scholarly journals Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study

10.2196/14821 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e14821 ◽  
Author(s):  
Sean Ing Loon Chua ◽  
Ngiap Chuan Tan ◽  
Wei Teen Wong ◽  
John Carson Allen Jr ◽  
Joanne Hui Min Quah ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Function ◽  
Older Persons ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Performance Score ◽  
Total Performance ◽  
Group 2 ◽  
Cognitively Intact ◽  
Group 1

Background The prevalence of dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing worldwide. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and, to a lesser extent, on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older persons is promising, but evidence for its use is sparse. Objective The primary aim was to examine the feasibility and acceptability of using VR to screen for cognitive impairment in older persons in a primary care setting. The secondary aim was to assess the module’s ability to discriminate between cognitively intact and cognitively impaired participants. Methods A comparative study was conducted at a public primary care clinic in Singapore, where persons aged 65-85 years were recruited based on a cut-off score of 26 on the Montreal Cognitive Assessment (MoCA) scale. They participated in a VR module for assessment of their learning and memory, perceptual-motor function, and executive function. Each participant was evaluated by the total performance score (range: 0-700) upon completion of the study. A questionnaire was also administered to assess their perception of and attitude toward VR. Results A total of 37 participants in Group 1 (cognitively intact; MoCA score≥26) and 23 participants in Group 2 (cognitively impaired; MoCA score<26) were assessed. The mean time to completion of the study was 19.1 (SD 3.6) minutes in Group 1 and 20.4 (3.4) minutes in Group 2. Mean feedback scores ranged from 3.80 to 4.48 (max=5) in favor of VR. The total performance score in Group 1 (552.0, SD 57.2) was higher than that in Group 2 (476.1, SD 61.9; P<.001) and exhibited a moderate positive correlation with scores from other cognitive screening tools: Abbreviated Mental Test (0.312), Mini-Mental State Examination (0.373), and MoCA (0.427). A receiver operating characteristic curve analysis for the relationship between the total performance score and the presence of cognitive impairment showed an area under curve of 0.821 (95% CI 0.714-0.928). Conclusions We demonstrated the feasibility of using a VR-based screening tool for cognitive function in older persons in primary care, who were largely in favor of this tool.

scholarly journals Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study (Preprint)

2019 ◽  
Author(s):  
Sean Ing Loon Chua ◽  
Ngiap Chuan Tan ◽  
Wei Teen Wong ◽  
John Carson Allen Jr ◽  
Joanne Hui Min Quah ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Function ◽  
Older Persons ◽  
Screening Tools ◽  
Cognitively Impaired ◽  
Cognitive Screening ◽  
Performance Score ◽  
Total Performance ◽  
Group 2 ◽  
Group 1

BACKGROUND Dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is becoming more prevalent. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and to a lesser extent on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older person is promising but evidence for its use is sparse. OBJECTIVE The primary aim is to examine the feasibility and acceptability of using VR to screen for cognitive impairment in older person in a primary care setting, through a VR module. The secondary aim is to assess the module’s ability to discriminate between cognitively normal and cognitively impaired participants. METHODS A comparative study was conducted at a public primary care clinic in Singapore, where 60 older persons were recruited based on a cut-off score of 26 using the Montreal Cognitive Assessment (MoCA) scale. They participated in the VR module to assess their learning and memory, perceptual-motor function and executive function. Each participant was evaluated by a total performance score (range: 0 – 700) upon completion. An assisted questionnaire was also administered to assess their perception of and attitude towards VR. RESULTS 37 participants in Group 1 (cognitively normal; MoCA >= 26) and 23 participants in Group 2 (cognitively impaired; MoCA < 26) were assessed. All participants completed the study with a mean total time of 19.1±3.6 minutes in Group 1 and 20.4±3.4 minutes in Group 2. Mean feedback scores ranged from 3.80 to 4.48 (max=5) in favour of VR. The total performance score in Group 1 (552.0±57.2) was higher than in Group 2 (476.1±61.9) (P < .001), and exhibited moderate positive correlation with scores from other cognitive screening tools: Abbreviated Mental Test (AMT) (0.312), Mini-Mental State Examination (MMSE) (0.373) and MoCA (0.427). A ROC curve analysis, relating total performance score to the presence of cognitive impairment, showed an area under curve of 0.821 (95% confidence interval: 0.714 to 0.928). CONCLUSIONS We demonstrated the feasibility of using an VR-based screening tool for cognitive function in older persons in primary care, who were largely in favour of this tool.

Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial

2019 ◽  
Vol 31 (6) ◽  
pp. 894-901 ◽  
Author(s):  
Anna A. Ezhevskaya ◽  
Alexei M. Ovechkin ◽  
Zhanna B. Prusakova ◽  
Valery I. Zagrekov ◽  
Sergey G. Mlyavykh ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Pain Management ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Group 2 ◽  
Cellular Immune ◽  
Inflammatory Changes ◽  
Group 1

OBJECTIVESurgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction.METHODSForty-eight patients, ages 45–60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected.RESULTSGroup 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients.CONCLUSIONSThe use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru)

scholarly journals Vitamin B12 Status of Pregnant Indian Women and Cognitive Function in their 9-year-old Children

2008 ◽  
Vol 29 (4) ◽  
pp. 249-254 ◽  
Author(s):  
Vidya Bhate ◽  
Swapna Deshpande ◽  
Dattatray Bhat ◽  
Niranjan Joshi ◽  
Rasika Ladkat ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Maternal Nutrition ◽  
Short Term Memory ◽  
Digit Span ◽  
Maternal Plasma ◽  
Vitamin B ◽  
Plasma Vitamin ◽  
Maternal Vitamin ◽  
Group 2 ◽  
Group 1

Background Recent research has highlighted the influence of maternal factors on the health of the offspring. Intrauterine experiences may program metabolic, cardiovascular, and psychiatric disorders. We have shown that maternal vitamin B12 status affects adiposity and insulin resistance in the child. Vitamin B12 is important for brain development and function. Objective We investigated the relationship between maternal plasma vitamin B12 status during pregnancy and the child's cognitive function at 9 years of age. Methods We studied children born in the Pune Maternal Nutrition Study. Two groups of children were selected on the basis of maternal plasma vitamin B12 concentration at 28 weeks of gestation: group 1 ( n = 49) included children of mothers with low plasma vitamin B12 (lowest decile, < 77 pM) and group 2 ( n = 59) children of mothers with high plasma vitamin B12 (highest decile, > 224 pM). Results Children from group 1 performed more slowly than those from group 2 on the Color Trail A test (sustained attention, 182 vs. 159 seconds; p < .05) and the Digit Span Backward test (short-term memory, p <.05), after appropriate adjustment for confounders. There were no differences between group 1 and group 2 on other tests of cognitive function (intelligence, visual agnosia). Conclusions Maternal vitamin B12 status in pregnancy influences cognitive function in offspring.

scholarly journals Optimizing The Diagnosis and Management of Dementia Within Primary Care: A Systematic Review of Systematic Reviews

2021 ◽  
Author(s):  
Brooklynn Fernandes ◽  
Zahra Goodarzi ◽  
Jayna Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Systematic Reviews ◽  
Family Physicians ◽  
Outcome Data ◽  
Screening Tools ◽  
Care Practice ◽  
Cognitive Screening ◽  
Mental Test Score ◽  
Diagnosis And Management

Abstract Background: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care.Methods: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework.Results: Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100%, 95% CI: 70%-100%) and specificity (82%, 95% CI: 72%-90%) within the shortest amount of time (3.16 to 5 minutes) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer's Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers.Conclusions: There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.

Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function.

1991 ◽  
Vol 9 (9) ◽  
pp. 1580-1590 ◽  
Author(s):  
E A Neuwelt ◽  
D L Goldman ◽  
S A Dahlborg ◽  
J Crossen ◽  
F Ramsey ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Blood Brain Barrier ◽  
Median Survival ◽  
Primary Cns Lymphoma ◽  
Brain Barrier ◽  
Cns Lymphoma ◽  
Blood Brain ◽  
Cranial Radiation ◽  
Group 2 ◽  
Group 1

Combination chemotherapy with or without radiotherapy has had only modest efficacy in the treatment of primary CNS lymphoma. Median survival of these patients, treated primarily with radiotherapy, is 13 months; 5-year survival is less than 5%. Thirty consecutive non-acquired immune deficiency syndrome patients with primary CNS lymphoma were treated with barrier-dependent chemotherapy using intraarterial mannitol to open the blood-brain barrier (BBB). Follow-up included extensive neuropsychologic testing of all patients. Thirteen patients received cranial radiation 1 to 9 months before referral (group 1). Seventeen patients received initial BBB disruption chemotherapy with subsequent radiation only for tumor progression or recurrence (group 2). The difference in median survivals from diagnosis--17.8 months for group 1 and 44.5 months for group 2--was statistically significant (P = .039). Group 1 survival is comparable with the 20-month median survival of a historical series of patients (n = 208) treated with radiotherapy with or without chemotherapy. Group 2 patient survival represents an advance in the survival of CNS lymphoma and was associated with preservation of cognitive function in six of seven nonirradiated complete responders observed for 1 to 7 years. Patient toxicity was manageable in this intensive therapeutic regimen. In this series, a plateau in survival curves suggests that a major portion of these patients may be cured without the neuropsychologic sequelae associated with cranial radiation.

scholarly journals Screening for Cognitive Function in Primary Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 583-584
Author(s):  
Tara Cortes ◽  
Liz Seidel
Keyword(s):  
Primary Care ◽  
Cognitive Function ◽  
Cognitive Screening ◽  
Provider Education ◽  
Community Based ◽  
Caregiver Support ◽  
Education Assessment ◽  
Community Based Organizations ◽  
Picture Memory ◽  
Cognitive Screen

Abstract A comprehensive program for early detection and treatment of Alzheimer’s and related dementias requires a systematic process for provider education, assessment of cognitive function and referral to appropriate resources when indicated. This discussion will focus on the implementation of cognitive screening into primary care. Over 200 staff across 11 primary care sites were trained on screening for dementia in the annual wellness visit. In the following 6 months nearly 2000 annual wellness visits were conducted. The annual wellness visit was designed to include a cognitive screen. 83% of the patients were asked the cognitive screen questions and 13% responded “yes” to the question. Further testing was offered to that group and 71% of those who had responded “yes” agreed to be tested with a picture memory screen. 32% scored less than 5 on that screen and were referred to gero-psychiatry, geriatricians and community based organizations for caregiver support services.

Machine Learning Enhances the Efficiency of Cognitive Screenings for Primary Care

2019 ◽  
Vol 32 (3) ◽  
pp. 137-144 ◽  
Author(s):  
Boaz Levy ◽  
Courtney Hess ◽  
Jacqueline Hogan ◽  
Matthew Hogan ◽  
James M. Ellison ◽  
...  
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Machine Learning Algorithms ◽  
Screening Tools ◽  
Gradient Boosting ◽  
Support Vector ◽  
Cutoff Score ◽  
Cognitive Screening ◽  
Assessment Protocol ◽  
Age Related

Background: Incorporation of cognitive screening into the busy primary care will require the development of highly efficient screening tools. We report the convergence validity of a very brief, self-administered, computerized assessment protocol against one of the most extensively used, clinician-administered instruments—the Montreal Cognitive Assessment (MoCA). Method: Two hundred six participants (mean age = 67.44, standard deviation [SD] = 11.63) completed the MoCA and the computerized test. Three machine learning algorithms (ie, Support Vector Machine, Random Forest, and Gradient Boosting Trees) were trained to classify participants according to the clinical cutoff score of the MoCA (ie, < 26) from participant performance on 25 features of the computerized test. Analysis employed Synthetic Minority Oversampling TEchnic to correct the sample for class imbalance. Results: Gradient Boosting Trees achieved the highest performance (accuracy = 0.81, specificity = 0.88, sensitivity = 0.74, F1 score = 0.79, and area under the curve = 0.81). A subsequent K-means clustering of the prediction features yielded 3 categories that corresponded to the unimpaired (mean = 26.98, SD = 2.35), mildly impaired (mean = 23.58, SD = 3.19), and moderately impaired (mean = 17.24, SD = 4.23) ranges of MoCA score ( F = 222.36, P < .00). In addition, compared to the MoCA, the computerized test correlated more strongly with age in unimpaired participants (ie, MoCA ≥26, n = 165), suggesting greater sensitivity to age-related changes in cognitive functioning. Conclusion: Future studies should examine ways to improve the sensitivity of the computerized test by expanding the cognitive domains it measures without compromising its efficiency.

Comparative Assessment of Cognitive Function and Mood Dynamics in Patients with Depression and Eating Disorders in the Process of Treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S285-S285
Author(s):  
I. Makhortova ◽  
O. Shiryaev
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Cognitive Function ◽  
Rating Scale ◽  
Co Morbidity ◽  
Icd 10 ◽  
Group 2 ◽  
Competing Interest ◽  
Clinically Significant ◽  
Group 1

Eating disorders of bulimic type are among the most common comorbidities with depression. The objective is to evaluate cognitive function and mood dynamics in patients with depression and eating disorders in pharmacotherapy. In total, 52 outpatients, who met criteria for “major depressive episode” (ICD-10), participated. The level of depression was estimated with Hamilton Depression rating scale (HAM-D) and cognitive function–Montreal Cognitive Assessment (MoCa). Sample was divided into two groups. Patients of group 1 also met criteria for eating disorder of bulimic type and patients of group 2 did not have any eating disorder. Treatment included standard doses of SSRI. Assessments were performed after 2, 4 and 8 weeks (D14, D30, D60). The level of HAM-D was significantly greater (P < 0.05) in eating disorders group (16.75 ± 2.83 in group 1; 13.04 ± 1.93 in group 2 at screening) and significance was preserved till D60 (9.39 ± 2.54 in group 1; 6.32 ± 1.27 in group 2 at D60). Clinically significant antidepressive effect was revealed faster in group 2 (at D7) compared to group 1 (at D14). Overall score of MoCA was significantly lower (P < 0.05) in eating disorders group (20.33 ± 0.54 in group 1; 23.43 ± 2.32 in group 2 at screening) at all stages of treatment (23.39 ± 0.78 in group 1; 26.96 ± 3.27 in group 2 at D60) and it reached normal range (25 and more) only in group 2 at D60. Significant change from screening was revealed at D30 at group 2 and at D60 at group 1.ConclusionEating disorder have an impact on SSRI treatment efficacy including antidepressive and procognitive effects. It is necessary to reveal eating disorders as a co-morbidity in patients with depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Will mild atypical pneumonia remain underdiagnosed and undertreated in primary care setting?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Gatsura ◽  
V Deriushkin ◽  
O Gatsura ◽  
E Ulyanova
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Atypical Pneumonia ◽  
Care Providers ◽  
Beta Lactams ◽  
Atypical Pathogens ◽  
Group 2 ◽  
Group 1

Abstract Background Non severe community acquired pneumonia (CAP) is a common problem in primary care. So called “walking” CAP is frequently caused by atypical intracellular pathogens Chlamydia pneumoniae and Mycoplasma pneumonia which are resistant to beta-lactams and can be transmitted from an infected person to a healthy one. Taking into account medical and epidemiologic importance of this problem we aimed to estimate appropriateness of the antimicrobial agent (AM) choice for outpatient treatment of mild CAP by current and future primary care providers with regard to atypical pathogens coverage. Methods Total 240 final year medical students of A.I.Yevdokimov Moscow State University of Medicine and Dentistry (Group 1) and 206 Moscow primary care physicians (Group 2) were surveyed in 2019. Respondents were asked to specify in writing what particular AM they would recommend to 35 year old previously healthy male patient with subfebrile body temperature (37.3 °C), non-productive cough and documented CAP. Chi-square test was used to compare the data obtained in both groups. Results Group 1 respondents returned questionnaires with 271 recommendations, Group 2 participants named 230 items. AMs with atypical pathogens coverage (macrolides, fluoroquinolones and doxycycline) accounted for just 33.2% in Group 1 versus 20.0% in Group 2 (p=.0009). Amoxicillin/clavulanate was the leading choice equally popular both in students and physicians (42.1% and 40.9% respectively). The rest of recommendations in both Groups included amoxicillin and various cephalosporins. Conclusions Only one of three students and one of five physicians made the right choice in offered clinical scenario. A majority of respondents in both groups hastily recommended beta-lactams instead of clinical estimation of atypical CAP probability in given situation, but students indicated appropriate AMs more often. This problem obviously persists and requires action from both academics and healthcare managers. Key messages Medical students and primary care physicians’ awareness of atypical CAP presentation and treatment is not quite satisfactory. Resulting undertreatment of atypical CAP may harm the patient and promote further spread of causative pathogen within the community.

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