scholarly journals Post-Operative Delirium and Cognitive Decline in Kidney Transplant Recipients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 520-520
Author(s):  
Nadia Chu ◽  
Xiaomeng Chen ◽  
Dorry Segev ◽  
Mara McAdams-DeMarco
Keyword(s):  
Executive Function ◽  
Cognitive Performance ◽  
Repeated Measures ◽  
Cognitive Vulnerability ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Fixed And Random Effects ◽  
Reduce Risk ◽  
Preventative Interventions ◽  
Function Time

Abstract Post-operative delirium may be a marker for cognitive reserve, or a greater cognitive vulnerability to stressors. As a result, those with post-operative delirium may experience steeper decline in cognitive performance following stressors of surgery post-KT. We leveraged a single-center cohort study of 912 adult KT recipients with delirium assessments abstracted from medical records. Global cognitive function (3MS) and executive function (time to complete TMT-B minus TMT-A) were measured at time of KT, 1-month, 3-months, 6-months, 1-year, and annually thereafter post-KT. We used mixed effects models with fixed and random effects for person and time to describe repeated measures of cognitive performance and compared trajectories by post-operative delirium. Among 912 KT recipients, 44 (4.8%) had post-operative delirium. Post-operative delirium was associated with higher levels of cognitive impairment at KT (18.2% vs 8.0%), and was associated with lower 3MS component scores including in memory, identification/association, and orientation. After adjustment, those with delirium had 3MS scores that were on average 3.6 points lower than those without delirium (95%CI: -6.9, 0.3) at time of KT; delirium was not associated with differing global cognitive trajectories post-KT (difference=0.04 points/month, 95%CI:-0.1, 0.2). However, delirium was associated with lower executive function at KT (difference=44.0s, 95%CI: 17.4, 70.6) and steeper decline in executive function post-KT (difference=-1.1s/month, 95%CI:-2.1,-0.05). KT recipients with delirium experience greater decline in executive function, indicating greater cognitive vulnerability with potential vascular etiologies. Transplant centers should be aware of the cognitive risks associated with post-KT delirium and implement available preventative interventions to reduce risk of delirium.

scholarly journals PHYSICAL FRAILTY AND ITS ASSOCIATION WITH COGNITION: THE PREDICTIVE VALUE OF A SYNDROME BEYOND ITS COMPONENT PARTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S100-S101
Author(s):  
Nadia M Chu ◽  
Karen Bandeen-Roche ◽  
A Richey Sharrett ◽  
Michelle C Carlson ◽  
Qianli Xue ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Performance ◽  
Predictive Value ◽  
Cognitive Vulnerability ◽  
Strong Predictor ◽  
Word List ◽  
Cognitive Change ◽  
Community Dwelling ◽  
Cohen’S D ◽  
Cohen's D

Abstract The extent to which frailty (PFP) affects cognitive performance and change beyond that expected from its component parts is uncertain. Leveraging NHATS, a nationally-representative cohort of U.S. Medicare beneficiaries, we quantified associations between each PFP criterion and global and domain-specific cognitive level and change (memory: immediate/delayed word-list test, executive function: clock drawing test (CDT), orientation: date, time, president-vice-resident naming), using adjusted mixed effects models with random slopes (time) and intercepts (person). We tested whether presence of frailty was associated with excess cognitive vulnerability (synergistic/excess effects, Cohen’s d) above and beyond those found for its criteria by adding an interaction term between each PFP criterion and frailty. Among 7,439 community-dwelling older adults (mean age=75.2 years) followed for a weighted mean of 3.2 years (SE= 0.03), 14.1% were frail. The most prevalent PFP criteria were low activity (30.5%) and exhaustion (29.8%). Associations were strongest for executive function, where frailty added predictive value beyond its criteria (excess effects of cognitive vulnerability ranging from -0.38SD (SE-0.05) for slowness to -0.47SD (SE=0.06) for shrinking). Slowness was a strong predictor of cognitive change in both frail and non-frail participants, especially for executive function (frail: Cohen’s d per year=-0.16, SE= 0.02; non-frail: Cohen’s d per year=-0.15, SE= 0.02). PFP is an important measure of frailty that adds predictive value beyond its criteria, especially for cognitive levels. Additionally, gait speed remains an important predictor of change in executive function. These results suggest that frailty’s contribution to cognitive performance amounts to more than the sum of its component parts.

scholarly journals Prescription Medications and Co-Morbidities in Late Middle-Age are Associated with Greater Cognitive Declines: Results from WRAP

2022 ◽  
Vol 2 ◽  
Author(s):  
Lianlian Du ◽  
Rebecca Langhough Koscik ◽  
Nathaniel A. Chin ◽  
Lisa C. Bratzke ◽  
Karly Cody ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Performance ◽  
Repeated Measures ◽  
Cognitive Change ◽  
Cognitive Domain ◽  
Objective Measures ◽  
Mixed Effect ◽  
Health History ◽  
Age Related ◽  
Increased Risk

The present study investigated: 1) sex differences in polypharmacy, comorbidities, self-rated current health (SRH), and cognitive performance, 2) associations between comorbidities, polypharmacy, SRH, and objective measures of health, and 3) associations of these factors with longitudinal cognitive performance. Analyses included 1039 eligible Wisconsin Registry for Alzheimer’s Prevention (WRAP) participants who were cognitively unimpaired at baseline and had ≥2 visits with cognitive composites, self-reported health history, and concurrent medication records. Repeated measures correlation (rmcorr) examined the associations between medications, co-morbidities, SRH, and objective measures of health (including LIfestyle for BRAin Health Index (LIBRA), and depression). Linear mixed-effect models examined associations between medications, co-morbidities, and cognitive change over time using a preclinical Alzheimer’s cognitive composite (PACC3) and cognitive domain z-scores (executive function, working memory, immediate learning, and delayed recall). In secondary analyses, we also examined whether the number of medications interacted with co-morbidities and whether they modified age-related cognitive trajectories. The number of prescribed medications was associated with worse SRH and a higher number of self-reported co-morbidities. More prescribed medications were associated with a faster decline in executive function, and more comorbidities were associated with faster PACC3 decline. Those with a non-elevated number of co-morbidities and medications performed an average of 0.26 SD higher (better) in executive function and an average of 0.18 SD higher on PACC3 than those elevated on both. Associations between medications, co-morbidities, and executive function, and PACC3 suggest that persons with more co-morbidities and medications may be at increased risk of reaching clinical levels of impairment earlier than healthier, less medicated peers.

scholarly journals Feasibility and preliminary effects of a theory-based self-management program for kidney transplant recipients: A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0248947
Author(s):  
Hye Won Jeong ◽  
Chi Eun Song ◽  
Minjeong An
Keyword(s):  
Pilot Study ◽  
Kidney Transplant ◽  
Repeated Measures ◽  
Self Care ◽  
Management Program ◽  
Self Management ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Video Education ◽  
Care Agency

Self-care activities are important to prevent transplant-related side effects and complications among kidney transplant recipients. Therefore, we developed a theory-based self-management program for kidney transplant recipients hospitalized after surgery. This study aimed to examine the feasibility of the program and to identify its preliminary effects on autonomy, competence, and self-care agency. We assessed feasibility using quantitative data collected based on a single group repeated-measures design, along with qualitative data such as patients’ feedback on satisfaction during patient counseling. The program comprised video education and individual counseling by nurses. Thirty patients completed this program. Outcome variables were measured thrice: before education, immediately following the first week of video education, and after two consecutive weeks of counseling. A repeated measures ANOVA showed a statistically significant increase in autonomy (F = 5.03, p = .038), competence (F = 17.59, p < .001), and self-care agency (F = 24.19, p < .001). Our pilot study provided preliminary evidence supporting the feasibility for implementation of the theory-based self-management program, and suggesting its preliminary effects in improving autonomy, competence, and self-care agency among kidney transplant recipients. Further research is needed to examine the short- and long-term effects of this program in a longitudinal, randomized control study with a larger sample.

scholarly journals The impact of vaccination on incidence and outcomes of SARS-CoV-2 infection in patients with kidney failure in Scotland

2022 ◽  
Author(s):  
Samira Bell ◽  
Jacqueline Campbell ◽  
Emilie Lambourg ◽  
Chrissie Watters ◽  
Martin O'Neill ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Data Linkage ◽  
Vaccine Effectiveness ◽  
Mortality Data ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Scottish Population ◽  
Kidney Replacement Therapy ◽  
Reduce Risk ◽  
The Impact

Background Patients with kidney failure requiring kidney replacement therapy (KRT) are at high risk of complications and death following SARS-CoV-2 infection with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on incidence of infection, hospitalization and death of COVID-19 infection. Methods Study design was an observational data linkage cohort study. Multiple healthcare datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland, from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses and vaccine effectiveness were calculated. Results As of 19th September 2021, 93% (n=5281) of the established KRT population in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness against infection and hospitalization was 33% (95% CI 0-52) and 38% (95% CI 0-57) respectively. 9.2% of fully vaccinated individuals died within 28 days of a SARS-CoV-2 positive PCR test (7% dialysis patients and 10% kidney transplant recipients). This compares to <0.1% of the vaccinated Scottish population being admitted to hospital or dying death due to COVID19 during that period. Conclusions These data demonstrate a primary vaccine course of two doses has limited impact on COVID-19 infection and its complications in patients treated with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complications in this population are urgently required.

scholarly journals Martial Art Training and Cognitive Performance in Middle-Aged Adults

2015 ◽  
Vol 47 (1) ◽  
pp. 277-283 ◽  
Author(s):  
Peter Douris ◽  
Christopher Douris ◽  
Nicole Balder ◽  
Michael LaCasse ◽  
Amir Rand ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Performance ◽  
Processing Speed ◽  
Repeated Measures ◽  
Middle Aged ◽  
Motor Tasks ◽  
Repeated Measures Design ◽  
Martial Art ◽  
Treatment Conditions ◽  
Middle Aged Adults

AbstractCognitive performance includes the processes of attention, memory, processing speed, and executive functioning, which typically declines with aging. Previous research has demonstrated that aerobic and resistance exercise improves cognitive performance immediately following exercise. However, there is limited research examining the effect that a cognitively complex exercise such as martial art training has on these cognitive processes. Our study compared the acute effects of 2 types of martial art training to aerobic exercise on cognitive performance in middle-aged adults. We utilized a repeated measures design with the order of the 3 exercise conditions randomly assigned and counterbalanced. Ten recreational middle-aged martial artists (mean age = 53.5 ± 8.6 years) participated in 3 treatment conditions: a typical martial art class, an atypical martial art class, and a one-hour walk at a self-selected speed. Cognitive performance was assessed by the Stroop Color and Word test. While all 3 exercise conditions improved attention and processing speed, only the 2 martial art conditions improved the highest order of cognitive performance, executive function. The effect of the 2 martial art conditions on executive function was not different. The improvement in executive function may be due to the increased cortical demand required by the more complex, coordinated motor tasks of martial art exercise compared to the more repetitive actions of walking.

scholarly journals Cardiorespiratory Fitness Mediates Cognitive Performance in Chronic Heart Failure Patients and Heart Transplant Recipients

2020 ◽  
Vol 17 (22) ◽  
pp. 8591
Author(s):  
Florent Besnier ◽  
Béatrice Bérubé ◽  
Christine Gagnon ◽  
Miloudza Olmand ◽  
Paula Aver Bretanha Ribeiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Executive Function ◽  
Cognitive Performance ◽  
Processing Speed ◽  
Verbal Memory ◽  
Transplant Recipients ◽  
Memory Processing ◽  
Heart Failure Patients ◽  
Heart Transplant Recipients ◽  
The Relationship

We compared cognitive profiles in chronic heart failure patients (HF), heart transplant recipients (HT) and healthy controls (HC) and examined the relationship between cardiorespiratory fitness (V˙O2peak), peak cardiac output (COpeak) and cognitive performance. Stable HT patients (n = 11), HF patients (n = 11) and HC (n = 13) (61.5 ± 8.5 years) were recruited. Four cognitive composite scores targeting different cognitive functions were computed from neuropsychological tests: working memory, processing speed, executive functions and verbal memory. Processing speed and executive function scores were higher, which indicates lower performances in HF and HT compared to HC (p < 0.05). V˙O2peak and first ventilatory threshold (VT1) were lower in HF and HT vs. HC (p < 0.01). COpeak was lower in HF vs. HT and HC (p < 0.01). Processing speed, executive function and verbal memory performances were correlated with V˙O2peak, VT1 and peak cardiac hemodynamics (p < 0.05). Mediation analyses showed that V˙O2peak and VT1 mediated the relationship between group and processing speed and executive function performances in HF and HT. COpeak fully mediated executive function and processing speed performances in HF only. V˙O2peak and COpeak were related to cognitive performance in the entire sample. In addition, V˙O2peak and VT1 fully mediated the relationship between group and executive function and processing speed performances.

Power of Modified Brown-Forsythe and Mixed-Model Approaches in Split-Plot Designs

Methodology ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 9-22 ◽  
Author(s):  
Pablo Livacic-Rojas ◽  
Guillermo Vallejo ◽  
Paula Fernández ◽  
Ellián Tuero-Herrero
Keyword(s):  
Repeated Measures ◽  
Statistical Power ◽  
Mixed Model ◽  
Covariance Structure ◽  
Simulation Method ◽  
Future Research ◽  
Repeated Measures Design ◽  
Fixed And Random Effects ◽  
Split Plot ◽  
High Level

Abstract. Low precision of the inferences of data analyzed with univariate or multivariate models of the Analysis of Variance (ANOVA) in repeated-measures design is associated to the absence of normality distribution of data, nonspherical covariance structures and free variation of the variance and covariance, the lack of knowledge of the error structure underlying the data, and the wrong choice of covariance structure from different selectors. In this study, levels of statistical power presented the Modified Brown Forsythe (MBF) and two procedures with the Mixed-Model Approaches (the Akaike’s Criterion, the Correctly Identified Model [CIM]) are compared. The data were analyzed using Monte Carlo simulation method with the statistical package SAS 9.2, a split-plot design, and considering six manipulated variables. The results show that the procedures exhibit high statistical power levels for within and interactional effects, and moderate and low levels for the between-groups effects under the different conditions analyzed. For the latter, only the Modified Brown Forsythe shows high level of power mainly for groups with 30 cases and Unstructured (UN) and Autoregressive Heterogeneity (ARH) matrices. For this reason, we recommend using this procedure since it exhibits higher levels of power for all effects and does not require a matrix type that underlies the structure of the data. Future research needs to be done in order to compare the power with corrected selectors using single-level and multilevel designs for fixed and random effects.

Immune Checkpoint Inhibitor (ICPI) induced Nephrotoxicity – An Insight.

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Mohmad Hussian Mir ◽  
Tariq Ahmad Bhat ◽  
Khalid Parvez Sofi ◽  
Imtiyaz Ahmad Wani ◽  
Muzafar Maqsood Wani
Keyword(s):  
Acute Kidney Injury ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Kidney Injury ◽  
Check Point ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
New Class ◽  
Transplant Patients ◽  
Check Point Inhibitors

Immune check point inhibitors (ICPIs) are a new class of anti-neoplastic agents being increasingly used by oncologists to treat various malignancies. These drugs have been associated with varied side effects and have a nephrotoxic potential. Many cases of ICPI induced acute kidney injury are increasingly being reported. Their use in CKD patients on dialysis as well as in kidney transplant recipients is associated with various challenges. This review discusses the use of ICPIs in CKD, dialysis and renal transplant patients and their nephrotoxic potential  

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