Neurocognitive Dysfunction and predictors in non-CNS cancer patients: Rationale and methods for the neuro-oncology research at a South African academic hospital.

Background: The focus on central nervous system (CNS) malignancies has overshadowed scant but substantial research that suggests non-central nervous cancer patients experience cancer-related cognitive impairment (CRCI), which affects higher-order brain function and influences their quality of life. Despite such evidence of the occurrence of CRCI among non-CNS cancer patients, the factors associated with the CRCIs remain a highly debated issue with discrepancies noted. Whether non-CNS cancer itself can affect the brain independent of cancer treatment is an important question to unpack. This necessitates further research, particularly in the sub-Saharan region where the evidence is limited. Methods: This study aims to assess the effect of chemotherapy-associated cognitive and affective changes in non-CNS cancer patients. A non-experimental, time-series, correlational design will be used, in which a battery of computerized neuropsychological tests will be administered, including the e-MoCA, the CNS Vital Signs, the Patient Health Questionnaire-4, the Center for Epidemiologic Studies Depression Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment of Cancer Therapy-Fatigue, and the Semi-structured Interview Schedule. Descriptive and inferential statistical analysis will be conducted, as well as NVivo thematic analysis of the qualitative data. The scope of the neurocognitive issues and risk factors that may be present in cancer patients and survivors in a developing environment could be determined by this study. Implications: The study is expected to extend research on the extent at which cancer and cancer treatments are associated with neurocognitive changes among non-CNS cancer patients and their impact on their quality of life in the local context. The results are expected to inform treatment providers to develop treatment guidelines tailored for individuals diagnosed with cancer and who have received cancer treatment, as well as individualized psychosocial interventions aimed at addressing psychological challenges associated with quality of life among cancer survivors.

Cognitive and neural mechanisms underlying false memories: misinformation, distortion or erroneous configuration?

Errors can affect our memory, yet even when there are gaps in our recollection of events, memory often serves us fairly well. Memory formation involves at least three different sub-processes, that are regulated by an underlying neural structure. From a cognitive neuropsychological perspective, a complex process of encoding, consolidating, and retrieval is involved in remembering an event, and it might be hindered by one's emotional state, physiological response to the event itself, and misinformation. As a result, it is very likely that one may struggle to remember specifics of what happened which can increase our susceptibility to the formation of false memories. This has major implications for everyday functioning, as in the case when you mistakenly remember you took your pills when you never did, or where errors have led to false accusations about trauma or abuse, and wrongful convictions of crimes. Memories sometimes contain biases and inaccuracies that prevent them from accurately recalling events. The review will provide an updated overview of current research advances on the cognitive and neural mechanisms underlying inaccurate, distorted, or false memories.

Protocol for a systematic review of the effects of gardening physical activity on neuroplasticity and cognitive function.

Background: The beneficial effects of gardening as a form of physical activity have garnered growing interest in recent years. Existing research suggests that physical activity enhances brain function through modifying synaptic plasticity, growth factor synthesis, and neurogenesis. Gardening physical activity is a promising, cost-effective, non-invasive intervention that can easily be augmented in the rehabilitation of neurodegenerative conditions. However, there is still insufficient literature. This protocol describes a systematic review to be conducted of scientific literature on the benefits of gardening as a physical activity that can promote neuroplasticity and improve cognitive function. This information can be useful as an intervention for persons who experience cognitive impairment brought on by cancer and chemotherapy in developing countries such as South Africa where there is real need to access cognitive rehabilitation. Methods and analysis: The systematic review strategy will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic literature database search of MEDLINE (PubMed), Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science will be carried out using medical search terms (MeSH), with English as the only permitted language, during the time period of January 2010 to December 2022. We will search for and review studies on how gardening as a physical activity impacts neuroplasticity and cognition. Two reviewers will read the titles, and abstracts and full text of the studies identified during the search to exclude records that do not meet the inclusion criteria. Data will then be extracted from the remaining studies. Any differences in opinion arising between the reviewers during the procedure will be resolved through discussion with a third reviewer. The Joanna Briggs Institute (JBI) Critical Appraisal Tool checklist will be utilized independently by two reviewers to evaluate the possibility of bias. The included articles will be subjected to narrative synthesis, with the results being presented in a thematic manner. Ethics and dissemination: There are no need for ethical approval because no patient data will be gathered. The results will be disseminated through an open-access peer-reviewed indexed journal, presented scientific meetings.PROSPERO registration number: CRD42023394493.

Correlation between Body Mass Index (BMI) and Performance on the Montreal Cognitive Assessment (MoCA) in a Cohort of Adult Women in South Africa.

OBJECTIVE: Recent evidence suggests that obesity is increasing worldwide and may negatively impact neurocognition. Local studies on the association of weight status with neurocognitive function are sparse. This study is aimed at examining the association between body mass index (BMI) and neurocognitive functioning scores in a cohort of adult women. METHODS: A convenience sample of 175 women aged 18 to 59 years (28.03 ± 8.87) recruited in a community-based quantitative study completed the Montreal Cognitive Assessment (MoCA). The BMI metric was used to measure body fat based on weight and height and was stratified as high BMI (overweight or obese) or low BMI (normal weight). The Beck Depression Inventory (BDI) was used to assess depression. Pearson's correlation analysis and the student's t-test analysis were performed. RESULTS: We observed a significant inverse association between BMI and performance on MoCA (r(173) = -0.32, p < 0.001). Performance on subtest of attention, memory, constructive abstraction, and executive functions significantly and inversely correlated with BMI. Significantly lower scores on the MoCA were found in women with a high BMI compared to women with a low BMI (23 ± 4 vs. 26 ± 3), t(173) = 4.12, p < 0.0001). CONCLUSIONS: BMI and MoCA were inversely associated on both global and domain-specific neurocognitive test of attention, memory, and executive function; key neurocognitive control; and regulatory functions underlying behavior and decision-making. The findings provide a rationale for further research into the long-term effects of BMI on neurocognition.

Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients. AIM: The current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa. SETTING: The patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa. METHODS: In a randomised, quantitative, time-based series study, 30 female patients aged 21-60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T0, T1, T2). RESULTS: The results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T0) to completion (T2) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001. CONCLUSION: This study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients. CONTRIBUTION: The context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.

Psychosocial Aspects During the First Wave of COVID-19 Infection in South Africa.

Background: In South Africa, as in many countries, the nationwide spread of COVID-19 caused a public health emergency that resulted in the government implementing necessary restrictive measures such as the nationwide lockdown as a way of containing the pandemic. Such restrictive measure, while necessary, can disrupt many aspects of people's lives resulting in unprecedented psychosocial distress. Aim: The present study aims to describe the psychosocial health and situational factors associated with the novel coronavirus (COVID-19) in South Africa during the first wave of infection. Methods: This cross-sectional survey, recruited a total of 203 participants through convenience sampling via online platforms-WhatsApp, Facebook, emails, etc.-during COVID-19 lockdown in the country. Through the snowball technique, participants from across South Africa completed the online survey that assessed socio-demographic information, risk perception, history of mental health, COVID-19-related stress, and fears during the lockdown (first wave). Results: The majority of the participants who completed the survey were young, Black African, and female. Participants reported feelings of stress and anxiety (61.2%); stress about finances (39.5%); and feelings of sadness, anger, and/or frustration (31.6%) during the lockdown. Females compared to males were more likely to perceive COVID-19 as a risk to their household, X ( 20 ) 2 = 45,844, p < 0.001 and community, X ( 20 ) 2 = 40,047, p = 0.005. COVID-19 differentially impacted the mental health of participants with and without mental health diagnosis, X ( 4 ) 2 = 16.596, p = 0.002. Participants with a prior mental health diagnosis reported significant extra stress during lockdown (p < 0.05). Conclusion: The findings may be of significance to assist in the development of targeted psychosocial interventions to help people during and after the pandemic.

Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa.

Despite the undisputed benefits of combination antiretroviral therapy (cART), perinatally acquired human immunodeficiency virus (PHIV) children on treatment often present with a spectrum of neurological deficits known as HIV-associated neurocognitive impairment. Even higher CD4 cell count does not seem to prevent the development of neurocognitive impairment in children with PHIV. While CD4 cell count has shown to have the greatest prognostic value, its association with neurocognitive abilities remains to be clarified. This study aimed at determining the correlation between plasma CD4+ lymphocyte and neurocognitive function in children with PHIV on cART. In total, 152 purposively recruited hospital-based sample of children with PHIV on cART, aged 3 years to 7 years 6 months (mean age, 63.13 months), underwent neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition. Immunological status of each child was based on the plasma CD4+ lymphocyte levels. The mean CD4+ lymphocyte cell count at the time of neurocognitive assessment was 1,259.85 cells/mm3 (mean range, 139-2,717 cells/mm3), with significant age difference on CD4+ lymphocyte count levels [F (2, 149) = 13.58, p = 0.000]. CD4+ lymphocyte counts was significantly correlated with subdomains of neurocognitive function scores of task that measures working memory, processing speed, and perceptual reasoning. Global cognitive ability (Full Scale Intellectual Quotient) had no significant association with immunological status of the children. The findings support an association between immunological status of PHIV infection and executive function task. These neurocognitive faculties are critical for learning, school readiness and success in early childhood, and ultimately treatment adherence in adolescence. The need for early identification of neurodevelopment deficits in children, even when on cART, is crucial because early psychosocial and neurorehabilitative interventions can lead to better outcome for children with PHIV.

The Association of Home Environment and Caregiver Factors With Neurocognitive Function in Pre-school- and School-Aged Perinatally Acquired HIV-Positive Children on cART in South Africa.

Background: Children with perinatally acquired HIV in low resource settings are at risk for neurocognitive impairments not only due to the direct effects of HIV on the brain and in utero ART exposure but also due to factors associated with their environment. Thus, the aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities. Materials and Methods: The Wechsler Preschool and Primary Scale of Intelligence-III was administered to assess the neurocognitive functioning of 152 purposively sampled perinatally acquired HIV-positive children on cART, aged 3 years to 7 years 6 months (mean age 63.13 months). The primary caregivers (n = 152) completed the Home Screening Questionnaire to assess the quality of the home-environment of the children. Results :The results showed that unfavorable environment, caregiver type, and quality of stimulation in the home were negatively associated with the neurocognitive development of perinatally HIV-positive children on cART. Most of the HIV-positive children (n = 95) were under the care of an extended relative. Older HIV-positive boys, reared by biological mothers, who also lived in suboptimal and poor quality home-environments had poorer neurocognitive function when compared to HIV-positive children reared by non-biological (extended relatives) caregivers, [F (2,149) = 14.42, p < 0.001]. Conclusion: The child's early home environment is associated with general neurocognitive development, which highlights the need for early psychosocial interventions that can promote better cognitive outcomes among children living with HIV.

Psychosocial Challenges Associated with Caregiving in the Context of Pediatric HIV in Rural Eastern Cape.

BACKGROUND: While survival among human immunodeficiency virus (HIV)-infected children has increased due to combination antiretroviral therapy, many children remain vulnerable to the adverse effects of poverty and family disruptions as a result of the loss of one or both biological parents to acquired immunodeficiency syndrome. The aim of this qualitative study was to develop an understanding of the psychosocial challenges experienced by caregivers caring for a child with perinatally acquired HIV. METHOD: A series of interviews were conducted with 44 HIV-positive and -negative primary caregivers of HIV+ children. Data were analyzed through interpretative phenomenological analysis using NVivo8 software. FINDINGS: The findings suggest that caregiving is compromised by inadequate, financial resources and single-headed households where mainly grandparents assume the role of primary caregivers of HIV+ children. HIV remains a stigmatized illness that weakens support networks, as well as timeous and free accessibility to healthcare. This has a negative impact on the mental health of caregivers, with the majority of women in the study displaying symptoms of depression. CONCLUSION: The findings highlight the contextual challenges of caregiving in the presence of HIV, which impacts negatively on social ecology of the families. The need for interventions to enhance resilience and coping in families confronted with HIV is indicated.

Use of crystal methamphetamine among male adolescents in Cape Town, South Africa: Caregivers' experiences.

BACKGROUND: Against the background that crystal methamphetamine (colloquially known as "tik") is extensively used by the emerging working class Coloured youth in Cape Town, South Africa, this exploratory qualitative study was conducted to explore the experience of mothers whose children use methamphetamine. METHODS: The researchers conducted one-to-one semi-structured in-depth interviews with sixteen (16) purposively selected caregivers (mothers) whose sons use methamphetamine. Interviews were recorded and simultaneously translated and transcribed. Thematic analysis was used to identify themes related to the experiences of caregivers of youth with methamphetamine problems. RESULTS: Findings showed that youth misbehaviour provided a context that led to feelings of shame and embarrassment. Participants also experienced personal challenges which included emotional problems, fear and self-blame. Participants also expressed family disruptions and financial drain as adverse experiences as a results of their sons' misbehaviour. CONCLUSION: The study results highlight the psychosocial challenges for caregivers of children who use methamphetamine. These findings underscore the need for effort to be directed at the development of formal support interventions for mothers of youth who are troubled with addiction.

Psychological functioning among vertically infected HIV-positive children and their primary caregivers.

The current study sought to explore the association between primary caregiver depressive symptoms and the psychological functioning in children vertically infected with human immunodeficiency virus (HIV) living in Eastern Cape, South Africa. A cross-sectional data were collected using the Beck Depression Inventory and Strength and Difficulties Questionnaire in a sample of 152 caregiver/child dyads. The results revealed that poorer psychological functioning in children was significantly associated with depressive symptoms in caregivers. This relationship existed whether or not the child was raised by a biological or non-biological caregiver as well as for both genders. Younger children's psychological functioning was more negatively influenced than that of older children raised by a caregiver with depressive symptoms. In the context of a large treatment gap for common mental disorders in South Africa, there is a need for interventions to address maternal mental health in families infected and affected by the HIV/AIDS pandemic as a mental health promotion strategy given that HIV-infected children are a particularly vulnerable population for poor mental and behavioural health outcomes.