Factors associated with cognitive impairment and cognitive concerns in patients with metastatic non-small cell lung cancer

Background Knowledge regarding cognitive problems in metastatic non-small cell lung cancer (mNSCLC) is limited. Such problems may include both patient-reported cognitive concerns and demonstrable cognitive impairment. Greater understanding of these outcomes is needed to inform rehabilitation strategies for these difficulties. We aimed to identify the frequency of cognitive problems and associated factors in patients with mNSCLC. Methods In this cross-sectional study, adults with mNSCLC completed validated neuropsychological tests and self-report questionnaires measuring cognitive concerns, neurobehavioral concerns, depression, demoralization, illness intrusiveness, self-esteem, and physical symptoms. Cognitive impairment (performance-based) was defined according to International Cancer and Cognition Task Force criteria. Clinically significant cognitive concerns were defined by a score ≥1.5SD below the normative mean on the FACT-Cog PCI. Univariate and multivariate logistic regression analyses were performed to identify associated factors. Results Of 238 patients approached, 77 participated (median age: 62 years, range: 37-82). Brain metastases were present in 41 patients (53%), and 23 (29%) received cranial irradiation. Cognitive impairment and cognitive concerns were present in 31 (40%) and 20 patients (26%), respectively. Cognitive impairment and cognitive concerns co-occurred in 10 patients (13%), but their severity was unrelated. Cognitive impairment was associated with cranial irradiation (OR=2.89, p=0.04), while cognitive concerns were associated with greater illness intrusiveness (OR=1.04, p=0.03) and lower self-esteem (OR=0.86, p=0.03). Conclusions Cognitive impairment and cognitive concerns are both common in mNSCLC patients, but are not necessarily related and their risk factors differ. The association of illness intrusiveness and self-esteem with cognitive concerns can inform therapeutic interventions in this population.

Dializált betegek életviteli nehézségeinek megismerése kvantitatív vizsgálómódszerekkel

Összefoglaló. Bevezetés: A krónikus vesebetegség tünetei, a kezelés sajátosságai nagymértékben korlátozzák a páciensek mindennapi életvitelét, hatással vannak testi és lelki egészségükre, és nehezítik társas kapcsolataikat. Célkitűzések: A jelen kutatás célja a magyar dializált betegpopuláció egészségműveltségének, életminőségének és betegségterhének megismerése, továbbá a kezelési típusok hatását kívántuk felmérni a fent említett pszichológiai tényezők mentén. Módszer: A vizsgálatban 42 krónikus dializált személy vett részt: 31 hemodializált és 11 hasi dialízist végző vesebeteg. Átlagéletkoruk 63,33 ± 12,92 év. A minta életkor, nemi eloszlás és családi állapot alapján reprezentatív. Kérdőíves technikával mértük a betegek életminőségét, egészségműveltségét és betegségterhét. Eredmények: Eredményeink szerint a peritonealis dialízist végző betegek szignifikánsan magasabb egészségműveltséggel rendelkeznek, mint hemodializált betegtársaik. Ez a jelentős különbség az életminőségük több területén is kimutatható volt. Következtetés: Eredményeink a betegedukáció és a kezelőszemélyzettől kapott támogatás (bátorítás) jelentőségére hívják fel a figyelmet. A betegoktatás a hemodializált betegcsoport esetében is kiemelten fontos. A klinikai szempontból hasznos intervenciós javaslatokat fogalmaztunk meg, melyek célzottan az egészségműveltség fejlesztésére irányulnak. Orv Hetil. 2021; 162(30): 1208–1215. Summary. Introduction: The symptoms of chronic kidney disease, the peculiarities of the treatment greatly limit the patients’ daily life, affect their physical and mental health and make their social relationships more difficult. Objective: The purpose of this research is to explore the health literacy, the health-related quality of life and illness intrusiveness of Hungarian dialysis patients. Furthermore, we wanted to assess the effect of treatment types along the psychological factors mentioned above. Method: The sample consisted of 42 patients with chronic kidney disease, 31 of whom have hemodialysis and 11 have peritoneal dialysis treatment. Their mean age was 63.33 ±12.92 years. The sample is representative by age, gender, and marital status. We measured the health-related quality of life, the health literacy and illness intrusiveness of the patients using special questionnaire techniques. Results: The peritoneal dialysis patients have significantly higher health literacy than their hemodialysis counterparts. This significant difference was seen in several areas of their quality of life as well. Conclusion: Our results draw attention to the importance of patient education and the special support by the treatment staff. The patient education for the haemodialysis group is of paramount importance for the hemodialysis group, too. We have formulated clinically useful intervention proposals aimed at improving health literacy. Orv Hetil. 2021; 162(30): 1208–1215.

Illness intrusiveness and sexual satisfaction among women with multiple sclerosis

Multiple sclerosis (MS) is a disorder of the central nervous system that occurs in 55,000 - 75,000 Canadians. MS causes symptoms such as muscle weakness, poor balance, pain, fatigue, bladder and bowel dysfunction, and sexual dysfunction. Although high rates of sexual dysfunction are well documented among MS patients, predictors of sexual satisfaction among this population have been understudied. Illness intrusiveness (how intrusive one finds his or her illness) has been found to mediate the link between illness symptoms and quality of life. Therefore, the mediational role of illness intrusiveness between sexual dysfunction and sexual satisfaction was examined in this cross-sectional study. Eighty-two women with MS completed self-report measures to investigate how illness intrusiveness mediated, and age moderated the relationship between sexual dysfunction and sexual satisfaction. Higher illness intrusiveness into intimacy mediated sexual dysfunction and sexual satisfaction. The impact of illness intrusiveness and other relationship variables on sexual satisfaction are discussed.

Illness intrusiveness and sexual satisfaction among women with multiple sclerosis

Multiple sclerosis (MS) is a disorder of the central nervous system that occurs in 55,000 - 75,000 Canadians. MS causes symptoms such as muscle weakness, poor balance, pain, fatigue, bladder and bowel dysfunction, and sexual dysfunction. Although high rates of sexual dysfunction are well documented among MS patients, predictors of sexual satisfaction among this population have been understudied. Illness intrusiveness (how intrusive one finds his or her illness) has been found to mediate the link between illness symptoms and quality of life. Therefore, the mediational role of illness intrusiveness between sexual dysfunction and sexual satisfaction was examined in this cross-sectional study. Eighty-two women with MS completed self-report measures to investigate how illness intrusiveness mediated, and age moderated the relationship between sexual dysfunction and sexual satisfaction. Higher illness intrusiveness into intimacy mediated sexual dysfunction and sexual satisfaction. The impact of illness intrusiveness and other relationship variables on sexual satisfaction are discussed.

Stigma by association: Parent stigma and youth adjustment in inflammatory bowel disease

Objective Examine the indirect association between parents’ experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). Methods During routine clinic visits, 150 youth with well-controlled IBD (ages 10–18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. Results Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents’ experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. Conclusions Parents who face stigma related to their child’s IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths’ illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents’ associative stigma and youths’ illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.

Neuropsychiatric symptoms, quality of life and caregivers’ burden in dementia

The objective of this research is to identify the relationship between the neuropsychiatric symptoms (NPSs) of patients with major neurocognitive disorder (mNCD), their quality of life, illness intrusiveness and the caregiver’s burden. We assessed 131 patients with mNCD. Examination methods included WHO well-being index short version, illness intrusiveness rating scale, Alzheimer’s Disease Assessment Scale-Cog, Mini Mental State Examination and neuropsychiatric inventory. The results were analysed using standard statistical tests. In our sample, the prevalence of NPSs is 100%. A significant correlation (p < 0.0001) was observed with quality of life and illness intrusiveness. Additionally, a strong relationship was observed between NPSs and the caregiver’s burden (r = 0.9). The result is significantly twice as much stronger in comparison to the relationship between NPS and cognitive symptoms (r = 0.4). This is the first study in Hungary to assess the impact of NPS on the burden of relatives and quality of life. NPS had twice stronger impact on caregivers’ burden than cognitive decline. However, further studies are needed to assess the sub-syndromes in mNCD in relation to NPS.