Acute and Subacute Clinical Markers After Sport-Related Concussion

ObjectiveThis study aimed to determine the association of a range of off-field symptoms reported by athletes retrospectively with on-field concussion signs and in-office symptoms among rugby union players.BackgroundPlayers with sports concussion experience multiple symptoms. Understanding the association between these symptoms and clinical markers of concussion would facilitate a targeted approach to symptom assessment and treatment.Design/MethodsCross-sectional study. We consecutively enrolled 92 adult rugby union players, within the first 72 hours after sport concussion. Ten symptoms assessed using a retrospective symptoms interview were examined for their association with observed concussion signs and post-concussion symptoms using the Post-Concussion Symptoms Scale (PCSS).ResultsOdds ratios revealed that athletes who was overtly symptomatic based on retrospective concussion interview at the time of the concussion were over 2.6 times more likely (p = 0.047) to have exhibited post-traumatic amnesia when compared with athletes who was asymptomatic. There were no differences between groups in terms of on-field loss of consciousness or confusion. Off-field symptoms reported by athlete were associated with symptoms reporting on the Beck Depression Inventory (OR 2.8; 95% CI 1.14–6.88), headache (OR 4.9; 95% CI 1.92–12.79), memory concerns (OR 3.15; 95% CI 1.06–9.34), pressure in head (OR 2.8; 95% CI 1.03–8.08), and visual disturbances (OR 3.9; 95% CI 1.05–14.50) within the first 72 hours after concussion.ConclusionsSymptomatic concussed rugby athletes have increased odds for sustaining on-field concussion signs that can be observed by others and persistent symptoms within the first 72 hours after concussion. Information from the on-field and off-field assessment is essential in understanding the severity of sports concussion.

Identification Of Dementia In Recent Medicare Claims Data, Compared To Rigorous Clinical Assessments

BACKGROUND Medicare fee-for-service (FFS) claims data are increasingly leveraged for dementia research. Few studies address the validity of recent claims data to identify dementia, or carefully evaluate characteristics of those assigned the wrong diagnosis in claims. METHODS We used claims data from 2014-2018, linked to participants administered rigorous, annual dementia evaluations in five cohorts at the Rush Alzheimer’s Disease Center. We compared prevalent dementia diagnosed through the 2016 cohort evaluation versus claims identification of dementia, applying the Bynum-standard algorithm. RESULTS Of 1,054 participants with Medicare Parts A and B FFS in a 3-year window surrounding their 2016 index date, 136 had prevalent dementia diagnosed during cohort evaluations; the claims algorithm yielded 217. Sensitivity of claims diagnosis was 79%, specificity 88%, positive predictive value 50%, negative predictive value 97%, and overall accuracy 87%. White participants were disproportionately represented among detected dementia cases (true-positive) versus cases missed (false-negative) by claims (90% versus 75%, respectively, p=0.04). Dementia appeared more severe in detected than missed cases in claims (mean MMSE=15.4 versus 22.0, respectively, p<0.001; 28% with no limitations in activities of daily living versus 45%, p=0.046). By contrast, those with “over-diagnosis” of dementia in claims (false-positive) had several worse health indicators than true negatives (eg, self-reported memory concerns=51% versus 29%, respectively, p<0.001; mild cognitive impairment in cohort evaluation=72% versus 44%, p<0.001; mean comorbidities=7 versus 4, p<0.001). CONCLUSIONS Recent Medicare claims perform reasonably well in identifying dementia; however, there are consistent differences in cases of dementia identified through claims than in rigorous cohort evaluations.

User Perceptions of a Technology-Based Social Memory Aid for Persons With Memory Concerns

People with memory concerns (PWMC) are likely to experience social withdrawal and isolation. Although assistive technologies and memory aids are available to support PWMC and their family caregivers, few have been shown to improve social engagement. This study aimed to gain perspectives of PWMC and their family caregivers on the feasibility and utility of a technology-based social memory aid. We recruited 20 dyads of people with mild to moderate memory concerns and family caregivers to evaluate Smartwatch Reminder (SR), a notification system that provides a name, relationship, and photograph of nearby social contacts to aid in recognition. Dyads viewed a demonstration of the SR prototype, and then participated in semi-structured interviews over Zoom video conferencing from June to August, 2020. Interview transcripts were analyzed using thematic analysis, with analyses completed in August 2021. Our findings indicate that participants anticipated important benefits from using the technology, and thought the technology would be easy to use. Participants perceived that the memory aid could benefit them now and in the future by alleviating socialization-related stress for both members of the care dyad; however, certain features of SR restricted the potential benefits, such as the requirement that social contacts have the SR application, and that prompts are only provided during social encounters. Our findings will inform future technology-enabled memory aid development to improve social engagement for PWMC and support family caregivers.

Use and Disuse of Technology Among Persons With Memory Concerns and Their Caregivers During the COVID-19 Pandemic

Social distancing and shelter-in-place orders designed to curb the spread of COVID-19 increased isolation among persons with memory concerns (PWMC) and increased the burden on individuals providing their care. Technology, such as smartphones or tablets, has demonstrated potential to improve the social connections and mental health of older adults; however, older adults historically have been reluctant to adopt new technology. We aimed to understand why some PWMC and their caregivers used new technology to adapt to lifestyle changes during the COVID-19 pandemic while others did not. In this study, we used data collected in 20 qualitative interviews from June to August, 2020 with PWMC and their family caregivers to assess changes in and barriers to technology use. Qualitative thematic analysis identified three themes which explained motivations for using new technology during a pandemic: 1) seeking relief from caregiver burden, 2) alleviating boredom, and 3) maintaining social connection. Results further revealed lingering barriers to PWMC and caregiver adoption of technologies, including: 1) PWMC dependence upon caregivers, 2) a lack of familiarity with technology, and 3) difficulties using technology. This in-depth investigation suggests that technology has the ability to provide caregivers relief from caregiving duties and provide PWMC with more independence during periods of pronounced isolation

“Citizens Too”: Safety Setting Collaboration Among Older Adults with Memory Concerns

Designing technologies that support the cybersecurity of older adults with memory concerns involves wrestling with an uncomfortable paradox between surveillance and independence and the close collaboration of couples. This research captures the interactions between older adult couples where one or both have memory concerns—a primary feature of cognitive decline—as they make decisions on how to safeguard their online activities using a Safety Setting probe we designed, and over the course of several informal interviews and a diary study. Throughout, couples demonstrated a collaborative mentality to which we apply a frame of citizenship in opensource collaboration, specifically (a) histories of participation , (b) lower barriers to participation, and (c) maintaining ongoing contribution. In this metaphor of collaborative enterprise, one partner (or member of the couple) may be the service provider and the other may be the participant, but at varying moments, they may switch roles while still maintaining a collaborative focus on preserving shared assets and freedom on the internet. We conclude with a discussion of what this service provider-contributor mentality means for empowerment through citizenship, and implications for vulnerable populations’ cybersecurity.