Cognitive performance and the course of depressive symptoms over 7 years of follow-up: the SMART-MR study

2014 ◽  
Vol 45 (8) ◽  
pp. 1741-1750 ◽  
Author(s):  
M. Kooistra ◽  
N. P. A. Zuithoff ◽  
A. M. Grool ◽  
M. Zinsmeester ◽  
G. J. Biessels ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Performance ◽  
Estimating Equation ◽  
Multiple Time ◽  
Information Processing Speed ◽  
Cognitive Domains ◽  
Interaction Terms ◽  
Multiple Time Points ◽  
Mr Study

BackgroundDepressive symptoms and cognitive impairment often co-occur, but their interactive relationship is complex and the direction of causation is still a topic of research. We examined the influence of cognitive performance on the course of depressive symptoms during 7 years of follow-up in patients with vascular disease.MethodWithin the SMART-MR study, 736 patients (mean age 62 ± 10 years) had neuropsychological assessment on four cognitive domains at baseline [memory (MEM), working memory (WMEM), executive functioning (EXEC), and information processing speed (SPEED)]. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) at baseline and every 6 months during 7 years of follow-up. Generalized Estimating Equation (GEE) models were used to assess the association between cognitive performance with depressive symptoms at multiple time points during follow-up. Interaction terms between the respective cognitive domains and time was included to examine if the course of depressive symptoms differed according to baseline cognitive performance.ResultsThe GEE analyses showed no significant interactions between the respective cognitive domains and time indicating no different course of depressive symptoms according to baseline cognitive performance. Lower MEM, EXEC or SPEED, but not WMEM performance, was significantly associated with more depressive symptoms during follow-up per z score decrease: MEM [B = 0.70, 95% confidence interval (CI) 0.35–1.05]; EXEC (B = 0.88, 95% CI 0.41–1.36), and SPEED (B = 0.57, 95% CI 0.21–0.92).ConclusionsPoorer cognitive performance on the domains MEM, EXEC and SPEED, but not WMEM, was associated with higher levels of depressive symptoms over 7 years of follow-up, but not with a different course of depressive symptoms over time.

P3-330: COGNITIVE PERFORMANCE AND THE TEMPORAL COURSE OF DEPRESSIVE SYMPTOMS OVER SEVEN YEARS' FOLLOW-UP: THE SMART-MR STUDY

2014 ◽  
Vol 10 ◽  
pp. P750-P750
Author(s):  
Minke Kooistra ◽  
Margitta Zinsmeester ◽  
Anne Merlijn Grool ◽  
Peter Zuithoff ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Performance ◽  
Temporal Course ◽  
Mr Study

scholarly journals Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old

2020 ◽  
Author(s):  
Tam Watermeyer ◽  
Jantje Goerdten ◽  
Boo Johansson ◽  
Graciela Muniz-Terrera
Keyword(s):  
Cognitive Performance ◽  
Cox Regression ◽  
Oldest Old ◽  
Cost Effective ◽  
Carrier Status ◽  
Dementia Diagnosis ◽  
Cognitive Domains ◽  
Dementia Incidence ◽  
Composite Scores

Abstract Background Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. Objective The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. Methods Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. Results Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. Conclusions The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.

The association of D4, 3-keto-abi (D4A) and response to abiraterone in castration-resistant prostate cancer (CRPC).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 245-245
Author(s):  
Hamid Emamekhoo ◽  
Mohammad Alyamani ◽  
Zhenfei Li ◽  
Paul Elson ◽  
Petros Grivas ◽  
...  
Keyword(s):  
Median Time ◽  
Specific Antigen ◽  
Response To Treatment ◽  
Multiple Time ◽  
Castration Resistant Prostate Cancer ◽  
Androgen Receptor Antagonist ◽  
Duration Of Response ◽  
Multiple Time Points ◽  
The Impact

245 Background: Abiraterone (Abi), a potent inhibitor of 17α-hydroxylase/17,20-lyase (CYP17A1), is a standard treatment for men with metastatic CRPC. Abi is converted to D4A by 3β-hydroxysteroid dehydrogenase (3βHSD). D4A inhibits CYP17A1, 3βHSD, and steroid-5α-reductase (SRD5A) and has direct androgen receptor antagonist activity, which together make it a more potent agent than Abi in xenograft models. It is not known if conversion to D4A in patients (pts) correlates with response or resistance to Abi. Methods: Blood was collected (single time point on Abi) from CRPC pts who started Abi during 2011-2015. Abi and D4A were extracted from serum and analyzed by mass spectrometry. The purpose of this ongoing study is to assess the potential correlation between D4A and response to treatment. Results: 32 patients with CRPC had blood collected. 4 pts (12.5%) received ketoconazole and 6 (18.8%) chemotherapy prior to Abi. Median pre-Abi prostate-specific antigen (PSA) was 14.3 ng/ml (0.6-646.1). Median time from initiation of androgen deprivation therapy (ADT) to CRPC was 34.3 months (m) (6-129.6) and median time from CRPC to Abi initiation was 4.8 m (0-14.9). PSA decline > 50% (PSA50) on Abi was seen in 68% (12/31) and 73% (19/26) of pts at 3 and 6 m, respectively. Treatment with Abi was ongoing in 23/32 pts (74%), and discontinued in 8 pts (26%) due to disease progression (no follow up data on 1 pt) with median duration of Abi treatment 14.6 m (2.9-44.4 m) at last follow up. As the absolute concentration of detected levels of Abi and D4A varied significantly among pts, the percentage of the total extracted metabolites was used to assess correlation with response. Abi and D4A comprised 94.3% (73.8-97.4%) and 5.7% (2.6-26.2%), respectively, of total levels. Conclusions: Abi absorption and metabolism significantly vary among pts. Most of these pts had prolonged duration of response to Abi (74% ongoing treatment and median treatment duration 13.3 m in 8 pts that came off treatment). Longer follow up, accrual of pts with shorter duration of response, and sampling at multiple time points on Abi and at progression is ongoing to further evaluate the impact of D4A on treatment response.

Return to Preinjury Function Following Knee Injury

2020 ◽  
pp. 1-12
Author(s):  
Aaron D. Sciascia ◽  
Arthur J. Nitz ◽  
Patrick O. McKeon ◽  
Jennifer Havens ◽  
Timothy L. Uhl
Keyword(s):  
Knee Injury ◽  
Injury Severity ◽  
Multiple Time ◽  
Balance Test ◽  
Patient Recall ◽  
Initial Injury ◽  
Baseline Values ◽  
Multiple Time Points ◽  
Time Point

Athletic preinjury function is typically determined via patient recall, however obtaining preinjury function before injury occurs should be attempted. The purpose of this study was to obtain preinjury physical function baseline values using the Knee Injury and Osteoarthritis Outcome Score (KOOS), single-leg hop for distance (SLH), and Star Excursion Balance Test (SEBT) anterior reach to determine if athletes return to those baseline values following knee injury. Out of 27 qualifying injuries, KOOS scores were significantly reduced at initial injury compared to baseline and all follow-up points (p ≤ .02). In most instances, baseline KOOS scores were not met at the discharge time point. SLH and SEBT recovered to baseline values by discharge. Injury severity and previous injury created variations in KOOS scores across multiple time points. Subjective and objective preinjury function can be re-established following knee injury but recovery may not occur at discharge from rehabilitation.

Fluoxetine Versus Placebo in Advanced Cancer Outpatients: A Double-Blinded Trial of the Hoosier Oncology Group

2003 ◽  
Vol 21 (10) ◽  
pp. 1937-1943 ◽  
Author(s):  
Michael J. Fisch ◽  
Patrick J. Loehrer ◽  
Jean Kristeller ◽  
Steven Passik ◽  
Sin-Ho Jung ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Advanced Cancer ◽  
Performance Status ◽  
Estimating Equation ◽  
Equation Modeling ◽  
Advanced Cancer Patients ◽  
Symptoms Of Depression ◽  
Double Blinded

Purpose: To determine whether fluoxetine improves overall quality of life (QOL) in advanced cancer patients with symptoms of depression revealed by a simple survey. Patients and Methods: One hundred sixty-three patients with an advanced solid tumor and expected survival between 3 and 24 months were randomly assigned in a double-blinded fashion to receive either fluoxetine (20 mg daily) or placebo for 12 weeks. Patients were screened for at least minimal depressive symptoms and assessed every 3 to 6 weeks for QOL and depression. Patients with recent exposure to antidepressants were excluded. Results: The groups were comparable at baseline in terms of age, sex, disease distribution, performance status, and level of depressive symptoms. One hundred twenty-nine patients (79%) completed at least one follow-up assessment. Analysis using generalized estimating equation modeling revealed that patients treated with fluoxetine exhibited a significant improvement in QOL as shown by the Functional Assessment of Cancer Therapy–General, compared with patients given placebo (P = .01). Specifically, the level of depressive symptoms expressed was lower in patients treated with fluoxetine (P = .0005), and the subgroup of patients showing higher levels of depressive symptoms on the two-question screening survey were the most likely to benefit from treatment. Conclusion: In this mix of patients with advanced cancer who had symptoms of depression as determined by a two-question bedside survey, use of fluoxetine was well tolerated, overall QOL was improved, and depressive symptoms were reduced.

537 Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A212-A212
Author(s):  
Afsara Zaheed ◽  
Adam Spira ◽  
Ronald Chervin ◽  
Laura Zahodne
Keyword(s):  
Executive Function ◽  
Depressive Symptoms ◽  
Episodic Memory ◽  
Cognitive Performance ◽  
Processing Speed ◽  
Vascular Diseases ◽  
Cognitive Domains ◽  
Falling Asleep ◽  
Function Language ◽  
Insomnia Symptoms

Abstract Introduction Alzheimer’s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations. Methods Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., “baseline”) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values. Results Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed. Conclusion Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD. Support (if any):

scholarly journals A Normotensive Patient with Primary Aldosteronism

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Xiao Lin ◽  
Xiaoyu Miao ◽  
Pengli Zhu ◽  
Fan Lin
Keyword(s):  
Blood Pressure ◽  
Primary Aldosteronism ◽  
Adrenal Incidentaloma ◽  
Confirmatory Test ◽  
Multiple Time ◽  
Normal Blood Pressure ◽  
Normotensive Patient ◽  
History Of ◽  
Multiple Time Points

This study was to report a case of normotensive patient with primary aldosteronism who was admitted to our department recently. The patient was a 33-year-old male with right adrenal incidentaloma, but without any symptom. He has no history of hypertension, and blood pressure was normal when measured at multiple time points during hospitalization stay. The 24-hour ambulatory blood pressure prompted a normal blood pressure with the existence of circadian rhythm. The patient was diagnosed with primary aldosteronism by screening and confirmatory test. Due to the absence of symptom, surgery was not preferred. Blood pressure was found to be normal with the 2-month follow-up from discharge until now.

The Clinical Course of Depression: Chronicity is the Rule Rather than the Exception

2017 ◽  
Vol 41 (S1) ◽  
pp. S144-S145 ◽  
Author(s):  
J. Verhoeven ◽  
J. Verduijn ◽  
Y. Milaneschi ◽  
A. Beekman ◽  
B. Penninx
Keyword(s):  
Recovery Rate ◽  
Multiple Time ◽  
Depression And Anxiety ◽  
Major Depressive ◽  
Chronic Disorder ◽  
Co Morbidity ◽  
Multiple Time Points ◽  
Chronic Course ◽  
Course Of Depression

IntroductionMajor depressive disorder (MDD) is often considered an episodic disorder. However, literature might underestimate the chronicity of MDD since results depend on follow-up duration and the extent to which psychiatric co-morbidity is taken into account.AimTo determine, whether MDD should be considered an episodic or chronic disorder.ObjectiveTo examine the 6 year course of MDD, incorporating data of multiple time points and taking common psychiatric comorbidities into account.MethodsData were from 903 patients with current MDD at baseline in the Netherlands study of depression and anxiety, with subsequent data from 2 year, 4 year and 6 year follow-up. Four course trajectories were created taking all information during follow-up into account classifying patients as (1) recovered, (2) recurrent without chronic episodes, (3) recurrent with chronic episodes or (4) consistently chronic. A chronic episode was defined as having symptoms consistently over 2 years.ResultsThe recovery rate of MDD was 58% at 2 year follow-up but looking at 6 year follow-up and taking into account co-morbid dysthymia, (hypo) mania and anxiety disorders reduced this recovery rate to 17%. Moreover, more than half of the patients experienced chronic episodes.ConclusionsLongitudinal data of this psychiatric cohort study showed that full recovery is the exception rather than the rule. MDD follows a chronic course and, moreover, persons are prone to switch to other psychiatric disorders.

Benefit-Finding Intervention Delivered Individually to Alzheimer Family Caregivers: Longer-Term Outcomes of a Randomized Double-Blind Controlled Trial

2019 ◽  
Vol 75 (9) ◽  
pp. 1884-1893 ◽  
Author(s):  
Sheung-Tak Cheng ◽  
Emily P M Mak ◽  
Timothy Kwok ◽  
Helene Fung ◽  
Linda C W Lam
Keyword(s):  
Depressive Symptoms ◽  
Controlled Trial ◽  
Well Being ◽  
Benefit Finding ◽  
Post Intervention ◽  
Double Blind ◽  
Interaction Terms ◽  
Positive Aspects Of Caregiving ◽  
Secondary Outcomes

Abstract Objectives To examine the longer-term effects of benefit-finding on caregivers’ depressive symptoms (primary outcome), and global burden, role overload, psychological well-being, and positive aspects of caregiving (secondary outcomes). Method Ninety-six Hong Kong Chinese caregivers of relatives with Alzheimer’s disease were randomly assigned to receive the benefit-finding intervention (BFT) or one of the two control conditions, namely, simplified psychoeducation (lectures only; SIM-PE) or standard psychoeducation (STD-PE). Caregivers received four biweekly one-to-one interventions of 3 hours each at their own homes. We focused on outcomes measured at 4- and 10-month follow-ups. The trajectories of intervention effects were modeled by BFT × time and BFT × time2 interaction terms. Results Mixed-effects regression showed significant BFT × time2 interaction effects on depressive symptoms against both control conditions, suggesting diminishing BFT effects over time. Z tests showed that, compared with controls, BFT participants reported substantial reductions in depressive symptoms at 4-month follow-up (d = −0.85 and −0.75 vs. SIM-PE and STD-PE, respectively). For depressive symptoms measured at 10-month follow-up, BFT was indistinguishable from STD-PE, whereas a moderate effect was observed in comparison with SIM-PE (d = −0.52). Moreover, positive aspects of caregiving, but not other secondary outcomes, continued to show intervention effect up to 10-month follow-up. Discussion Benefit-finding is an efficacious intervention for depressive symptoms in Alzheimer caregivers, with strong effects in the medium-term post-intervention and possible moderate effects in the longer-term post-intervention.

scholarly journals The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

2019 ◽  
Vol 28 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Landon Lempke ◽  
Abbis Jaffri ◽  
Nicholas Erdman
Keyword(s):  
Physical Activity ◽  
Acute Phase ◽  
Current Evidence ◽  
Symptom Duration ◽  
Multiple Time ◽  
Initial Examination ◽  
Bottom Line ◽  
Time Points ◽  
Multiple Time Points

Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical Question: Does early physical activity decrease postconcussion symptoms compared to physical rest following concussion? Summary of Key Findings: A total of 5 articles were included that examined symptom duration changes at multiple time points. All 5 studies utilized follow-up time points compared to initial examination, but there was variance in the specific time points reported. Two studies employed control groups and compared strict or recommended rest to early activity or limited rest. Three studies were observational studies that directly compared baseline measurements to follow-up assessments. Clinical Bottom Line: Current evidence suggests that early physical activity in the acute phase following a concussion may decrease the time needed for symptom resolution compared to immediate rest. Strength of Recommendation: Using Centre for Evidence-Based Medicine 2011 level 3 evidence and higher, the results suggest that early physical activity during the acute phase of a concussion may decrease symptom duration; however, a lack of high-quality studies and inconsistent interventions are limitations to this recommendation.

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