Cognitive and brain reserve predict decline in adverse driving behaviors among cognitively normal older adults.

Daily driving is a multi-faceted, real-world, behavioral measure of cognitive functioning requiring multiple cognitive domains working synergistically to complete this instrumental activity of daily living. As the global population of older adult continues to grow, motor vehicle crashes become more frequent among this demographic. Cognitive reserve (CR) is the brain's adaptability or functional robustness despite damage, while brain reserve (BR) refers the structural, neuroanatomical resources. This study examined whether CR and BR predicted changes in adverse driving behaviors in cognitively normal older adults. Cognitively normal older adults (Clinical Dementia Rating 0) were enrolled from longitudinal studies at the Knight Alzheimer's Disease Research Center at Washington University. Participants (n = 186) were ≥65 years of age, required to have Magnetic Resonance Imaging (MRI) data, neuropsychological testing data, and at least one full year of naturalistic driving data prior to the beginning of COVID-19 lockdown in the United States (March 2020) as measured by Driving Real World In-vehicle Evaluation System (DRIVES). Findings suggest numerous changes in driving behaviors over time were predicted by increased hippocampal and whole brain atrophy, as well as lower CR scores as proxied by the Wide Range Achievement Test 4. These changes indicate that those with lower BR and CR are more likely to reduce their driving exposure and limit trips as they age and may be more likely to avoid highways where speeding and aggressive maneuvers frequently occur.

Prehospital triage of patients suffering severe dyspnoea using N-terminal pro-brain natriuretic peptide, the PreBNP trial: a randomised controlled clinical trial.

PURPOSE: The purpose of this study was to examine whether the addition of brain natriuretic peptide measurement to the routine diagnostic work-up by prehospital critical care team physicians improves triage in patients with severe dyspnoea. METHODS: Prehospital critical care team physicians randomly assigned patients older than 18 years with severe dyspnoea to routine diagnostic work-up or diagnostic work-up with incorporated point-of-care N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement. The primary endpoint was the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology. RESULTS: A total of 747 patients were randomly assigned and 711 patients consented to participate, 350 were randomly assigned to the NT-proBNP group and 361 to the routine work-up group. NT-proBNP was measured in 90% (315/350) of patients in the NT-proBNP group and in 19% (70/361) of patients in the routine work-up group. There was no difference in the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology between the NT-proBNP group and the routine work-up group (75% vs. 69%, P=0.22) in the intention-to-treat analysis. Sensitivity analysis according to the de facto diagnostics performed showed results consistent with this. No differences in hospital length of stay, intensive care unit admission rates or mortality between the NT-proBNP group and the routine work-up group were observed. CONCLUSION: Routine supplementary point-of-care measurement of NT-proBNP in patients with severe dyspnoea did not improve triage of patients with dyspnoea primarily caused by heart disease. ClinicalTrials.gov identifier NCT02050282.

[Improvement of angina, quality of life, and working capacity after enhanced external counterpulsation]. / Bedring i angina, livskvalitet og arbejdskapacitet efter enhanced external counterpulsation.

This case report describes a 43 year-old woman who had had 15 hospital admissions in six years due to chest pain. Repeated coronary angiography showed no significant stenoses, but myocardial scintigraphy revealed reversible ischaemia. In spite of optimal medical treatment, she was in Canadian Cardiovascular Society (CCS) class 3 with a poor quality of life (QoL). After a course of enhanced external counterpulsation the CCS class was reduced to 1, and QoL was significantly improved and remained high for the following three years, resulting in only one hospital admission due to chest pain. The case illustrates that EECP is an efficient therapy for angina pectoris in patients, who are not amenable for invasive procedures.

Prinzmetal's variant angina is effectively treated with enhanced external counterpulsation.

A 57-year-old woman suffering from severe Prinzmetal's angina was treated with a 7-week course of enhanced external counterpulsation (EECP). After completing EECP the angina intensity was reduced from CCS class IV to class I, quality of life was increased and medication was significantly reduced. The number of hospitalisations due to chest pain was reduced from 81 in the two years before EECP to 2 in the two years after EECP. To our knowledge, this is the first report demonstrating the effect of EECP on Printzmetal's angina.