Recovery of cognitive function in a substance abuse population

Background: Substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety. The most commonly identified impairments are in attention, working memory, and executive functioning. Although research has found that most people do experience some level of cognitive improvement after stopping substance use, it is unclear how quickly this happens and if there is a particular pattern in improvement. This pilot study tested the natural rate of cognitive recovery in early substance abuse treatment.Methods: Participants were 28 adults newly admitted to a residential substance abuse treatment facility. All were post-detox. The majority were in treatment for polysubstance abuse, with 15 having primary opioid abuse. NIH Toolbox cognition battery was administered at intake and 4 weeks later.Results: Regarding cognition, primary weaknesses at baseline were in processing speed (Pattern Comparison mean t- score=41.96), attention and executive function (Flanker mean t- score=43.0) and working memory (List Sorting mean t- score=44.04). Cognitive recovery during the normal course of early inpatient treatment was significant in the areas of processing speed, attention and executive functioning and yielded significant improvement in the Cognitive Function Composite Score (p < .01).Conclusions: Consistent with previous research, this pilot study found that patients commonly enter inpatient treatment with inefficiencies in fluid cognition skills. Over the course of 1-month of inpatient treatment, this sample of patients experienced significant improvement across multiple domains, with significant improvements in composite Fluid and Total Cognition scores. Further study on the pattern of cognitive changes during substance abuse treatment may be used to help better match intervention strategy to cognitive level and possibly develop cognitive rehabilitation protocols to increase treatment engagement and extend abstinence via improvement in cognitive capacity

Cognitive recovery in early substance abuse treatment

Background: Substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety. The most commonly identified impairments are in attention, working memory, and executive functioning. Although research has found that most people do experience some level of cognitive improvement after stopping substance use, it is unclear how quickly this happens and if there is a particular pattern in improvement. This pilot study tested the natural rate of cognitive recovery in early substance abuse treatment.Methods: Participants were 28 adults newly admitted to a residential substance abuse treatment facility. All were post- detox. The majority were in treatment for polysubstance abuse, with 15 having primary opioid abuse. NIH Toolbox cognition battery was administered at intake and 4 weeks later.Results: Regarding cognition, primary weaknesses at baseline were in processing speed (Pattern Comparison mean t- score=41.96), attention and executive function (Flanker mean t- score=43.0) and working memory (List Sorting mean t- score=44.04). Cognitive recovery during the normal course of early inpatient treatment was significant in the areas of processing speed, attention and executive functioning and yielded significant improvement in the Cognitive Function Composite Score (p<.01).Conclusions: Consistent with previous research, this pilot study found that patients commonly enter inpatient treatment with inefficiencies in fluid cognition skills. Over the course of 1-month of inpatient treatment, this sample of patients experienced significant improvement across multiple domains, with significant improvements in composite Fluid and Total Cognition scores. Further study on the pattern of cognitive changes during substance abuse treatment may be used to help better match intervention strategy to cognitive level and possibly develop cognitive rehabilitation protocols to increase treatment engagement and extend abstinence via improvement in cognitive capacity

Perceptions of Multicultural Training in Predoctoral Internship Programs: A Survey of Interns and Training Directors

Multicultural training at internship sites is a critical component in the preparation of doctoral-level psychologists, so the quality of this training is of the utmost importance. In the following study, the authors examine multicultural training from the perspective of predoctoral interns and training directors at counseling center sites that offer a major or minor rotation in multicultural therapy. Results suggest that perspectives vary between interns and training directors and that there is a great difference in the type of criteria used by each site as evidence of a major or minor rotation. The need for more standardized criteria to define major and minor rotations and suggestions for the Association of Psychology Postdoctoral and Internship Centers, internship training directors, and prospective interns are discussed

The Engagement Model of Person-Environment Interaction

This article focuses on growth-promoting aspects in the environment, and the authors propose a strength-based, dynamic model of person-environment interaction. The authors begin by briefly discussing the typical recognition of contextual variables in models that rely on the concept of person-environment fit. This is followed by a review of recent approaches to incorporating positive environmental factors in conceptualizations of human functioning. These approaches lead to an alternative model of person-environment interaction in which the engagement construct (i.e., the quality of a person-environment relationship determined by the extent to which negotiation, participation, and evaluation processes occur during the interaction) replaces the static notion of fit. Finally, the authors outline recommendations for overcoming environmental neglect in research, practice, and training

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

P4â 069: Relationship between longitudinal telephone screening and neuropsychological test performance

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153192/1/alzjjalz200904838.pd

Health inequities in dialysis care: A scoping review

Background: Dialysis is a life-sustaining treatment that thousands of Americans with end-stage renal disease (ESRD) rely upon. Understanding the health inequities that exist within dialysis treatment is integral to the improvement of care — especially for those in historically marginalized groups. Our scoping review’s objective was to identify potential gaps in the current literature on inequities in dialysis as well as explore future research that could contribute to more equitable care.Methods: Following guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review of health inequities in dialysis. PubMed and Ovid Embase were searched in July 2022 for articles published between 2016 and 2022 that examined at least one of the following health inequities as defined by the NIH: race and ethnicity, sex or gender, LGBTQ+ identity, underserved rural populations, education level, income, and occupation status. Frequencies of each health inequity as well as trends over time of the 4 most examined inequities were analyzed.Results: In our sample of 69 included studies, gaps were identified in LGBTQ+ identity and patient education. Inequities pertaining to race and ethnicity, sex or gender, underserved rural populations, and income were sufficiently reported. No trends between inequities investigated over time were identified.Conclusions: Our scoping review examined current literature on health inequities pertaining to dialysis and found gaps concerning LGBTQ+ and patients with lower levels of education. To help fill these gaps, and possibly alleviate additional burden to these patients, we recommend cultural competency training for providers and dialysis center staff as well as community-based educational programs to improve dialysis patients’ health literacy

P3‐127: Identification of cognitive decline using a longitudinal telephone screening versus brief, one‐day computerized testing

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152977/1/alzjjalz2008051692.pd

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I 2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None