Pain in the Context of Virtual Neuropsychological Assessment of Older Adults.

OBJECTIVE: Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. METHOD: The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. RESULTS: Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. CONCLUSIONS: Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.

Validation of the Burden Transfer Inventory-abbreviated and examination across veterinary medicine positions and settings in the United States.

Background: Burden transfer, when veterinary client caregiver burden underlies stressful encounters with providers, elevates risk for occupational distress in veterinary medicine. To date, burden transfer has been primarily examined in veterinarians working in general practice, using methods that are time consuming. The current work validates an abbreviated Burden Transfer Inventory (BTI-A) and explores burden transfer across positions of employment and veterinary settings. Methods: Participants completed online measures of burden transfer, stress and burnout. A BTI-A with items representing each BTI domain was created with an initial validation sample (n = 1151 veterinarians). Confirmatory psychometric analyses were conducted in a cross-validation sample (n = 440 veterinarians and support staff), followed by exploration of the BTI and BTI-A across veterinary settings and position of employment. Results: The BTI-A correlated with the full-length BTI (r = 0.89-0.96) shows good internal consistency (α = 0.72-0.88) and 1-month test-retest reliability (r = 0.69-0.74). The BTI-A correlated significantly (p < 0.001) with stress and burnout. Exploratory comparisons suggested group differences including greater reactivity in general compared to specialty referral/emergency practice (p = 0.02). Conclusion: The BTI-A can be used in place of the original measure when brevity is important. Use of the BTI-A may help guide allied mental health professionals in providing support for wellbeing in veterinary healthcare team members.

The Moderating Role of Pain Self-efficacy in the Relationships Among Caregiver Burden and Care Recipient Pain and Neuropsychiatric Symptoms in a Sample of Persons With Dementia.

Past research suggests relationships among dementia caregiver burden and care recipient pain and neuropsychiatric symptoms, but no prior work has examined the influence of pain self-efficacy on these associations. A sample of 502 dementia caregivers completed an online protocol assessing caregiver burden and care recipient neuropsychiatric symptoms, presence of pain, and pain self-efficacy in this cross-sectional, observational study. The indirect effect of neuropsychiatric symptoms on the relationship between pain and caregiver burden was significant. Pain self-efficacy significantly moderated the effect of pain on neuropsychiatric symptoms (P=0.04) and the direct association between pain and caregiver burden (P=0.004), but did not moderate the indirect effect. Future research should explore how pain influences neuropsychiatric symptoms, and whether improvement in pain self-efficacy in dementia care recipients attenuates the influence of pain on neuropsychiatric symptoms and caregiver burden in other samples.

Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery.

BACKGROUND: Bariatric surgery candidates exhibit cognitive impairment on neuropsychological testing and these deficits are associated with reduced post-operative weight loss. However, less is known about the prevalence of cognitive function in older adults that pursue surgery, despite being at higher risk for cognitive dysfunction. OBJECTIVE: To examine the prevalence and profile of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in elderly bariatric patients. We hypothesized that increased body mass index (BMI) and higher number of medications would be linked to lower MoCA score, and that men would evidence poorer MoCA scores than women given past work showing that men presenting for bariatric surgery have more medical comorbidities. METHODS: Data was retrospectively extracted from electronic medical records. Patients 65 and older who completed pre-surgical MoCA assessment and bariatric surgery were included in the study (n = 55). RESULTS: Twenty-two percent of patients scored below cutoff for impairment on the MoCA. MoCA total score was negatively correlated with BMI and number of medications pre-surgery. There was a significant effect for gender, with men outperforming women. CONCLUSIONS: The current findings suggest that cognitive impairment is common in older adults presenting for bariatric surgery. Future studies are needed to determine the most appropriate methods for detecting cognitive dysfunction in this high-risk population.

Associations among measures of awareness of cognitive deficits in dementia.

BACKGROUND: Awareness of deficits is a complex phenomenon. In this study, we examined the relationships among various measures of awareness of cognitive deficits in dementia, and investigated the unique association between clinician ratings and alternative approaches to assessing awareness. METHODS: Participants included 108 patients with very mild (n = 50) or mild (n = 58) dementia. Awareness of cognitive difficulties was assessed by clinician ratings, informant ratings, patients' reports of cognitive difficulties, discrepancies between patients' and informants' reports of cognitive difficulties, and patients' perceptions of performance on neuropsychological tests. Correlational analyses were used to assess associations among these measures of awareness, and ordinal logistic regression was used to examine the unique relationship between clinician ratings of awareness and the other approaches. RESULTS: All measures of awareness were significantly correlated with one another. Coefficients ranged from 0.26 to -0.64. Patients categorized as unaware by either clinicians or informants reported fewer cognitive difficulties. Of the awareness measures evaluated, clinician ratings had the strongest correlation with measures of global cognition. In the regression analysis, only informant global ratings and patients' reports of cognitive difficulties were significantly associated with clinician ratings. The model's classification accuracy was satisfactory for patients in the "intact awareness" and "severe unawareness" categories, but not for those in the "mild unawareness" category. CONCLUSIONS: Although measures of awareness likely share overlapping variance, they are not interchangeable. Each potentially elucidates unique aspects of the complex phenomenon of awareness, with clinician assessment being the most suited for ambiguous cases. When clinician assessment is not feasible, informant rating (but not patient-informant discrepancy) would be a valid substitute.

Serum brain-derived neurotrophic factor is associated with cognitive function in healthy older adults.

Cognitive decline is common in older adults, even in the absence of significant medical or neurological conditions. Recent work implicates serum levels of brain-derived neurotrophic factor in age-related cognitive decline, though no study has directly examined this possibility. A total of 35 older adults without neurological history underwent fasting blood draw and completed a brief neuropsychological test battery during a single session. After adjusting for demographic and medical confounds, higher serum brain-derived neurotrophic factor levels were associated with better performance on the Mini-Mental State Examination (r = .36) and short form of the Boston Naming Test (r = .39). These findings extend work from Alzheimer disease and vascular dementia samples and indicate that higher brain-derived neurotrophic factor levels are associated with better neuropsychological function in healthy older adults. The exact mechanisms for this relationship are unknown and require further examination.