A randomized control trial of a behavioral intervention for older adults with subjective cognitive complaints that combines cognitive rehabilitation strategies and lifestyle modifications.

This study examined the effectiveness of a 10-week cognitive rehabilitation and lifestyle modifying intervention that integrated compensation strategies, engagement in brain activities, and improving everyday function. The trial was registered with ClinicalTrials.gov (NCT03549078). Older adults with subjective cognitive concerns and normal performance on a cognitive screener were randomized into the intervention (n = 28) or waitlist control (n = 29) groups. The total sample comprised 57 individuals (age, mean = 74.8, SD = 6.5), mostly female (80.4% of the total sample), and well educated (education years: mean = 15.9, SD = 2.1). Outcome measures were completed at baseline, and immediately and 3- and 6-months post-intervention. Intervention participants reported significant improvements in aspects of everyday functioning and select compensation strategies and brain health activities. Increased compensation strategy use was maintained at 6-month follow up. This intervention has benefits for improving everyday functioning and increasing engagement with compensation strategies and brain health activities.

A Combined Treatment Approach to Support Everyday Function and Promote Brain Health in Older Adults: A Pilot Study.

Objective: Subtle changes in functional abilities are an early indicator of cognitive impairment. Early intervention may be key to prolonging independence. This study describes the development and program evaluation of an intervention designed to (1) bolster the use of compensation strategies that support everyday executive and memory functioning and (2) utilize these strategies to promote engagement in brain health activities.Method: Older adults (n = 35) with subjective cognitive complaints completed an eight-week group program targeting compensation strategies (e.g., calendars) and brain health activities (e.g., physical exercise). Participants completed outcome measures at first, last, and 3 month follow-up sessions.Results: Compensation strategy use can be successfully taught to and implemented by older adults, and increasing engagement in brain health behaviors is possible, although particular lifestyle changes are challenging to implement.Conclusion: Findings support the use of interventions aimed at increased engagement in compensation strategies to aid everyday memory and executive functioning.Clinical Implications: Early intervention may help to promote prolonged functional independence.

Compensation Strategies in Older Adults: Association With Cognition and Everyday Function.

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.

Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment.

OBJECTIVES: To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI. DESIGN: As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing. SETTING: Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center. PARTICIPANTS: Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324). MEASUREMENTS: Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains. RESULTS: Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3-3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4-3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations. CONCLUSION: Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults.

Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort.

INTRODUCTION: Investigation of the conversion rates from normal cognition (NC) to mild cognitive impairment (MCI) is important, as effective early intervention could potentially prevent or substantially delay the onset of dementia. However, reported conversion rates differ across studies and recruitment source. Our study examined predictors of conversion from NC to MCI in a racially and ethnically diverse sample drawn both from community and clinic recruitment sources. METHODS: Rates and predictors of conversion were assessed in an ongoing prospective longitudinal study at University of California, Davis, Alzheimer's Disease Center from 2000 to 2015. Participants (n = 254) were recruited through a clinic (5%) and community sample (95%). They were clinically confirmed as cognitively normal at baseline and followed up to seven years. Recruitment source, demographic factors (age, gender, race/ethnicity, year of education, APOE ε4 positive), cognitive measures (SENAS test scores), functional assessments (CDR sum of boxes), and neuroimaging measures (total brain volume, total hippocampal volume, white hyperintensity volume) were assessed as predictors of conversion from cognitively normal to mild cognitive impairment using proportional hazards models. RESULTS: Of 254 participants, 62 (11 clinic, 51 community) progressed to MCI. The clinic-based sample showed an annual conversion rate of 30% (95% CI 17%-54%) per person-year, whereas the community-based sample showed a conversion rate of 5% (95% CI 3%-6%) per person-year. Risk factors for conversion include clinic-based recruitment, being older, lower executive function and worse functional assessment at baseline, and smaller total brain volume. DISCUSSION: Older adults who sought out a clinical evaluation, even when they are found to have normal cognition, have increased risk of subsequent development of MCI. Results are consistent with other studies showing subjective cognitive complaints are a risk for future cognitive impairment, but extend such findings to show that those who seek evaluation for their complaints are at particularly high risk. Moreover, these individuals have subtle, but significant differences in functional and cognitive abilities that, in the presence of concerns and evidence of atrophy on by brain imaging, warrant continued clinical follow-up. These risk factors could also be used as stratification variables for dementia prevention clinical trial design.

Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury.

AIM: To examine complications associated with the use of therapeutic temperature modulation (mild hypothermia and normothermia) in patients with severe traumatic brain injury (TBI). METHODS: One hundred and fourteen charts were reviewed. Inclusion criteria were: severe TBI with Glasgow Coma Scale (GCS) < 9, intensive care unit (ICU) stay > 24 h and non-penetrating TBI. Patients were divided into two cohorts: the treatment group received therapeutic temperature modulation (TTM) with continuous surface cooling and indwelling bladder temperature probes. The control group received standard treatment with intermittent acetaminophen for fever. Information regarding complications during the time in the ICU was collected as follows: Pneumonia was identified using a combination of clinical and laboratory data. Pulmonary embolism, pneumothorax and deep venous thrombosis were identified based on imaging results. Cardiac arrhythmias and renal failure were extracted from the clinical documentation. acute respiratory distress syndrome and acute lung injury were determined based on chest imaging and arterial blood gas results. A logistic regression was conducted to predict hospital mortality and a multiple regression was used to assess number and type of clinical complications. RESULTS: One hundred and fourteen patients were included in the analysis (mean age = 41.4, SD = 19.1, 93 males), admitted to the Jackson Memorial Hospital Neuroscience ICU and Ryder Trauma Center (mean GCS = 4.67, range 3-9), were identified and included in the analysis. Method of injury included motor vehicle accident (n = 29), motor cycle crash (n = 220), blunt head trauma (n = 212), fall (n = 229), pedestrian hit by car (n = 216), and gunshot wound to the head (n = 27). Ethnicity was primarily Caucasian (n = 260), as well as Hispanic (n = 227) and African American (n = 223); four patients had unknown ethnicity. Patients received either TTM (43) or standard therapy (71). Within the TTM group eight patients were treated with normothermia after TBI and 35 patients were treated with hypothermia. A logistic regression predicting in hospital mortality with age, GCS, and TM demonstrated that GCS (Beta = 0.572, P < 0.01) and age (Beta = -0.029) but not temperature modulation (Beta = 0.797, ns) were significant predictors of in-hospital mortality [χ(2) (3) = 22.27, P < 0.01] A multiple regression predicting number of complications demonstrated that receiving TTM was the main contributor and was associated with a higher number of pulmonary complications (t = -3.425, P = 0.001). CONCLUSION: Exposure to TTM is associated with an increase in pulmonary complications. These findings support more attention to these complications in studies of TTM in TBI patients.

Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability.

Examining personality and psychopathological symptoms among unaccompanied refugee minors (URMs), we measured intra-individual dimensions (repression and correlates thereof) usually associated with resilience. Forty-one URMs completed the Weinberger Adjustment Inventory (WAI), assessing personality, and the Youth Self-Report (YSR), describing current symptoms. URMs endorsed high levels of Repressive Defensiveness, Denial of Distress, and Restraint; unexpectedly, URMs reported high Distress and reduced Happiness (WAI, p's < 0.05). Although YSR symptoms were below clinical cut points, there were notable correlations between Distress and Attention Problems, Self-destructive, and Aggressive Behavior (all on the YSR), correcting for multiple comparisons (p's < 0.004). URMs exposed to non-normative stressors reported non-symptomatic outcomes, and high levels of personality dimensions correlating with resilience. However, URMs also endorsed high Distress and low Happiness, calling their resilience into question. Positive correlations between WAI Distress and YSR symptom subscales suggest that URMs harbor vulnerabilities of clinical and forensic significance.

External and internal factors influencing happiness in elite collegiate athletes.

When under conditions of high demand and allostatic load, are happiness and satisfaction in four domains (family, friends, academics, recreation) influenced more by external or internal factors? Do student-athletes who lead exceedingly complicated lives report happiness as a function of athletic achievement or internal disposition? Stanford student-athletes (N=140) were studied with a standardized questionnaire which examined internal factors ((1) locus of control, (2) mindfulness, (3) self-restraint, and (4) self-esteem) to see whether they better account for happiness than external factors (playing time, scholarship). As predicted, internal factors were more powerful correlates of happiness when holding constant demographics. Regression models differed for different aspects of happiness, but the main postulated result of internal versus external was maintained throughout. These findings have implications for how well athletes cope with adversity which, in turn, could shed light on the development of traits that may provide a buffer against adversity and build resilience.