Working Memory Capacity as a Predictor of Cognitive Training Efficacy in the Elderly Population

Aging is associated with a decline in a wide range of cognitive functions and working memory (WM) deterioration is considered a main factor contributing to this. Therefore, any attempt to counteract WM decline seems to have a potential benefit for older adults. However, determination of whether such methods like WM trainings are effective is a subject of a serious debate in the literature. Despite a substantial number of training studies and several meta-analyses, there is no agreement on the matter of their effectiveness. The other important and still not fully explored issue is the impact of the preexisting level of intellectual functioning on the training’s outcome. In our study we investigated the impact of WM training on variety of cognitive tasks performance among older adults and the impact of the initial WM capacity (WMC) on the training efficiency. 85 healthy older adults (55–81 years of age; 55 female, 30 males) received 5 weeks of training on adaptive dual N-back task (experimental group) or memory quiz (active controls). Cognitive performance was assessed before and after intervention with measures of WM, memory updating, inhibition, attention shifting, short-term memory (STM) and reasoning. We found post-intervention group independent improvements across all cognitive tests except for inhibition and STM. With multi-level analysis individual learning curves were modeled, which enabled examining of the intra-individual change in training and inter-individual differences in intra-individual changes. We observed a systematic and positive, but relatively small, learning trend with time. Moderator analyses with demographic characteristics as moderators showed no additional effects on learning curves. Only initial WMC level was a significant moderator of training effectiveness. Older adults with initially lower WMC improved less and reached lower levels of performance, compared to the group with higher WMC. Overall, our findings are in accordance with the research suggesting that post-training gains are within reach of older adults. Our data provide evidence supporting the presence of transfer after N-back training in older adults. More importantly, our findings suggest that it is more important to take into account an initial WMC level, rather than demographic characteristics when evaluating WM training in older adults

Outcome of refractory and relapsed acute myeloid leukemia in children treated during 2005-2011 : experience of the Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG)

AIM OF THE STUDY: Recent studies showed relatively better outcome for children with refractory (refAML) and relapsed acute myeloid leukemia (relAML). Treatment of these patients has not been unified within Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG) so far. The goal of this study is to analyze the results of this therapy performed between 2005–2011. MATERIAL AND METHODS: The outcome data of 16 patients with refAML and 62 with relAML were analyzed retrospectively. Reinduction was usually based on idarubicine, fludarabine and cytarabine with allogenic hematopoietic stem cell transplant (alloHSCT) in 5 refAML and 30 relAML children. RESULTS: Seventy seven percent relAML patients entered second complete remission (CR2). Five-year OS and disease-free survival (DFS) were estimated at 16% and 30%. The outcome for patients after alloHSCT in CR2 (63%) was better than that of those not transplanted (36%) with 5-year OS of 34% vs. 2-year of 7% and 5-year DFS of 40% vs. 12.5%. Second complete remission achievement and alloHSCT were the most significant predictors of better prognosis (p = 0.000 and p = 0.024). The outcome of refAML children was significantly worse than relAML with first remission (CR1) rate of 33%, OS and DFS of 25% at 3 years and 53% at 2 years, respectively. All survivors of refAML were treated with alloHSCT after CR1. CONCLUSIONS: The uniform reinduction regimen of the documented efficacy and subsequent alloHSCT in remission is needed to improve the outcome for ref/relAML children treated within PPLLSG. The focus should be on the future risk-directed both front and second line AML therapy

THE EFFECIVENESS OF COGNITIVE TRAININGS IN OLDER ADULTS – REVIEW

There is a gradual increase in the number of elderly people living in the world. Also, human aging is associated with a deterioration of cognitive processes, that touches multiple domains, including memory, attention, processing speed and cognitive control. For this reason, intervention programs that improve the intellectual functioning of older citizens became very popular. One of the broadly discussed approach aims to support the elderly’s functioning with the usage of cognitive trainings. Although, emerged training regimes are considered by some researchers to be effective, they are systematically criticized by others. Possible causes are due to a diversity of approaches to the training design itself, to the way it is applied, as well as to the training methodology. In terms of their utility, it is crucial to decide which interventions are effective, how strongly they affect behavior, and to what extent they actually transfer to everyday life of older participants. Especially the last attribute should be e  ential, considering participants’ well-being. Therefore, this article aims not only to systematize reports on improving the cognitive functioning of the elderly, but above all to draw attention to the increasingly perceptible problem of verification of the training effects of seniors. We would like to emphasize the need for implementation a stronger methodological unification of cognitive trainings, that allows a fair assessment of their impact on the quality of life of the participating seniors.Na świecie stopniowo wzrasta liczba osób dożywających sędziwego wieku. Jednocześnie wraz z wiekiem ulega pogorszeniu szereg procesów poznawczych, takich jak: pamięć, uwaga, szybkość przetwarzania informacji czy kontrola poznawcza. Z tego względu bardzo popularne stały się programy usprawniające zdolności intelektualne tej grupy. Jednym z szeroko dyskutowanych podejść jest wspomaganie funkcjonowania osób starszych z wykorzystaniem treningów poznawczych. Powstałe reżimy treningowe są przez część badaczy uznawane za skuteczne, przez innych zaś systematycznie krytykowane. Obserwujemy heterogeniczność podejść zarówno do samego treningu, jak i do metodologii badań. Z punktu widzenia ich użyteczności kluczowe jest natomiast rozstrzygnięcie, jakiego rodzaju interwencje są najbardziej skuteczne, jak szeroki mają zasięg i w jakim stopniu przekładają się na realne korzyści dla trenujących. Profitem powinna być przede wszystkim poprawa jakości codziennego życia. Dlatego niniejszy artykuł ma na celu nie tylko systematyzac   doniesień z dziedziny usprawniania funkcjonowania poznawczego osób starszych, lecz przede wszystkim zwrócenie uwagi na coraz bardziej odczuwalny problem weryfikacji efektywności treningów poznawczych seniorów. Pragniemy podkreślić potrzebę wprowadzenia silniejszej unifikacji metodologicznej interwencji poznawczych w celu umożliwienia rzetelnej oceny ich wpływu na jakość życia badanych seniorów. Na podstawie dokonanego przeglądu przedstawiamy sugestie dotyczące metodologii treningów

SKUTECZNOŚĆ TRENINGÓW POZNAWCZYCH W GRUPIE OSÓB STARSZYCH – PRZEGLĄD BADAŃ

Z wiekiem pogorszeniu ulega szereg procesów poznawczych, takich jak pamięć, uwaga, szybkość przetwarzania informacji czy kontrola poznawcza. Jednocześnie na świecie wzrasta stopniowo liczba osób, które dożywają sędziwego wieku. Z tego względu środowiska naukowe, polityczne czy nawet komercyjne firmy starają się stworzyć programy usprawniające zdolności intelektualne w tej grupie.Jednym z szeroko dyskutowanych podejść jest wspomaganie funkcjonowania osób starszych z użyciem treningów poznawczych. Powstałe reżimy treningowe są przez część badaczy uznawane za skuteczne, przez innych zaś systematycznie krytykowane. Spowodowane jest to różnorodnością podejść zarówno do samej konstrukcji treningu, sposobu jego aplikacji jak i metodologii badań. Natomiast, z punktu widzenia ich użyteczności kluczowe jest rozstrzygnięcie, jakiego rodzaju interwencji są najbardziej skuteczne, jak duży mają wpływ, i w jakim stopniu przekładają się na realne korzyści dla osób biorących w nich udział. Profitem powinna być przede wszystkim namacalna poprawa jakości codziennego życia. Z tego względu niniejszy artykuł ma na celu, nie tylko systematyzację doniesień z dziedziny usprawniania funkcjonowania poznawczego osób starszych, ale przede wszystkim zwrócenie uwagi na coraz bardziej odczuwalny problem weryfikacji efektów treningowych seniorów. Pragniemy także podkreślić potrzebę wprowadzenia silniejszej unifikacji metodologicznej badań treningów poznawczych w celu umożliwienia rzetelnej oceny ich wpływu na jakość życia badanych seniorów. Na podstawie dokonanego przeglądu formułujemy również wioski jakiego rodzaju elementy powinny w tego typu działaniach być uwzględnione

Association between bisphosphonate use and COVID-19 related outcomes

Background: Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high disease burden and emergence of viral variants. Repurposing of existing therapeutics that prevent or mitigate severe COVID-19 could help to address these challenges. The objective of this study was to determine whether prior use of bisphosphonates is associated with reduced incidence and/or severity of COVID-19. Methods: A retrospective cohort study utilizing payer-complete health insurance claims data from 8,239,790 patients with continuous medical and prescription insurance January 1, 2019 to June 30, 2020 was performed. The primary exposure of interest was use of any bisphosphonate from January 1, 2019 to February 29, 2020. Bisphosphonate users were identified as patients having at least one bisphosphonate claim during this period, who were then 1:1 propensity score-matched to bisphosphonate non-users by age, gender, insurance type, primary-care-provider visit in 2019, and comorbidity burden. Main outcomes of interest included: (a) any testing for SARS-CoV-2 infection; (b) COVID-19 diagnosis; and (c) hospitalization with a COVID-19 diagnosis between March 1, 2020 and June 30, 2020. Multiple sensitivity analyses were also performed to assess core study outcomes amongst more restrictive matches between BP users/non-users, as well as assessing the relationship between BP-use and other respiratory infections (pneumonia, acute bronchitis) both during the same study period as well as before the COVID outbreak. Results: A total of 7,906,603 patients for whom continuous medical and prescription insurance information was available were selected. A total of 450,366 bisphosphonate users were identified and 1:1 propensity score-matched to bisphosphonate non-users. Bisphosphonate users had lower odds ratios (OR) of testing for SARS-CoV-2 infection (OR = 0.22; 95%CI:0.21–0.23; p<0.001), COVID-19 diagnosis (OR = 0.23; 95%CI:0.22–0.24; p<0.001), and COVID-19-related hospitalization (OR = 0.26; 95%CI:0.24–0.29; p<0.001). Sensitivity analyses yielded results consistent with the primary analysis. Bisphosphonate-use was also associated with decreased odds of acute bronchitis (OR = 0.23; 95%CI:0.22–0.23; p<0.001) or pneumonia (OR = 0.32; 95%CI:0.31–0.34; p<0.001) in 2019, suggesting that bisphosphonates may protect against respiratory infections by a variety of pathogens, including but not limited to SARS-CoV-2. Conclusions: Prior bisphosphonate-use was associated with dramatically reduced odds of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalizations. Prospective clinical trials will be required to establish a causal role for bisphosphonate-use in COVID-19-related outcomes. Funding: This study was supported by NIH grants, AR068383 and AI155865, a grant from MassCPR (to UHvA) and a CRI Irvington postdoctoral fellowship, CRI2453 (to PH)

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality : a Polish national study

Abstract Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality. Material and methods This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed. Results SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days). Conclusions For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy