'It gets into your head as well as your body': The experiences of patients with cancer during oncology treatment with curative intent.

This study explored the psychosocial experiences of patients with cancer during the course of oncology treatment with curative intent. Our aim was to gather in-depth insights into the shared elements of oncology treatment across a range of cancer types. A total of 10 individuals undergoing oncology treatment participated in semi-structured interviews. Six themes were identified using interpretative phenomenological analysis: diminished well-being, perceived role changes in intimate relationships, heightened awareness of limited time, a new order of priorities, taking things as they come and development of trust in health professionals. These themes indicate relevant areas of patients' well-being, which might be enhanced through psychosocial support services.

Oncology healthcare professionals' perspectives on the psychosocial support needs of cancer patients during oncology treatment.

This study explored oncology healthcare professionals' perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients' acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients' experiences during oncology treatment.

Lack of effect of the apolipoprotein E ε4 genotype on cognition during healthy aging.

BACKGROUND: The apolipoprotein E (APOE) ε4 genotype is associated with an increased risk of Alzheimer's disease. In community surveys, older adults with this genotype have been found to have lower scores on neuropsychological tests than those who do not. It is possible that this is the consequence of subclinical changes in cognition in those persons who later develop dementia. The aim of this research was to determine whether the effect of APOE genotype on cognition would remain if those who subsequently became demented were retrospectively removed from the analysis of the baseline test data from a sample of healthy adults. METHOD: A sample of 241 nondemented persons over the age of 65 for whom APOE genotyping was available were administered a range of neuropsychological tests at baseline and were followed up 10 years later. RESULTS: Significant differences between the ε4-present and ε4-absent groups were found for the delayed recall trial of the Rey Auditory Verbal Learning Test and the Trail Making Test. When those participants known to have developed dementia during the follow-up period were excluded from the analysis of the baseline data these differences disappeared. A total of 113 nondemented survivors from the original sample were retested, and no difference was found in the rate of decline on any measure between the ε4-present and ε4-absent groups. CONCLUSIONS: It is likely that the reported effect of the ε4 APOE genotype on cognition is the consequence of the ε4-present group containing persons whose cognition is subtly affected by the early stages of a dementing process. It is also unlikely that the presence of the ε4 allele by itself leads to a significantly accelerated rate of cognitive decline in the nondemented elderly.

The dynamics of word retrieval in major depression.

OBJECTIVE: Impairment in the retrieval of specific episodes from autobiographical memory is commonly observed in major depression. However, it is unclear whether impairment in retrieval processes is a general characteristic of major depression or is confined to the recollection of personal memories. This study examined the time course of the retrieval of words from semantic memory. METHOD: A letter fluency test was administered to 65 inpatients with major depression and 50 healthy controls. A two-parameter model was fit to the decay curve representing the production of words over a 90-second period. One parameter, N, is an estimate of the total number of words that would be generated if the respondent was given unlimited time. The other, tau, is the average of the difference in time between the first word generated and each subsequent word. RESULTS: There was evidence of a deficit in the retrieval of words from long-term memory in depressed patients. The significant difference between groups suggested that even if given an extended period of time in which to respond to compensate for possible slowness, the depressed group would not retrieve as many words as the controls. The retrieval failure could not be attributed solely to cognitive slowing or the effects of antidepressant medication. CONCLUSIONS: The results extend findings of a deficit in the process of retrieving specific episodes from autobiographical memory and suggest that a generalised impairment in memory retrieval may be characteristic of major depression.

Internet-delivered cognitive behavioural therapy for depression: a feasibility open trial for older adults.

BACKGROUND: Depression is an important health issue amongst older adults. Internet-delivered cognitive behaviour therapy (iCBT) may help to reduce barriers and improve access to treatment, but few studies have examined its use with older adults. The present study evaluated the efficacy, acceptability and feasibility of a brief iCBT program, the Managing Your Mood Program, to treat depression amongst adults aged 60 years and older. METHOD: Using an open trial design, 20 participants with elevated symptoms of depression (Patient Health Questionnaire 9-item (PHQ-9) total scores ≥ 10) received access to five educational lessons and homework summaries, additional resources, a moderated discussion forum and weekly telephone or email contact from a clinical psychologist. Eighty percent of the sample met diagnostic criteria for a major depressive episode at pre-treatment. RESULTS: Completion rates and response rates were high, with 16/20 participants completing the five lessons within the 8 weeks, and post-treatment and 3-month follow-up data being collected from 17/20 participants. Participants improved significantly on the PHQ-9 and Geriatric Depression Scale (GDS), with large within-group effect sizes (Cohen's d) at follow-up of 1.41 and 2.04, respectively. The clinician spent a mean time of 73.75 minutes (SD = 36.10 minutes) contacting participants within the trial and the program was rated as highly acceptable by participants. CONCLUSIONS: The results are encouraging and support the potential value of iCBT in the treatment of depressive symptoms amongst older adults.

Differences in erythrocyte folate concentrations in older adults reached steady-state within one year in a two-year, controlled, 1 mg/d folate supplementation trial.

Daily supplementation with folate increases erythrocyte folate concentrations; however, the time to reach steady-state concentrations has not been empirically demonstrated. Previous predictions of time to steady state or time to 90% steady-state concentration, based on modeling changes in erythrocyte folate during short-term trials, range widely from 40 to 86 wk. We sought to determine the time to steady-state erythrocyte folate concentrations following the initiation of daily folate supplementation using data collected from a 2-y, double-blind, placebo-controlled, randomized trial involving 276 participants aged 65 y or older. The daily supplement contained 1 mg of folate. Erythrocyte folate concentrations were measured, using a microbiological assay, at baseline and at 6, 12, 18, and 24 mo. The mean plasma and erythrocyte folate concentrations in the folate-supplemented group were higher than in the placebo group at 6, 12, 18, and 24 mo (P < 0.001). Adjusted for baseline differences, the difference in erythrocyte folate concentrations between the folate and placebo group at 6 mo was 1.78 µmol/L (95% CI: 1.62-1.95 µmol/L). The difference increased significantly to 2.02 µmol/L (95% CI: 1.85-2.18 µmol/L) at 12 mo. This difference (between the folate and placebo groups) did not significantly change after a further year of folate supplementation; at 18 mo, it was 2.09 µmol/L (95% CI: 1.92-2.27 µmol/L) and at 24 mo it was 1.98 µmol/L (95% CI: 1.18-2.15 µmol/L). Twelve months of daily folate supplementation with 1 mg is sufficient time to cause erythrocyte folate concentrations to reach a new steady state.

Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: a feasibility trial.

This study examined the efficacy of an Internet-delivered cognitive-behavior therapy program developed for older adults. Twenty-two participants with elevated scores (≥8) on the Generalized Anxiety Disorder 7-Item Scale (GAD-7) participated in the course, which consisted of five lessons, homework tasks, additional resources, a moderated discussion forum, and weekly telephone support from a Clinical Psychologist. Ninety-five percent of the sample met diagnostic criteria for an anxiety disorder at pre-treatment. All participants completed the five lessons within the allotted eight weeks. Three-month follow-up data was collected from 95% of participants. Reductions in symptoms of anxiety and stress, with large within-group effect sizes (Cohen's d) were found on the GAD-7 (d=1.03) and the Depression, Anxiety and Stress Scales - 21 Items (d=0.98) at follow-up. Participants reported high levels of satisfaction with the program. These encouraging results provide tentative support for the online treatment of older adults with anxiety.

Neuropsychological changes and treatment response in severe depression.

BACKGROUND: Impaired neuropsychological function and differences in facial emotion processing are features of major depression. Some aspects of these functions may change during treatment and may be useful in assessing treatment response, even at an early stage of treatment. AIMS: To examine early and later changes in neuropsychological functioning and facial emotion processing as potential markers of treatment response in major depression. METHOD: In total, 68 newly admitted in-patients with a primary diagnosis of major depression and 50 healthy controls completed an assessment, including mood ratings, neuropsychological measures and facial emotion processing measures at three time points (baseline, 10-14 days and 6 weeks). RESULTS: Pervasive neuropsychological impairment was evident at baseline in patients with depression compared with healthy controls. During 6 weeks of treatment, only simple reaction time, verbal working memory and the recognition of angry facial expressions showed differential change in those whose depression responded to treatment compared with treatment non-responders in the depression group. None of the measures showed a significant difference between treatment responders and non-responders at 10-14 days. CONCLUSIONS: Despite significant impairment in neuropsychological functioning in the depression group, most measures failed to differentiate between treatment responders and non-responders at 10-14 days or at 6 weeks. Simple reaction time, verbal working memory and recognition of angry facial expressions may be useful in assessing response in severe depression but probably not at an early stage.

Reliable change indices for the ruff 2 and 7 selective attention test in older adults.

The assessment of suspected dementia often involves the analysis of change scores from neuropsychological tests administered on two occasions. Frequently, no information is available to allow the significance of a change to be evaluated. Our aim was to prepare data useful for estimating the statistical significance of retest changes for persons older than the age of 65 on the Ruff 2 and 7 Selective Attention Test, one of the few paper-and-pencil tests of attention available to the clinician. The sample tested was composed of 234 healthy adults taking part in a randomized double-blind trial of the effect on cognitive performance of lowering homocysteine using dietary supplements, during which no treatment effects were detected. The test was found to be sensitive to the effects of aging and was well tolerated by our sample of older adults. Retest reliability for the speed of visual search for digit targets (2 and 7) under both the same category (other digits) and different category (letter) distracter conditions was high, and the practice effects during a 12-month period were substantial. Test-retest data with a 1-year interval were used to estimate reliability coefficients and to calculate Reliable Change indices useful for evaluating persons with suspected dementia. The rate of decline in search speed as a function of age was the same for both distraction conditions, suggesting that older persons used a controlled serial search process for targets in both conditions of this test.

The long-term effects of traumatic brain injury on the coordinative function of the central executive.

The objective of this study was to compare the coordinative function of the central executive of working memory in matched groups of controls and persons with traumatic brain injury (TBI) with long-term impairments in functioning, using a dual-task paradigm. The dual-task procedure required participants to complete digit span and tracing tasks separately and then together to produce a change index that reflects loss of productivity on the dual trial. A TBI group and a matched group of controls were compared on this task and on ratings of social competency and neuropsychological tests. The two groups were found to differ in social competence, in the number of dysexecutive symptoms, and on dual-task performance, but not on any other measures of cognitive ability. Poor performance on the dual task was found only in persons with initial very severe TBI. There was no evidence that the group difference on the dual task was the consequence of increased task difficulty level, distribution of attention, or other within-task biases. Performance on the dual task was correlated with dysexecutive symptoms and social competency (in particular interpersonal and cognitive competence), but not with other tests of executive functioning. The findings suggest that deficits in the coordinative function persist in long-term survivors of TBI after other deficits in executive functioning may have resolved and are associated with lower ratings of current interpersonal competence.

Autobiographical memory in long-term survivors of severe traumatic brain injury.

The aim of this study was to examine the ability of persons who had sustained a severe traumatic brain injury (TBI) at least 6 years previously to recall memories associated with famous names. Each of 19 persons with TBI was matched with a healthy control of the same age, gender, and occupational-educational background. A list of 115 names of famous people was compiled, 25 of whom came to prominence in each decade from 1960 to 1999, and 15 in the period 2000 to 2005. Participants were first asked whether they recognized each name as being of a famous person and to state the reason for the individual's fame. For those names they correctly identified, they were asked to recall a memory associated with the person; each memory produced was categorized as a context-specific memory or a general memory. The ability to recognize and identify famous names was well preserved in the TBI group; however, they showed a consistent impairment in the ability to recall specific episodic memories acquired before and after the date of the TBI. This inability to generate personal and specific information is likely to have an impact on the ability of the person with TBI to participate in interpersonal interactions and problem solve in complex social situations.

Monitoring of cognitive effects during a course of electroconvulsive therapy: recommendations for clinical practice.

Cognitive impairment is the most important side effect of electroconvulsive therapy (ECT), and if detected early, modifications to treatment can be made to reduce the severity of it. Various guidelines suggest that regular, detailed monitoring of cognitive function should be routine during ECT. We hypothesize that such monitoring would be able to detect cognitive effects of ECT at an early stage but that this would require careful selection of tests to be both sensitive and practical in routine clinical practice. We review evidence regarding the sensitivity of various cognitive tests to the effects of ECT. From this, we suggest a battery and testing schedule which may be both practical and useful in early detection of the cognitive effects of ECT.

Evaluation of social problem solving after traumatic brain injury.

A trial of a procedure for the assessment of social problem-solving skills (the Social Problem-Solving Test; SPST), designed to assess 18 component skills distributed across five domains of functioning, is reported. A group of 48 persons with traumatic brain injury (TBI) observed seven videotaped scenarios involving a complex social interaction between two people. They were first questioned about their interpretation of the event, and how the actors should respond, and then asked to complete a role-play in which they were required to implement a strategy to reach a specified goal. Their performance on each of the components was compared with the results from 20 aged-matched family controls. The TBI participants were most impaired in their ability to perform in a socially skilled manner in the role-play and evaluate this performance, and their orientation towards resolving the problem was characterised by greater anxiety and evaluation of difficulty. The results support the usefulness of procedures designed to identify the specific deficits in social problem solving of persons in post-acute rehabilitation.

The effects of old age and distraction on the assessment of prospective memory in a simulated naturalistic environment.

BACKGROUND: The ability to remember to complete future intentions, prospective memory, often begins to fail in old age. The aim of the present study was to examine the sensitivity of a computer-based procedure using naturalistic stimuli to age-related increases in forgetting under conditions of high (increased visual and auditory noise) or low distraction. METHODS: Participants were tested in a virtual shopping precinct constructed from linked photographs, sounds, and video segments. Groups of 32 older and younger persons completed two concurrent memory tasks while moving along the street. In one task, participants were given errands to complete with an accessible checklist, in the other, they were required to remember to respond to three different targets that appeared repeatedly. RESULTS: The results confirmed previous findings that older adults have difficulty remembering future intentions, even on a self-paced task using naturalistic stimuli, and showed that this was accentuated in noisy environments. CONCLUSIONS: Older persons have particular difficulty remembering in noisy environments, and results from testing in the clinic may underestimate the practical memory problems experienced by older adults with mild cognitive impairments. The findings provide encouragement for the construction of computer-generated environments to measure functional deficits in cognition.

Reliable Change Index scores for persons over the age of 65 tested on alternate forms of the Rey AVLT.

An issue that often confronts the clinician referred an elderly person for neuropsychological assessment is how to interpret the significance of changes in test scores over time. In this report, data useful for estimating the statistical significance of changes on the Rey Auditory Verbal Learning Test (AVLT) are presented. The sample tested comprised 253 healthy persons aged 65 and over taking part in a randomized double-blind trial of the effect on cognitive performance of lowering homocysteine using dietary supplements. Results were based on the full sample because of the absence of any treatment effects. Test-retest data with a 1-year interval were used to estimate reliability coefficients and to calculate reliable change indices. The magnitude of a change necessary for a deterioration or improvement in scores at the two-tailed 90% confidence interval is given for the full sample, and persons above and below the age of 75.

Speed of word retrieval in postconcussion syndrome.

Speed of information processing in persons with postconcussion syndrome (PCS) was examined using word fluency tasks. Twenty patients with PCS and twenty controls matched for age, gender, and occupation were given two word fluency tasks, and the speed of word generation was measured. Response latencies were analyzed to determine whether slowed retrieval or degradation of words in semantic memory was responsible for problems with word retrieval after traumatic brain injury. The PCS group recalled fewer words, had significantly longer interresponse times, and took significantly longer to generate their first word than the controls. There was no evidence that either structure loss or slowness in word retrieval from semantic memory could account for the word fluency deficits. Rather, the findings suggest that the primary cause of word retrieval difficulties in patients with PCS is a generalized slowness of cognitive processing.

Regression equations for predicting scores of persons over 65 on the rey auditory verbal learning test, the mini-mental state examination, the trail making test and semantic fluency measures.

OBJECTIVES: Scores on neuropsychological tests are often used to detect abnormal changes in cognition in older persons. Accordingly, it is important to have normative data that allow the abnormality of a test score to be determined precisely and accurately. Regression equations that estimate an expected score based on demographic or premorbid factors can be an efficient method of making normative comparisons. Our aim was to compute regression equations with age, gender and estimated premorbid IQ as predictors of scores on the Rey Auditory Verbal Learning Test (AVLT), the Trail Making Test (TMT), Mini-mental State Examination (MMSE) and measures of semantic fluency. DESIGN: All measures were administered to a group of 272 healthy older persons aged between 65 and 90 during the pre-treatment phase of a study evaluating the effect of nutritional supplements on cognition. Premorbid IQ was estimated using the National Ault Reading Test (NART). Stepwise multiple regression procedures were used to determine the weights to be applied to the predictor variables. RESULTS: Age and premorbid IQ were found to be significantly correlated with all test variables; gender correlated significantly with most scores. Regression equations based on the 3 predictor variables explained between 10% and 30% of the variance of the range of test scores. The use of these equations in clinical practice was illustrated. CONCLUSION: The significant correlations between the predictor variables and test scores justified computing a set of equations for use in interpreting data from older persons. The abnormality of the difference between predicted and obtained scores provides a convenient index of an individual's current level of neuropsychological functioning.

A controlled trial of homocysteine lowering and cognitive performance.

BACKGROUND: The results of observational studies suggest that plasma homocysteine concentrations are inversely related to cognitive function in older people. Our objective was to test the hypothesis that lowering the plasma homocysteine concentration improves cognitive function in healthy older people. METHODS: We conducted a two-year, double-blind, placebo-controlled, randomized clinical trial involving 276 healthy participants, 65 years of age or older, with plasma homocysteine concentrations of at least 13 micromol per liter. Homocysteine-lowering treatment was a daily supplement containing folate (1000 microg) and vitamins B12 (500 microg) and B6 (10 mg). Tests of cognition were conducted at baseline and after one and two years of treatment. Treatment effects were adjusted for baseline values, sex, and education. RESULTS: On average, during the course of the study, the plasma homocysteine concentration was 4.36 micromol per liter (95 percent confidence interval, 3.81 to 4.91 micromol per liter) lower in the vitamin group than in the placebo group (P<0.001). Overall, there were no significant differences between the vitamin and placebo groups in the scores on tests of cognition. CONCLUSIONS: The results of this trial do not support the hypothesis that homocysteine lowering with B vitamins improves cognitive performance. (Australian Clinical Trials registry number, ACTR NO 12605000030673.).

The effects of distraction on prospective remembering following traumatic brain injury assessed in a simulated naturalistic environment.

The aim of this investigation was to assess deficits in prospective remembering following chronic traumatic brain injuries (TBI), under conditions of high and low distraction. We constructed a virtual shopping precinct from photographs, sounds, and video segments linked together. The street was divided into halves, a low distraction zone and a high distraction zone (with increased visual and auditory noise). Twenty persons with TBI (7 severe, 7 very severe, 6 extremely severe) and 20 matched controls completed ongoing and prospective memory tasks while "walking" along the street. In the ongoing task, participants were given ten errands to complete with a checklist accessible at any time. The prospective component required responding to three targets that appeared repeatedly. As predicted, the TBI group performed both the ongoing and the prospective components of the street task poorly compared with the controls and was more affected by distractions. The results suggest that the real-life deficits in memory skills reported by persons with TBI may become more apparent when remembering engages executive processes and that computer simulations can be used to construct sensitive measures of practical memory abilities.

The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering.

PRIMARY OBJECTIVE: The aim of the present study was to assess prospective memory (PM) with a video-based task using naturalistic stimuli, in a group with long-term disabilities resulting from traumatic brain injury (TBI). The specific focus of the research was on comparing the accuracy of the TBI and control groups' estimates of successful completion of the prospective memory tasks. RESEARCH DESIGN: A group of 25 persons with TBI and 20 matched controls were compared on the video-based test of prospective remembering, on a test of retrospective memory (the Logical Memory sub-test of the Wechsler Memory Scale) and tests of executive dysfunction. Correlations between the neuropsychological and PM test scores were calculated and an item analysis of the PM test was undertaken. PROCEDURES: For the PM test, participants were given a scenario involving a robbery, and a list of tasks to be completed in a nearby city centre. The instructions were given twice and on the second occasion they were asked to rate the likelihood of remembering each item. They then watched a videotaped segment showing the perspective of a person first driving and then walking through an unfamiliar city. Their task was to recall each instruction when a relevant cue appeared. OUTCOMES AND RESULTS: The TBI group ratings of likelihood of recalling items were entirely equivalent to those made by the controls. On the PM test, however, their performance was significantly reduced. The performance of the TBI group on the PM test was correlated with scores on the Logical Memory and verbal fluency measures. CONCLUSIONS: The results showed that, although the TBI group performed more poorly on the PM task, their expectations about how much they would remember were comparable to those of the controls. The findings suggest that persons with TBI may have unrealistic expectations about how much they will remember in a novel situation. Awareness and acceptance of cognitive changes after TBI can be a significant issue for rehabilitation.