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Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition
- Jarrod J Homer, Stuart C Winter, Elizabeth C Abbey, Hiba Aga, Reshma Agrawal, Derfel ap Dafydd, Takhar Arunjit, Patrick Axon, Eleanor Aynsley, Izhar N Bagwan, Arun Batra, Donna Begg, Jonathan M Bernstein, Guy Betts, Colin Bicknell, Brian Bisase, Grainne C Brady, Peter Brennan, Aina Brunet, Val Bryant, Linda Cantwell, Ashish Chandra, Preetha Chengot, Melvin L K Chua, Peter Clarke, Gemma Clunie, Margaret Coffey, Clare Conlon, David I Conway, Florence Cook, Matthew R Cooper, Declan Costello, Ben Cosway, Neil J A Cozens, Grant Creaney, Daljit K Gahir, Stephen Damato, Joe Davies, Katharine S Davies, Alina D Dragan, Yong Du, Mark R D Edmond, Stefano Fedele, Harriet Finze, Jason C Fleming, Bernadette H Foran, Beth Fordham, Mohammed M A S Foridi, Lesley Freeman, Katherine E Frew, Pallavi Gaitonde, Victoria Gallyer, Fraser W Gibb, Sinclair M Gore, Mark Gormley, Roganie Govender, J Greedy, Teresa Guerrero Urbano, Dorothy Gujral, David W Hamilton, John C Hardman, Kevin Harrington, Samantha Holmes, Jarrod J Homer, Deborah Howland, Gerald Humphris, Keith D Hunter, Kate Ingarfield, Richard Irving, Kristina Isand, Yatin Jain, Sachin Jauhar, Sarra Jawad, Glyndwr W Jenkins, Anastasios Kanatas, Stephen Keohane, Cyrus J Kerawala, William Keys, Emma V King, Anthony Kong, Fiona Lalloo, Kirsten Laws, Samuel C Leong, Shane Lester, Miles Levy, Ken Lingley, Gitta Madani, Navin Mani, Paolo L Matteucci, Catriona R Mayland, James McCaul, Lorna K McCaul, Pádraig McDonnell, Andrew McPartlin, Valeria Mercadante, Zoe Merchant, Radu Mihai, Mufaddal T Moonim, John Moore, Paul Nankivell, Sonali Natu, A Nelson, Pablo Nenclares, Kate Newbold, Carrie Newland, Ailsa J Nicol, Iain J Nixon, Rupert Obholzer, James T O'Hara, S Orr, Vinidh Paleri, James Palmer, Rachel S Parry, Claire Paterson, Gillian Patterson, Joanne M Patterson, Miranda Payne, L Pearson, David N Poller, Jonathan Pollock, Stephen Ross Porter, Matthew Potter, Robin J D Prestwich, Ruth Price, Mani Ragbir, Meena S Ranka, Max Robinson, Justin W G Roe, Tom Roques, Aleix Rovira, Sajid Sainuddin, I J Salmon, Ann Sandison, Andy Scarsbrook, Andrew G Schache, A Scott, Diane Sellstrom, Cherith J Semple, Jagrit Shah, Praveen Sharma, Richard J Shaw, Somiah Siddiq, Priyamal Silva, Ricard Simo, Rabin P Singh, Maria Smith, Rebekah Smith, Toby Oliver Smith, Sanjai Sood, Francis W Stafford, Neil Steven, Kay Stewart, Lisa Stoner, Steve Sweeney, Andrew Sykes, Carly L Taylor, Selvam Thavaraj, David J Thomson, Jane Thornton, Neil S Tolley, Nancy Turnbull, Sriram Vaidyanathan, Leandros Vassiliou, John Waas, Kelly Wade-McBane, Donna Wakefield, Amy Ward, Laura Warner, Laura-Jayne Watson, H Watts, Christina Wilson, Stuart C Winter, Winson Wong, Chui-Yan Yip, Kent Yip
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- Journal:
- The Journal of Laryngology & Otology / Volume 138 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 14 March 2024, pp. S1-S224
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- April 2024
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2 Neuropsychological Test Performance Following Acute COVID-19 Infection Recovery: A Case Control Study
- Theone S. E. Paterson, Kristina M Gicas
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 875-876
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Objective:
Cognition has been identified as an area of priority in examining health impacts of COVID-19 infection, and evidence suggests the virus invades the brain, with potential for long-term cognitive impact. Studies utilizing screening measures have reported cognitive sequelae (e.g., attention disorder, executive dysfunction) of the post-COVID-19 condition (i.e., long-haulers). More extensive examination of cognitive difficulties via comprehensive neuropsychological assessment is critical to informing treatment for those experiencing cognitive or functional difficulties post-infection. We aimed to comprehensively evaluate cognitive resiliencies and vulnerabilities of acutely recovered COVID-19 patients, across key domains (i.e., attention, processing speed, language, visuospatial abilities, memory, executive functioning), compared to healthy controls.
Participants and Methods:Adults (N=103; aged 19-85; 69.2% female) who had COVID-19 at least three months prior (n=50) and those with no history of infection (n=53) completed demographic and health questionnaires via Qualtrics, along with measures of depressive (CES-D) and anxiety (GAD-7) symptoms, the Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale, and a measure of subjective cognitive difficulties (SCD-Q). Participants (n=84) completed a teleneuropsychology assessment including a short interview and battery of neuropsychological tests assessing attention (BTA, Digit Span Forward), processing speed (DKEFS Colour Naming & Word Reading, SDMT), language (FAS, Animals, NAB Naming), visuospatial abilities (JLO, RCFT Copy), verbal and visual memory (HVLT-R, NAB Shape Learning, RCFT), and executive function (DKEFS Color-Word Interference & Switching, Digit Span Backward & Sequencing, BRIEF), and including multiple measures of cognitive effort/assessment validity (RFIT, RDS), and a self-report measure of symptom validity (SIMS). T-tests were used to examine demographic and health variables between COVID-19 and control groups. MANCOVA were used to examine group differences across each cognitive domain assessed, and across cognitive effort and symptom validity tasks, while controlling for English language status.
Results:Group comparisons indicated that the COVID-19 group was slightly older (mean age = 40 vs. 34 yrs.; f=-2.101, p=0.04). Those who had COVID-19 reported more difficulties completing IADLs (f=2.204; p=0.03), more depressive symptoms (f=-2.299; p=0.02), and more subjective cognitive difficulties (f=-3.886; p<0.01). Examination of cognitive performance indicated a main effect of prior infection on executive function, controlling for language status (Wilks’ /\=0.817, F(6,73)=2.733, p=0.02). Specifically, having COVID-19 was associated with worse DKEFS Colour-Word Switching performance (p=0.01) and slightly higher selfreported difficulties on the BRIEF MI (p=0.04). No other significant group differences were seen across cognitive domains. There was also a main effect of COVID-19 infection on effort and symptom validity task performance (Wilks’ /\=0.705, F(10,70)=2.923, p<0.01). Specifically, prior infection was associated with higher SIMS Neurologic Impairment (p<0.01) and Amnestic Disorders (p<0.01) subscale scores, and paradoxically, slightly higher RFIT combined scores (p=0.02).
Conclusions:Interestingly, results indicate a significant role for subjective cognitive complaints and potential exaggeration of cognitive symptoms post-COVID-19 infection, in the absence of differences in objective performance in most cognitive domains. While subtle differences are seen on some executive function measures, mean group differences are small, and in the context of higher SIMS subscale scores, may not be readily interpretable. Studies employing similarly comprehensive neuropsychological assessments including validity measures in larger samples are needed to further disambiguate potential objective cognitive performance decrements from subjectively experienced difficulties.
47 The Impact of COVID-19 Infection on Objective and Subjective Cognitive Functioning: Resilience as a Protective Factor
- Alexa M. Danyluk, Morgan J. Schaeffer, Laurel Caldwell-MacIntyre, Kristina M. Gicas, Theone S. E. Paterson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 44-45
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Objective:
Growing evidence indicates that COVID-19 infection adversely impacts cognitive functioning, with COVID-19 patients demonstrating high rates of objective and subjective cognitive impairments (Daroische et al., 2020; Miskowiak et al., 2021). Given the prevalence and potentially debilitating nature of post-COVID-19 cognitive symptoms, understanding factors that mitigate the impact of COVID-19 infection on cognitive functioning is paramount to developing interventions that facilitate recovery. Resilience, the ability to cope with and grow from challenges, has been associated with improved cognitive performance in healthy adults and linked to decreased perceived cognitive difficulties in post-COVID-19 patients (Connor & Davidson, 2003; Deng et al., 2018; Jung et al., 2021). However, resilience has not yet been examined as a potential attenuator of the relationship between COVID-19 and either perceived or objective cognitive function. This study aims to investigate the role of resilience as a protective factor against experience of cognitive function difficulties in COVID-19 patients by probing the role of resilience as a moderator of the relationship between COVID-19 diagnosis and cognitive functioning (both perceived and objective).
Participants and Methods:Participants (mean age=36.93, 30.10% male) were recruited from British Columbia and Ontario. The sample included 53 adults who had never been diagnosed with COVID-19 and 50 adults diagnosed with symptomatic COVID-19 at least three months prior and not ventilated. Participants completed online questionnaires (n=103) to assess depression (the Center for Epidemiological Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), subjective cognitive functioning (The Subjective Cognitive Decline Questionnaire), and resilience (2-item Connor-Davidson Resilience Scale). Participants then completed neuropsychological tests (n=82) measuring attention, processing speed, memory, language, visuospatial skills, and executive function via teleconference, with scores averaged to create a global objective cognition score. Moderated multiple regression was employed to assess the impact of resilience on the relationship between COVID-19 diagnosis and both objective and perceived cognition, controlling for gender, ethnicity, income, age, anxiety, and depression.
Results:Average scores in the COVID-19 group exceeded diagnostic cut-offs for clinical depression (M=16.67, SD=10.77) and mild anxiety (M=5.27, SD=4.99), while the control group scored below diagnostic thresholds for depression (M=11.96, SD=9.76) and mild anxiety (M=4.48, SD=5.07). Controlling for sociodemographic and mental health characteristics, COVID-19 diagnosis was not associated with objective global cognitive functioning (b=-.07, se=1.71, p=.624) or subjective cognitive functioning (b=.16, se=1.32, p=.12), nor was resilience associated with objective global cognitive functioning (b=.19, se=1.50, p=.44) or subjective cognitive functioning (b=-.02, se=1.09, p=.89).
Conclusions:Findings indicate that COVID-19 patients may be at risk for depression and anxiety. Results of this study fail to support a relationship between COVID-19 and cognitive functioning beyond the impact of sociodemographic and mental health variables. Thus, the role of resilience as a protective factor against COVID-19 related cognitive difficulties could not be fully explored. However, findings should be considered in the context of study limitations, including a small sample size. Future research should employ larger samples to further examine the relationship between COVID-19 infection and cognition, focusing on mental health characteristics and resilience as potential risk and protective factors.
52 Depressive Symptoms and Subjective Cognitive Decline in Individuals with COVID-19
- Eva Friedman, Petra Legaspi, Katie C Benitah, Samantha J Feldman, Theone S. E. Paterson, Kristina M Gicas
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 49-50
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Objective:
Many individuals with COVID-19 develop mild to moderate physical symptoms that can last days to months. In addition to physical symptoms, individuals with COVID-19 have reported depressive symptoms and cognitive decline, posing a long-term threat to mental health and functional outcomes. Few studies have examined the presence of co-occurring depression and subjective cognitive decline in individuals who tested positive for COVID-19. The current study examined whether having COVID-19 is subsequently associated with greater depressive symptoms and subjective cognitive decline when compared to healthy individuals. Our study also examined differential associations between symptoms of depression and subjective cognitive decline between individuals who have and have never had COVID-19.
Participants and Methods:Adults (N = 104; mean age = 37 years, 69% female) were recruited online from Ontario and British Columbia, Canada. Participants were categorized into two groups: (1) persons who tested positive for COVID-19 at least three months prior, had been symptomatic, and had not been ventilated (N = 50); and (2) persons who have never been suspected of having COVID-19 (N = 54). The Center for Epidemiological Studies Depression Scale (CES-D) and the Subjective Cognitive Decline Questionnaire (SCD-Q) were administered to both groups as part of a larger clinical neuropsychological evaluation. Two separate linear regression analyses were conducted to examine the association of COVID-19 with depressive symptoms and subjective cognitive decline. A moderation analysis was performed to examine whether depressive symptoms were associated with subjective cognitive decline and the extent to which this differed by group (COVID-19 and controls). Participants’ age, self-reported sex, and history of depression were included as covariates.
Results:The first regression model explained 17.2% of the variance in CES-D scores. It was found that the COVID-19 group had significantly higher CES-D scores (ß = .20, p = .03). The second regression model explained 35.9% of the variance in SCD-Q scores. Similar to the previous model, it was found that the COVID-19 group had significantly higher SCD-Q scores compared to healthy controls (ß = .22 p = .01). Lastly, the moderation model indicated that higher CES-D scores were associated with higher SCD-Q scores (ß = .43, p < .01), but there was no statistically significant group X CES-D score interaction.
Conclusions:These findings suggest that individuals who previously experienced a mild to moderate symptomatic COVID-19 infection report greater depressive symptom severity as well as greater subjective cognitive decline. Additionally, while more severe depressive symptoms predicted greater subjective cognitive decline in our sample, the magnitude of this association did not vary between those with and without a previous COVID-19 infection. While the underlying neurobiological and social mechanisms of cognitive difficulties and depressive symptoms in persons who have had COVID-19 have yet to be fully elucidated, our findings highlight treatment for depression and cognitive rehabilitation as potentially useful intervention targets for the post COVID-19 condition.
Evidence for the continued existence of Abraxas Lake, Vestfold Hills, East Antarctica during the Last Glacial Maximum
- John A.E. Gibson, Kristina S. Paterson, Camille A. White, Kerrie M. Swadling
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- Antarctic Science / Volume 21 / Issue 3 / June 2009
- Published online by Cambridge University Press:
- 16 February 2009, pp. 269-278
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Evidence is provided from a sediment core from saline Abraxas Lake, Vestfold Hills, that indicates that the lake existed through the Last Glacial Maximum. It can therefore be concluded that at least part of the Vestfold Hills also remained ice-free through the Last Glacial Maximum, or at most was covered by a thin, non-erosive cold-based ice sheet. The evidence for the continued existence of Abraxas Lake includes a 14C date that significantly predates the Last Glacial Maximum (though this cannot be considered direct proof of the existence of the lake prior to the Last Glacial Maximum); the presence of saline porewater throughout the core, including in compacted sediments deposited during the glacial period, which implies that the lake obtained its salt prior to any Holocene marine highstand; and the occurrence of marine-derived fauna from the onset of significant biological activity late in the Pleistocene. The occurrence of ice-free land in the Vestfold Hills and similar oases suggests that the margin of the polar ice cap did not reach far beyond its current position at the Last Glacial Maximum, at least in regions now occupied by these oases.