Estimation of dietary flavonoid intake and cognitive performance in older adults with Alzheimer\u27s type dementia

Abstract presented at The Nutrition Society of Australia and Nutrition Society of New Zealand 2013 Joint Annual Scientific Meeting, 4-6 December 2013, Brisbane, Australi

Medication adherence in randomized controlled trials evaluating cardiovascular or mortality outcomes in dialysis patients: A systematic review

Background: Medication non-adherence is common among renal dialysis patients. High degrees of non-adherence in randomized controlled trials (RCTs) can lead to failure to detect a true treatment effect. Cardio-protective pharmacological interventions have shown no consistent benefit in RCTs involving dialysis patients. Whether non-adherence contributes to this lack of efficacy is unknown. We aimed to investigate how medication adherence and drug discontinuation were assessed, reported and addressed in RCTs, evaluating cardiovascular or mortality outcomes in dialysis patients. Methods: Electronic database searches were performed in MEDLINE, EMBASE & Cochrane CENTRAL for RCTs published between 2005-2015, evaluating self-administered medications, in adult dialysis patients, which reported clinical cardiovascular or mortality endpoints, as primary or secondary outcomes. Study characteristics, outcomes, methods of measuring and reporting adherence, and data on study drug discontinuation were analyzed. Results: Of the 642 RCTs in dialysis patients, 22 trials (12 placebo controlled), which included 19,322 patients, were eligible. The trialed pharmacological interventions included anti-hypertensives, phosphate binders, lipid-lowering therapy, cardio-vascular medications, homocysteine lowering therapy, fish oil and calcimimetics. Medication adherence was reported in five trials with a mean of 81% (range: 65-92%) in the intervention arm and 84.5% (range: 82-87%) in the control arm. All the trials that reported adherence yielded negative study outcomes for the intervention. Study-drug discontinuation was reported in 21 trials (mean 33.2%; 95% CI, 22.0 to 44.5, in intervention and 28.8%; 95% CI, 16.8 to 40.8, in control). Trials with more than 20% study drug discontinuation, more often yielded negative study outcomes (p = 0.018). Non-adherence was included as a contributor to drug discontinuation in some studies, but the causes of discontinuation were not reported consistently between studies, and non-adherence was listed under different categories, thereby potentiating the misclassification of adherence. Conclusions: Reporting of medication adherence and study-drug discontinuation in RCTs investigating cardiovascular or mortality endpoints in dialysis patients are inconsistent, making it difficult to compare studies and evaluate their impact on outcomes. Recommendations for consistent reporting of non-adherence and causes of drug discontinuation in RCTs will therefore help to assess their impact on clinical outcomes

Dietary flavonoid intake and cognitive performance in older adults with Alzheimer\u27s type dementia

Background: Dietary flavonoid intake and intake of flavonoid subclasses has been associated with improved cognitive performance. However, the association between flavonoid intake and cognitive performance in older adults with Alzheimer\u27s type dementia has not been investigated. Objectives: To estimate dietary total flavonoid intake and intake of flavonoid subclasses in older adults with Alzheimer\u27s type dementia and assess the relationship of flavonoid intake with measures of cognition. Design: Cross sectional analysis. Setting: Community dwelling older adults in NSW, Australia. Participants: Older adults (+65y) with mild to moderate dementia (n=49). Measurements: A 24h diet recall was collected with help from a carer and used to estimate flavonoid intake. A battery of cognitive tasks assessed cognitive performance of several cognitive domains. Results: Pearson and spearman correlation coefficients identified an association between flavonoid intake and executive function (r=0.319, p=0.025). After controlling for depression, the relationship was reduced. Conclusion: The identified association between cognitive functioning, depression and flavonoid intake in older adults with Alzheimer\u27s type dementia warrants further research in a larger sample

Atypical interference control in children with AD/HD with elevated theta/beta ratio

The theta/beta ratio (TBR) is a major area of interest within electroencephalogram (EEG) research in AD/HD. While researchers suggest a prognostic role for TBR in AD/HD, its relationship to behavior remains uncertain. Recent evidence suggests that elevated TBR in AD/HD may be related to atypical inhibition, particularly at an attentional level. This study aimed to examine the performance on three inhibitory tasks of children with AD/HD. Fifty-eight children with AD/HD participated, divided into an elevated TBR (ET) group and a control group (CT). A behavioral disassociation was found − compared to CT, ET showed more difficulty in inhibiting surrounding stimuli but had less day-to-day inhibitory issues measured by BRIEF. There was no significant group difference on response inhibition. The results support the prognostic value of TBR in AD/HD. Elevated TBR may be an inhibitory biomarker; further studies are needed to explore the behavioral implications in patients without elevated TBR

Serial reconstruction of order and serial recall in verbal short-term memory

A series of experiments was carried out on verbal short-term memory for lists of words. In the first experiment, participants were tested via immediate serial recall and word frequency and list set size were manipulated. With closed lists the same set of items was repeatedly sampled, with open lists no item was presented more than once. In serial recall, effects of word frequency and set size were found. When a serial reconstruction of order task was used, in a second experiment, robust effects of word frequency emerged but set size failed to show an effect. The effect of word frequency in order reconstruction were further examined in two final experiments. The data from these experiments revealed that the effects of word frequency are robust and are apparently not exclusively indicative of output processes. A multiple mechanisms account is adopted in which word frequency can influence both retrieval and pre-retrieval processes

The interaction of word frequency and concreteness in immediate serial recall

Word frequency and word concreteness arc language attributes that have been shown to independently int1uence the recall of items in verbal short-term memory (STM), It has been argued that such effects arc evidence for the action of long-term memory knowledge on STM traces. However, research to date has not investigated whether these variables interact in serial recall. In two experiments, we examined the behavior of these variables under factorial manipulation and demonstrated that the effect of word frequency is dependent on the level of concreteness of items, Serial recall performance is examined with reference to two explanatory approaches: Walker and Hulme\u27s (1999) dual-redintegration account and language-based models of STM, The data indicate that language-based models arc more compatible with the observed effects and challenge the view that frequency and concreteness effects in STM are the products of distinct mechanisms

Conditional recall and the frequency effect in the serial recall task: An examination of item-to-item associativity

The frequency effect in short-term serial recall is influenced by the composition of lists. In pure lists, a robust advantage in the recall of high-frequency (HF) words is observed, yet in alternating mixed lists, HF and low-frequency (LF) words are recalled equally well. It has been argued that the preexisting associations between all list items determine a single, global level of supportive activation that assists item recall. Preexisting associations between items are assumed to be a function of language co-occurrence; HF-HF associations are high, LF-LF associations are low, and mixed associations are intermediate in activation strength. This account, however, is based on results when alternating lists with equal numbers of HF and LF words were used. It is possible that directional association between adjacent list items is responsible for the recall patterns reported. In the present experiment, the recall of three forms of mixed lists-those with equal numbers of HF and LF items and pure lists-was examined to test the extent to which item-to-item associations are present in serial recall. Furthermore, conditional probabilities were used to examine more closely the evidence for a contribution, since correct-in-position scoring may mask recall that is dependent on the recall of prior items. The results suggest that an item-to-item effect is clearly present for early but not late list items, and they implicate an additional factor, perhaps the availability of resources at output, in the recall of late list items