Everyday functioning among older adults with subjective cognitive decline: a scoping review.

PURPOSE: Older adults with subjective cognitive decline (SCD) experience cognitive difficulties without objectively measurable cognitive impairments but which may affect their everyday functioning. However, everyday functioning in this population has not yet been characterized. We sought to describe the empirical literature on the everyday functioning of community-dwelling older adults with SCD, their recruitment methods, and the measurements used. METHODS: A scoping review was conducted for primary research articles including at least one measure of everyday functioning. Retrieved records were independently screened. Data were extracted then analyzed using descriptive statistics and summative content analysis. RESULTS: 6544 studies were screened; 21 studies were included. All were observational analytic studies. Most compared an SCD group with a group of healthy control (47.6%), mild cognitive impairment (71.5%), and/or dementia (33.3%). Subjective cognition was measured via interview (28.6%) or clinical question(s) (14.3%). Normal cognition was determined by a wide variety of cognitive tests. The most studied everyday functioning domain was instrumental activities of daily living (90.5%). Most studies used questionnaires (81.0%), and measured ability to do an everyday life task (76.2%). CONCLUSIONS: More research is needed on everyday functioning other than IADL, with greater focus on measures that consider an individual's real-life participation.

These is heterogeneity in the operational definitions and reporting of subjective cognitive decline in the empirical literature.Assessment of everyday functioning in the empirical literature on people with subjective cognitive decline is focused on the individual's ability to do instrumental activities of daily living.There is a need for consensus on: (1) standards to assess subjective and objective cognition in determining subjective cognitive decline; and (2) best practice in assessing changes in everyday functioning in people with subjective cognitive decline.Clinical and research assessment of older adults with subjective cognitive decline should be expanded to functional domains other than instrumental activities of daily living.

Inclusion of People With Peripheral Artery Disease in Cardiac Rehabilitation Programs: A Pan-Canadian Survey.

PURPOSE: To determine the proportion of cardiac rehabilitation programs (CRPs) in Canada that accept referrals for individuals with peripheral artery disease (PAD), eligibility criteria, and barriers/facilitators to inclusion. METHODS: CRPs across Canada were sent a web-based questionnaire. RESULTS: Of 180 questionnaires sent, 98 CRP managers representing 114 CRPs (62.6% of CRPs in Canada) responded. Of respondents, 81.6% accepted referrals for people with PAD; however 44.6% reported that ≤10 patients participated in the previous calendar year; two CRPs had no participants. Of CRPs accepting PAD, 23.7% accepted patients only with coexisting cardiac disease, 68.4% accepted post-lower limb amputees with prosthesis and 53.9% without prosthesis (non-ambulatory). Further, 32.2% did not provide formal/informal PAD-specific education to patients and only 14.3% provided education to staff regarding PAD in the previous 3 years. Three (3) numerical pain scales were used to guide exercise intensity. Within these scales up to four pain thresholds were used. Most frequently cited barriers to participation included lack of referrals (61.6%), and programs being at capacity (59.3%). Frequently cited facilitators were providing information on benefits of CRPs to referral sources (88.3%) and patients (88.3%), providing PAD-specific education to staff (85.5%), and PAD-toolkits for prescribing aerobic/resistance training (81.5%, both). CONCLUSION: Most CRPs accept individuals with PAD, however, few are referred. Inclusion of PAD with and without cardiac disease, collaboration between referral source and CRPs to improve the referral process, and PAD-specific education for staff and information/brochures on benefits of CRPs for patients and referral sources should improve participation and delivery of secondary prevention strategies.

Evaluation of the United States Preventative Services Task Force Screening Guidelines for Breast Cancer in a Hispanic Underserved Population.

There are several major breast cancer guidelines that have been promoted by various health organizations. Arrowhead Regional Medical Center (ARMC) Family Health Centers adopted the current guideline by the U.S. Preventive Services Task Force (USPSTF), which recommends breast cancer screening with mammograms starting at age 50 for low-risk women. This study evaluates the effectiveness of this screening guideline in the selected Hispanic underserved population in San Bernardino, California (CA). This is a retrospective chart review study. Data were reviewed for any female with the confirmed diagnosis of breast cancer at the Family Health Centers between 2009 and 2018. The current study showed that 25% (40 of 160) of women diagnosed with breast cancer in this selected population were less than 50 years old. This finding suggests that high vigilance in breast cancer screening may be necessary in this population.

Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene.

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication resulting from neuroleptic drug therapy. Presentation of NMS can vary, and diagnosis relies primarily upon medical history and symptomatology. Due to the potential delay in diagnosis, emergency physicians should remain vigilant in recognizing the symptoms of NMS and be prepared to initiate immediate treatment following diagnosis. Dantrolene, which has been used for spasticity and malignant hyperthermia, has been reported as a potential treatment for NMS and led to off-label use for NMS. We report two cases of NMS induced by antipsychotic monotherapy for which dantrolene was administered.

Intense training overcomes effects of the Val66Met BDNF polymorphism on short-term plasticity.

The val(66)met polymorphism in the brain-derived neurotrophic factor (BDNF) gene impacts activity-dependent secretion of BDNF and modifies short-term cortical plasticity. The current study examined whether sustained training overcomes polymorphism effects on short-term plasticity and also examined polymorphism effects on long-term plasticity. Twenty-four subjects completed a 12-day protocol of daily training on a marble navigation task that required intense use of the first dorsal interosseus (FDI) muscle. In parallel, transcranial magnetic stimulation (TMS) mapping was used to assess serial measures of short-term cortical motor map plasticity, plus long-term cortical motor map plasticity, of the cortical FDI map. On Day 1, subjects with the polymorphism did not show significant short-term cortical motor map plasticity over 30 min of FDI activity, but subjects without the polymorphism did. After 5 days of intense training, a genotype-based difference in short-term cortical motor map plasticity was no longer found, as both groups showed short-term plasticity across the 30 min of FDI activity. Also, across 12 days of training, map area decreased significantly, in a manner that did not vary in relation to genotype. Training of sufficient intensity and duration overcomes effects that the val(66)met polymorphism has on short-term cortical motor map plasticity. The polymorphism-related differences seen with short-term plasticity are not found with long-term cortical motor map plasticity.

Dual antennular chemosensory pathways mediate odor-associative learning and odor discrimination in the Caribbean spiny lobster Panulirus argus.

Chemosensory neurons in the antennular flagella of lobsters mediate long-range responses to chemicals. These neurons are part of two parallel chemosensory pathways with different peripheral and central components. Aesthetasc sensilla on the lateral flagella are innervated by chemosensory neurons that project to the olfactory lobes. A diversity of other 'non-aesthetasc' sensilla on both lateral and medial flagella are innervated by mechano- and chemosensory neurons, and most of these non-aesthetasc neurons project to the lateral antennular neuropils. We investigated the roles of these two pathways in odor-associative learning and odor discrimination by selectively removing either aesthetasc or non-aesthetasc sensilla from the spiny lobster Panulirus argus. Lobsters lacking both aesthetasc and non-aesthetasc antennular sensilla show very reduced or no odor-mediated searching behavior. We associatively conditioned lobsters using two paradigms: aversive conditioning with generalization testing (which reveals the similarity in the lobsters' perception of odorants) and discrimination conditioning (which reveals the lobsters' ability to discriminate odorants). Sham-control intact lobsters performed these tasks well, as did lobsters lacking either aesthetascs or non-aesthetasc setae. There was a strong but statistically non-significant trend that lobsters lacking either aesthetascs or non-aesthetasc setae generalized more between complex odor mixtures than did intact lobsters. After aversive conditioning with generalization testing, aesthetasc-ablated lobsters had more difficulty discriminating among the most closely related complex mixtures than did intact or non-aesthetasc-ablated lobsters. However, after discrimination conditioning, aesthetasc-ablated lobsters were as proficient as intact animals in discriminating highly similar mixtures. These results indicate overlap and redundancy in the function of these two chemosensory pathways in odor-associative learning and odor discrimination, but these pathways also complement each other to enable better discrimination. This study presents the first evidence for a role of non-aesthetasc chemosensory neurons in complex odor-mediated behaviors such as learning and discrimination.