The Effectiveness of Non-clozapine Antipsychotics Combined with Electroconvulsive Therapy versus Clozapine Combined with Electroconvulsive Therapy for Treatment-resistant Schizophrenia

The study aimed to compare the effectiveness and safety of other atypical antipsychotics (non-clozapine) plus electroconvulsive therapy (ECT) (NC+ECT) versus clozapine plus ECT (C+ECT) for treating treatment-resistant schizophrenia (TRS). Data of 32 patients with TRS who was receiving ECT were analysed. We compared clinical characteristics, response to treatment [defined as an improvement of 40% in the Brief Psychotic Rating Scale (BPRS) psychotic symptom subscale from pretreatment scores], change of Mini-mental Status Exam (MMSE) scores, and other adverse effects between the NC+ECT group (N= 16) and C+ECT group (N =16). We found that the overall response rate was 65.6% (75.8% for the NC+ECT group and 56.3% for the C+ECT group, p=0.26). The overall BPRS score in both groups decreased significantly. The mean difference in total BPRS psychotic subscale score between pre-ECT and after last ECT was 10.4 + 5.8 (p<0.001) for the NC+ECT group and 6.6 + 7.3 (p = 0.002) for the C+ECT group. When comparing the NC+ECT group to the C+ECT group, the mean difference in total BPRS psychotic subscale score was not significant. (p = 0.104). The mean difference in MMSE score between pre-ECT and after the last ECT was -1.1 + 5.1 (p =0.45) for the NC+ECT group and 0.2 + 4.3 (p=0.855) for the C+ECT group. The change of MMSE score in the NC+ECT group was not significant different compare to the C+ECT group (p = 0.461). We concluded the combination of antipsychotics and ECT is an effective and safe treatment option for patients with TRS. Other NC+ECT groups’ efficacy may be comparable to that of clozapine plus ECT.

Measurement Invariance of a Latent Dementia Index by Gender in the Aging, Demographics, and Memory Study

Population-based aging studies allow researchers to study dementia and its correlates. Few include dementia diagnoses. Latent variable models have been used to create latent dementia indexes (LDI) using cognitive and functional ability to approximate dementia. The LDI is applied across diverse populations, but it is unclear whether gender affects its measurement properties. We assess whether the LDI can be used to measure dementia equivalently for men and women. We use the 2001-2003 Aging, Demographics, and Memory Study (n=856, 355 men, 501 women). Cognitive ability was assessed using memory, executive function, attention, spatial ability, orientation, and language tasks. Functional ability was informant-reported. We used confirmatory factor analysis to test factorial invariance across gender and compare latent means to determine which group had lower means, consistent with greater dementia likelihood. Model fitting results suggest metric invariance of the LDI but only partial scalar invariance across gender. Latent mean differences in the LDI were observed (Mdiff = .39, SE = 0.19, p = .042), with women lower, on average, than men. Correlations between LDI and dementia diagnosis were stronger for both men (r=-.82) and women (r=-.85) than correlations between dementia and Mini-Mental Status Exam scores (-.69 and -.73, respectively). The LDI may be reliably and validly used to measure and compare dementia likelihood in men and women. Results suggest lower LDI scores in women, indicating greater dementia likelihood. Gender differences may be partially attributed to differences in measurement properties of items, possibly due to gender differences in educational returns and employment factors.

Egg Consumption and 4-Year Change in Cognitive Function: The Rancho Bernardo Study

The role of dietary cholesterol in cognitive decline is unclear. Eggs are a rich source of nutrients and dietary cholesterol. This study examines the association of egg consumption with 4-year change in cognitive function in 890 older, community-dwelling adults. Participants were 357 men and 533 women aged □55y (means=70.1□8.4 and 71.5□8.8, respectively, p=0.016), from the Rancho Bernardo Cohort who attended a 1988-91 clinic visit. Egg intake was obtained with a food frequency questionnaire. Cognitive function was assessed with the Mini-Mental Status Exam (MMSE), Trails B and category fluency, and reassessed in 1992-96. In this sample, rates of egg consumption ranged from never (14.0% of men, 16.5% of women) to □5/week (7.0% of men, 3.8% of women; p=0.0013). Mean 1988-91 cognitive function scores for men vs. women were 27.5 vs. 27.7 on the MMSE (p=0.08), 105.9 vs. 121.6 on Trails B (p&lt;0.0001), and 20.2 vs. 18.2 on category fluency (p&lt;0.0001). Sex-specific regression analyses examined associations of egg consumption with change in cognitive function. In women, after adjustment for age and education, egg intake was associated with less decline over time in category fluency (beta=-.10, p=0.01), which remained significant after adjustment for smoking, alcohol, exercise, cholesterol, calorie intake, and protein intake (p=0.02). No other associations were found in women, and no associations were observed in men before and after adjustment for covariates. Results suggest that while high in dietary cholesterol, egg consumption is not associated with decline in cognitive function. For women, there may be a small beneficial effect for verbal memory.

Translation of a Falls Prevention Behavioral Intervention for Family Caregiver Administration

FallsTalk is a one-month evidence-based falls prevention (FP) program that focuses attention on causes of an individual’s falls and encourages new FP behaviors. We translated the program for family caregivers of persons with cognitive impairment or dementia (PwCID) to administer to the PwCID and examined the number of new FP behaviors (#newFPBs) reported during the intervention period by the Caregiver. Thirty-four Dyads (Caregiver+PwCID) were trained to conduct brief daily FP discussions together using paper (FTCGnoTech) or computerized (FTCGTech, n=20) guidance. Dyads had FallsTalk training, daily discussions and weekly check-in calls. FTCGTech included discussion suggestions tailored to Caregiver concerns. To examine the use of technology, Poisson regression models compared #newFPBs between FTCGnoTech and FTCGTech and included covariates age (&lt;80 or &gt;=80), Mini-Mental Status Exam (MMSE &gt;25 or &lt;=25) and interactions. To evaluate the influence of Caregiver participation, #newFPBs reported by 115 non-demented clinical trial participants (no Caregiver- FT-ClTrNoCG) were compared with the Caregiver outcomes. Dyads using technology reported significantly more #newFPBs (MeanFTCGnoTech=5.34(SEM=0.68), MeanFTCGTech=8.46(SEM=0.76); p=.004) during the intervention month. A significant interaction was observed whereby Dyads with MMSE&lt;=25 using technology, reported significantly more #newFPBs than the non-technology group (MeanFTCGnoTech=4.23(SEM=0.72), MeanFTCGTech=9.01(SEM=0.90); p=.047). Caregiver (n=34) involvement substantially increased #newFPBs (MeanFT-ClTrNoCG=1.39(SEM=0.15), MeanCaregiver=7.21(SEM=0.49); p&lt;.0001), independent of technology. Across studies, participants or Caregivers for those with MMSE&lt;=25 and &lt;80yo reported significantly more #newFMBs (Mean=4.38(SEM=0.55) than those 80+yo (Mean=2.06(SEM=0.30); p=.0026). FallsTalk Caregiver provides an effective means to promote new Dyad FP strategies. The influence of Caregiver involvement and technology show promise in encouraging behavioral change to prevent falls.

QOLP-06. THE CHALLENGE OF FACING A NEW MALIGNANT GLIOMA DIAGNOSIS: PATIENT EXPERIENCES LEARNING ABOUT THEIR ILLNESS AND COMMUNICATING WITH THEIR PROVIDERS IN THE NEURO-ONCOLOGY CLINIC

BACKGROUND Patients with newly diagnosed malignant gliomas (MG) face the sudden and unexpected news that they have a terminal neurological illness. However, little is known about these patients’ experiences learning about their illness and communicating with their oncology providers. METHODS We conducted semi-structured interviews with patients with MG who had recently completed chemoradiation, to explore patient-clinician communication and evaluate how patients process information about their diagnosis. We excluded patients with marked cognitive dysfunction, with eligible patients required to have a Mini-Mental Status Exam score of 24/30 or greater. We terminated enrollment once we reached thematic saturation, after a total of 9 patient interviews. We thematically analyzed qualitative data to describe patterns common to the patients’ experiences. RESULTS Most patients were male (6/9, 66.7%), with median age of 55 years (range 26-72) and had a diagnosis of glioblastoma (6/9, 66.7%). The majority of patients described a positive experience communicating with their providers, noting that information was delivered clearly, and visits were not rushed. Despite this, patients found it difficult to absorb and process the large volume of new information, particularly in the setting of their shock and dismay about the diagnosis and their ongoing neurological deficits. Emergent themes included concerns about the impact of the disease on their loved ones, struggles in coping with uncertainty, and worries about preserving their quality of life and functioning. Additionally, patients described their efforts to balance their knowledge about their poor prognosis with their desire to maintain hope, with many patients expressing a goal to “beat the odds” or exceed expectations with respect to their survival. CONCLUSION Although patients with newly diagnosed MG describe effective communication with their providers, they face many challenges coping with their terminal diagnosis. Supportive interventions aimed at this population are needed.

A Case Report on Korean Medical Treatment for a Patient with Quadriplegia and Impaired Cognition as Neurological Sequelae after Ingestion of Herbicides

This study is a case report of Korean medicine treatment for a patient with quadriplegia and impaired cognition as neurological sequelae after ingestion of herbicides. A 59-year-old man with toxic encephalopathy and hypoxic encephalopathy after the ingestion of herbicides was treated with acupuncture, Hyulbuchuko-tang mixed with Ondam-tang-gami (血府逐瘀湯合溫膽湯加味), cupping, moxibustion, and rehabilitation. Clinical symptoms were measured with the Manual Muscle Test (MMT), Korean Mini Mental Status Exam (K-MMSE), Functional Independence Measure (FIM), and Modified Barthel Index (MBI). After three months of treatment, clinical symptoms improved. The motor function improved (MMT on both sides, Gr. 3+F/4G →Gr. 4-G~4G/4+G), cognition improved (K-MMSE, 13→21), and ADL (Activities of Daily Living) scores also improved (FIM 41→74; MBI 20→63). Korean medical treatment could effectively treat neurological sequelae after ingestion of herbicides in this case.

Lateralized Deficits in Motor, Sensory, and Olfactory Domains in Dementia

Background: There exist functional deficits in motor, sensory, and olfactory abilities in dementias. Measures of these deficits have been discussed as potential clinical markers. Objective: We measured the deficit of motor, sensory, and olfactory functions on both the left and right body side, to study potential body lateralizations. Methods: This IRB-approved study (N = 84) performed left/right clinical tests of gross motor (dynamometer test), sensory (Von Frey test), and olfactory (peppermint oil test) ability. The Mini-Mental Status Exam was administered to determine level of dementia; medical and laboratory data were collected. Results: Sensory and olfactory deficits lateralized to the left side of the body, while motor deficits lateralized to the right side. We found clinical correlates of motor lateralization: female, depression, MMSE <15, and diabetes. While clinical correlates of sensory lateralization: use of psychotherapeutic agent, age ≥85, MMSE <15, and male. Lastly, clinical correlates of olfactory lateralization: age <85, number of medications >10, and male. Conclusion: These lateralized deficits in body function can act as early clinical markers for improved diagnosis and treatment. Future research should identify correlates and corresponding therapies to strengthen at-risk areas.

Associations of Performance-Based Functional Assessments and Adverse Outcomes in Chronic Kidney Disease

Background: The comparative utility of performance-based functional assessments in predicting adverse outcomes in Chronic Kidney Disease (CKD) is unknown. We examined three performance-based functional assessments in an observational cohort of CKD patients to determine their relative utility. Methods: 350 participants with Stage II-V, pre-dialysis CKD were recruited. Participants were administered three performance-based functional assessments: Short Physical Performance Battery (SPPB), Modified Mini Mental Status Exam (M3SE), and Lawton Instrumental Activities of Daily Living (IADL). Scores were dichotomized based on the median and combined into a summary score. Outcomes included 50% glomerular filtration rate (GFR) reduction, end-stage kidney disease (ESKD), and death. Cox proportional hazards assessed the association of performance-based functional assessments with outcomes. Results: Compared to high performers, low SPPB performers had the highest adjusted rate of death, ESKD, or 50% reduction in GFR (HR: 1.96, 95% CI: 1.28, 2.99). Low SPPB had the strongest association with death when adjusted for multiple covariates (HR: 2.43, 95% CI: 1.36, 4.34). M3SE performance was not associated with any adverse outcome. None of the performance-based functional assessments were associated with ESKD, but a low IADL score was associated with a lower hazard ratio for ESKD or 50% decline GFR (HR: 0.49, 95% CI: 0.24, 1.00). Conclusions: Low SPPB score was the strongest predictor of death and all adverse outcomes as a composite. Future trials should determine if outcomes for CKD patients with poor physical performance and low SPPB scores are improved by targeted interventions.

Greater Perceived Physical Fatigability Is Associated with Lower Cognition: The Long Life Family Study

Greater perceived physical fatigability is associated with physical functional decline, but few studies have examined its relation with cognition. Adults ≥60 (mean±SD age 73.7±10.5, 54.7% female, 99.6% white) from the Long Life Family Study (n=2355) completed the Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater fatigability) and a neurocognitive examination. Generalized estimating equations were used to account for family structure. Covariates included age, sex, field center, depressive symptoms (Center for Epidemiological Studies-Depression), education, and self-reported health. Each 1-point greater PFS was associated with lower: (1) global cognition (Mini-Mental Status Exam; β=-0.36,p&lt;.0001), (2) verbal fluency (phonemic: β=-0.09,p=.029 and semantic: β=-0.14,p&lt;.0001), (3) memory (Hopkins Verbal Learning Test-Revised: β=-0.06,p=.037), and (4) psychomotor speed (Digit Symbol Substitution Test: β=-0.10,p&lt;.0001), after covariate adjustment. Greater perceived physical fatigability was significantly associated with lower memory and cognitive function in older adults, and may represent a promising new biomarker of biological aging reflecting declining brain reserve, resilience, and neurodegeneration.