Trajectory of Cognitive Decline After Incident Heart Failure Hospitalization: Findings From the REGARDS Study.

BACKGROUND: Cognitive impairment is common among adults with heart failure (HF) and associated with poor outcomes. However, less is known about the trajectory of cognitive decline after a first HF hospitalization. We examined the rate of cognitive decline among adults with incident HF hospitalization compared with those without HF hospitalization. METHODS AND RESULTS: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective longitudinal study of 23 894 participants aged ≥45 years free of HF at baseline. HF hospitalization was expert adjudicated. Changes in global cognitive function (primary outcome) were assessed with the Six-Item Screener (range, 0-6). Secondary outcomes included change in Word List Learning (range, 0-30), Word List Delayed Recall (WLD; range, 0-10), and Animal Fluency Test (range, 0+). Segmented linear mixed-effects regression models were used. Over 5 years, mean scores across all 4 cognitive tests declined for all participants regardless of HF status. Those with incident HF hospitalization experienced faster declines in the Six-Item Screener versus those who were HF free (difference, -0.031 [95% CI, -0.047 to -0.016]; P<0.001), a finding that persisted in fully adjusted models. Those with incident HF hospitalization did not experience faster declines in Word List Learning, Word List Delayed Recall, or Animal Fluency Test scores compared with those without HF hospitalization. Participants with hospitalization for HF with preserved, compared with reduced, ejection fraction had faster decline in Animal Fluency Test. CONCLUSIONS: Global cognitive decline occurred faster among adults with incident HF hospitalization compared with those who remained free of HF hospitalization. This pattern was not seen for the other cognitive domains.

Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study.

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient's Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen's d) ranging 0.13-0.41 for MAQ and 0.02-0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.

Correlates of subjective and objective everyday functioning in middle-aged and older adults with human immunodeficiency virus.

People with human immunodeficiency virus (HIV) (PWH) are at an increased risk for impaired everyday functioning and they may also experience poor awareness of their functional status. This study identified factors associated with (1) subjective and objective instrumental activities of daily living (IADLs) and (2) awareness of functional capacity in PWH. In this cross-sectional study, 236 PWH completed a neurobehavioral assessment, including self-report and performance-based measures of IADLs. Multiple regressions were performed to identify demographic, personality, and cognitive factors contributing to subjective and objective evaluation of everyday functioning, as well as discrepancy between self-report and performance-based measures of IADLs. Results indicated that increased depression was associated with worsened self-report of everyday functioning but not performance of IADLs. Cognitive function and age were associated with IADL performance. Most participants (58.1%) demonstrated a discrepancy between self-report and actual performance of IADLs. Worse processing speed was correlated with greater discrepancy. Inaccurate self-reporters had worse overall cognitive functioning and lower levels of personality traits, including openness, conscientiousness, and agreeableness. In conclusion, self-report and actual performance of IADLs in PWH is influenced by different factors. Self-report may be more affected by psychological variables, such as mood and personality, while actual performance is more sensitive to age and cognitive function.

Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.

OBJECTIVE: The present study evaluated changes in stress and loneliness among participants with obesity engaged in weight loss self-management in the United States (US) during COVID-19, and identified factors that may increase risk or protect against psychosocial distress during this time. DESIGN: Participants who were enrolled in a weight self-management program prior to the COVID-19 pandemic (N = 55, 91% female, 36% Caucasian, mean age = 49.8 years) completed an online survey about social, economic and health behaviour changes during COVID-19 and their relationship to changes in perceived stress and loneliness. MAIN OUTCOME MEASURES: Perceived Stress (PSS-4), Loneliness (PROMIS loneliness and social isolation questionnaire). RESULTS: Compared to pre-COVID assessments, stress and loneliness increased 40% two months into the COVID-19 pandemic-related shutdown. Higher body mass index (BMI) and social distancing were associated with increases in both loneliness and stress. Alcohol intake was associated with increased stress, and working from home was associated with increased loneliness. CONCLUSION: Individuals with obesity endorsed increased stress and loneliness during COVID-19, which may be exacerbated among those with a higher BMI and greater adherence to social distancing guidelines. Ongoing attention to psychosocial well-being among individuals with obesity will remain imperative both during the ongoing pandemic and beyond.

Smell status in functional movement disorders: New clues for diagnosis and underlying mechanisms.

OBJECTIVE: Functional movement disorders (FMDs) mimic a range of movements, neuropsychiatric and neurodegenerative disorders known to have smell dysfunction, which has been neglected in terms of its application to FMD. We aim to determine the smell status in FMD patients tested by a non-invasive, reliable and validated olfactory test. PATIENTS AND METHODS: We quantitatively assessed in thirty-five FMD patients their smell status and compared it to that of healthy age- and sex-matched controls, and of patients with Parkinson's disease (PD). All participants were administered the Brief Smell Identification Test (B-SIT), a standardized short version of the University of Pennsylvania Smell Identification Test (UPSIT). The Picture Identification Test (PIT), a visual test analogous in content and form to the UPSIT designed to control for non-olfactory cognitive confounds, was also administered. RESULTS: The B-SIT scores of the FMD patients were higher than those from PD patients [respective means (standard deviations: SDs) = FMD, 9.54 (1.57); PD, 4.64 (1.05), p < 0.01)] but similar to the smell scores from healthy controls [9.97 (1.77), p = 0.35]. Gender, age, time of disease onset, smoking status, and phenotypic expression did not influence the test scores. Fourteen FMD patients who mentioned having olfactory dysfunction before smell testing have their test results within normal range. PIT scores from patients and healthy controls were within normal range. CONCLUSIONS: These findings indicate that FMD patients have normal olfactory function. Olfactory testing may be helpful in identifying and differentiating FMD from other movement, neurodegenerative and neuropsychiatric diseases for which smell function is altered.

Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1-Week Multidisciplinary Rehabilitation Program.

BACKGROUND: Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies. OBJECTIVE: To assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success. DESIGN: Retrospective chart review. SETTING: University-affiliated rehabilitation institute. PATIENTS: Thirty-two consecutive FMD patients admitted to the MoRe program from July 2014-July 2016. INTERVENTION: Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions. MAIN OUTCOME MEASUREMENTS: Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program. RESULTS: Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes. CONCLUSIONS: The majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed. LEVEL OF EVIDENCE: III.

Maternal-Infant interaction in women with unipoloar and bipolar depression.

BACKGROUND: One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants. The purpose of this study was to describe maternal-infant interactions in women with bipolar depression at 12 months postpartum and to compare interactions to women with unipolar depression and a control group. METHODS: Using a descriptive design, maternal-infant interactions in women with bipolar disorder (n=40) were videotaped, coded, and analyzed for maternal sensitivity and maternal-infant reciprocity and compared to maternal-infant interaction in women with unipolar depression (n=50) and women without depression (n=40). RESULTS: Women with bipolar depression had lower scores on both maternal sensitivity and infant reciprocity, but differences were nonsignificant. CONCLUSIONS: This research is the first study to examine maternal-infant interaction in women with bipolar disorder, and important trends were noted. Future research should examine maternal-infant interaction at earlier time periods.