Dysesthesia and Depression in Undiagnosed Alzheimer's Disease.

Dysesthesia is an abnormal sensation typically described as tingling, burning, or itching. Dysesthesia may occur in the presence or absence of causative dermatologic or medical pathology. Sensory abnormalities have been well documented in patients suffering from Alzheimer's disease (AD), though reported abnormalities typically affect the olfactory, visual, and auditory systems. Research describing dysesthetic symptoms in AD is scarce. Major depressive disorder (MDD) is another phenomenon commonly associated with AD, though depressive symptoms are frequently masked by cognitive deficits. Less attention has been given to the reverse of this relationship, in which MDD masks the symptoms of AD. Here, we present a case of undiagnosed AD in a geriatric patient presenting with primary complaints of depression and dysesthesia. We then discuss the pathophysiology of dysesthesia, MDD, and AD, as well as how these entities may interact in a single patient. Lastly, we emphasize the importance of thorough history-taking and multi-specialty collaboration in the care of older adults.

Unraveling the impact of time-dependent perioperative variables on 30-day readmission after coronary artery bypass surgery.

OBJECTIVES: Readmission within 30 days of discharge after coronary artery bypass grafting is a measure of quality and a driver of cost in health care. Traditional predictive models use time-independent variables. We developed a new model to predict time to readmission after coronary artery bypass grafting using both time-independent and time-dependent preoperative and perioperative data. METHODS: Adults surviving to discharge after isolated coronary artery bypass grafting at a multi-hospital academic health system from January 2017 to September 2018 were included in this study. Two distinct data sources were used: the institutional cardiac surgical database and the clinical data warehouse, which provided more granular data points for each patient. Patients were divided into training and validation sets in an 80:20 ratio. We evaluated 82 potential risk factors using Cox survival regression and machine learning techniques. The area under the receiver operating characteristic curve was used to estimate model predictive accuracy. RESULTS: We trained the model with 21 variables that scored a P value of less than .05 in the univariable analysis. The multivariable model determined 16 significant risk factors, and 6 of them were time-dependent. These included preoperative hemoglobin a1c level, preoperative creatinine, preoperative hematocrit, intraoperative hemoglobin, postoperative creatinine, and postoperative hemoglobin. Area under the receiver operating characteristic values were 0.906 and 0.868 for training and validation sets, respectively. CONCLUSIONS: Time-dependent perioperative variables in an isolated coronary artery bypass grafting cohort provided better predictive ability to a readmission model. This study was unique in the inclusion of time-dependent covariates in the predictive model for readmission after discharge after coronary artery bypass grafting.

The future is now: prospective temporal self-appraisals among defensive pessimists and optimists.

Three studies found that prospective temporal self-appraisals can be part of defensive pessimists' strategy; they felt closer to equally distant negative than positive futures. In Study 1, defensive pessimists felt closer to future failures and reported more negative affect than those considering success. In Study 2, when manipulated negative futures were close, defensive pessimists felt bad and performed well; results suggested that viewing negative futures as close may be part of their natural strategy. Study 3 found that prospective self-appraisals influenced performances through felt preparation. Optimists did not use prospective self-appraisals (Study 1) and their performances were unaffected by manipulated temporal distance (Studies 2 and 3). Discussion centers on prospective self-appraisals and multiple strategies of defensive pessimists.

All our troubles seem so far away: temporal pattern to accessible alternatives and retrospective team appraisals.

Three studies tested the hypothesis that thoughts about alternatives become increasingly accessible over time, leading poor outcomes to feel subjectively farther away and less inevitable. This subjective temporal distance bias was obtained even though actual time since poor and good outcomes was identical. In Study 1, participants who recalled distant poor team outcomes thought of alternatives easily and outcomes felt farther away and less inevitable. Thoughts about outcomes were most easily accessible after good outcomes, which felt closer and more inevitable. In Study 2, with measures obtained immediately or at a later time on a negotiation task, changes over time occurred primarily for poor team outcomes. In Study 3, team performance on an investment task indicated it is whether alternatives are thought of easily, not thought content, that produces this effect. Discussion centers on temporal appraisals, other temporal biases, and teams.