7 results
96 Feasibility Trial of a Mobile Health Intervention for Dementia Caregivers
- Taylor R Maynard, Shehjar Sadhu, Dhaval Solanki, Kunal Mankodiya, Jennifer Davis, Lisa Uebelacker, Brian R Ott, Geoffrey Tremont
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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. 498-499
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Objective:
There are numerous adverse health outcomes associated with dementia caregiving, including increased stress and depression. Caregivers often face time-related, socioeconomic, geographic, and pandemic-related barriers to treatment. Thus, implementing mobile health (mHealth) interventions is one way of increasing caregivers’ access to supportive care. The objective of the current study was to collect data from a 3-month feasibility trial of a multicomponent mHealth intervention for dementia caregivers.
Participants and Methods:40 community-dwelling dementia caregivers were randomized to receive the CARE-Well (Caregiver Assessment, Resources, and Education) App or internet links connected to caregiver education, support, and resources. Caregivers were encouraged to use the App or links at least 4 times per week for 3 months. The App consisted of self-assessments, caregiver and stress reduction education, behavior problem management, calendar reminders, and online social support. Caregivers completed measures of burden, depression, and desire to institutionalize at baseline and post-intervention. Feasibility data included App usage, retention and adherence rates, and treatment satisfaction. Data were analyzed via descriptive statistics.
Results:Caregivers were mostly white (95%), female (68%), in their mid-60s, (M= 66.38, SD= 10.64), and well-educated (M= 15.52 years, SD= 2.26). Caregivers were mainly spouses (68%) or adult children (30%). Care recipients were diagnosed with mild (60%) or moderate (40%) dementia, with 80% diagnosed as having Alzheimer’s disease. Overall, the study had an 85% retention rate (80% for App group; 90% for links group). 58% of caregivers in the App group were considered high users, using the App >120 minutes over the course of 3 months (M= 362.42, SD= 432.68), and an average of 16.44 days (SD= 15.51). 15% of the sample was non-adherent due to time constraints, disinterest, and/or technology issues. Most participants (75%) using the App were mostly or very satisfied, about 87% would be likely or very likely to seek similar programs in the future, and 93% found the App mostly or very understandable. Groups did not significantly differ on clinical outcomes, although the study was not powered for an efficacy analysis. Within groups analysis revealed significant increases in depressive symptoms at post-treatment for caregivers in both groups.
Conclusions:This study demonstrated initial feasibility of the CARE-Well App for dementia caregivers. App use was lower than expected, however, high satisfaction, ease of use, and willingness to use similar programs in the future were endorsed. Some caregivers did not complete the intervention due to caregiving responsibilities, general disinterest, and/or technology issues. Although the study was not designed to assess clinical outcomes, we found that both groups reported higher depressive symptoms at post-treatment. This finding was unexpected and might reflect pandemic-related stress, which has been shown to particularly impact dementia caregivers. Future studies should address the efficacy of multicomponent mHealth interventions for dementia caregivers and the effects of increased dose on clinical outcomes. mHealth interventions should be refined to cater to varying levels of technology literacy among caregivers, and further research should aim to better integrate interventions into caregivers’ routines to enhance treatment engagement.
Sex-specific differences in neuropsychological profiles of mild cognitive impairment in a hospital-based clinical sample
- Aimee J. Karstens, Taylor R. Maynard, Geoffrey Tremont
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 9 / November 2023
- Published online by Cambridge University Press:
- 03 March 2023, pp. 821-830
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Objective:
Mild cognitive impairment (MCI) is an etiologically nonspecific diagnosis including a broad spectrum of cognitive decline between normal aging and dementia. Several large-scale cohort studies have found sex effects on neuropsychological test performance in MCI. The primary aim of the current project was to examine sex differences in neuropsychological profiles in a clinically diagnosed MCI sample using clinical and research diagnostic criteria.
Method:The current study includes archival data from 349 patients (age M = 74.7; SD = 7.7) who underwent an outpatient neuropsychological evaluation and were diagnosed with MCI. Raw scores were converted to z-scores using normative datasets. Sex differences in neurocognitive profiles including severity, domain-specific composites (memory, executive functioning/information processing speed, and language), and modality-specific learning curves (verbal, visual) were examined using Analysis of Variance, Chi-square analyses, and linear mixed models. Post hoc analyses examined whether sex effects were uniform across age and education brackets.
Results:Females exhibit worse non-memory domain and test-specific cognitive performances compared to males with otherwise comparable categorical MCI criteria and global cognition measured via screening and composite scores. Analysis of learning curves showed additional sex-specific advantages (visual Males>Females; verbal Females >Males) not captured by MCI subtypes.
Conclusions:Our results highlight sex differences in a clinical sample with MCI. The emphasis of verbal memory in the diagnosis of MCI may result in diagnosis at more advanced stages for females. Additional investigation is needed to determine whether these profiles confer greater risk for progressing to dementia or are confounded by other factors (e.g., delayed referral, medical comorbidities).
Comparing the Mini-Mental State Examination and the modified Mini-Mental State Examination in the detection of mild cognitive impairment in older adults
- Ryan Van Patten, Karysa Britton, Geoffrey Tremont
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- Journal:
- International Psychogeriatrics / Volume 31 / Issue 5 / May 2019
- Published online by Cambridge University Press:
- 19 July 2018, pp. 693-701
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Objectives:
To show enhanced psychometric properties and clinical utility of the modified Mini-Mental State Examination (3MS) compared to the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI).
Design:Psychometric and clinical comparison of the 3MS and MMSE.
Setting:Neuropsychological clinic in the northeastern USA.
Participants:Older adults referred for cognitive concerns, 87 of whom were cognitively intact (CI) and 206 of whom were diagnosed with MCI.
Measurements:The MMSE, the 3MS, and comprehensive neuropsychological evaluations.
Results:Both instruments were significant predictors of diagnostic outcome (CI or MCI), with comparable odds ratios, but the 3MS explained more variance and showed improved classification accuracies relative to the MMSE. The 3MS also demonstrated greater receiver operating characteristic area under the curve values (0.85, SE = 0.02) compared to the MMSE (0.74, SE = 0.03). Scoring lower than 95/100 on the 3MS suggested MCI, while scoring lower than 28/30 on the MMSE suggested MCI. Additionally, compared to the MMSE, the 3MS shared more variance with neuropsychological composite scores in Language and Memory domains but not in Attention, Visuospatial, and Executive domains. Finally, 65.5% MCI patients were classified as impaired (scoring ≤1 SD below the mean) using 3MS normative data, compared to only 11.7% of patients who were classified as impaired using MMSE normative data.
Conclusions:Broadly speaking, our data strongly favor the widespread substitution of the MMSE with the 3MS in older adults with concerns for cognitive decline.
Telephone-based Minnesota Cognitive Acuity Screen predicts time to institutionalization and homecare
- Seth A. Margolis, George D. Papandonatos, Geoffrey Tremont, Brian R. Ott
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- Journal:
- International Psychogeriatrics / Volume 30 / Issue 3 / March 2018
- Published online by Cambridge University Press:
- 25 September 2017, pp. 365-373
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Background:
We assessed the ability of a telephone-administered cognitive screening test – Minnesota Cognitive Acuity Screen (MCAS) – to predict time to assisted living/nursing home placement (i.e. institutionalization) and homecare/institutionalization in healthy controls (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD).
Methods:Participants (N = 146; HC = 37; MCI = 70; AD = 39) had baseline MCAS testing and were re-contacted over eight years for dates of starting homecare, institutionalization, and death. Occasionally, outcomes were obtained via medical records. Accounting for informative censoring due to death within a competing risks framework, Cox regression examined the associations of baseline MCAS performance with the start of (a) institutionalization and (b) homecare/institutionalization.
Results:Hazard ratios (HR) captured the effect of a ten-point difference in baseline MCAS scores, corresponding to a change from the MCI/HC to AD/MCI boundaries. In unadjusted models, increased baseline cognitive impairment was associated with nearly two-fold increases in the hazard of institutionalization (HR = 1.81, 95% CI = 1.32, 2.48) and homecare/institutionalization (HR = 1.87, 95% CI = 1.44, 2.42). However, hazards were not proportional over time in models adjusting for sex. This was resolved when regressions were run for men and women separately. Both sexes showed significant increases in the hazard of institutionalization (Females: HR = 2.39, 95% CI = 1.53–3.74; Males: HR = 1.68, 95% CI = 1.02–2.76) and homecare/institutionalization (Females: HR = 2.31, 95% CI = 1.66, 3.21; Males: HR = 1.98, 95% CI = 1.32, 2.96) with increased impairment, although hazards were lower for males.
Conclusions:Telephone-administered MCAS provides useful information about the risk of needing homecare assistance or institutionalization. It may be particularly useful when office/home visits are prohibitive but cognitive monitoring is indicated.
Cognitive Reserve and Brain Reserve in Prodromal Huntington's Disease
- Aaron Bonner-Jackson, Jeffrey D. Long, Holly Westervelt, Geoffrey Tremont, Elizabeth Aylward, Jane S. Paulsen, The PREDICT-HD Investigators and Coordinators of the Huntington Study Group
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- Journal:
- Journal of the International Neuropsychological Society / Volume 19 / Issue 7 / August 2013
- Published online by Cambridge University Press:
- 23 May 2013, pp. 739-750
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Huntington disease (HD) is associated with decline in cognition and progressive morphological changes in brain structures. Cognitive reserve may represent a mechanism by which disease-related decline may be delayed or slowed. The current study examined the relationship between cognitive reserve and longitudinal change in cognitive functioning and brain volumes among prodromal (gene expansion-positive) HD individuals. Participants were genetically confirmed individuals with prodromal HD enrolled in the PREDICT-HD study. Cognitive reserve was computed as the composite of performance on a lexical task estimating premorbid intellectual level, occupational status, and years of education. Linear mixed effects regression (LMER) was used to examine longitudinal changes on four cognitive measures and three brain volumes over approximately 6 years. Higher cognitive reserve was significantly associated with a slower rate of change on one cognitive measure (Trail Making Test, Part B) and slower rate of volume loss in two brain structures (caudate, putamen) for those estimated to be closest to motor disease onset. This relationship was not observed among those estimated to be further from motor disease onset. Our findings demonstrate a relationship between cognitive reserve and both a measure of executive functioning and integrity of certain brain structures in prodromal HD individuals. (JINS, 2013, 19, 1–12).
14 - Lifespan aspects of endocrine disorders
- from Section II - Disorders
- Edited by Jacobus Donders, Scott J. Hunter, University of Chicago
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- Book:
- Principles and Practice of Lifespan Developmental Neuropsychology
- Published online:
- 07 May 2010
- Print publication:
- 14 January 2010, pp 409-426
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Summary
Endocrine disorders across the lifespan
Endocrine disorders are a complex set of conditions resulting in abnormal hormonal release and regulation that can negatively impact growth and development, metabolism, and sexual functioning/reproduction. These disorders can arise at almost any point throughout the lifespan, from the prenatal period to old age. The effect of these conditions on the central nervous system may also vary from profound developmental disorders to subtle and possibly reversible cognitive impairments. In many cases, the mechanisms for cognitive and neurobehavioral effects of endocrine disorders are poorly understood.
Overview of the endocrine system
Table 14.1 presents the major anatomical structures of the endocrine system, their general function, and associated hormones. These structures regulate and release hormones in the body. The system is responsible for growth and development, reproduction, metabolism (energy production and storage), homeostasis, and responding to internal and external environmental changes. There are strong interactions between the endocrine, nervous, and immune systems. The pituitary gland and the hypothalamus are particularly important because they are involved in a feedback regulation of hormone production across the thyroid, adrenal, and gonadal axes. In general, a neural signal of imbalance in one of these endocrine systems leads to secretion of releasing factor from the hypothalamus, which triggers the pituitary gland to release a tropic hormone. The tropic hormone stimulates production and release of hormones from the specified endocrine gland. As a result, levels of circulating hormones normalize.
Stress and the Brain: A Fresh Perspective
- Geoffrey Tremont
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- Journal:
- Journal of the International Neuropsychological Society / Volume 11 / Issue 5 / September 2005
- Published online by Cambridge University Press:
- 26 August 2005, pp. 656-657
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Stress, the Brain and Depression, by Herman M. van Praag, Ron de Kloet, and Jim van Os. (2004). Cambridge, UK: Cambridge University Press. 293 pp., $110.00, £65.00.
This book addresses one of the fundamental questions in the etiology of depression: Does stress cause depression? Although intuitively one may answer yes to this question, the book presents detailed psychological and neurobiological evidence to show the complexity of the issue. The book focuses on three major themes: (1) pathophysiology of stress in depression; (2) stress-inducible subtypes of depression; and (3) diagnosing depression to understand biological underpinnings of the condition. Although each of the three authors wrote individual chapters (with van Praag writing most chapters), the book is well organized and flows smoothly. The book is well written in an entertaining style, especially the chapters written by van Praag. For example, when discussing the problems with the current DSM-IV diagnostic system, van Praag states, “psychiatric diagnosing is locked up in a nosological straightjacket, and thus immobilized” (p. 8). It is this type of commentary, sprinkled throughout the book, that holds the reader's interest. In addition, the authors provide a fresh perspective on diagnostic issues in depression, stress/negative life events, and the neurobiology of depression. I expect the volume will stimulate research ideas. To get the most out of the book, it should be read in its entirety. Exceptions are the chapters reviewing the psychobiology of stress and depression, which provide very comprehensive summaries of the research literature, and may serve as a good reference. The initial chapters build the theoretical foundation for the presentation of the biological data, and the final chapters integrate the biological data with the initial hypotheses. The authors take issue with diagnostic trends in psychiatry, definitions of stress and life events, and to a lesser extent, neurobiological approaches to psychiatric research. The authors do not rehash old findings, but include the most recent literature. For example, when discussing corticotrophin releasing hormone (CRH) receptors, they present new findings supporting a possible parallel parasympathetic-related system in addition to the traditional sympathetic response. When the data presentation becomes complex, information is summarized in easy-to-read tables.