A Methodological Perspective on the Longitudinal Cognitive Change after Stroke

Background/Aims: Most studies of poststroke cognitive impairment (PSCI) have analyzed cognitive levels at specific time points rather than their changes over time. Furthermore, they seldom consider correlations between cognitive domains. We aimed to investigate the effects of these methodological considerations on determining significant PSCI predictors in a longitudinal stroke cohort. Methods: In patients who underwent neuropsychological tests at least twice after stroke, we adopted a multilevel hierarchical mixed-effects model with domain-specific cognitive changes and a multivariate model for multiple outcomes to reflect their correlations. Results: We enrolled 375 patients (median follow-up of 34.1 months). Known predictors of PSCI were generally associated with cognitive levels; however, most of the statistical significances disappeared when cognitive changes were set as outcomes, except age for memory, prior stroke and baseline cognition for executive/attention domain, and baseline cognition for visuospatial function. The multivariate analysis which considered multiple outcomes simultaneously further altered these associations. Conclusions: This study shows that defining outcomes as changes over time and reflecting correlations between outcomes may affect the identification of predictors of PSCI.

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Evolution of impulsive–compulsive behaviors and cognition in Parkinson’s disease

Journal of Neurology ◽

10.1007/s00415-019-09584-7 ◽

2019 ◽

Vol 267 (1) ◽

pp. 259-266

Author(s):

Aleksander H. Erga ◽

Guido Alves ◽

Ole Bjørn Tysnes ◽

Kenn Freddy Pedersen

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Short Form ◽

Population Based ◽

Self Report ◽

Cognitive Changes ◽

Compulsive Behaviors ◽

Changes Over Time ◽

Over Time

Abstract The longitudinal course of ICBs in patients with Parkinson’s disease (PwP) relative to controls has not been explored as of yet. The aim of this study is to determine the frequency, evolution and associated cognitive and clinical features of impulsive and compulsive behaviors (ICBs) over 4 years of prospective follow-up in a population-based cohort with early Parkinson’s disease (PD). We recruited 124 cognitively intact participants with early PD and 156 matched controls from the Norwegian ParkWest study. ICBs were assessed using the self-report short form version of the Questionnaire for Impulsive–Compulsive Disorders in PD. Cognitive changes were examined in PwP with and without ICBs who completed the 4-year follow-up. Generalized linear mixed modelling and mixed linear regression were used to analyze clinical factors and cognitive changes associated with ICBs in PwP over time. ICBs were more common in PwP than controls at all visits, with an age-adjusted odds ratio (OR) varying between 2.5 (95% CI 1.1–5.6; p = 0.022) and 5.1 (95% CI 2.4–11.0; p < 0.001). The 4-year cumulative frequency of ICBs in PwP was 46.8% and 23.3% developed incident ICBs during the study period, but the presence of ICBs was non-persistent in nearly 30%. ICBs were independently associated with younger age (OR 0.95, 95% CI 0.91–0.99: p = 0.008) and use of dopamine agonist (OR 4.1, 95% CI 1.56–10.69). Cognitive changes over time did not differ between patients with and without ICBs. In conclusion, ICBs are common in PwP, but are often non-persistent and not associated with greater cognitive impairment over time.

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T189. FREE THYROXIN CONCENTRATIONS MODERATE THE RESPONSE TO A COGNITIVE REMEDIATION THERAPY IN PEOPLE WITH EARLY PSYCHOSIS: PRELIMINARY FINDINGS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.749 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S303-S304

Author(s):

Francesc Estrada ◽

Josep Maria Crosas ◽

Maribel Ahuir ◽

Sara Pérez ◽

Wanda Zabala ◽

...

Keyword(s):

Repeated Measures ◽

Cognitive Remediation ◽

Early Psychosis ◽

Cognitive Tasks ◽

First Episode ◽

Cognitive Changes ◽

Cognitive Domains ◽

Episode Psychosis ◽

Changes Over Time ◽

Over Time

Abstract Background Cognitive deficits are a common cause of functional disability in people with psychotic disorders. Cognitive remediation produces moderate improvements in cognitive performance in people with schizophrenia, although there is variability in the responses between patients. As previous longitudinal studies suggest that free thyroxin (FT4) levels influence attention cognitive tasks in patients with early psychosis, we aimed to conduct a pilot study to explore whether thyroid hormones might predict the response to cognitive remediation therapy (CRT) in patients with first-episode psychosis. Methods 27 patients (8 women; 19 men) with first-episode psychosis aged between 18 and 35 years old were randomized to receive a computerized CRT for three months (2 sessions/week) (N=14) or treatment as usual (TAU) (N=13). A full cognitive battery (CANTAB Schizophrenia) was administered at baseline and follow-up (3 months later, after the CRT/TAU period). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Data were analyzed on an intention-to-treat basis. Correlation analyses were conducted to explore the association between TSH and FT4 levels and cognitive changes over time. An ANOVA for repeated measures was used to compare longitudinal changes over time by the experimental group while adjusting for TSH and FT4 levels. Significance was defined as p<0.05. Results TSH concentrations were not associated with cognitive changes over time. FT4 concentrations were associated with cognitive worsening over time in cognitive tasks dealing with reaction time (simple median movement time [r= 0.60, p= 0.003]; simple median reaction time [r= 0.44, p= 0.039]), sustained attention (signal detection for the rapid visual processing task [r= -0.46, p= 0.028]) and verbal memory (immediate recognition [r= -0.54, p= 0.008]; delayed recognition [r= -0.48, p= 0.019]). The ANOVA for repeated measures did not show time by group effects although a time by FT4 significant effect was found for cognitive tasks dealing with these cognitive domains (p<0.05 for all). Discussion Although a direct effect of the CRT on cognitive improvement was not found, baseline FT4 concentrations appeared to predict the response to CRT in people with early psychosis. Significant associations were found for cognitive domains dealing with attention processes, which are in accordance with previous studies exploring the association between thyroid function and cognitive functioning in early psychotic patients. Our preliminary findings suggest that the determination of thyroid function status might be important for establishing which patients could show cognitive improvements over time. If these results are replicated in larger studies, the determination of thyroid status might help identify those individuals more prone for showing cognitive improvements, and allowing the implementation of a personalized medicine approach in the field of cognitive rehabilitation in psychosis.

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Sleep Polygenic Risk Score Is Associated with Cognitive Changes over Time

Genes ◽

10.3390/genes13010063 ◽

2021 ◽

Vol 13 (1) ◽

pp. 63

Author(s):

Angeliki Tsapanou ◽

Niki Mourtzi ◽

Sokratis Charisis ◽

Alex Hatzimanolis ◽

Eva Ntanasi ◽

...

Keyword(s):

Sleep Duration ◽

Spatial Ability ◽

Risk Score ◽

Polygenic Risk Score ◽

Cognitive Changes ◽

Cognitive Domains ◽

Polygenic Risk ◽

Sleep Medication ◽

Over Time

Sleep problems have been associated with cognition, both cross-sectionally and longitudinally. Specific genes have been also associated with both sleep regulation and cognition. In a large group of older non-demented adults, we aimed to (a) validate the association between Sleep Polygenic Risk Score (Sleep PRS) and self-reported sleep duration, and (b) examine the association between Sleep PRS and cognitive changes in a three-year follow-up. Participants were drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). A structured, in-person interview, consisting of a medical history report and physical examination, was conducted for each participant during each of the visits (baseline and first follow-up). In total, 1376 participants were included, having all demographic, genetic, and cognitive data, out of which, 688 had at least one follow-up visit. In addition, an extensive neuropsychological assessment examining five cognitive domains (memory, visuo-spatial ability, attention/speed of processing, executive function, and language) was administered. A PRS for sleep duration was created based on previously published, genome-wide association study meta-analysis results. In order to assess the relationship between the Sleep PRS and the rate of cognitive change, we used generalized estimating equations analyses. Age, sex, education, ApolipoproteinE-ε4 genotype status, and specific principal components were used as covariates. On a further analysis, sleep medication was used as a further covariate. Results validated the association between Sleep PRS and self-reported sleep duration (B = 1.173, E-6, p = 0.001). Further, in the longitudinal analyses, significant associations were indicated between increased Sleep PRS and decreased visuo-spatial ability trajectories, in both the unadjusted (B = −1305.220, p = 0.018) and the adjusted for the covariates model (B = −1273.59, p = 0.031). Similarly, after adding sleep medication as a covariate (B = −1372.46, p = 0.019), none of the associations between Sleep PRS and the remaining cognitive domains were significant. PRS indicating longer sleep duration was associated with differential rates of cognitive decline over time in a group of non-demented older adults. Common genetic variants may influence the association between sleep duration and healthy aging/cognitive health.

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Stress-related inflammation and social withdrawal in mothers after childhood cancer diagnosis

10.31234/osf.io/d27r5 ◽

2021 ◽

Author(s):

Emily K Lindsay ◽

Tristen K. Inagaki ◽

Catherine Walsh ◽

Berhane Messay ◽

Linda Ewing ◽

...

Keyword(s):

Social Network ◽

Social Behavior ◽

Systemic Inflammation ◽

Cancer Diagnosis ◽

Social Roles ◽

Social Changes ◽

Related Stress ◽

Changes Over Time ◽

Over Time

Objective: Acute inflammation-induced sickness behavior involves changes in social behavior that are believed to promote recovery. Whether chronic inflammation can influence social behaviors in ways that promote recovery is unknown. In a sample of mothers of a child with cancer, this report explores the relationship between inflammation that accompanies the stress of diagnosis and changes in social network, cancer-related stress, and inflammation across one year. Three hypotheses were tested, that (1) initial stress would associate with initial inflammation, (2) initial inflammation would predict social changes over time, and (3) social changes over time would buffer stress and inflammation over time. Methods: Cancer-related stress (Impact of Events Scale), social network (social roles and contacts from the Social Network Inventory), and systemic inflammation (circulating IL-6) were assessed in 120 mothers three times after their child’s cancer diagnosis: following diagnosis (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Results: Consistent with predictions, greater cancer-related stress following diagnosis (T1) was associated with higher IL-6 following diagnosis (T1; b=.014, p=.008). In turn, higher IL-6 following diagnosis (T1) was associated with a decrease in social roles over time (T1-->T3; B=-.030, p=.041), particularly peripheral social roles. Finally, dropping social roles over time (T1-->T3) was associated with decreases in cancer-related stress (B=21.83, p=.040) and slower increases in IL-6 (B=.940, p=.036) over time.Conclusions: This study provides a first indication that chronic stress-related systemic inflammation may predict changes in social behavior that associate with stress recovery and slower increases in inflammation in the year following a major life stressor.

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B-38 Gamified Mobile Cognitive Tests: Preliminary Feasibility and Acceptability in Persons with Bipolar Disorder

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.121 ◽

2019 ◽

Vol 34 (6) ◽

pp. 984-984

Author(s):

T Filip ◽

S Kamarsu ◽

D Lomas ◽

L Eyler ◽

C Depp ◽

...

Keyword(s):

Bipolar Disorder ◽

Community Dwelling ◽

Cognitive Testing ◽

Cognitive Tests ◽

Cognitive Changes ◽

Average Completion Time ◽

Temporal Relationships ◽

Assessment Period ◽

Changes Over Time

Abstract Objective Current measurements of cognitive functioning are time-consuming and costly, often done as point-in-time assessments. We examined the feasibility and acceptability of six newly developed smartphone-based mobile cognitive tests (MCTs), completed in the real-world, among persons with bipolar disorder (BD) and healthy controls (HC). Methods Thirteen community-dwelling participants (seven BD and six HC), aged 18-65, completed in-person neurobehavioral assessments at baseline and our MCTs three times daily for the following 14 days. The MCTs measure cognition in the following domains: reaction time, executive functions, attention, processing speed, working memory, and learning and memory. Our protocol delivered 1-2 MCTs per session, and each test was only administered once daily. Timing of the MCTs was adjusted according to individual sleep/wake schedules. Results MCT adherence was, on average, high (82.38%). The two groups did not differ in terms of adherence (p = 0.45, 95% CI = -29.51, 13.96) or average completion time (5.21 mins, SD = 1.54 min per each assessment period; t(11) = 1.12, p = .29, 95% CI = -0.91, 2.81). There was no relationship between age and adherence (r = .296, p = .326). Acceptability was measured at follow-up via a Likert-scale rating from 0 = not at all to 4 = very much; mean likeability was high (M = 3.0, SD = 1.28). Most participants noted a high willingness to complete additional MCT testing in the future. Conclusion Our preliminary findings indicate mobile cognitive testing is feasible and accepted among bipolar disorder and comparison participants. The implications of using smartphone-based MCTs are far reaching, including increased visibility of cognitive changes over time as well as examining real-time temporal relationships between cognition and other lifestyle and environmental factors.

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Changes in Voice- and Swallowing-Related Symptoms After Thyroidectomy: One-Year Follow-Up Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489417751472 ◽

2018 ◽

Vol 127 (3) ◽

pp. 171-177 ◽

Cited By ~ 6

Author(s):

Young Min Park ◽

Kyung Ho Oh ◽

Jae-Gu Cho ◽

Seung-Kuk Baek ◽

Soon-Young Kwon ◽

...

Keyword(s):

Risk Factors ◽

Symptom Relief ◽

Temporal Changes ◽

Rehabilitation Programs ◽

Significant Difference ◽

One Year ◽

Associated Risk Factors ◽

Changes Over Time ◽

Over Time

Objective: We analyzed the changes in voice- and swallowing-related symptoms that occurred over time in patients who underwent thyroidectomy and identified any associated risk factors. Methods: One hundred and three patients who underwent thyroidectomy were enrolled. Results: The mean thyroidectomy voice-related questionnaire (TVQ) score before surgery was 12.41 ± 12.19; it significantly increased to 28.24 ± 18.01 ( P < .001) 1 month postoperatively, decreased to 24.02 ± 17.30 ( P = .014) and 20.66 ± 15.29 ( P = .023) 3 and 6 months postoperatively, respectively. It was continuously decreased to 18.83 ± 14.63 twelve months postoperatively. The temporal changes in TVQ scores between patients who underwent total thyroidectomy or lobectomy were significantly different. There was a statistically significant difference in the temporal changes in TVQ according to whether neck dissection was performed. The temporal changes in TVQ in patients with and without extrathyroidal extension were significantly different. Conclusions: Voice- and swallowing-related discomfort in patients who received thyroidectomy showed dynamic changes over time. There was a significant difference in the degree of change according to clinicopathological factors. Patients with these risk factors may benefit from appropriate patient education and various rehabilitation programs for symptom relief.

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Incidence of fractures and changes over time among the aged in a Finnish municipality: a population-based 12-year follow-up

Aging Clinical and Experimental Research ◽

10.1007/bf03324701 ◽

2007 ◽

Vol 19 (4) ◽

pp. 269-276 ◽

Cited By ~ 16

Author(s):

Maarit Piirtola ◽

Tero Vahlberg ◽

Raimo Isoaho ◽

Pertti Aarnio ◽

Sirkka-Liisa Kivelä

Keyword(s):

Population Based ◽

Changes Over Time ◽

Over Time

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Apathy as a herald of cognitive changes in multiple sclerosis: A 2-year follow-up study

Multiple Sclerosis Journal ◽

10.1177/1352458519828296 ◽

2019 ◽

Vol 26 (3) ◽

pp. 363-371 ◽

Cited By ~ 1

Author(s):

Simona Raimo ◽

Daniele Spitaleri ◽

Luigi Trojano ◽

Gabriella Santangelo

Keyword(s):

Multiple Sclerosis ◽

Rating Scale ◽

Neuropsychological Battery ◽

Interference Task ◽

Cognitive Changes ◽

Follow Up Study ◽

Prevalence Of Depression ◽

Executive Dysfunctions ◽

Over Time

Background: Behavioral symptoms, such as apathy and depression, are common in multiple sclerosis (MS) but their relationship with cognitive and clinical characteristics often remains underinvestigated and not monitored over time. Objective: The aim of this study was to assess the evolution of cognitive profile of patients affected by MS in relation to apathy and depression using a 2-year follow-up study. Methods: Two years after the first assessment, 100 of 125 MS patients were re-evaluated on a comprehensive neuropsychological battery, and on specific scales for assessment of apathy (Apathy Evaluation Scale—Self-reported) and depression (Hamilton Depression Rating Scale). Results: After 2 years (T1), we found a relatively consistent prevalence of apathy (about 40%) and a reduction in prevalence of depression (from 44% to 30%). Higher level of apathy at baseline predicted the progressive cognitive changes at follow-up; and patients with apathy without depression (“pure” apathy) than patients without apathy had poorer performance on the interference task of the Stroop test assessing inhibitory control. Conclusion: The present results suggested that apathy in MS was associated with more severe executive dysfunctions (in particular cognitive control). Apathy rather than depression predicted cognitive impairment in MS over time.

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OS09.4.A Health-related quality of life in low-grade glioma survivors 26 years after diagnosis

Neuro-Oncology ◽

10.1093/neuonc/noab180.038 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii12-ii12

Author(s):

F W Boele ◽

J C Reijneveld ◽

P C de Witt Hamer ◽

H F van Thuijl ◽

P Wesseling ◽

...

Keyword(s):

Quality Of Life ◽

Low Grade ◽

Group Level ◽

Related Quality ◽

Health Related ◽

Changes Over Time ◽

Over Time

Abstract BACKGROUND Many patients with low-grade gliomas (LGGs) continue to survive for many years, yet little is known about patients’ health-related quality of life (HRQOL) in long-term survivorship. We previously investigated HRQOL in LGG patients diagnosed on average 6 years prior to assessment (T1, N=195) with a follow-up in stable patients on average 12 years after diagnosis (T2, N=65). We present a final follow-up of LGG survivors (T3), now decades after diagnosis. MATERIAL AND METHODS We invited patients who participated in our previous assessment (N=65), regardless of disease status. Patients completed questionnaires to assess HRQOL, fatigue, and depressive symptoms: Short Form-36 Health Survey (SF-36), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Tumour Module (EORTC BN20), Checklist Individual Strength (CIS), and the Center for Epidemiological Studies Depression Scale (CES-D). Changes over time (T1-T2-T3) on group level and participant level were assessed. RESULTS Of the 65 patients, 18 (27.7%) were deceased, 3 (4.6%) experienced tumour progression to WHO III, 7 (10.8%) declined, and 3 (4.6%) could not be contacted. Thirty-four patients (52.3%) participated. Of these, 2 had missing HRQOL data, with 32 patients included in analysis. Survivors were M=52.0 (sd=11.3) years old and diagnosed M=26.2 (sd=3.7, range 19–35) years prior. On group level, a statistically significant (but not clinically relevant) improvement in mental health (p=0.049), and a clinically relevant (but not statistically significant) decline in emotional role functioning was found. No other group-level changes over time in HRQOL were found. Minimal detectable change in HRQOL scale scores over time was observed in individual participants (28.1% only improvement; 25.0% only decline; 21.9% both improvement and decline) with 25.0% remaining completely stable. At T3, 25.0% of survivors scored above the cut-off for high risk of clinical depression (≥16 CES-D), and 53.1% of survivors classed as severely fatigued (≥35 CIS). CONCLUSION In this cohort of LGG survivors, assessed decades after diagnosis and treatment, HRQOL does not appear to be greatly impacted during survivorship. However, depressive symptoms and fatigue remain relatively common. Findings can help inform patients, their families, and clinicians and can serve as a benchmark for treatment trials evaluating interventions that can have very long-term effects.

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Longitudinal Stability of Cognition in Early-Phase Relapsing-Remitting Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2016-073 ◽

2018 ◽

Vol 20 (4) ◽

pp. 173-179 ◽

Cited By ~ 3

Author(s):

Roxana M. Barbu ◽

Jason A. Berard ◽

Louise M. Gresham ◽

Lisa A.S. Walker

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Executive Functions ◽

Early Phase ◽

Cognitive Reserve ◽

Cognitive Change ◽

Disease Stage ◽

Cognitive Domains ◽

Relapsing Remitting ◽

Over Time

Abstract Background: Up to 70% of people with multiple sclerosis (MS) experience cognitive impairment. Some remain cognitively intact despite advanced disease. Cognitive reserve (CR) theory postulates that individuals with higher levels of intellectual enrichment can tolerate more pathology than others before exhibiting cognitive impairment. Methods: Thirty-two individuals with early-phase relapsing-remitting MS with mild physical disability and disease duration less than 10 years and 32 controls were recruited. At baseline and after 3 years, participants completed neuropsychological tests evaluating several cognitive domains. The CR was assessed via a cognitive reserve index (CRI) using educational levels and North American Adult Reading Test scores. Change in cognition was assessed using a reliable change index. Results: At baseline, people with MS performed worse than controls on visual memory. There were no significant group differences on information processing speed, learning, language, and executive functions. Most cognitive domains showed no change over time, and CRI was not a significant predictor in the regression model. Conclusions: People with MS performed worse on memory tasks at baseline compared with controls. Cognitive change differed between people with MS and controls in executive functions. Although people with MS and controls improved over time, beyond practice effects, people with MS improved less than controls. Overall, no cognitive deterioration was noted over time, and CR did not predict change in cognition. Sample homogeneity in terms of disease stage and CR may explain these findings.

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