Anxiety following mild traumatic brain injury

Purpose/Objective: The goals of the present study were (1) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months post-injury in individuals with mild traumatic brain injury (mTBI) while considering pre-injury history of anxiety disorders and (2) to verify whether the presence of anxiety in the first months following mTBI was associated with more symptoms present one year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months post-accident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain. Results: At 4 months, 23.8% of participants presented with at least one anxiety-related disorder compared to 15.2% at 8 months and 11.2% at 12 months. Overall, 32.5% presented with at least one anxiety disorder over the first 12 months post-mTBI. Participants with a history of anxiety (20.5%) were significantly more anxious following their accident. Individuals who were anxious 4 months after the accident presented with more symptoms in different areas 12 months post-injury compared to non-anxious individuals. Conclusions/Implications: The present results highlight that anxiety should be evaluated and managed carefully as it appears to be a key factor in the persistence of other mTBI-related symptom

Impacts of Remote Physical Exercises on Functional Status and Mobility among Community-Dwelling Pre-Disabled Seniors during the Covid-19 Lockdown

peer reviewedObjectives: To assess whether remote physical exercise interventions helped maintain function in daily life, level of physical activities, basic mobility and frailty status in pre-disabled seniors during the first Covid-19 lockdown. Design: This is an interventional study conducted from May 2020 to May 2021. Setting: Community-dwelling older adults in 2 Canadian cities. Participants: 84 pre-disabled seniors. Intervention: 12-week physical exercise programs (1 hour/ 3 times/ week) in kinesiologist-guided groups using Zoom or phone-supervised individual booklet-based home-program (n=44) vs. Control (usual life habits; n=40). Measurements: Functional status in daily activities (OARS scale); Daily level of aerobic (TAPA-1) and strengthening/flexibility (TAPA-2) physical activities; Basic mobility abilities (SPPB: balance, lower limbs strength, walking speed; Timed Up-and-Go) and Frailty (SOF index) were assessed at baseline and at 3, 6, 9 and 12-month follow-ups. Results: The participants’ mean age was 78.5 ± 7.2 and 76.5 % were women. There was a group * time effect for the OARS scale (p=0.02), the TAPA-1 (p=0.06) and the TAPA-2 (p=0.007) scores. For these outcomes, scores significantly improved during the first 3 months of follow-up and then stabilised in the intervention group whereas they remained constant in the control group over time. There was an overall time effect for the SPPB (p=0.004), the 4-m walking speed (p=0.02) and for the SOF index (p=0.004), with no between-group differences. Finally, no effect was observed for the TUG. Conclusion: Remote home-based physical exercise interventions and monitoring during the first Covid-19 lockdown seemed to have helped maintain seniors’ level of physical activities without impacting on basic mobility abilities. Further studies are needed to identify parameters of remote exercise programs that can improve daily function and mobility in this population

Painful Memories: Reliability of Pain Intensity Recall at 3 Months in Senior Patients

Background. Validity of pain recall is questioned in research. Objective. To evaluate the reliability of pain intensity recall for seniors in an emergency department (ED). Methods. This study was part of a prospective multicenter project for seniors (≥65 years old) treated in an ED for minor traumatic injury. Pain intensity (0–10 numerical rating scale) was evaluated at the initial ED visit, at one week (baseline), and 3 months. At three months, patients were asked to recall the pain intensity they had at baseline. Results. 482 patients were interviewed (mean age 76.6 years, SD ± 7.3) and 72.8% were female. Intraclass correlation coefficient between pain at baseline and its recall was 0.24 (95% CI: 0.14–0.33). Senior patients tended to overestimate their pain intensity by a mean of 1.2 (95% CI: 0.9–1.5) units. A stepwise multiple regression analysis showed that the variance of baseline pain recall at 3 months was explained by pain at ED visit (11%), pain at 3 months (7%), and pain at baseline (2%). Conclusion. The accuracy of pain intensity recall after three months is poor in seniors and seems to be influenced by the pain experienced at the time of injury

A cross-cultural study of the Montreal Cognitive Assessment for people with hearing impairment

Background: Cognitive screening tools enable the detection of cognitive impairment, facilitate timely intervention, inform clinical care, and allow long-term planning. The Montreal Cognitive Assessment for people with hearing impairment (MoCA-H) was developed as a reliable cognitive screening tool for people with hearing loss. Using the same methodology across four languages, this study examined whether cultural or linguistic factors affect the performance of the MoCA-H. Methods: The current study investigated the performance of the MoCA-H across English, German, French, and Greek language groups (n = 385) controlling for demographic factors known to affect the performance of the MoCA-H. Results: In a multiple regression model accounting for age, sex, and education, cultural–linguistic group accounted for 6.89% of variance in the total MoCA-H score. Differences between languages in mean score of up to 2.6 points were observed. Conclusions: Cultural or linguistic factors have a clinically significant impact on the performance of the MoCA-H such that optimal performance cut points for identification of cognitive impairment derived in English-speaking populations are likely inappropriate for use in non-English speaking populations. To ensure reliable identification of cognitive impairment, it is essential that locally appropriate performance cut points are established for each translation of the MoCA-H