Neuropsychiatric Symptoms Exacerbate the Cognitive Impairments in Patients With Late-Life Depression

Background: Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). However, the relationship between NPS and cognitive functions in LLD patients remains unclear. The current study aims to explore the effects of NPS on cognitive impairments in LLD patients.Methods: Two hundred and sixty-two LLD patients and 141 normal controls (NC) were recruited. Exploratory factor analysis was used to extract factors from the Neuropsychiatric Inventory (NPI). Correlation, mediation, and moderation analyses were used to explore whether NPS exacerbated the cognitive impairments in LLD and whether NPS exhibited different effects on cognitive impairments in acute-state LLD (aLLD) and recovery-state LLD (rLLD).Results: Three main factors were extracted from the NPI, including emotional, behavioral, and psychotic factors. The patients with LLD exhibited worse cognition and higher NPI scores, and the scores of NPI-total and three extracted factors were negatively associated with cognitive scores. The mediation analyses exhibited that NPI-total and behavioral factor scores increase the difference in cognition scores between LLD and NC groups. The mediation analyses exhibited that behavioral factor score played a greater effect on impairing MMSE in the rLLD group than in the aLLD group. Additionally, behavioral factor score was in a trend to be negatively associated with Mini-Mental State Examination (MMSE) score changes at a one-year follow-up (p = 0.051).Conclusions: NPS, especially behavioral symptoms, exacerbate cognitive impairments in LLD and may contribute to residual cognitive impairment in rLLD patients. Early intervention for behavioral symptoms in LLD patients may be beneficial to their long-term clinical prognosis.

Diet quality and cardiometabolic health in childhood: the Generation R Study

Purpose Diet is an important determinant of cardiometabolic disease risk in adults. We aimed to study associations of diet quality with cardiometabolic health in school-age children. Methods This study was embedded in the Generation R Study a prospective population-based cohort in Rotterdam, the Netherlands and included 3991 children. Food intake was assessed with a Food-Frequency Questionnaire at age 8 years. A diet quality score (0–10) was calculated reflecting adherence to age-specific dietary guidelines. The following outcome variables were measured at age 10 years and used to create a continuous cardiometabolic risk factor score: body fat percentage, insulin, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure. Outcomes were expressed in age- and sex-specific standard deviation scores (SDS). Multivariable linear regression models were used to assess associations between the diet quality score and the cardiometabolic risk factor score and with the individual cardiometabolic risk factors. Results In models adjusted for socioeconomic and lifestyle factors and BMI, a higher diet quality was associated with a lower cardiometabolic risk factor score [− 0.08 per point higher diet score, (95% CI − 0.15, − 0.001)]. This association was mainly driven by associations of higher diet quality with lower systolic [− 0.04 SD (95% CI − 0.06, − 0.01)] and diastolic blood pressure [− 0.05 SD, (95% CI − 0.07, − 0.02)]. No statistically significant associations were found for insulin, triglycerides, HDL cholesterol, or body fat percentage as individual factors. Conclusions We found an association between higher diet quality and better cardiometabolic health in childhood, mainly driven by a lower blood pressure. Further research is needed to explore associations of diet quality in childhood with long-term cardiometabolic health.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

Background Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. Methods This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1–40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a “general alexithymia” factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. Results The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with “TAS” no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. Limitations Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. Conclusions These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia).

Dimensionality of the Mental Toughness Questionnaire (MTQ48)

Currently there is debate as to whether mental toughness is a unidimensional or multidimensional construct. To investigate the dimensionality of the Mental Toughness Questionnaire 48-items (MTQ48), a widely used measure of mental toughness, we examined data from a sample of 78,947 participants. A series of exploratory structural equation models (ESEM) assessed unidimensional, multidimensional, and bifactor solutions. Overall, results supported a bifactor conceptualization of mental toughness. Bifactor analysis was consistent with the use of a general factor score. In conclusion, the authors argue that mental toughness should be considered as an umbrella term representing a general trait comprised of related constructs that provide a psychological advantage in performance and promote positive mental health. Finally, this article identifies limitations in the existing measurement of mental toughness and proposes necessary directions in future research.

Evaluating N95 Respirator Filtration, Seal, Qualitative and Quantitative Fit with Vaporous Hydrogen Peroxide Reprocessing

Background: The COVID-19 pandemic has created personal protective equipment (PPE) shortages, particularly of N95 respirators. Institutions have used decontamination strategies including vaporous hydrogen peroxide (VHP) to augment respirator supplies. VHP can be used to decontaminate nonporous surfaces without compromising material integrity. However, little is known about its impact on N95 respirator efficacy. We assessed whether repeated VHP reprocessing altered 4 key respirator efficacy qualities: quantitative fit, qualitative fit, seal check, and filtration rate. Methods: We conducted a prospective cohort study from June 15 to August 31, 2020. In total, 7 participants were fitted to a 3M 1860 small or regular N95 respirator based on qualitative and quantitative fit testing. Respirators underwent 25 disinfection cycles with the Bioquell BQ-50 VHP generator. After each cycle, participants donned and doffed respirators and performed a seal check. Participants were given 2 attempts to pass their seal check. Every 10 cycles, qualitative fit testing was done using an aerosolized Bitrex solution. Quantitative fit testing was conducted using a PortaCount Pro 8038 Fit Tester to generate a fit factor score. Appropriate fit is defined as a fit factor score of 100 or greater. Quantitative testing was done at cycles 1, 3, 5, 7, 10, 15, 20, and 25. Filtration efficiencies of particles ≥0.3 µm in diameter were measured using the TSI Optical Particle Sizer 3330 at cycles 1, 5, 10, 15, 20, and 25. The Fisher exact test was used to assess qualitative fit and seal check. The Kruskal-Wallis test was used to analyze quantitative fit and filtration rate. Results: We observed no seal-check or quantitative-fit test failures during the study window. All participants passed qualitative fit testing. Although there was a significant degree of variability in fit factor scores across disinfection cycles (mean score 163.5, p <0.05), there was no significant difference between participants (p = 0.6) (Figure 1). There was no statistically significant change in mean filtration rate from cycle 10 to 25 (P = .05), and the filtration rate remained >95% by cycle 25 (Figure 2). Conclusions: VHP reprocessing did not diminish the efficacy of N95 respirators based on the 4 metrics we assessed: filtration rate, seal check, qualitative fit, and quantitative fit. Of significance, the filtration rate remained well above the 95% standard filtration for N95 respirators—even through 25 cycles of reprocessing. VHP reprocessing is a safe, viable strategy to disinfect N95 respirators and extend their use, particularly during supply shortages.Funding: NoDisclosures: None