review the current understanding of the neurobiological underpinnings of apathy as a neuropsychiatric symptom of AD. Specifically, we highlight the neural circuits and brain regions recognized to be correlated with the apathetic symptomatology. We also discuss the current evidence that supports the notion that apathy and cognitive deficits may develop as independent but concurrent phenomena driven by AD pathology, suggesting its efficacy as an additional outcome measure in Alzheimer's disease clinical trials. The current and prospective therapeutic interventions for apathy in AD from a neurocircuitry based perspective are also reviewed

Apathy and anxiety are early markers of Alzheimer's disease

In this study, we investigated associations between neuropsychiatric symptoms (i.e., apathy, anxiety, and depression) and cerebral atrophy, white matter lesions (WML), beta-amyloid (Aβ) deposition, and cognitive decline in a nondemented sample. 104 cognitively unimpaired and 53 subjects with mild cognitive impairment were followed for up to 4 years within the Swedish BioFINDER study. Neuropsychiatric assessments included the Hospital Anxiety and Depression Scale and the Apathy Evaluation Scale. Magnetic resonance imaging and 18F-flutemetamol-positron emission tomography quantified brain atrophy, WML, and Aβ deposition. Mini-Mental State Examination assessed longitudinal global cognition. Regression analyses were used to test for associations. Apathy and anxiety were shown related to Aβ deposition and predicted cognitive decline. Anxiety also interacted with amyloid status to predict faster cognitive deterioration. Apathy was further related to frontotemporal and subcortical atrophy, as well as WML. To conclude, the associations between apathy and anxiety with Aβ deposition and cognitive decline point to these symptoms as early clinical manifestations of Alzheimer's disease

Development of Apathy, Anxiety, and Depression in Cognitively Unimpaired Older Adults : Effects of Alzheimer's Disease Pathology and Cognitive Decline

Background: The impact of Alzheimer's disease (AD) pathology and cognitive deficits on longitudinal neuropsychiatric symptoms is unclear, especially in early disease stages. Methods: Cognitively unimpaired older adults (N = 356) enrolled in the prospective Swedish BioFINDER study were examined. Neuropsychiatric assessments encompassed the Apathy Evaluation Scale and the Hospital Anxiety and Depression Scale, performed biennially (together with tests of global cognition) for up to 8 years. Biomarkers were measured in cerebrospinal fluid or plasma at baseline. Magnetic resonance imaging quantified white matter lesions. We used linear mixed-effect models to test associations between baseline AD biomarkers (for amyloid-β [Aβ], tau, and neurodegeneration) and white matter lesions with longitudinal neuropsychiatric symptoms (apathy, anxiety, and depressive symptoms). We also tested associations between changes in cognition and changes in neuropsychiatric symptoms. Finally, we tested if change in cognition mediated the effects of different brain pathologies on neuropsychiatric symptoms. Results: Aβ pathology at baseline was associated with increasing levels of apathy (β = −0.284, p =.005) and anxiety (β = −0.060, p =.011) longitudinally. More rapid decline of cognition over time was related to increasing levels of apathy. The effects of baseline Aβ pathology on longitudinal apathy were partly mediated by changes in cognitive performance (proportion mediated 23%). Conclusions: Aβ pathology may drive the development of both apathy and anxiety in very early stages of AD, largely independent of cognitive change. The effect of Aβ on apathy is only partially conveyed by worse cognition. Together, these findings highlight certain neuropsychiatric symptoms as early manifestations of AD

Mild behavioral impairment and its relation to tau pathology in preclinical Alzheimer's disease

Mild behavioral impairment (MBI) is suggested as risk marker for neurodegenerative diseases, such as Alzheimer's disease (AD). Recently, pathologic tau deposition in the brain has been shown closely related to clinical manifestations, such as cognitive deficits. Yet, associations between tau pathology and MBI have rarely been investigated. It is further debated if MBI precedes cognitive deficits in AD. Here, we explored potential mechanisms by which MBI is related to AD, this by studying associations between MBI and tau in preclinical AD. In all, 50 amyloid-β-positive cognitively unimpaired subjects (part of the BioFINDER-2 study) underwent MBI-checklist (MBI-C) to assess MBI, and the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) delayed word recall (ADAS-DR) to assess episodic memory. Early tau pathology was determined using tau-PET ([18F]RO948 retention in entorhinal cortex/hippocampus) and cerebrospinal fluid (CSF) P-tau181. Regression models were used to test for associations. We found that higher tau-PET signal in the entorhinal cortex/hippocampus and CSF P-tau181 levels were associated with higher MBI-C scores (β = 0.010, SE = 0.003, p = 0.003 and β = 1.263, SE = 0.446, p = 0.007, respectively). When MBI-C and ADAS-DR were entered together in the regression models, tau-PET (β = 0.009, p = 0.009) and CSF P-tau181 (β = 0.408, p = 0.006) were predicted by MBI-C, but not ADAS-DR. We conclude that in preclinical AD, MBI is associated with tau independently from memory deficits. This denotes MBI as an important early clinical manifestation related to tau pathology in AD