Exercise has been shown to benefit brain structure and function, particularly in aging populations. However, the mechanisms by which exercise exerts its effects, especially in humans, are not fully ...understood. This review argues that one reason for this knowledge gap is that exercise likely operates through multiple levels of mechanisms. Furthermore, the mechanisms of exercise may vary depending on factors such as age and health state. We discuss the state of evidence at each of three levels of analysis (molecular/cellular, brain structure/function, and mental states and higher-order behaviors) and highlight consistencies across these levels, inconsistencies within them, and knowledge gaps. Lastly, based on these, we speculate about which mechanisms of exercise may be universal across age groups and populations versus those that might be distinct to specific age ranges or populations.
There is evidence that aerobic exercise can affect the brain and cognition through different levels of mechanisms at various points in the lifespan. The strongest evidence comes from children and older adults.Exercise has significant promise for mitigating some of the cognitive and brain deficits resulting from a variety of neurologic, non-neurological, and psychiatric conditions.There is a dire need for more rigorous randomized controlled trials (RCTs) of exercise in lesser studied age groups, especially children aged <5 years, adolescents, and young adults.A common limitation of the existing exercise literature relates to the heterogeneous nature of studies (e.g., in terms of design, duration, and included outcomes assessments).
Postoperative delirium (POD) after cancer surgeries can be a result of chemo brain, anesthesia, surgery duration, and preoperative cognitive impairment. Although older age and preoperative cognitive ...dysfunction were reported to increase the risk of POD in noncardiac surgery, the role of preoperative cognitive function and age in the development of POD after all types of cancer surgeries is not clear. This study aimed to determine the relationship between preoperative cognitive function and likelihood of POD after cancer surgeries. This study used three main online databases and followed PRISMA guidelines. English language original articles that examined preoperative cognitive function before solid tumor cancer surgery and assessed patients for postoperative delirium were included. We employed the random effect meta‐analysis method. The overall incidence of POD ranged from 8.7% to 50.9%. The confusion assessment method was the most common tool used to assess delirium. Mini‐mental state evaluation (MMSE), Mini‐cog, and Montreal cognitive assessment were the most common tools to assess cognitive function. The pooled (total observation = 4676) random effects SMD was estimated at −0.84 (95% confidence interval CI: −1.30 to −0.31), indicating that lower MMSE scores before surgery are associated with a higher risk of POD. The pooled (total observation = 2668) random effects OR was estimated at 5.17 (95% CI: 2.51 to −10.63), indicating preoperative cognitive dysfunction can significantly predict the occurrence of POD after cancer surgeries. In conclusion, preoperative cognitive function is an independent and significant predictor of POD after solid tumor cancer surgeries.
Women with breast cancer treated with aromatase inhibitor (AI) therapy experience multiple concurrent symptoms or symptom clusters. Understanding of the symptom experience and identifying symptom ...clusters before and during AI therapy are important for the development of interventions to improve clinical outcomes.
The aim of this study was to identify symptom clusters experienced by women with breast cancer treated with AI therapy from pre–adjuvant therapy up to 18 months of adjuvant therapy using a broad scope of symptoms assessment.
Forty-seven symptoms were evaluated in postmenopausal women with breast cancer (N = 354) who received AI therapy or chemotherapy followed by AI therapy. Symptoms were assessed at four semiannual time points with the Breast Cancer Prevention Trial Symptom Checklist, Patient's Assessment of Own Functioning Inventory, Beck Depression Inventory-II, and Profile of Mood States Tension/Anxiety and Fatigue/Inertia subscales. Exploratory factor analyses were conducted at each time point to identify symptom clusters.
Four stable symptom clusters (i.e., musculoskeletal, vasomotor, urinary, sexual) and three relatively stable symptom clusters (i.e., psychological, neurocognitive, weight) were identified across the 18-month follow-up period. The gastrointestinal symptom cluster only appeared at after six months of adjuvant therapy (postchemotherapy).
This study helps us to better understand the most common symptom clusters over the first 18 months of adjuvant therapy among postmenopausal women with early-stage breast cancer. It is critical for health care providers to know the symptom clusters commonly experienced by women receiving AI therapy with or without chemotherapy and manage them properly over time.
Aim: The pattern of increasing biological diversity from high latitudes to the equator latitudinal diversity gradient (LDG) has been recognized for > 200 years. Empirical studies have documented this ...pattern across many different organisms and locations. Our goal was to quantify the evidence for the global LDG and the associated spatial, taxonomic and environmental factors. We performed a meta-analysis on a large number of individual LDGs that have been published in the 14 years since Hillebrand's ground-breaking meta-analysis of the LDG, using meta-analysis and meta-regression approaches largely new to the fields of ecology and biogeography. Location: Global. Time period: January 2003–September 2015. Major taxa studied: Bacteria, protists, plants, fungi and animals. Methods: We synthesized the outcomes of 389 individual cases of LDGs from 199 papers published since 2003, using hierarchical mixed-effects meta-analysis and multiple meta-regression. Additionally, we re-analysed Hillebrand's original dataset using modern methods. Results: We confirmed the generality of the LDG, but found the pattern to be weaker than was found in Hillebrand's study. We identified previously unreported variation in LDG strength and slope across longitude, with evidence that the LDG is strongest in the Western Hemisphere. Locational characteristics, such as habitat and latitude range, contributed significantly to LDG strength, whereas organismal characteristics, including taxonomic group and trophic level, did not. Modern meta-analytical models that incorporate hierarchical structure led to more conservative and sometimes contrasting effect size estimates relative to Hillebrand's initial analysis, whereas meta-regression revealed underlying patterns in Hillebrand's dataset that were not apparent with a traditional analysis. Main conclusions: We present evidence of global latitudinal, longitudinal and habitat-based patterns in the LDG, which are apparent across both marine and terrestrial realms and over a broad taxonomic range of organisms, from bacteria to plants and vertebrates.
Purpose
This study aimed to identify unobserved distinct latent classes/subgroups of breast cancer (BC) patients in China with respect to various sexual health measures and examine the association of ...the latent membership with individual characteristics.
Methods
In a cross-sectional study, 123 BC patients were analyzed. Their sexual health was measured using the Female Sexual Functioning Index (FSFI). Latent class analysis (LCA) was used to examine the patterns of sexual health in patients. Associations of the latent class membership with individual characteristics were examined using multinomial logistic regression.
Results
Three a priori unknown distinct latent classes of patients were identified with respect to the 19 FSFI sexual health measures: 50 patients (41.6%) were classified in class 1 “No Impairment Group,” 49 patients (39.4%) in class 2 “Organic Sexual Dysfunction Group,” and 24 patients (19.1%) in class 3 “Poor Sexual Health Group.” Income and anxiety were positively, whereas disease duration was negatively associated with the likelihood of being in class 2 than in class 1, patients with recurrence of cancer were likely to be in classes 2 and 3. Patients classified in class 3 were more likely to have better prior body image and have more severe menopausal symptoms, whereas less likely to have better post body image and have better partner relationships.
Conclusion
The findings revealed the heterogeneity of sexual health among BC patients in China and may guide to identify the high-risk patients and enable early intervention.
Objective:
Medication nonadherence has been a persistent problem over the past three decades; forgetting and being distracted from regular routines are the barriers most frequently cited by patients. ...Prior research on cognitive function and medication adherence has yielded mixed results.
Design:
This report compares findings of three studies: All were longitudinal, two were randomized controlled intervention trials, and one was descriptive. Samples of adult patients taking once daily lipid-lowering medication, diabetic patients with comorbid conditions on complex regimens, and early stage breast cancer patients on hormonal therapy completed similar batteries of standardized, valid, neuropsychological tests at baseline.
Main Outcome Measures:
Adherence to medication regimens, over time, was tracked with electronic event monitors.
Results:
Medication nonadherence was prevalent in all studies. Deficits in attention/mental flexibility and/or working memory predicted nonadherence in all studies; impaired executive function was related to poor adherence in one study.
Conclusion:
These findings suggest that better mental efficiency may be the key to better medication adherence with any regimen, and that targeted cognitive functions, which can be easily and quickly assessed, may identify patients at risk of poor adherence regardless of diagnosis or regimen.
Abstract
Background and Objectives
This secondary analysis examined (a) the association between illness perceptions (perceived understanding and cause of mild cognitive impairment MCI) and ...self-management behaviors for cognitive health, and (b) whether sociodemographic and clinical factors moderate such relationships among persons with MCI.
Research Design and Methods
We conducted a cross-sectional study of 85 participants using baseline data from the Return of Amyloid Imaging Scan Results Study. The coherence and causality subscales of the Revised Illness Perceptions Questionnaires were used. Self-management behaviors (dietary changes, physical activity, mental activities, dietary supplements) were assessed using the Risk Evaluation and Education for ALzheimer’s disease health behavior measure. Sociodemographic and clinical information was extracted from patients’ medical records. We performed hierarchical linear regression and binary logistic regression.
Results
We found no main effects for illness perceptions and self-management of cognitive health. Interaction effects were detected, including (a) coherence and age on the total number of self-management behaviors (b = 0.01, p = .04) and on physical activity (p = .04, odds ratio OR = 1.02, 95% confidence interval CI = 1.00–1.03), (b) causality and age on dietary supplements (p = .03, OR = 1.31, 95% CI = 1.02–1.67), and (c) causality and education on mental activities (p = .02, OR = 0.44, 95% CI = 0.22–0.88).
Discussion and Implications
Findings suggest that age and education moderate the relationship between illness perceptions and self-management behaviors. Health care professionals should consider subjective perceptions about MCI in light of sociodemographic and clinical factors when discussing cognitive health self-management.
Purpose
The purpose of this pilot study was to evaluate the feasibility of an 8-week Qigong intervention to improve objectively and subjectively assessed cognitive function in breast cancer survivors ...who were 2 months to 8 years post completion of chemotherapy and radiation therapy.
Methods
A randomized, single-blind, three-arm intervention pilot was conducted to compare Qigong to gentle exercise and survivorship support. Feasibility was measured by recruitment, group session attendance, and adherence to home practice for the two exercise groups. Changes in self-report and objectively measured cognitive function were compared between the three groups from baseline (T1) to completion of the intervention (T2) and 4 weeks post intervention (T3).
Results
Fifty participants consented (83% of desired sample) with an overall attrition rate of 28%. Attrition was highest for the gentle exercise group (50%). Group attendance adherence ranged from 44 to 67%. The a priori established rate of 75% weekly attendance was not achieved, nor was the goal of 75% adherence to home practice for the two exercise groups (7 to 41%). Self-report of cognitive function improved most for the Qigong group (
p
= .01). Improvement was demonstrated for the Trail Making A (gentle exercise,
p
= .007) and F-A-S verbal fluency (support group,
p
= .02) tests. Qigong participants reported the most reduction of distress (
p
= .02).
Conclusions
The study results suggest that mindfulness-based exercise may be superior to gentle exercise alone or survivorship support for improving self-report of cognitive function and distress after treatment for breast cancer. The mindfulness component may enhance the positive impact of exercise on cognitive function.
Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in ...people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer’s disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL). Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD. Research Design: We conducted a concept analysis using Walker and Avant’s eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords “dignity,” “dementia,” “Alzheimer’s disease,” and “dementia care.” Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person’s sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced. Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.
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