Cognitive Impairment and Psychological State in Acute Coronary Syndrome Patients: A prospective descriptive study at Cardiac Rehabilitation Entry, Completion and Follow-up

Background: Cognitive impairments (CI) may limit uptake of secondary prevention in acute coronary syndrome (ACS) patients but is poorly understood, including in cardiac rehabilitation (CR) participants. Aim: To explore CI in relation to psychological state in ACS patients over the course of CR and follow-up. Methods: ACS patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at CR entry, completion and follow up and scores adjusted using normative data. The Hospital Anxiety and Depression Scale measured psychological state.Results: Participants (n=40) had an average age of 66.2 (±8.22) years and were 70% male. Mild CI occurred at CR entry in single 62.5% and multiple domains 22.5% but was significantly less prevalent by CR completion (52.5% and 15.0%) and follow-up (32.5% and 7.0%). Domains most often impaired were verbal learning (52.5%) and processing speed (25.6%), again decreasing significantly with time (verbal learning CR completion 42.5%, follow-up 22.5%; processing speed CR completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain CI. At CR entry patients with CI in processing speed, a single domain or multiple domains had more depression, and patients with CI in executive function had more depression and anxiety. Conclusions: At CR entry, mild CI is very common in post-ACS patients and worse in patients who have depression or anxiety symptoms. CI decreases significantly by CR follow-up. A small proportion of patients have persistent, multiple domain CI flagging potential long-term changes and the need for further investigations and cognitive rehabilitation

Dementia prevention: The time to act is now

"A multilayered action plan is needed for a substantial, timely and sustained investment in dementia prevention

Safety of higher doses of melatonin in adults: A systematic review and meta-analysis

Melatonin is commonly used for sleep and jetlag at low doses. However, there is less documentation on the safety of higher doses, which are being increasingly used for a wide variety of conditions, including more recently COVID-19 prevention and treatment. The aim of this review was to investigate the safety of higher doses of melatonin in adults. Medline, Scopus, Embase and PsycINFO databases from inception until December 2019 with convenience searches until October 2020. Randomised controlled trials investigating high-dose melatonin (≥10 mg) in human adults over 30 years of age were included. Two investigators independently abstracted articles using PRISMA guidelines. Risk of bias was assessed by a committee of three investigators. 79 studies were identified with a total of 3861 participants. Studies included a large range of medical conditions. The meta-analysis was pooled data using a random effects model. The outcomes examined were the number of adverse events (AEs), serious adverse events (SAEs) and withdrawals due to AEs. A total of 29 studies (37%) made no mention of the presence or absence of AEs. Overall, only four studies met the pre-specified low risk of bias criteria for meta-analysis. In that small subset, melatonin did not cause a detectable increase in SAEs (Rate Ratio = 0.88 [0.52, 1.50], p =.64) or withdrawals due to AEs (0.93 [0.24, 3.56], p =.92), but did appear to increase the risk of AEs such as drowsiness, headache and dizziness (1.40 [1.15, 1.69], p <.001). Overall, there has been limited AE reporting from high-dose melatonin studies. Based on this limited evidence, melatonin appears to have a good safety profile. Better safety reporting in future long-term trials is needed to confirm this as our confidence limits were very wide due to the paucity of suitable data

Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus

IntroductionWe aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. MethodsA consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. ResultsConsensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DiscussionThis work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine

AU‐ARROW (Australia)

Background The highly encouraging findings from the Finnish Geriatric Intervention Study (known as FINGER) led to the global initiative for dementia risk reduction known as world-wide FINGERS (WW FINGERS). As part of the collaboration, our Australian AU-ARROW trial will follow the general protocol of the FINGER trial, and will also be aligned with the U.S. arm of the study, US-POINTER, though will have minor cultural and dietary modifications to determine the validity of the intervention in an Australian setting. Method AU-ARROW is a randomised, single-blind 2-year clinical trial that will recruit 600 participants aged 60-79 satisfying specific inclusion/exclusion criteria, including normal cognition and one or more cardiovascular risk factors that place them at greater risk of cognitive decline. Participants will be distributed across two sites (a) Macquarie University Health Clinics, Sydney, NSW and (b) Sarich Neuroscience Research Institute, Edith Cowan University, Perth, WA, and will be randomised equally into either the innovative multi-modal intervention group or the study control group, who will receive general lifestyle advice and annual health check-ups, without treatment. Multi-modal intervention consists of aerobic exercise, resistance training and stretching; dietary advice with monitoring to encourage adherence to the MIND diet; cognitive training sessions via the Brain HQ computerised online training system; and medical monitoring and regular health education sessions. Heart rate trackers, diet and exercise log books, and the monitoring of Brain HQ sessions will all help with adherence. Primary outcome measure is improvement in global cognitive score, measured using neurocognitive tests identical to those in the US-POINTER protocol. Additional neurocognitive tests, physical function improvements, detailed diet monitoring and sleep monitoring will provide added data. The unique extra value of AU-ARROW trial consists of the testing for Alzheimer’s disease (AD) blood biomarkers in all participants; as well as the AD Aβ amyloid-specific ligand-PET imaging, brain MRI and retinal biomarker tests that half of the participants will undergo. These tests will provide comprehensive data which have the ultimate purpose of increasing knowledge of the preclinical stages of AD, and help not only to develop preclinical AD diagnostic tests but also efficacy of AU-ARROW’s intervention