Association of Brain Age, Lesion Volume, and Functional Outcome in Patients With Stroke

BACKGROUND AND OBJECTIVES: Functional outcomes after stroke are strongly related to focal injury measures. However, the role of global brain health is less clear. In this study, we examined the impact of brain age, a measure of neurobiological aging derived from whole-brain structural neuroimaging, on poststroke outcomes, with a focus on sensorimotor performance. We hypothesized that more lesion damage would result in older brain age, which would in turn be associated with poorer outcomes. Related, we expected that brain age would mediate the relationship between lesion damage and outcomes. Finally, we hypothesized that structural brain resilience, which we define in the context of stroke as younger brain age given matched lesion damage, would differentiate people with good vs poor outcomes. METHODS: We conducted a cross-sectional observational study using a multisite dataset of 3-dimensional brain structural MRIs and clinical measures from the ENIGMA Stroke Recovery. Brain age was calculated from 77 neuroanatomical features using a ridge regression model trained and validated on 4,314 healthy controls. We performed a 3-step mediation analysis with robust mixed-effects linear regression models to examine relationships between brain age, lesion damage, and stroke outcomes. We used propensity score matching and logistic regression to examine whether brain resilience predicts good vs poor outcomes in patients with matched lesion damage. RESULTS: We examined 963 patients across 38 cohorts. Greater lesion damage was associated with older brain age (β = 0.21; 95% CI 0.04-0.38, DISCUSSION: We provide evidence that younger brain age is associated with superior poststroke outcomes and modifies the impact of focal damage. The inclusion of imaging-based assessments of brain age and brain resilience may improve the prediction of poststroke outcomes compared with focal injury measures alone, opening new possibilities for potential therapeutic targets

Vitreo-Retinal Traction and Anastrozole Use

Purpose—This study tested a prediction stemming from the hypothesis that anastrozole users experience heightened vitreo-retinal traction. This hypothesis was based on the knowledge that menopause increases the risk of intraocular tractional events such as posterior vitreous detachments (PVDs). Methods—Retinal thickness was measured for 3 groups of amenorrheic women: (1) anastrozole users and (2) tamoxifen users undergoing adjuvant therapy for early-stage breast cancer, and (3) control subjects not using hormonal medication. Foveal shape indices were derived for subjects without PVDs. Results—For anastrozole users, the distance to the temporal side of the fovea became less than the distance to the nasal side at a sufficient height above the foveal base. This effect did not exist for control subjects; the between-group difference was appreciable. Results concerning tamoxifen users were inconclusive. Conclusions—The foveas of women using anastrozole appear to be subjected to more tractional force than are the foveas of women not using any hormonal medication

Tinnitus management retrospective (Edmonds et al., 2017)

<div><b>Purpose:</b> The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1–5 years after completing the workshops.</div><div><b>Method:</b> In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1–5 years after completion of the workshops and the impact on quality-of-life indicators.</div><div><b>Results:</b> All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus.</div><div><b>Conclusion:</b> The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth).</div><div><br></div><div><b>Supplemental Material S1.</b> Six-week post-workshop telephone interview script. </div><div><b><br></b></div><div><b>Supplemental Material S2.</b> Self-Efficacy for Managing Reactions to Tinnitus (SMRT) questionnaire. </div><div><br></div><div><b>Supplemental Material S3.</b> Tinnitus workshop follow-up questionnaire. </div><div><br></div><div><b>Supplemental Material S4.</b> Return rate of tinnitus workshop follow-up (TWF) questionnaires, by site, for participants in progressive tinnitus management (PTM) Level 3 skills education workshops in years 2010–2014.</div><div><br></div><div><b>Supplemental Material S5.</b> Patients’ report of number of self-management skills they are using on the tinnitus workshop follow-up (TWF) questionnaire. For four self-management skills, patients are asked whether or not they are using those skills. For each respondent, the number of "yes" responses is totaled.</div><div><br></div><div><b>Supplemental Material S6.</b> Summary of responses regarding change in managing reactions to tinnitus since participating in progressive tinnitus management (PTM) Level 3 workshops.</div><div><br></div><div><b>Supplemental Material S7. </b>Summary of responses regarding change in ability to cope with tinnitus since participating in progressive tinnitus management (PTM) Level 3 workshops.</div><div><br></div><div><b>Supplemental Material S8.</b> Summary of responses regarding change in quality of life since participating in progressive tinnitus management (PTM) Level 3 workshops.</div><div><br></div><div><b>Supplemental Material S9. </b>Summary of responses regarding change in how much bothered by tinnitus since participating in progressive tinnitus management (PTM) Level 3 workshops.</div><div><br></div><div><b>Supplemental Material S10.</b> This table shows the number of respondents who would recommend the progressive tinnitus management (PTM) workshops to someone else with tinnitus. The first line in each section summarizes the responses of all participants. Below that, the responses are of those who were doing the same or worse on the item indicated.</div><div><br></div><div><b>Supplemental Material S11. </b>Percentage of respondents reporting use of self-management skills on the tinnitus workshop follow-up (TWF) questionnaire. Yes = the number who reported using the skill; N = the total number who answered the question. Percentages (%) are based on the number of individuals who answered each item.</div><div><br></div><div>Edmonds, C. M., Ribbe, C., Thielman, E. J., & Henry, J. A. (2017). Progressive tinnitus management Level 3 skills education: A 5-year clinical retrospective. <i>American Journal of Audiology, 26</i>, 242–250<i>.</i> https://doi.org/10.1044/2017_AJA-16-0085</div

Factors affecting the implementation of evidence-based Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers.

PurposeProgressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers.MethodWe conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents' facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites.ResultsSurveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans' preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice.ConclusionResults suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans' need for and interest in PTM, including delivery by telehealth modalities