The Aging Physician

2021 ◽  
pp. 259-274
Author(s):  
Gia Merlo
Keyword(s):  
Cognitive Impairment ◽  
Financial Literacy ◽  
Cognitive Abilities ◽  
Successful Aging ◽  
Medical Profession ◽  
Current System ◽  
Self Regulation ◽  
Optimal Solution ◽  
Mandatory Retirement

After decades of working in the medical field, physicians have gathered an extensive knowledge of human pathology as well as effective courses of treatment for illnesses. However, aging may also bring about cognitive deterioration, which may compromise the quality of care physicians provide to their patients. In 2015, 23 percent of physicians were above the age of 65. An estimated 25,000 to 50,000 active physicians are expected to suffer from mild cognitive impairment and up to 25,000 from dementia. Currently, physicians are not held to a mandatory retirement age and are not subject to oversight of their cognitive abilities and physical health as they age. However, the current system of self-regulation for cognitive impairment is insufficient for protecting patient safety; on the other hand, mandatory retirement or screening of aging physicians may be ethically or legally problematic. An optimal solution would balance the safety of patients and the dignity of aging physicians. It is likely to be multipronged and multifactorial, involving multiple screening steps and continued development to assess the quality of validation. Adoption of healthy lifestyle practices and financial literacy, as well as providing opportunities for retired physicians to stay involved with the medical profession, may encourage successful aging among physicians and ease the transition to retirement.

The Boundaries of “Good Behavior” and Judicial Competence: Exploring Responsibilities and Authority Limitations of Cognitive Specialists in the Regulation of Incapacitated Judges

2018 ◽  
Vol 46 (2) ◽  
pp. 514-520
Author(s):  
Brandon Hamm ◽  
Bryn S. Esplin
Keyword(s):  
Cognitive Impairment ◽  
Conflicts Of Interest ◽  
Ethical Dilemmas ◽  
Medical Profession ◽  
Self Regulation ◽  
Legal Profession ◽  
Previous Literature ◽  
Severe Cognitive Impairment ◽  
Administration Of Justice

Both law and medicine rely on self-regulation and codes of professionalism to ensure duties are performed in a competent, ethical manner. Unlike physicians, however, judges are lawyers themselves, so judicial oversight is also self-regulation. As previous literature has highlighted, the hesitation to report a cognitively-compromised judge has resulted in an “opensecret” amongst lawyers who face numerous conflicts of interest.Through a case study involving a senior judge with severe cognitive impairment, this article considers the unique ethical dilemmas that cognitive specialists may encounter when navigating duties to patient, society, and the medical profession, without clear legal guidance.Systemic self-regulatory inadequacies in the legal profession are addressed, as well as challenges that arise when trying to preserve the trust and dignity of an incapacitated patient who must fulfill special duties to society.Ultimately, because of their unique neurological expertise and impartial assessments, we submit that allowing cognitive specialists to submit their assessments to an internal judiciary board may act as an additional check and balance to ensure the fair and competent administration of justice.

scholarly journals Treatment of canine cognitive dysfunction with novel butyrylcholinesterase inhibitor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maja Zakošek Pipan ◽  
Sonja Prpar Mihevc ◽  
Malan Štrbenc ◽  
Urban Košak ◽  
Ilija German Ilić ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Cognitive Abilities ◽  
Cognitive Status ◽  
Moderate Cognitive Impairment ◽  
Interesting Candidate ◽  
Butyrylcholinesterase Inhibitor

AbstractCanine cognitive dysfunction (CCD) is common in aged dogs and has many similarities with Alzheimer’s disease. Unfortunately, like Alzheimer’s disease, CCD cannot be cured. In the present study, we treated dogs with CCD with our newly developed and characterized butyrylcholinesterase inhibitor (BChEi). Seventeen dogs were randomized into two groups (treated with BChEi and untreated) and followed for 6 months at regular check-ups. The dogs’ cognitive status was determined by a Canine Dementia Scale (CADES) questionnaire and two cognitive tests. In dogs with moderate cognitive impairment, treatment caused significant improvement in the clinical rating of cognitive abilities and the performance-based tests of cognitive functioning when compared to the untreated group (p < 0.001). Dogs treated with BChEi showed markedly improved cognitive function with enhanced quality of life. No side effects were observed in the treated dogs with moderate cognitive impairment. According to the results of this preliminary study, there is an indication that novel BChEi may be a promising drug for the treatment of CCD in dogs and may be an interesting candidate for the treatment of Alzheimer's disease in humans. However, further clinical studies are needed to confirm this.

The effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Mohannad Alajlani ◽  
Dari Alhuwail ◽  
Carla T Toro ◽  
Anna Giannicchi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly People ◽  
Cognitive Training ◽  
Cognitive Abilities ◽  
Serious Games ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Global Cognition ◽  
Meta Analyses

BACKGROUND Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a non-pharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games in improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was conducted. Eight electronic databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Fifteen studies met the eligibility criteria of 466 citations retrieved. Of those, 14 RCTs were eventually included in meta-analyses. We found that, regardless of their type, serious games are more effective than no intervention (P=0.04) and conventional exercises (P=0.002) in improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games are more effective than no intervention (P=0.05) and conventional exercises (P<0.001) in improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames are as effective as no intervention and conventional exercises (P=0.38) in improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events was comparable between groups. CONCLUSIONS Serious games (in general) and cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as complementary and not a substitute to existing interventions until further, more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effect. CLINICALTRIAL Serious games; Cognitive training; Exergames; Mild cognitive impairment; Alzheimer's disease; Dementia; Global cognition; Systematic reviews; Meta-analysis

scholarly journals Treatment of Canine Cognitive Dysfunction With Novel Butyrylcholinesterase Inhibitor

2020 ◽  
Author(s):  
Maja Zakošek Pipan ◽  
Sonja Prpar Mihevc ◽  
Malan Štrbenc ◽  
Urban Košak ◽  
Ilija German Ilić ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Cognitive Abilities ◽  
Cognitive Status ◽  
Promising Candidate ◽  
Moderate Cognitive Impairment ◽  
Butyrylcholinesterase Inhibitor

Abstract Background: Canine cognitive dysfunction (CCD) is common in aged dogs and has many similarities with Alzheimer’s disease. Unfortunately, like Alzheimer’s disease, CCD cannot be cured. Methods: In the present study, we treated dogs with CCD with our newly developed and characterized butyrylcholinesterase inhibitor (BChEi). Seventeen dogs were randomized into two groups (treated with BChEi and untreated) and followed for 6 months at regular check-ups. The dogs’ cognitive status was determined by a CADES questionnaire and two cognitive tests. Results: In dogs with moderate cognitive impairment, treatment caused significant improvement in the clinical rating of cognitive abilities and the performance-based tests of cognitive functioning when compared to the untreated group (p < 0.001). Dogs treated with BChEi showed markedly improved cognitive function with enhanced quality of life. No side effects were observed in the treated dogs with moderate cognitive impairment. Conclusions: Novel BChE inhibitor is a promising candidate for treating CCD, and might be an interesting canidate drug for the treatment of Alzheimer disease in humans.

The effectiveness of serious games in improving executive functions among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

2022 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Dari Alhuwail ◽  
Arfan Ahmed ◽  
Mowafa Househ
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Functions ◽  
Elderly People ◽  
Cognitive Abilities ◽  
Serious Games ◽  
Small Sample ◽  
Meta Analyses

BACKGROUND Executive functions are one of the known cognitive abilities that decline by age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses. OBJECTIVE This study aims to investigate the effectiveness of serious games in improving executive functions among elderly people with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Out of 548 publications identified, 16 RCTs were eventually included in this review. Our meta-analyses showed that serious games are as effective as no or passive interventions in improving executive functions (P=0.29). Surprisingly, conventional exercises were more effective than serious games in improving executive functions (P=0.03). Our subgroup analysis showed that both types of serious games (cognitive training games (P=0.08) and exergames (P=0.16)) are as effective as conventional exercises in improving executive functions. No difference was found between adaptive serious games and non-adaptive serious games in improving executive functions (P=0.59). CONCLUSIONS Serious games are not superior to no or passive interventions and conventional exercises in improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by healthcare providers nor used by patients for improving executive functions among older adults with cognitive functions. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.

Financial literacy of the population of the Tyva Republic

2020 ◽  
Vol 18 (4) ◽  
pp. 652-661
Author(s):  
Sh.Ch. Soyan ◽  
V.K. Sevek ◽  
R.S. Taibyl
Keyword(s):  
Quality Of Life ◽  
Economic Development ◽  
Financial Literacy ◽  
Socio Economic Development ◽  
Survey Results ◽  
Questionnaire Method ◽  
Tyva Republic

Subject. This article deals with the issues of determining the level of financial literacy of the population of the Tyva Republic. Objectives. The article aims to analyze the level of financial literacy of the population of the Tyva Republic and identify factors that cause the financial illiteracy rates. Methods. For the study, we used a questionnaire method within a sociological survey. Results. The article presents results of the sociological survey of respondents and highlights the main reasons for the financial illiteracy of the majority of the population of the Tyva Republic. Conclusions. The results obtained can be taken into account when developing the area's socio-economic development programmes improving the quality of life of the population.

scholarly journals What’s going on following acute covid-19? Clinical characteristics of patients in an out-patient rehabilitation program

2021 ◽  
pp. 1-12
Author(s):  
Sergiu Albu ◽  
Nicolas Rivas Zozaya ◽  
Narda Murillo ◽  
Alberto Garcia-Molina ◽  
Cristian Andres Figueroa Chacón ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Acute Infection ◽  
Rehabilitation Program ◽  
Neuropsychological Impairment ◽  
Outpatient Rehabilitation ◽  
Screening Process ◽  
Icu Patients ◽  
Persistent Symptoms

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8–62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.

scholarly journals Structural Model to Determine the Factors That Affect the Quality of Emergency Teaching, According to the Perception of the Student of the First University Courses

2021 ◽  
Vol 13 (5) ◽  
pp. 2945
Author(s):  
Isabel del Arco ◽  
Òscar Flores ◽  
Anabel Ramos-Pla
Keyword(s):  
Online Teaching ◽  
Structural Model ◽  
Self Regulation ◽  
Digital Competence ◽  
Online Questionnaire ◽  
Student Interactions ◽  
Material Resources ◽  
Emotional Component ◽  
Total Participation

A quantitative study was conducted in order to know, from the perspective of university students, the relationship between the quality perceived (QP) during the period of confinement derived from the SARS-CoV-2 virus, with the variables teaching plan (PL), material resources (MR), interaction processes (IN), and the affective–emotional component (EM). An online questionnaire was designed, directed to students from 20 universities in Spain, with a total participation of 893 individuals. The results indicate that the perception of the students on the quality of online teaching is directly associated with the material resources provided by the professors and the professor–student interactions. However, this perception does not have any direct effect on the planning or the emotional state or affectation created by the unprecedented situation of confinement. Among the conclusions, we highlight the need for the universities to apply models of support and tutoring, especially for students in their first years at university, to develop competences such as autonomy, digital competence, and self-regulation, and the need for a change of approach of the students and the professors based on the new normality we are currently experiencing.

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