Neurocognitive outcomes of head and neck chemoradiotherapy: A pilot study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6068-6068
Author(s):  
H. K. Gan ◽  
L. J. Bernstein ◽  
J. Brown ◽  
J. Ringash ◽  
M. Vakilha ◽  
...  
Keyword(s):  
Head And Neck ◽  
Normative Data ◽  
Affective State ◽  
Z Score ◽  
Curative Intent ◽  
Z Scores ◽  
The Difference ◽  
Mean Time ◽  
Univariate Analyses

6068 Background: Evidence suggests cancer-related treatments affect cognition. To our knowledge, no studies have systematically investigated cognitive impairment in head and neck cancer (HNC) patients (pts). We assessed ten relapse-free HNC pts after curative-intent radiotherapy (RT), half of whom received cisplatin (Cp). Methods: Pts completed a 2-hr battery of tests/questionnaires assessing objective cognitive function (CF), subjective CF, quality of life and affect. Objective measures of CF were transformed to Z-scores (mean=0, standard deviation=1) using age normative data. A negative value for the Difference Score (DS=Z-score minus IQ score) in each tested domain indicates cognitive deterioration as IQ is a pre-morbid estimate of pts’ CF. A Global Deficit Score (GDS) was obtained by averaging the DS of all tested CF domains. Results: Pt demographics were: M:F=8:2; mean age=58 yrs(range 47–66); mean smoking pack yrs=15(0–45); mean drinks/week=7(0–25); mean IQ Z-score=+1.2(-1.0 to +2.0), mean school yrs=15 (6–18) and mean time post treatment=20 mo(9–41). All pts completed the battery within 2 hr. Nine participants appeared to have impaired CF based on negative DS and GDS scores ( Table 1 ). Exploratory univariate analyses showed trends that higher RT dose and Cp use were associated with increased impairment but cytokines, anemia, hormonal status and affective state were not. Conclusions: This feasibility study suggests cancer-related treatment affects cognition in HNC survivors. A longitudinal study is underway. [Table: see text] No significant financial relationships to disclose.

Italian Normative Data for the Original Version of the Tower of London Test: A Bivariate Analysis on Speed and Accuracy Scores

Assessment ◽  
2020 ◽  
pp. 107319112096183
Author(s):  
Francesca Bruni ◽  
Alessio Toraldo ◽  
Federica Scarpina
Keyword(s):  
Problem Solving ◽  
Experimental Research ◽  
Normative Data ◽  
Bivariate Analysis ◽  
Italian Population ◽  
Tower Of London ◽  
Reasoning Problem ◽  
Z Scores ◽  
Univariate Analyses ◽  
Speed And Accuracy

The Tower of London (ToL) test is traditionally used to assess strategical reasoning, problem-solving, and mental planning in clinical populations. Here, we provide the Italian standardization norms for the original, 12-problem version of the ToL test. The performance of 216 Italian individuals ranging 18 to 89 in age was scored in terms of both Time ( Speed) and Accuracy—the time, and the number of attempts, necessary to find a solution. We performed univariate analyses on separate Time and Accuracy scores, using Age in years, Education in years, and Sex (male vs. female) as predictors. z scores and equivalent scores were provided. Moreover, we performed a bivariate analysis for the assessment of individuals’ performance in terms of Time and Accuracy simultaneously. This standardization allows clinicians to use the original, most widespread version of ToL with the Italian population, thus optimizing comparability with other clinical and experimental research worldwide. Critically, this article offers a new statistical perspective on how Time and Accuracy scores, which are typically related to each other, can be combined to obtain a single, consistent clinical categorization that captures most of the information contained in the patient’s performance.

scholarly journals Longitudinal Follow-Up on Cardiopulmonary Exercise Capacity Related to Cardio-Metabolic Risk Factors in Children With Renal Transplants

2021 ◽  
Vol 3 ◽  
Author(s):  
Susanne Westphal Ladfors ◽  
Ebba Bergdahl ◽  
Oli Hermannsson ◽  
Julius Kristjansson ◽  
Tina Linnér ◽  
...  
Keyword(s):  
Physical Activity ◽  
Exercise Capacity ◽  
Blood Lipids ◽  
Healthy Controls ◽  
Z Score ◽  
Cardiopulmonary Exercise ◽  
Z Scores ◽  
Mean Time ◽  
Over Time

Background: Children with chronic kidney disease, including those treated with kidney transplantation (KT), have an increased risk of cardiovascular disease. The aim of this study was to examine the cardiopulmonary exercise capacity after KT compared to matched controls, to relate the results to physical activity, blood pressure and biochemical findings and to follow exercise capacity over time.Methods: Patients with KT (n = 38, age 7.7–18 years), with a mean time from transplantation of 3.7 years (0.9–13.0) and mean time in dialysis 0.8 years, were examined at inclusion and annually for up to three years. Healthy controls (n = 17, age 7.3–18.6 years) were examined once. All subjects underwent a cardiopulmonary exercise test, resting blood pressure measurement, anthropometry and activity assessment. Patients also underwent echocardiography, dual-energy X-ray absorptiometry (DXA), 24-h ambulatory BP measurements (ABPM), assessment of glomerular filtration rate (GFR) and blood sampling annually.Results: As compared to healthy controls, KT patients showed decreased exercise capacity measured both as VO2peak (34.5 vs. 43.9 ml/kg/min, p < 0.001) and maximal load (2.6 vs. 3.5 W/kg, p < 0.0001), similarly as when results were converted to z-scores. No significant difference was found in weight, but the KT patients were shorter and had higher BMI z-score than controls, as well as increased resting SBP and DBP z-scores. The patient or parent reported physical activity was significantly lower in the KT group compared to controls (p < 0.001) In the combined group, the major determinants for exercise capacity z-scores were activity score and BMI z-score (β = 0.79, p < 0.0001 and β = −0.38, p = 0.007, respectively). Within the KT group, low exercise capacity was associated with high fat mass index (FMI), low activity score, low GFR and high blood lipids. In the multivariate analysis FMI and low GFR remained predictors of low exercise capacity. The longitudinal data for the KT patients showed no change in exercise capacity z-scores over time.Conclusion: Patients with KT showed decreased exercise capacity and increased BP as compared to healthy controls. Exercise capacity was associated to GFR, physical activity, FMI and blood lipids. It did not improve during follow-up.

Wall stress misrepresents afterload in children and young adults with abnormal left ventricular geometry

2002 ◽  
Vol 92 (3) ◽  
pp. 1053-1057 ◽  
Author(s):  
Thomas L. Gentles ◽  
Steven D. Colan
Keyword(s):  
Normal Population ◽  
Wall Stress ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Z Score ◽  
Fiber Stress ◽  
Ventricular Geometry ◽  
Wide Range ◽  
Z Scores ◽  
The Difference

Wall stress, although commonly used as an index of afterload, fails to take into account forces generated within the wall of the left ventricle (LV) that oppose systolic fiber shortening. Wall stress may, therefore, misrepresent fiber stress, the force resisting fiber shortening, particularly in the presence of an abnormal LV thickness-to-dimension ratio ( h/ D). M-mode LV echocardiograms were obtained from 207 patients with a wide range of values for LV mass and/or h/ D. Diagnoses were valvar aortic stenosis, coarctation repair, anthracycline treated, and severe aortic and/or mitral regurgitation. End-systolic wall stress (WSes) and fiber stress (FSes) were expressed as age-corrected Z scores relative to a normal population. The difference between WSes and FSes was extreme when h/ D was elevated or reduced [WSes Z score − FSes Z score = 0.14 × ( h/ D)−1.47 − 2.13; r = 0.78, P < 0.001], with WSes underestimating FSes when h/ D was increased and overestimating FSes when h/ D was decreased. Analyses of myocardial mechanics based on wall stress have limited validity in patients with abnormal ventricular geometry.

scholarly journals Maternal emotional states in relation to their offspring weight status and health-related quality of life: Tehran Lipid and Glucose Study

2020 ◽  
Author(s):  
Parnian Parvin ◽  
Parisa Amiri ◽  
Sara Jalali-Farahani ◽  
Mehrdad Karimi ◽  
Mina MoeinEslam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Status ◽  
Emotional State ◽  
Emotional States ◽  
Z Score ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Z Scores

Abstract Background: Maternal characteristics have been known to be associated with parenting practices that could eventually influence their child’s weight and health-related quality of life (HRQoL). This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety and stress) with body mass index (BMI) and HRQoL in their children. Methods: This study was conducted within the framework of Tehran Lipid and Glucose Study (TLGS). Participants were children (n=231) who participated in the TLGS during 2014-2016 with complete data on maternal emotional states. Body weight and height of children were measured using standard protocol and BMI-Z scores were determined using Anthroplus. HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQL TM 4.0) and the depression, anxiety and stress scales (DASS-21) respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children’s BMI Z score and HRQoL. Results: Mean age, BMI Z-score and HRQoL total score in children were 13.8±3.1 years, 0.74±1.5 and 84.7±11.3 respectively. In mothers, median scores (Interquartile ranges) of DASS-21 in three scales including depression, anxiety and stress were 4(0-10), 6(2-12) and 14(8-20) respectively. Maternal level of education was significantly associated with DASS-21 scores (β=-0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 scores were significantly associated with BMI Z scores only in girls (β=0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were child’s age (β=-0.21, 95% CI: -0.40, -0.01), maternal education (β=-0.24, 95%CI: -0.44, -0.02) and emotional state (β=-0.24, 95% CI: -0.44, -0.03). Child’s age (β=-0.33, 95%-CI: -0.53, -0.10) and maternal emotional state (β=-0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls. Conclusion: Our results indicate maternal emotional states to be the important determinants of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and sub-urban populations taking ino consideration more influential factors.

scholarly journals Evaluation of the Validity of SAMe-TT2R2 Score in a Cohort of Venous Thromboembolism Patients Treated With Warfarin

2020 ◽  
Vol 26 ◽  
pp. 107602962094503
Author(s):  
Eman Nawash Alhmoud ◽  
Hazem Elewa ◽  
Mohammed S. Abdul Gelil ◽  
Osama B. Abd El Samad ◽  
Abdelnasser Y. Elzouki
Keyword(s):  
Venous Thromboembolism ◽  
Statistical Significance ◽  
Clinical Factors ◽  
Risk Of Bleeding ◽  
Clinical Events ◽  
Caucasian Origin ◽  
Anticoagulation Control ◽  
The Difference ◽  
Mean Time

Low SAMe-TT2R2 score of <2 was validated as a predictor of optimum anticoagulation control, reflected by mean time in therapeutic range (TTR) above 65% to 70%, among warfarin-treated atrial fibrillation patients. This study aimed to validate the ability of SAMe-TT2R2 score and its individual components in predicting anticoagulation control (mean TTR and clinical events) among a cohort of venous thromboembolism (VTE) patients in Qatar. A total of 295 patients were retrospectively evaluated. There was a trend toward statistical significance in mean TTR between low (<2) and high (≥ 2) SAMe-TT2R2 score groups ( P = .05), a difference that was not sustained when a cutoff of 3 was used (ie, a score of 3 or more). Patients with poor INR control (TTR <70%) were numerically less likely to have SAMe-TT2R2 score of <2 compared with those with good INR control, though the difference was not statistically significant (16.7% vs 83.3%, respectively, P = .4). No thromboembolic events were reported, and no association was found between the score and risk of bleeding. Non-Caucasian origin was the only significant predictor of good anticoagulation in the studied cohort. In conclusion, SAMe-TT2R2 score could not predict quality of anticoagulation control in a cohort of VTE patients treated with warfarin in Qatar. Contribution of other clinical factors and whether a different scoring may yield better prediction of anticoagulation control remains to be tested.

Quality of life of elderly patients undergoing concomitant chemoradiation therapy for head and neck cancers, including assessment of geriatric parameters.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6100-6100 ◽  
Author(s):  
Martine Extermann ◽  
William J Fulp ◽  
Ji-Hyun Lee ◽  
Julie Ann Kish ◽  
Marina Sehovic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Locally Advanced ◽  
Stage Iv ◽  
Chemoradiation Therapy ◽  
Curative Intent ◽  
Significant Information ◽  
Concomitant Chemoradiation ◽  
Ecog Ps

6100 Background: Data on the quality of life of older patients undergoing concomitant chemoradiation therapy (CCRT) for head and neck (H&N) cancer are very scarce and no study has focused specifically on them. Furthermore, no study has assessed the contribution of geriatric symptoms to their quality of life. Methods: We prospectively assessed patients aged 65 and older undergoing curative intent CCRT for H&N cancers, either alone or adjuvantly after surgery. We used the Quality of life-Radiation Therapy Instrument (QOL-RTI), with its H&N module (Trotti et al., 1998). In addition we created a 12-items senior adult questionnaire (SAQ). Patients were assessed at baseline, at 4 weeks, at the end of treatment (EOT), and 2 months after EOT (recovery). Results: Fifty patients were enrolled. Median age was 69 years (range 65-87). Eighty-two percent of patients had locally advanced stage IV disease. Twenty-eight percent had prior surgery. All patients were treated with IMRT, 92% at 70 Gy. The most frequent chemotherapy regimen was cisplatin q3wks (58%), followed by weekly carboplatin (24%). Patients had on average 4 comorbidities (CIRS-G), 54% of them a grade 3 or 4 disease. Forty-four percent were independent in IADL, and 98% were ECOG PS 0 or 1. The baseline scores were QOL-RTI: 7.72 (SD 1.36), H&N module 7.7 (SD 2.16), SAQ 8.21 (SD 1.54). At EOT, the scores were 6.22 (1.26), 4.59 (1.82), 7.38 (1.38) respectively, and at recovery 7.17 (1.25), 6.06 (1.66), 7.96 (1.16). The scores paralleled functional evolution, as 24% of patients had an ECOG PS 2 and 76% were IADL dependent at EOT; 16% ECOG 2-3 and 55% IADL dependent at recovery. Cronbach alphas for the 3 QOL measures were 0.88, 0.89, and 0.81, suggesting adequate internal consistency reliability. The SAQ was low-to-moderately correlated with the other two QOL measures (r=0.22 to 0.59) at different points of assessment. Conclusions: Older H&N cancer patients experience significant impact of CCRT on their function, and on their quality of life on all three measures. Most recover after two months, although some may take longer. A geriatric module adds significant information to the general QOL-RTI and H&N questionnaires.

scholarly journals Quantitative Electroencephalogram Standardization: A Sex- and Age-Differentiated Normative Database

2021 ◽  
Vol 15 ◽  
Author(s):  
Juhee Ko ◽  
Ukeob Park ◽  
Daekeun Kim ◽  
Seung Wan Kang
Keyword(s):  
Resting State ◽  
Normative Data ◽  
Quantitative Eeg ◽  
Z Score ◽  
Data Set ◽  
Normative Database ◽  
Confounding Variables ◽  
Z Scores ◽  
Quantitative Electroencephalogram ◽  
Standardized Index

We describe the utility of a standardized index (Z-score) in quantitative EEG (QEEG) capable of when referenced to a resting-state, sex- and age-differentiated QEEG normative database (ISB-NormDB). Our ISB-NormDB comprises data for 1,289 subjects (553 males, 736 females) ages 4.5 to 81 years that met strict normative data criteria. A de-noising process allowed stratification based on QEEG variability between normal healthy men and women at various age ranges. The ISB-NormDB data set that is stratified by sex provides a unique, highly accurate ISB-NormDB model (ISB-NormDB: ISB-NormDB-Male, ISB-NormDB-Female). To evaluate the trends and accuracy of the ISB-NormDB, we used actual data to compare Z-scores obtained through the ISB-NormDB with those obtained through a traditional QEEG normative database to confirm that basic trends are maintained in most bands and are sensitive to abnormal test data. Finally, we demonstrate the value of our standardized index of QEEG, and highlight it’s capacity to minimize the confounding variables of sex and age in any analysis.

scholarly journals Preferential preservation of visuospatial memory over verbal memory in the Old Order Amish

2021 ◽  
Author(s):  
Michael B. Prough ◽  
Laura J. Caywood ◽  
Jason E. Clouse ◽  
Sharlene D. Herington ◽  
Susan H. Slifer ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Memory Loss ◽  
Cognitive Status ◽  
Visuospatial Memory ◽  
Z Score ◽  
Delayed Recall ◽  
Old Order Amish ◽  
Old Order ◽  
Z Scores ◽  
The Difference

Background: While studying cognition in the Old Order Amish (OOA), we have observed strong performance on the constructional praxis delayed recall (CPDR) as compared to other cognitive tests, independent of overall cognitive status. This may indicate a preferential preservation of visuospatial memory in this population. Here, we investigate this by comparing the CPDR to the word list delayed recall (WLDR) within the OOA, as well as by comparing these results to a non-Amish cohort. Method: 420 OOA individuals in Indiana/Ohio age 66-95 who had complete data for the CPDR and WLDR were included. From the non-Amish CERAD cohort, 401 individuals age 60-96 with the same tests were included. For both cohorts, education-adjusted Z-scores were calculated for the CPDR and WLDR. The difference between the CPDR Z-score and the WLDR Z-score was calculated as a measure of the preservation of visuospatial memory over verbal memory. T-tests were first used to compare the tests within both cohorts and then stratified by case/control status. Linear regression was then used to investigate the effects of age, sex, cognitive status, and cohort on the Z-scores and difference between Z-scores. Additional t-tests and regressions were then performed to further investigate the effect of sex and its interaction with cohort. Result: We found a significantly better performance on CPDR over WLDR in every cognitive status group in the OOA, but not in all groups of the CERAD cohort. After controlling for age, sex, and cognitive status, this preferential preservation remains significantly higher in the Amish, with being in the Amish cohort increasing the difference between Z-scores by an average of 0.615 units when compared to being in the CERAD cohort. When adjusting for age, sex, cognitive status, and cohort, the interaction between cohort and sex is significant, with the Amish males exhibiting a greater difference between Z-scores compared to other groups, with a significant interaction value of 0.676. Discussion: Overall, these findings suggest that the OOA preferentially preserve visuospatial memory over verbal memory, regardless of cognitive status. This effect is particularly strong in OOA males. In summary, this study gives additional evidence that the Amish exhibit unique patterns of memory loss and aging, with a preferential preservation of visuospatial memory over verbal memory. Additional studies are needed to further explain this phenomenon.

The following is the abstract of the article discussed in the subsequent letter:

2004 ◽  
Vol 97 (6) ◽  
pp. 2395-2397 ◽  
Author(s):  
Jeffrey H. Silber
Keyword(s):  
Normal Population ◽  
Wall Stress ◽  
Z Score ◽  
Fiber Stress ◽  
Lv Mass ◽  
Wide Range ◽  
Z Scores ◽  
The Difference ◽  
Range Of Values ◽  
Valvar Aortic Stenosis

Wall stress, although commonly used as an index of afterload, fails to take into account forces generated within the wall of the left ventricle (LV) that oppose systolic fiber shortening. Wall stress may, therefore, misrepresent fiber stress, the force resisting fiber shortening, particularly in the presence of an abnormal LV thickness-to-dimension ratio ( h/ D). M-mode LV echocardiograms were obtained from 207 patients with a wide range of values for LV mass and/or h/ D. Diagnoses were valvar aortic stenosis, coarctation repair, anthracycline treated, and severe aortic and/or mitral regurgitation. End-systolic wall stress (WSes) and fiber stress (FSes) were expressed as age-corrected Z scores relative to a normal population. The difference between WSes and FSes was extreme when h/ D was elevated or reduced [WSes Z score − FSes Z score = 0.14 × ( h/ D)−1.47 − 2.13; r = 0.78, P < 0.001], with WSes underestimating FSes when h/ D was increased and overestimating FSes when h/ D was decreased. Analyses of myocardial mechanics based on wall stress have limited validity in patients with abnormal ventricular geometry.

Letter to the Editor: The Continuing Challenge of Evaluating RSD Impairment and Disability

1998 ◽  
Vol 3 (5) ◽  
pp. 8-10
Author(s):  
Robert L. Knobler ◽  
Charles N. Brooks ◽  
Leon H. Ensalada ◽  
James B. Talmage ◽  
Christopher R. Brigham
Keyword(s):  
Disability Evaluation ◽  
Body Part ◽  
Loss Of Function ◽  
Regulatory Requirements ◽  
Major Cardiac Event ◽  
Clinical Scenarios ◽  
Impairment Score ◽  
Occupational Activities ◽  
The Difference

Abstract The author of the two-part article about evaluating reflex sympathetic dystrophy (RSD) responds to criticisms that a percentage impairment score may not adequately reflect the disability of an individual with RSD. The author highlights the importance of recognizing the difference between impairment and disability in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): impairment is the loss, loss of use, or derangement of any body part, system, or function; disability is a decrease in or the loss or absence of the capacity to meet personal, social, or occupational demands or to meet statutory or regulatory requirements because of an impairment. The disparity between impairment and disability can be encountered in diverse clinical scenarios. For example, a person's ability to resume occupational activities following a major cardiac event depends on medical, social, and psychological factors, but nonmedical factors appear to present the greatest impediment and many persons do not resume work despite significant improvements in functional capacity. A key requirement according to the AMA Guides is objective documentation, and the author agrees that when physicians consider the disability evaluation of people, more issues than those relating to the percentage loss of function should be considered. More study of the relationships among impairment, disability, and quality of life in patients with RSD are required.

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