scholarly journals Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

2021 ◽  
Vol 13 ◽  
Author(s):  
Riccardo Manca ◽  
Matteo De Marco ◽  
Paul G. Ince ◽  
Annalena Venneri
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Fatal Outcome ◽  
Case Series ◽  
Chronic Phase ◽  
Cellular Damage ◽  
Brain Areas ◽  
Hospitalised Patients ◽  
Long Term Impact

Background: Other than its direct impact on cardiopulmonary health, Coronavirus Disease 2019 (COVID-19) infection affects additional body systems, especially in older adults. Several studies have reported acute neurological symptoms that present at onset or develop during hospitalisation, with associated neural injuries. Whilst the acute neurological phase is widely documented, the long-term consequences of COVID-19 infection on neurocognitive functioning remain unknown. Although an evidence-based framework describing the disease chronic phase is premature, it is important to lay the foundations for future data-driven models. This systematic review aimed at summarising the literature on neuroimaging and neuropathological findings in older over-60 patients with COVID-19 following a cognitive neuroscientific perspective, to clarify the most vulnerable brain areas and speculate on the possible cognitive consequences.Methods: PubMed and Web of Science databases were searched to identify relevant manuscripts published between 1st March 2020 and 31th December 2020. Outputs were screened and selected by two assessors. Relevant studies not detected by literature search were added manually.Results: Ninety studies, mainly single cases and case series, were included. Several neuroimaging and neuropathological findings in older patients with COVID-19 emerged from these studies, with cerebrovascular damage having a prominent role. Abnormalities (hyperintensities, hypoperfusion, inflammation, and cellular damage) were reported in most brain areas. The most consistent cross-aetiology findings were in white matter, brainstem and fronto-temporal areas. Viral DNA was detected mainly in olfactory, orbitofrontal and brainstem areas.Conclusion: Studies on COVID-19 related neural damage are rich and diverse, but limited to description of hospitalised patients with fatal outcome (i.e., in neuropathological studies) or severe symptoms (i.e., in neuroimaging studies). The damage seen in this population indicates acute and largely irreversible dysfunction to neural regions involved in major functional networks that support normal cognitive and behavioural functioning. It is still unknown whether the long-term impact of the virus will be limited to chronic evolution of acute events, whether sub-clinical pathological processes will be exacerbated or whether novel mechanisms will emerge. Based on current literature, future theoretical frameworks describing the long-term impact of COVID-19 infection on mental abilities will have to factor in major trends of aetiological and topographic heterogeneity.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals Ageing, limb-loss and military veterans: a systematic review of the literature

2018 ◽  
Vol 39 (8) ◽  
pp. 1582-1610 ◽  
Author(s):  
NICK CADDICK ◽  
HELEN CULLEN ◽  
AMANDA CLARKE ◽  
MATT FOSSEY ◽  
MICHAEL HILL ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Military Service ◽  
Military Veterans ◽  
Limb Loss ◽  
Cochrane Library ◽  
Term Care ◽  
Long Term Impact ◽  
The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

Non-pharmacological interventions to improve constipation amongst older adults in long-term care settings: A systematic review of randomised controlled trials

2020 ◽  
Vol 41 (6) ◽  
pp. 992-999
Author(s):  
Iria Dobarrio-Sanz ◽  
José Manuel Hernández-Padilla ◽  
María Mar López-Rodríguez ◽  
Cayetano Fernández-Sola ◽  
José Granero-Molina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Randomised Controlled Trials ◽  
Long Term Care ◽  
Controlled Trials ◽  
Pharmacological Interventions ◽  
Term Care ◽  
Randomised Controlled

scholarly journals Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2019 ◽  
Vol 16 (14) ◽  
pp. 2527 ◽  
Author(s):  
Sansano-Nadal ◽  
Giné-Garriga ◽  
Brach ◽  
Wert ◽  
Jerez-Roig ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Active Control ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Community Dwelling ◽  
Exercise Interventions ◽  
Mean Differences

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

Interventions Using Technologies for Older Adults in Long-term Care Facilities: A Systematic Review

2018 ◽  
Vol 29 (2) ◽  
pp. 170 ◽  
Author(s):  
Da Eun Kim ◽  
Hyang Kim ◽  
Junghee Hyun ◽  
Hyojin Lee ◽  
Hyehyun Sung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities

Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 50 (6) ◽  
pp. 1095-1106 ◽  
Author(s):  
Antonio García-Hermoso ◽  
Robinson Ramirez-Vélez ◽  
Mikel L. Sáez de Asteasu ◽  
Nicolás Martínez-Velilla ◽  
Fabricio Zambom-Ferraresi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Exercise Interventions ◽  
Randomized Controlled

scholarly journals Effect of Cognitive Training on Daily Function in Older People without Major Neurocognitive Disorder: A Systematic Review

Geriatrics ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 44
Author(s):  
Brian J.Y. Fan ◽  
Roger Y.M. Wong
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Training ◽  
Outcome Measurement ◽  
Neurocognitive Disorder ◽  
And Function ◽  
Normal Cognition ◽  
Daily Function ◽  
Sizable Number

There is increasing interest in the effect of non-pharmacological treatments on preserving cognition and function in older adults without major neurocognitive disorder (dementia). However, its effect on everyday function in terms of instrumental activities of daily living (IADL) is unclear. We conducted a systematic review to examine whether cognitive training, independent of other interventions, can improve IADL function in older adults without major neurocognitive disorder. We searched multiple databases including MEDLINE, EMBASE, and PSYCINFO and found thirteen studies that met our inclusion criteria with 7130 participants in total. Six out of thirteen studies reported a significant change on validated IADL assessment. On subgroup analysis, five studies included older adults with normal cognition and one included mild cognitive impairment (MCI). Eleven out of twelve studies showed improvement in measures of cognition. None of the studies described changes in the ability to live independently. While variation in study protocol, outcome measurement, and effect size reporting precluded further inferential statistical analysis, our review found a sizable number of studies showing improvement in IADL. Cognitive training may have some benefit in improving IADL function in older adults without major neurocognitive disorder. Future long-term studies focusing on maintained IADL function and preserved independence are needed.

scholarly journals Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032605 ◽  
Author(s):  
Mary Katherine Huffman ◽  
Jason Brian Reed ◽  
Theresa Carpenter ◽  
Steve Amireault
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Older Adults ◽  
Meta Analysis ◽  
Well Being ◽  
Publication Date ◽  
Sample Mean ◽  
Institutional Review Board Review ◽  
Human Research Protection Program

IntroductionPhysical activity (PA) is an important aspect for health and well-being, yet many older adults do not maintain their PA long term. The identification of key factors that are associated with, and likely causally related to, older adults’ PA maintenance is a crucial first step towards developing programmes that are effective at promoting long-term PA behaviour change. The purpose of this protocol is to outline a systematic review that will examine the relationship between four motives (ie, satisfaction, enjoyment, self-determination and identity) and older adults’ PA maintenance.Methods and analysisStudies that investigated PA maintenance with a sample mean age ≥55 years will be included. Five electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, PsycINFO and ProQuest Dissertations and Theses) were searched on 6 April 2018 with no publication date limit (ie, from inception). One reviewer screened 100% of titles and abstracts (k=21 470) while a random subsample (20%) was screened independently by two reviewers. An update of the search was run on 1 October 2019. All studies for which the full text was retrieved will be independently screened by two reviewers. Data pertaining to study sample, design, motives, PA (eg, measurement validity evidence, study definition of maintenance) and essential bias domains (eg, bias due to missing data) will be extracted. Study-level effect sizes will be calculated, and if the number of studies is ≥5, a random-effects meta-analysis will be performed using inverse-variance methods; a narrative synthesis will be performed otherwise.Ethics and disseminationThe university’s Human Research Protection Program determined that the proposed study qualifies as exempt from the Institutional Review Board review under Exemption Category 4 (PROPEL #: 80047007). Results will be published in a peer-review journal, and the findings will help inform future interventions with older adults.PROSPERO registration numberCRD42018088161.

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