О распространении кольцевых гомеоморфизмов на границу

Samenvatting Koekkoek PS, Rutten GEHM, Van den Berg E, Kappelle LJ, Biessels GJ. Test Your Memory-test: een alternatief voor de MMSE. Huisarts Wet 2014;57(1):618-21. De Mini-Mental State Examination (MMSE) is de meest gebruikte screeningstest om een indruk over het cognitieve functioneren te krijgen. Deze test kost relatief veel tijd en kan niet door patiënt zelfstandig uitgevoerd worden. De Test Your Memory-test (TYM) is een potentieel alternatief. In dit onderzoek worden uitkomsten van de TYM en de MMSE vergeleken met een neuropsychologisch onderzoek (NPO) in een populatie die niet met klinisch relevante cognitieve stoornissen bekend was. Mensen zonder bekende cognitieve stoornissen, ondergingen een NPO inclusief MMSE en een TYM. De relatie tussen de TYM, de MMSE en een NPO werd onderzocht met correlatieanalyses, ROC-curves voor discriminatie tussen ‘normale’ cognitie en ‘lichte cognitieve tekorten’ (≥ 1 SD onder het gemiddelde), en bland-altmanplots. 86 mensen vulden de TYM in (gemiddelde leeftijd 69 jaar; 59% man). De correlatie met een volledig NPO was significant sterker voor de TYM dan de MMSE (r = 0,78 versus r = 0,55; Steiger’s Z = 2,66, p < 0,01). De oppervlakte onder de ROC-curve was 0,88 (TYM) versus 0,71 (MMSE). Bland-altmanplots laten zien dat de TYM beter overeenkomt met het NPO dan de MMSE. De TYM komt beter overeen met een NPO dan de MMSE en maakt een beter onderscheid tussen ‘lichte cognitieve tekorten’ en normaal cognitief functioneren. Hiermee is de TYM een veelbelovende test voor gebruik in de huisartsenpraktijk

Cognitive dysfunction in type 2 diabetes : detection and treatment in primary care

A less known complication of type 2 diabetes (T2DM) is cognitive dysfunction. Patients with T2DM already have cognitive decrements in an early stage of their disease. Cognitive dysfunction can lead to problems in diabetes treatment. Diabetes guidelines advise physicians to address patient’s cognitive functioning. However, cognitive dysfunction often remains undiagnosed. We introduce the term ‘diabetes-associated cognitive decrements’ for subtle cognitive changes in patients with T2DM, from all ages, who express concerns about their cognitive performance, typically increased mental effort, but with largely preserved social or occupational functioning. We examined cognitive function in 183 patients with screen-detected type 2 diabetes and subsequently randomized to six years of intensive multifactorial treatment (strict targets for glucose, blood pressure and cholesterol) or standard treatment. Cognitive decline proved not to be influenced by an intensive treatment. We did find that people with undiagnosed cognitive impairment have a lower health status (difference between the groups on physical scale 3.5 out of 100 points; on mental scale 2.9 points) and have depressive symptoms twice as often as diabetes patients without cognitive impairment. However, depressive symptoms did not influence cognitive function of patients with T2DM. All in all, patients with T2DM and cognitive impairment are a vulnerable group of patients; we therefore believe that early recognition of cognitive dysfunction as efficiently as possible is desirable. After a literature search, we developed a diagnostic algorithm that can guide the primary care physician towards the most probable diagnosis in case of cognitive complaints. We propose to use one of three different tests depending upon the prior probability of cognitive impairment , based on history taking. Additionally, we evaluated the TYM and SAGE questionnaires, tests that can be filled out by patients themselves in a few minutes, in 228 T2DM-patients for the detection of cognitive impairment. With these questionnaires, eight out of ten people can be reassured, substantially reducing the work load of primary care physicians in the suggested case-finding strategy. If primary care physicians approach cognitive dysfunction in patients with T2DM in this way, they can tailor diabetes treatment to the capacities of the patient

De Test Your Memory-test: een alternatief voor de MMSE

Koekkoek PS, Rutten GEHM, Van den Berg E, Kappelle LJ, Biessels GJ. Test Your Memory-test: een alternatief voor de MMSE. Huisarts Wet 2014;57(1):618-21. Achtergrond De Mini-Mental State Examination (MMSE) is de meest gebruikte screeningstest om een indruk over het cognitieve functioneren te krijgen. Deze test kost relatief veel tijd en kan niet door patiënt zelfstandig uitgevoerd worden. De Test Your Memory-test (TYM) is een potentieel alternatief. In dit onderzoek worden uitkomsten van de TYM en de MMSE vergeleken met een neuropsychologisch onderzoek (NPO) in een populatie die niet met klinisch relevante cognitieve stoornissen bekend was. Methode Mensen zonder bekende cognitieve stoornissen, ondergingen een NPO inclusief MMSE en een TYM. De relatie tussen de TYM, de MMSE en een NPO werd onderzocht met correlatieanalyses, ROC-curves voor discriminatie tussen ‘normale’ cognitie en ‘lichte cognitieve tekorten’ (≥ 1 SD onder het gemiddelde), en bland-altmanplots. Resultaten 86 mensen vulden de TYM in (gemiddelde leeftijd 69 jaar; 59% man). De correlatie met een volledig NPO was significant sterker voor de TYM dan de MMSE (r = 0,78 versus r = 0,55; Steiger’s Z = 2,66, p < 0,01). De oppervlakte onder de ROC-curve was 0,88 (TYM) versus 0,71 (MMSE). Bland-altmanplots laten zien dat de TYM beter overeenkomt met het NPO dan de MMSE. Conclusie De TYM komt beter overeen met een NPO dan de MMSE en maakt een beter onderscheid tussen ‘lichte cognitieve tekorten’ en normaal cognitief functioneren. Hiermee is de TYM een veelbelovende test voor gebruik in de huisartsenpraktijk

Long-term impact of a tailored seclusion reduction program: Evidence for change?

Contains fulltext : 194477.pdf (publisher's version ) (Closed access)International comparative studies show that Dutch seclusion rates are relatively high. Therefore, several programs to change this practice were developed and implemented. The purpose of this study was to examine the impact of a seclusion reduction program over a long time frame, from 2004 until 2013. Three phases could be identified; the phase of development and implementation of the program (2004-2007), the project phase (2008-2010) and the consolidation phase (2011-2013). Five inpatient wards of a mental health institute were monitored. Each ward had one or more seclusion rooms. Primary outcome were the number and the duration of seclusion incidents. Involuntary medication was monitored as well to rule out substitution of one coercive measure by another. Case mix correction for patient characteristics was done by a multi-level logistic regression analysis with patient characteristics as predictors and hours seclusion per admission hours as outcome. Seclusion use reduced significantly during the project phase, both in number (-73%) and duration (-80%) and was not substituted by the use of enforced medication. Patient compilation as analyzed by the multi- level regression seemed not to confound the findings. Findings show a slight increase in number and seclusion days over the last year of monitoring. Whether this should be interpreted as a continuous or temporary trend remains unclear and is subject for further investigation.14 p

Intensive multifactorial treatment and cognitive functioning in screen-detected type 2 diabetes - The ADDITION-Netherlands study: A cluster-randomized trial

Aim To assess whether an intensive multifactorial treatment can reduce cognitive decrements and cognitive decline in screen-detected type 2 diabetes. Methods The multinational ADDITION-study, a cluster-randomized parallel group trial in patients with screen-detected type 2 diabetes, compared the effectiveness of intensive multifactorial treatment (IT; lifestyle advice and strict regulation of metabolic parameters) with routine care (RC) on cardiovascular outcome. In The Netherlands randomization was stratified according to practice organization. Allocation was concealed from patients. The present study assessed the effect of IT on cognition through two neuropsychological assessments (NPA) on two occasions. The assessments took place three and six years after the start of the intervention. Non-diabetic controls served as reference group. The first NPA was performed in 183 patients (IT: 97; RC: 86) and 69 controls. The second NPA was performed in 135 patients (IT: 71; RC: 64) and 55 controls. Primary outcome was a composite score, including the domains memory, information-processing speed and attention and executive function. Comparisons between the treatment groups were performed with multi-level analyses. Results The first NPA showed no differences between the treatment groups (mean difference composite z-score: 0.00; 95%-CI −0.16 to 0.16; IT vs RC). Over the next three years cognitive decline in the diabetic groups was within the range of the reference group and did not differ between the treatment arms (difference decline between diabetic groups −0.12; −0.24 to 0.01; IT vs RC). Conclusions Six years of IT in screen-detected type 2 diabetes had no benefit on cognitive functioning over RC

Intensive multifactorial treatment and cognitive functioning in screen-detected type 2 diabetes - The ADDITION-Netherlands study: A cluster-randomized trial

Aim To assess whether an intensive multifactorial treatment can reduce cognitive decrements and cognitive decline in screen-detected type 2 diabetes. Methods The multinational ADDITION-study, a cluster-randomized parallel group trial in patients with screen-detected type 2 diabetes, compared the effectiveness of intensive multifactorial treatment (IT; lifestyle advice and strict regulation of metabolic parameters) with routine care (RC) on cardiovascular outcome. In The Netherlands randomization was stratified according to practice organization. Allocation was concealed from patients. The present study assessed the effect of IT on cognition through two neuropsychological assessments (NPA) on two occasions. The assessments took place three and six years after the start of the intervention. Non-diabetic controls served as reference group. The first NPA was performed in 183 patients (IT: 97; RC: 86) and 69 controls. The second NPA was performed in 135 patients (IT: 71; RC: 64) and 55 controls. Primary outcome was a composite score, including the domains memory, information-processing speed and attention and executive function. Comparisons between the treatment groups were performed with multi-level analyses. Results The first NPA showed no differences between the treatment groups (mean difference composite z-score: 0.00; 95%-CI −0.16 to 0.16; IT vs RC). Over the next three years cognitive decline in the diabetic groups was within the range of the reference group and did not differ between the treatment arms (difference decline between diabetic groups −0.12; −0.24 to 0.01; IT vs RC). Conclusions Six years of IT in screen-detected type 2 diabetes had no benefit on cognitive functioning over RC

The "Test Your Memory" test performs better than the MMSE in a population without known cognitive dysfunction

1. Introduction Brief cognitive tests are increasingly implemented in both clinical and research settings. They are not only used for early recognition of cognitive deficits and dementia [1], but also for measuring differences in cognitive functioning between groups, for assessment of treatment effects and for the detection of cognitive decline over time. For these purposes such an instrument should not only discriminate between dementia and normal cognitive functioning, but should also be able to measure more subtle variations in cognitive functioning. The most widely used brief cognitive screening test is the Mini-Mental State Examination (MMSE) [2]. A recent addition to the available instruments is the Test Your Memory (TYM) test [3]. This test is self-administered by patients, takes about five minutes to complete, and intends to measure a broad range of cognitive domains [3]. In a memory clinic setting, the TYM showed good diagnostic value compared with the MMSE [4] and [5]. Therefore, the TYM is a potentially interesting instrument to use, particularly in settings where little time is available for the assessment of cognitive functioning. One of those settings could be the practice of a general practitioner. The range of subtle cognitive decrements in a primary care population, however, is different from patients at the memory clinic, with more people performing in the range of “normal” cognitive functioning. The present study aimed to examine the relation of the performance on the TYM and the MMSE with a comprehensive neuropsychological assessment in a population sample including people with modest cognitive decrements

Mild depressive symptoms do not influence cognitive functioning in patients with type 2 diabetes.

Type 2 diabetes (T2DM) is associated both with cognitive decrements and depressive symptoms. Since depression in itself has been associated with cognitive decrements we aimed to investigate the influence of depressive symptoms on the relation between T2DM and cognitive functioning. Data were derived from three independent studies on cognitive functioning in patients with T2DM (n=366) and controls without diabetes (n=204), two with longitudinal and one with only cross-sectional assessments. Depressive symptoms were measured with self-report inventories (CES-D or BDI-II). The composite z-score of the domains memory, information-processing speed, and attention and executive function was the primary cognitive outcome measure. Mixed linear regression analyses were used in a stepped approach to compare cognitive functioning between (1) patients with T2DM and controls (cross-sectionally and longitudinally), (2) participants with and without depressive symptoms, separately for patients and controls, and (3) patients and controls after adjustment for depressive symptoms. In addition the mediating effect of depressive symptoms was assessed with a bootstrapping technique. Depressive symptoms were present in 11% of the patients with T2DM and in 7% of controls (p=0.15). Cognitive performance in patients with T2DM was worse than in controls (overall difference composite z-score -0.13). However, T2DM was not associated with accelerated cognitive decline over three years of follow-up relative to controls. Controls with depressive symptoms performed worse than those without depressive symptoms, although not statistically significant. Performance in patients with T2DM with and without depressive symptoms was similar. Adjustment for depressive symptoms and estimation of the mediating effect showed that the difference between patients and controls was not mediated by depressive symptoms. In conclusion, the modest cognitive decrements that are associated with T2DM are not due to the presence of mild depressive symptoms