Current clinician-rated tardive dyskinesia (TD) symptom scales have not addressed the expanding clinical signs and functional impact of TD. The study objective was to develop and test the reliability ...of a new integrated instrument.
A movement disorder neurologist devised the outline of the rating scale. A Steering Committee (5 neurologists and 2 psychiatrists) provided revisions until consensus was reached. The Clinician's Tardive Inventory (CTI) assesses abnormal movements of the eye/eyelid/face, tongue/mouth, jaw, and limb/trunk; complex movements defined as complicated movements different from simple patterned movements or postures; and vocalizations. The CTI rates frequency of symptoms from 0 to 3 (ranging from absent to constant). Functional impairments, including activities of daily living (ADL), social impairment, symptom distress, and physical harm, are rated 0-3 (ranging from unawareness to severe impact). The CTI underwent interrater and test-retest reliability testing between February and June 2022 based on videos and accompanying vignettes, which were reviewed by 2 movement disorder specialists to determine adequacy. Four clinicians rated each video/vignette. Interrater agreement was analyzed via 2-way random-effects intraclass correlation (ICC), and test-retest agreement was assessed utilizing the Kendall tau-b.
Forty-five video/vignettes were assessed for interrater reliability and 16 for test-retest reliability. The most prevalent movements were those of the tongue and mouth (77.8%) and jaw (55.6%). ICCs for movement frequency for anatomic symptoms were as follows: anatomic symptom summary score 0.92, abnormal eye movement 0.89, abnormal tongue/mouth movement 0.91, abnormal jaw movement 0.89, abnormal limb movement 0.76, complex movement 0.87, and abnormal vocalization 0.77; ICCs for functional impairments were as follows: total impairment score 0.92, physical harm 0.82, social embarrassment 0.88, ADLs 0.83, and symptom bother 0.92; Retests were conducted a mean (SD) of 15 (3) days later with correlation coefficients ranging from 0.66 to 0.87.
The CTI is a new integrated instrument with proven reliability in assessing TD signs and functional impacts. Future validation study is warranted.
Background Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of ...feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. Methods We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. Results After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. Conclusions Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.
Objective: Remote monitoring of physical activity using body-worn sensors provides an objective alternative to current functional assessment tools. The purpose of this study was to assess the ...feasibility of classifying categories of activities of daily living from the functional arm activity behavioral observation system (FAABOS) using muscle activation and motion data. Methods: Ten nondisabled, healthy adults were fitted with a Myo armband on the upper forearm. This multimodal commercial sensor device features surface electromyography (sEMG) sensors, an accelerometer, and a rate gyroscope. Participants performed 17 different activities of daily living, which belonged to one of four functional groups according to the FAABOS. Signal magnitude area (SMA) and mean values were extracted from the acceleration and angular rate of change data; root mean square (RMS) was computed for the sEMG data. A k-nearest neighbors machine learning algorithm was then applied to predict the FAABOS task category using these raw data as inputs. Results: Mean acceleration, SMA of acceleration, mean angular rate of change, and RMS of sEMG were significantly different across the four FAABOS categories (p<;0.001 in all cases). A classifier using mean acceleration, mean angular rate of change, and sEMG data was able to predict task category with 89.2% accuracy. Conclusion: The results demonstrate the feasibility of using a combination of sEMG and motion data to noninvasively classify types of activities of daily living. Significance: This approach may be useful for quantifying daily activity performance in ambient settings as a more ecologically valid measure of function in healthy and disease-affected individuals.
Background/Rationale:
Compensation strategies may contribute to greater resilience among older adults, even in the face of cognitive decline. This study sought to better understand how compensation ...strategy use among older adults with varying degrees of cognitive impairment impacts everyday functioning.
Methods:
In all, 125 older adults (normal cognition, mild cognitive impairment, dementia) underwent neuropsychological testing, and their informants completed questionnaires regarding everyday compensation and cognitive and functional abilities.
Results:
Cognitively normal and mild cognitive impairment older adults had greater levels of compensation use than those with dementia. Higher levels of neuropsychological functioning were associated with more frequent compensation use. Most importantly, greater frequency of compensation strategy use was associated with higher levels of independence in everyday function, even after accounting for cognition.
Conclusion:
Use of compensation strategies is associated with higher levels of functioning in daily life among older adults. Findings provide strong rational for development of interventions that directly target such strategies.
PURPOSETo compare the trunk biomechanical characteristics between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors and healthy-matched controls. ...METHODSThirty individuals (15 stroke survivors and 15 healthy-matched controls) were included. The following biomechanical characteristics were determined: peak of trunk forward flexion and time until the peak of trunk forward flexion, total duration, phase I (sit-to-stand: time spent from the beginning to seat-off; stand-to-sit: time spent from the beginning to seat-on) and II durations (sit-to-stand: time spent from seat-off to the end of the task; stand-to-sit: time spent from the seat-on to the end of the task). Two-way repeated measures ANOVA was used (α = 5%). RESULTSThe maximum angle of trunk forward flexion and time spent until the maximum angle of trunk forward flexion in both tasks were significantly higher in stroke survivors. For both groups and speeds, phase I duration and peak of trunk forward flexion of the stand-to-sit were significantly higher than that of the sit-to-stand (11.41≤F ≤ 33.60; 0.001 ≤ p ≤ 0.002) and, phase II duration was significantly higher during the sit-to-stand than that of the stand-to-sit (21.27 ≤ F ≤ 65.10; p ≤ 0.001). CONCLUSIONSThese results confirm specific trunk biomechanical characteristics between sit-to-stand and stand-to-sit in stroke survivors and healthy-matched controls.
Mindfulness practices are effective for injury/illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for healthcare professionals' ...well-being and improved patient outcomes and safety. However, mindfulness has not been studied in athletic trainers.
To investigate athletic trainers' utilization of mindfulness practices and their perceptions on its importance for self- and patient/client-care.
Cross-sectional study.
All athletic training practice settings.
A total of 547 athletic trainers who are currently practicing completed the survey.
We developed an 18-item survey that measured utilization (1(Never) to 6(Very Frequently)) and perceptions (1(Strongly Disagree) to 7(Strongly Agree)) of mindfulness practices. Mann-Whiney U or Kruskal-Wallis tests with post-hoc pairwise comparisons were performed to assess differences in utilization (p<0.05). A related samples Wilcoxon-signed-rank test was performed to assess differences in participants' perceptions between self- and patient/client-care.
Overall, 86% (n=471) of respondents reported participating in some form of mindfulness practice with females (Median(IQR) 4(2-5) vs. 3(2-4);p<0.002), those not in a committed relationship (4(2-5) vs. 3(2-4);p=0.048), and those without children in the home (4(2-5) vs. 3(2-4);p=0.040) reporting the highest frequency of use for self-care. Females (4(2-4) vs. 3(2-4);p<0.001), those without children in the home (3(2-4) vs. 3(2-4);p=0.036), and those in emerging (4(2-4);p=0.003) or collegiate settings (3(2-4);p=0.006) most frequently incorporated mindfulness into patient/client-care. Overall, frequency of use for self-care was higher than for patient/client-care (4, 'occasionally' (2-4) vs. 3, 'rarely' (2-4);p<0.001). Mindfulness practices were perceived as more important for self- than patient/client-care (6(5-7) vs. 5(5-6); p<0.001).
Athletic trainers perceived mindfulness practices as more important for personal well-being and they utilized it, albeit occasionally, more for self-than for patient/client-care. Differences in gender, relationship status, children and setting were observed. Mindfulness-based interventions on athletic trainer well-being and patient-centered care and implementation barriers should be explored.
Background:
Arthroscopic hip surgery has risen 18-fold in the past decade; however, there is a dearth of clinical trials comparing surgery with nonoperative management.
Purpose:
To determine the ...comparative effectiveness of surgery and physical therapy for femoroacetabular impingement syndrome.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
Patients were recruited from a large military hospital after referral to the orthopaedic surgery clinic and were eligible for surgery. Of 104 eligible patients, 80 elected to participate, and the majority were active-duty service members (91.3%). No patients withdrew because of adverse events. The authors randomly selected patients to undergo either arthroscopic hip surgery (surgery group) or physical therapy (rehabilitation group). Patients in the rehabilitation group began a 12-session supervised clinic program within 3 weeks, and patients in the surgery group were scheduled for the next available surgery at a mean of 4 months after enrollment. Patient-reported outcomes of pain, disability, and perception of improvement over a 2-year period were collected. The primary outcome was the Hip Outcome Score (HOS; range, 0-100 lower scores indicating greater disability; 2 subscales: activities of daily living and sport). Secondary measures included the International Hip Outcome Tool (iHOT-33), Global Rating of Change (GRC), and return to work at 2 years. The primary analysis was on patients within their original randomization group.
Results:
Statistically significant improvements were seen in both groups on the HOS and iHOT-33, but the mean difference was not significant between the groups at 2 years (HOS activities of daily living, 3.8 95% CI, –6.0 to 13.6; HOS sport, 1.8 95% CI, –11.2 to 14.7; iHOT-33, 6.3 95% CI, –6.1 to 18.7). The median GRC across all patients was that they “felt about the same” (GRC = 0). Two patients assigned to the surgery group did not undergo surgery, and 28 patients in the rehabilitation group ended up undergoing surgery. A sensitivity analysis of “actual surgery” to “no surgery” did not change the outcome. Twenty (33.3%) patients who underwent surgery and 4 (33.3%) who did not undergo surgery were medically separated from military service at 2 years.
Conclusion:
There was no significant difference between the groups at 2 years. Most patients perceived little to no change in status at 2 years, and one-third of military patients were not medically fit for duty at 2 years. Limitations include a single hospital, a single surgeon, and a high rate of crossover.
Registration:
NCT01993615 (ClinicalTrials.gov identifier)
A new syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side-effect of vaccination against COVID-19. Cerebral venous thrombosis is the most common ...manifestation of this syndrome but, to our knowledge, has not previously been described in detail. We aimed to document the features of post-vaccination cerebral venous thrombosis with and without VITT and to assess whether VITT is associated with poorer outcomes.
For this multicentre cohort study, clinicians were asked to submit all cases in which COVID-19 vaccination preceded the onset of cerebral venous thrombosis, regardless of the type of vaccine, interval between vaccine and onset of cerebral venous thrombosis symptoms, or blood test results. We collected clinical characteristics, laboratory results (including the results of tests for anti-platelet factor 4 antibodies where available), and radiological features at hospital admission of patients with cerebral venous thrombosis after vaccination against COVID-19, with no exclusion criteria. We defined cerebral venous thrombosis cases as VITT-associated if the lowest platelet count recorded during admission was below 150 × 109 per L and, if the D-dimer was measured, the highest value recorded was greater than 2000 μg/L. We compared the VITT and non-VITT groups for the proportion of patients who had died or were dependent on others to help them with their activities of daily living (modified Rankin score 3–6) at the end of hospital admission (the primary outcome of the study). The VITT group were also compared with a large cohort of patients with cerebral venous thrombosis described in the International Study on Cerebral Vein and Dural Sinus Thrombosis.
Between April 1 and May 20, 2021, we received data on 99 patients from collaborators in 43 hospitals across the UK. Four patients were excluded because they did not have definitive evidence of cerebral venous thrombosis on imaging. Of the remaining 95 patients, 70 had VITT and 25 did not. The median age of the VITT group (47 years, IQR 32–55) was lower than in the non-VITT group (57 years; 41–62; p=0·0045). Patients with VITT-associated cerebral venous thrombosis had more intracranial veins thrombosed (median three, IQR 2–4) than non-VITT patients (two, 2–3; p=0·041) and more frequently had extracranial thrombosis (31 44% of 70 patients) compared with non-VITT patients (one 4% of 25 patients; p=0·0003). The primary outcome of death or dependency occurred more frequently in patients with VITT-associated cerebral venous thrombosis (33 47% of 70 patients) compared with the non-VITT control group (four 16% of 25 patients; p=0·0061). This adverse outcome was less frequent in patients with VITT who received non-heparin anticoagulants (18 36% of 50 patients) compared with those who did not (15 75% of 20 patients; p=0·0031), and in those who received intravenous immunoglobulin (22 40% of 55 patients) compared with those who did not (11 73% of 15 patients; p=0·022).
Cerebral venous thrombosis is more severe in the context of VITT. Non-heparin anticoagulants and immunoglobulin treatment might improve outcomes of VITT-associated cerebral venous thrombosis. Since existing criteria excluded some patients with otherwise typical VITT-associated cerebral venous thrombosis, we propose new diagnostic criteria that are more appropriate.
None.
ABSTRACTAlzheimer’s disease (AD) is a progressive neurodegenerative disease characterized by the accumulation of amyloid β in the form of extracellular plaques and by intracellular neurofibrillary ...tangles, with eventual neurodegeneration and dementia. There is currently no disease-modifying treatment though several symptomatic medications exist with modest benefit on cognition. Acetylcholinesterase inhibitors have a consistent benefit across all stages of dementia; their benefit in mild cognitive impairment and prodromal AD is unproven. Memantine has a smaller benefit on cognition overall which is limited to the moderate to severe stages, and the combination of a cholinesterase inhibitor and memantine may have additional efficacy. Evidence for the efficacy of vitamin E supplementation and medical foods is weak but might be considered in the context of cost, availability, and safety in individual patients. Apparently promising disease-modifying interventions, mostly addressing the amyloid cascade hypothesis of AD, have recently failed to demonstrate efficacy so novel approaches must be considered.
Objectives
To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.
Design
Ten‐year follow‐up of a randomized, controlled single‐blind trial ...(Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no‐contact control group.
Setting
Six U.S. cities.
Participants
A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently.
Intervention
Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training.
Measurements
Objectively measured cognitive abilities and self‐reported and performance‐based measures of everyday function.
Results
Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADLs) (memory: effect size = 0.48, 99% confidence interval (CI) = 0.12–0.84; reasoning: effect size = 0.38, 99% CI = 0.02–0.74; speed of processing: effect size = 0.36, 99% CI = 0.01–0.72). At a mean age of 82, approximately 60% of trained participants, versus 50% of controls (P < .05), were at or above their baseline level of self‐reported IADL function at 10 years. The reasoning and speed‐of‐processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size = 0.23, 99% CI = 0.09–0.38; speed of processing: effect size = 0.66, 99% CI = 0.43–0.88). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size = 0.21, 99% CI = 0.01–0.41) and the speed‐of‐processing intervention for speed‐of‐processing performance (effect size = 0.62, 99% CI = 0.31–0.93).
Conclusion
Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self‐reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.
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