Impact of depression on the perception of fatigue and information processing speed in a cohort of multiple sclerosis patients.

BACKGROUND: Information processing speed is commonly impaired in people with multiple sclerosis (PwMS). However, depression and fatigue can affect the cognitive profile of patients: fatigue has a negative impact from the disease's earliest stage and a reduced information processing speed is often associated with higher levels of depression. Therefore, the aim of this study was to investigate the correlations between information processing speed and physical fatigue in a cohort of Italian PwMS from a single center, considering the effect of depression. METHODS: Two hundred (W = 128; mean age = 39.83 years; SD = 11.86) PwMS, from the Bari University Hospital, underwent testing for processing speed (Symbol Digit Modalities Test [SDMT]), fatigue level (Fatigue Severity Scale [FSS]), and depression (Beck's Depression Inventory [BDI]). RESULTS: Statistically significant correlations emerged between SDMT and FSS, SDMT and BDI, FSS and BDI. Mediation analyses revealed that while physical fatigue had no significant direct negative effect on information processing speed (z=-0.891; p > 0.05), depression predicted the relationship between fatigue and information processing speed (z=-2.181; p < 0.05). CONCLUSION: Our findings showed that cognitive performance at SDMT was not affected by patients' perceived level of physical fatigue, but by depression. The presence of a high BDI score mediates the physical fatigue on cognitive performance impact.

Use of technology to sustain mobility in older people with cognitive impairment and dementia: a scoping review.

PURPOSE: This paper provides a review of studies that evaluated technology devices to sustain various forms of mobility in older people with cognitive impairment or dementia and mobility problems (e.g., inability to ambulate or difficulties to orient with consequent failures to reach relevant destinations). METHODS: A literature search was performed for English language articles indexed in PubMed, PsycINFO, and Web of Science. This search was then supplemented with an ancestral and forward search. The search covered the period ranging between January 2010 and October 2020. RESULTS: Twenty-seven articles were included in the review. They were divided into four groups according to whether they aimed to promote (a) supported ambulation, (b) use of safe power wheelchair, (c) ambulation guided by orientation cues, and (d) ambulation with GPS-based assistance. The studies were coded in terms of the objective pursued, technology used, participants involved, strategies applied to assess the technology, and outcome reported. CONCLUSION: A variety of technology devices are available to address the mobility problems of older people with cognitive impairment or dementia. The devices' accessibility and usability differ widely. Data on their impact are still largely preliminary and new systematic research is needed.IMPLICATIONS FOR REHABILITATIONA variety of mobility problems may afflict older people with cognitive impairment or dementia and curtail their opportunities to freely move indoor or outdoor.Technology devices have been developed to (a) promote forms of supported ambulation, (b) facilitate safe use of power wheelchairs, (c) deliver orientation/navigation cues, and (d) ensure tracking and possible assistance.The technology devices differ in terms of accessibility and affordability, with some of them readily available and others at a developmental stage.Data on the effectiveness of the various technology devices in reducing the impact of the mobility problems are still largely preliminary and new systematic research is needed.

Pre-surgery supportive and goal-oriented strategies are associated with lower post-surgery perceived distress in women diagnosed with breast cancer.

BACKGROUND: Psycho-oncology literature pointed out that individual health outcomes may depend on patients' propensity to adopt approach or, conversely, avoidant coping strategies. Nevertheless, coping factors associated with postoperative distress remain unclear, unfolding the lack of tailored procedures to help breast cancer patients manage the psychological burden of scheduled surgery. In view of this, the present study aimed at investigating: 1. pre-/post-surgery distress variations occurring among women diagnosed with breast cancer; 2. the predictivity of approach and avoidant coping strategies and factors in affecting post-surgery perceived distress. METHODS: N = 150 patients (mean age = 59.37; SD = ± 13.23) scheduled for breast cancer surgery were administered a screening protocol consisting of the Distress Thermometer (DT) and the Brief-COPE. The DT was used to monitor patients' distress levels before and after surgery (± 7 days), whereas the Brief-COPE was adopted only preoperatively to evaluate patients' coping responses to the forthcoming surgical intervention. Non-parametric tests allowed for the detection of pre-/post-surgery variations in patients' perceived distress. Factor analysis involved the extraction and rotation of principal components derived from the Brief-COPE strategies. The predictivity of such coping factors was investigated through multiple regression (Backward Elimination). RESULTS: The Wilcoxon Signed-Rank Test yielded a significant variation in DT mean scores (TW = -5,68 < -zα/2 = -1,96; p < .001) indicative of lower perceived distress following surgery. The four coping factors extracted and Varimax-rotated were, respectively: 1. cognitive processing (i.e., planning + acceptance + active coping + positive reframing); 2. support provision (i.e., instrumental + emotional support); 3. emotion-oriented detachment (i.e., self-blame + behavioral disengagement + humor + denial); 4. goal-oriented detachment (i.e., self-distraction). Among these factors, support provision (B = .458; ß = - .174; t = - 2.03; p = .045), encompassing two approach coping strategies, and goal-oriented detachment (B = .446; ß = - .176; t = - 2.06; p = .042), consisting of one avoidant strategy, were strongly related to post-surgery distress reduction. CONCLUSION: The present investigation revealed that the pre-surgery adoption of supportive and goal-oriented strategies led to postoperative distress reduction among breast cancer patients. These findings highlight the importance of timely psychosocial screening and proactive interventions in order to improve patients' recovery and prognosis.

Smartphone technology for fostering goal-directed ambulation and object use in people with moderate Alzheimer's disease.

Purpose: This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently).Method: The study was carried out according to a non-concurrent multiple baseline design across participants. Two measures were recorded, that is, the number of target responses performed correctly (with each target response consisting of reaching a destination and putting away an object), and the number of observation intervals with indices of enjoyment/appreciation (e.g., smiles and positive comments). During baseline, the participants were provided with a walker and three objects that were to be transported to and put away at specific destinations. During the intervention, the participants also had the smartphone-based technology that provided them with instructions about the destinations and objects, praise, and preferred stimulation.Results: During baseline, the mean frequency of correct target responses was virtually zero. The mean frequency of intervals with indices of enjoyment/appreciation ranged from zero to close to one. During the intervention, the mean frequencies for the two measures were slightly below three and just over three, respectively. The maximum frequencies possible were three and four, respectively.Conclusions: A smartphone-based intervention may be suitable to foster goal-directed, walker-assisted ambulation and object use as well as enjoyment/appreciation in participants like those involved in this study.IMPLICATIONS FOR REHABILITATIONA smartphone-based intervention may be used to promote goal-directed, walker-assisted ambulation and object use as well as indices of enjoyment/appreciation in persons with moderate Alzheimer disease.The technology for such intervention might involve (a) a smartphone with Android operating system, light sensor, Bluetooth v4.0, and MacroDroid, (b) Bluetooth headphones or earpieces, and (c) battery-powered light sources.The technology may provide the participants with instructions about the destinations to reach and the objects to put away at those destinations, and with praise and brief periods of preferred stimulation at the target destinations.The technology may be considered easy to access, friendly for the participants, and suitable for use by staff within daily contexts.

Assisting persons with advanced amyotrophic lateral sclerosis in their leisure engagement and communication needs with a basic technology-aided program.

BACKGROUND: Eye-tracking communication devices and brain-computer interfaces are the two resources available to help people with advanced amyotrophic lateral sclerosis (ALS) avoid isolation and passivity. OBJECTIVE: This study was aimed at assessing a technology-aided program (i.e., a third possible resource) for five patients with advanced ALS who needed support for communication and leisure activities. METHODS: The participants were exposed to baseline and intervention conditions. The technology-aided program, which was used during the intervention, (a) included the communication and leisure options that each participant considered important for him or her (e.g., music, videos, statements/requests, and text messaging) and (b) allowed the participant to access those options with minimal responses (e.g., finger movement or eyelid closure) monitored via microswitches. RESULTS: The participants started leisure and communication engagement independently only during the intervention (i.e., when the program was used). The mean percentages of session time spent in those forms of engagement were between about 60 and 80. Preference checks and brief interviews indicated that participants and families liked the program. CONCLUSIONS: The program might be viewed as an additional approach/resource for patients with advanced ALS.

Effects of response-related music stimulation versus general music stimulation on positive participation of patients with Alzheimer's disease.

OBJECTIVE: Assessing the effects of response-related music stimulation versus general (response-unrelated) music stimulation on positive participation of 11 new patients with Alzheimer's disease. METHOD: The patients were functioning in the severe and low-moderate ranges of the disease. Positive participation included behaviors such as, singing or rhythmic movements and smiles. Both music conditions relied on the display of music/song videos on a computer screen. In the response-related (active) condition, the patients used a simple hand response and a microswitch to determine music stimulation inputs. In the general (unrelated/passive) condition, music stimulation was automatically presented throughout the sessions. RESULTS: Data showed that six of the 11 patients had higher levels of positive participation in the response-related stimulation condition. The remaining five patients did not have differences between the two conditions. CONCLUSION: Based on this evidence and previous findings, one might consider the use of the active condition beneficial for daily programs.

Reorientation deficits are associated with amnestic mild cognitive impairment.

BACKGROUND/AIMS: Spatial memory can be impaired in amnestic mild cognitive impairment (aMCI). The present study investigates categorical spatial memory deficits using a virtual navigation-based reorientation task. METHODS: Twenty-eight amnestic single domain and 23 amnestic multiple domain patients were compared with 53 healthy elderly controls on the performance of the virtual reorientation test (VReoT). RESULTS: The reorientation performance of participants in both aMCI groups was significantly worse than that of controls suggesting that VReoT detects spatial memory deficits. No significant difference emerged between the 2 groups of patients. A subsequent receiver-operating characteristic analysis showed that a score of 8 had a sensitivity of 80.4% and a specificity of 94.3% (area under the curve = 0.90). CONCLUSION: The VReoT seemed to be accurate in differentiating patients with aMCI from controls and may represent an evaluation supplement for spatial memory deficits in prodromal stages of Alzheimer's dementia.

Midbrain SERT in degenerative parkinsonisms: a 123I-FP-CIT SPECT study.

SPECT imaging is widely used for the differential diagnosis of degenerative parkinsonisms by exploiting the high affinitiy of the radiotracer (123)I-FP-CIT for the dopamine transporter. Reduced levels of DAT are found in Parkinson Disease (PD), Dementia with Lewy Bodies (DLB), and Progressive Supranuclear Palsy (PSP) compared to in Essential Tremor (ET) and Healthy Controls (HC). However, the extent of the neurodegenerative process may extend beyond nigrostriatal system. We have exploited the affinity of the same radiotracer (123)I-FP-CIT for the serotonin transporter to investigate SERT levels in the midbrain of patients with PD, DLB, PSP, and ET compared to HC. Using MRI images as anatomical templates for midbrain uptake quantification, we found a mild decrease in SERT levels in PD compared to ET and HC, with marked inter-individual variability; on the other side, PSP and DLB patients displayed markedly reduced to undetectable levels of SERT, respectively. These findings show that the neurodegenerative process affects serotoninergic neurons in parkinsonisms, with much more severe involvement in DLB than in PD patients, despite the comparable loss of striatal DAT. SERT-dependent (123)I-FP-CIT uptake may allow a more comprehensive assessment of neurochemical disturbances in degenerative parkinsonisms and may have a value for differential diagnosis.

Severity of neuropsychiatric symptoms and dopamine transporter levels in dementia with Lewy bodies: a 123I-FP-CIT SPECT study.

Neuropsychiatric symptoms are frequent in dementia with Lewy bodies (DLB). Dopamine transporter (DAT) imaging with (123)I-labeled ligand N-delta-(fluoropropyl)-2 beta-carbomethoxy-3beta-(4-iodophenyl)tropene ((123)I-FP-CIT), which reliably measures midbrain dopaminergic dysfunction, has provided important evidence on the neurobiological substrate of some of these symptoms including apathy and depression. However, little is known on DAT levels and other distressing symptoms such as delusions and hallucinations. Therefore, (123)I-FP-CIT imaging was performed in 18 well-characterized patients with DLB, and striatal DAT levels were correlated with the frequency/severity ratings of several neuropsychiatric symptoms. A wide range of neuropsychiatric symptoms could be observed in the sample. Significant correlations were observed between decreased striatal DAT levels and visual hallucinations. Although there were no correlations between striatal DAT levels and other neuropsychiatric symptoms, when considering the putamen and the caudate nucleus separately, delusions, depression, and apathy were inversely correlated to decreased caudate DAT levels. The seresults provide intriguing evidence on the involvement of the mesocortical dopaminergic pathways in neuropsychiatric symptoms in DLB.