Cognitive coordination
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CONTEXT: Advance care planning (ACP) is relevant yet challenging with cognitive decline. OBJECTIVE: To provide evidence and consensus-based clinical recommendations for how to conduct ACP in dementia. METHODS: International Delphi study conducted by the European Association for Palliative Care 'ACP in dementia' taskforce with four online surveys (September 2021-June 2022). A panel of 107 experts from 33 countries and seven individuals with dementia contributed. The recommendations specific for dementia were initially based on two earlier Delphi studies and literature searches addressing guidance including the right timing and how to personalize ACP. We used conservative preregistered criteria for consensus. RESULTS: Thirty constitutive elements of ACP were identified (e.g., 'assess understanding of ACP'). Only five were deemed 'optional.' The panel estimated a median of four conversations could address elements to be addressed at least once. Recommendations included to assume capacity as a principle, conscious of the need to explore its fluctuation, to encourage engaging and playing active roles, and to establish connection and inform and prepare family. There was a consensus to offer ACP around dementia diagnosis, to raise end-of-life issues later, and to personalize ACP with flexibility, providing of information and exploring understanding. The advice of the persons with dementia pointed to a wish for a well-coordinated holistic approach. CONCLUSION: Consensus was reached, including in areas of ambiguity, to guide ACP in dementia. ACP should be embedded in a nonprescriptive, individualized approach that involves both the person with dementia and their families. Future studies may evaluate trade-offs between optimal ACP and feasible implementation.
- MeSH
- delfská metoda MeSH
- demence * terapie MeSH
- konsensus MeSH
- lidé MeSH
- paliativní péče MeSH
- péče o umírající MeSH
- předběžné plánování péče * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Research has shown that external focus (EF) instructions-directing attention to intended movement effects (e.g., ball's or dart's path)-are more effective for enhancing motor performance and learning than internal focus (IF) instructions, which focus on body movements (e.g., arm or foot motion). Nonetheless, the impact of visuospatial working memory capacity (WMC) in this context, especially among children, has been less investigated. This research sought to examine the effects of EF compared to IF on the skill acquisition and motor learning of a dart-throwing task among children with both high and low visuospatial WMC. Forty-eight boys aged 9-11 (Mage: 9.67 ± 0.76 years) were grouped by high or low WMC based on spatial span and memory tests, then assigned to receive either EF or IF instructions. The experiment comprised three stages: practice, retention, and two transfer tests, including throwing from a longer distance and a dual-task scenario with added cognitive load (tone counting). Results showed that EF outperformed IF at all stages. While WMC did not affect performance during practice and retention, children with low WMC performed better than those with high WMC during the longer distance test. In dual-task conditions, an EF continued to surpass an IF, whilst the WMC exerted no significant impact. The present findings suggest that an EF relative to an IF promotes more automatic movement and enhanced multitasking, while the impact of visuospatial WMC was less than expected, highlighting the benefits of EF in teaching motor skills to children, regardless of visuospatial WMC.
- MeSH
- dítě MeSH
- krátkodobá paměť * fyziologie MeSH
- lidé MeSH
- motorické dovednosti * fyziologie MeSH
- pozornost * fyziologie MeSH
- psychomotorický výkon * fyziologie MeSH
- učení fyziologie MeSH
- vnímání prostoru fyziologie MeSH
- zraková percepce fyziologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
RATIONALE: Patients who experience seizures, including PNES, are usually advised to discontinue driving, or have their driving privileges revoked until a determined period of seizure-freedom is achieved. In this retrospective study, patients with PNES who requested driving privileges or reported having resumed driving were compared to those who did not on measures of depression, anxiety, PTSD, and cognitive flexibility/motor speed. METHODS: DiagnosisofPNESwasconfirmedwithvideo-EEG.Demographicand clinical dataand requests for reinstatement of driving privileges (requiring 6 or more months seizure freedom) and reports of decisions to resume driving were noted. Tests of motor speed and hand eye coordination and self-report questionnaires of depression, anxiety and PTSD administered as part of neuropsychological assessment were analyzed. RESULTS: A total of 403 patients with PNES evaluated in 2010-2020 were identified. Of those, 365 patients were eligible for inclusion, and of those, 60 applied for driving privileges or reported that they resumed driving. When the two groups were compared, the group that applied for driving privileges or decided to resume driving was significantly less depressed (p = 0.001) when tested than the group that did not. Furthermore, a significant difference was seen in measures of motor performance between those who requested to resume driving and those who did not (DKEFS T1, p = 0.006, DKEFS T2, p = 0.001, DKEFS T3, p = 0.002, DKEFS T4, p = 0.001; GPT dominant, p = 0.05, GPT non-dominant, p = 0.003). CONCLUSION: Driving a motor vehicle is a useful measure of improvement for PNES because patients with seizures are required to discontinue driving until seizure-freedom is achieved. This study revealed that lower levels of depression and better fine motor functioning were associated with reported seizure-freedom and driving resumption. Depression is commonly associated with diminished performance (slower motor response times and impaired fine motor movements) on tests of motor functioning, both of which may result in less interest in pursuing permission to resume driving. These findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.
- MeSH
- deprese psychologie diagnóza etiologie MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- konverzní poruchy psychologie diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- neuropsychologické testy MeSH
- posttraumatická stresová porucha psychologie diagnóza MeSH
- psychomotorický výkon fyziologie MeSH
- psychosomatické poruchy diagnóza psychologie MeSH
- retrospektivní studie MeSH
- řízení motorových vozidel * psychologie MeSH
- úzkost psychologie etiologie diagnóza MeSH
- záchvaty * psychologie diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Functional and molecular alterations in the cerebellum are among the most widely recognised associates of autism spectrum disorders (ASD). As a critical computational hub of the brain, the cerebellum controls and coordinates a range of motor, affective and cognitive processes. Despite well-described circuits and integrative mechanisms, specific changes that underlie cerebellar impairments in ASD remain elusive. Studies in experimental animals have been critical in uncovering molecular pathology and neuro-behavioural correlates, providing a model for investigating complex disease conditions. Herein, we review commonalities and differences of the most extensively characterised genetic lines of ASD with reference to the cerebellum. We revisit structural, functional, and molecular alterations which may contribute to neurobehavioral phenotypes. The cross-model analysis of this study provides an integrated outlook on the role of cerebellar alterations in pathobiology of ASD that may benefit future translational research and development of therapies.
Despite advances in understanding the cellular and molecular processes underlying memory and cognition, and recent successful modulation of cognitive performance in brain disorders, the neurophysiological mechanisms remain underexplored. High frequency oscillations beyond the classic electroencephalogram spectrum have emerged as a potential neural correlate of fundamental cognitive processes. High frequency oscillations are detected in the human mesial temporal lobe and neocortical intracranial recordings spanning gamma/epsilon (60-150 Hz), ripple (80-250 Hz) and higher frequency ranges. Separate from other non-oscillatory activities, these brief electrophysiological oscillations of distinct duration, frequency and amplitude are thought to be generated by coordinated spiking of neuronal ensembles within volumes as small as a single cortical column. Although the exact origins, mechanisms and physiological roles in health and disease remain elusive, they have been associated with human memory consolidation and cognitive processing. Recent studies suggest their involvement in encoding and recall of episodic memory with a possible role in the formation and reactivation of memory traces. High frequency oscillations are detected during encoding, throughout maintenance, and right before recall of remembered items, meeting a basic definition for an engram activity. The temporal coordination of high frequency oscillations reactivated across cortical and subcortical neural networks is ideally suited for integrating multimodal memory representations, which can be replayed and consolidated during states of wakefulness and sleep. High frequency oscillations have been shown to reflect coordinated bursts of neuronal assembly firing and offer a promising substrate for tracking and modulation of the hypothetical electrophysiological engram.
- MeSH
- elektroencefalografie MeSH
- kognice * fyziologie MeSH
- lidé MeSH
- mozek fyziologie MeSH
- mozkové vlny fyziologie MeSH
- paměť fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: There is variation in organization of geriatric rehabilitation across Europe. The purpose of this study was to describe the selection criteria for referral to geriatric rehabilitation, care provided, and recovery trajectories of post-COVID-19 patients referred to geriatric rehabilitation in Europe. METHODS: This observational cohort study included 723 patients in 59 care facilities for geriatric rehabilitation across 10 countries. Patient data were collected from medical records on admission to geriatric rehabilitation (between September 2020 and October 2021), discharge, 6 weeks and 6 months follow-up. The primary and secondary outcomes were recovery in daily functioning (Barthel Index) and Quality of Life (EQ-5D-5L) from admission to discharge. These were examined using linear mixed models with two levels (measurements nested in patients) and country as an independent variable. Random intercept and random linear slope parameters were added when they improved model fit. A survey about organization of geriatric rehabilitation for post-COVID-19 patients was filled out by country coordinators and data were analyzed using descriptive statistics and inductive coding of answers to open questions. RESULTS: Patients had a mean age of 75.7 years old and 52.4% were male. Many countries used various combinations of the selection criteria, such as functional status, age, frailty, Comprehensive Geriatric Assessment, comorbidities, and cognitive impairments. Most patients received physiotherapy (88.8%) and occupational therapy (69.7%), but there was substantial variance between countries in the percentages of patients that received protein or calorie enriched diets, oxygen therapy, and other treatment components. In all countries, patients showed recovery in daily functioning and quality of life, although there was variation in between countries in rate of recovery. Daily functioning seemed to increase most rapidly in the Czech Republic, Germany, and Russia. The steepest increases in quality of life were seen in the Czech Republic, Germany, and Spain. CONCLUSION: Post-COVID-19 patients showed recovery during geriatric rehabilitation, albeit at variable rates. The observed variation may be explained by the heterogeneity in selection criteria and care provided. This study highlights the need for harmonization of measurements in geriatric rehabilitation order to perform explanatory research and optimize geriatric rehabilitation throughout Europe to ensure optimal patient recovery.
- MeSH
- činnosti denního života MeSH
- COVID-19 * rehabilitace epidemiologie MeSH
- geriatrické hodnocení MeSH
- kohortové studie MeSH
- kvalita života MeSH
- lidé MeSH
- obnova funkce MeSH
- SARS-CoV-2 fyziologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
INTRODUCTION: One of the most debilitating problems encountered by people with multiple sclerosis (MS) is the loss of balance and coordination. Our study aimed to comprehensively evaluate the effectiveness of one year of Tai-chi exercise in patients with MS using both subjective and objective methods, including posturography. METHODS: This was a single-group longitudinal one-year study performed from the 1st of January 2019 to the 1st of January 2020. The primary outcomes of interest were the Mini-Balance Evaluation Systems Test (Mini-BESTest) and static posturography measures as objective methods to detect subtle changes associated with postural control/balance impairment. Secondary outcomes were measures of depression, anxiety, cognitive performance, and quality of life. All objective and subjective parameters were assessed four times: at baseline, and after three, six and 12 months of regular Tai-chi training. The difference was calculated as a subtraction of baseline values from every timepoint value for each measurement. If the normality test was passed, parametric one-sample t-test was used, if failed, Wilcoxon signed ranks test was used to test the difference between the baseline and each timepoint. Alpha was set to 0.017 using Bonferroni correction for multiple comparisons. RESULTS: Out of 25 patients with MS enrolled, 15 women with MS (mean age 44.27 years) were included for statistical analyses after completing the 12-month program. After 12 months, significant improvements were found in all objective balance and gait tests: Mini-BESTest (p<0.001), static posturography measures (total area of the centre of foot pressure - TA; p = 0.015), 25 Feet Walk Test (25FWT; p = 0.001), anxiety (Beck Anxiety Inventory - BAI; p = 0.005) and cognition tests (Paced Auditory Serial Addition Test - PASAT; p = 0.003). Measures of depression (Beck Depression Inventory - BDI; p = 0.071), cognition (Symbol Digit Modalities Test - SDMT; p = 0.079), and health-related quality of life (European Quality of Life 5-Dimensions Questionnaire - EQ-5D-5L; p = 0.095) showed a trend of improvement but were not significant, which could be the result of a small sample and increased bias due the type II error. CONCLUSION: According to these preliminary results, this study indicates the possible beneficial effects of long-term Tai-chi training on patients with MS. Although these findings need to be confirmed by further studies with a larger sample of participants of both genders and require more rigorous randomized controlled trials (RCT) design, our findings support the recommendation of regular and long-term Tai-chi exercise in patients with MS. GOV IDENTIFIER (RETROSPECTIVELY REGISTERED): NCT05474209.
- MeSH
- dospělí MeSH
- kognice MeSH
- kvalita života MeSH
- lidé MeSH
- posturální rovnováha MeSH
- prospektivní studie MeSH
- roztroušená skleróza * komplikace terapie MeSH
- taiči * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Given the key roles of the cerebellum in motor, cognitive, and affective operations and given the decline of brain functions with aging, cerebellar circuitry is attracting the attention of the scientific community. The cerebellum plays a key role in timing aspects of both motor and cognitive operations, including for complex tasks such as spatial navigation. Anatomically, the cerebellum is connected with the basal ganglia via disynaptic loops, and it receives inputs from nearly every region in the cerebral cortex. The current leading hypothesis is that the cerebellum builds internal models and facilitates automatic behaviors through multiple interactions with the cerebral cortex, basal ganglia and spinal cord. The cerebellum undergoes structural and functional changes with aging, being involved in mobility frailty and related cognitive impairment as observed in the physio-cognitive decline syndrome (PCDS) affecting older, functionally-preserved adults who show slowness and/or weakness. Reductions in cerebellar volume accompany aging and are at least correlated with cognitive decline. There is a strongly negative correlation between cerebellar volume and age in cross-sectional studies, often mirrored by a reduced performance in motor tasks. Still, predictive motor timing scores remain stable over various age groups despite marked cerebellar atrophy. The cerebello-frontal network could play a significant role in processing speed and impaired cerebellar function due to aging might be compensated by increasing frontal activity to optimize processing speed in the elderly. For cognitive operations, decreased functional connectivity of the default mode network (DMN) is correlated with lower performances. Neuroimaging studies highlight that the cerebellum might be involved in the cognitive decline occurring in Alzheimer's disease (AD), independently of contributions of the cerebral cortex. Grey matter volume loss in AD is distinct from that seen in normal aging, occurring initially in cerebellar posterior lobe regions, and is associated with neuronal, synaptic and beta-amyloid neuropathology. Regarding depression, structural imaging studies have identified a relationship between depressive symptoms and cerebellar gray matter volume. In particular, major depressive disorder (MDD) and higher depressive symptom burden are associated with smaller gray matter volumes in the total cerebellum as well as the posterior cerebellum, vermis, and posterior Crus I. From the genetic/epigenetic standpoint, prominent DNA methylation changes in the cerebellum with aging are both in the form of hypo- and hyper-methylation, and the presumably increased/decreased expression of certain genes might impact on motor coordination. Training influences motor skills and lifelong practice might contribute to structural maintenance of the cerebellum in old age, reducing loss of grey matter volume and therefore contributing to the maintenance of cerebellar reserve. Non-invasive cerebellar stimulation techniques are increasingly being applied to enhance cerebellar functions related to motor, cognitive, and affective operations. They might enhance cerebellar reserve in the elderly. In conclusion, macroscopic and microscopic changes occur in the cerebellum during the lifespan, with changes in structural and functional connectivity with both the cerebral cortex and basal ganglia. With the aging of the population and the impact of aging on quality of life, the panel of experts considers that there is a huge need to clarify how the effects of aging on the cerebellar circuitry modify specific motor, cognitive, and affective operations both in normal subjects and in brain disorders such as AD or MDD, with the goal of preventing symptoms or improving the motor, cognitive, and affective symptoms.
- MeSH
- depresivní porucha unipolární * MeSH
- dospělí MeSH
- konsensus MeSH
- kvalita života MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- mozeček patologie MeSH
- průřezové studie MeSH
- senioři MeSH
- stárnutí MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Klasický snus je sáček plněný vlhčeným tabákem, který si jeho uživatel vkládá do úst, obvykle mezi horní ret a dáseň. Hlavní složkou snusu v dnešních výrobcích je speciální vlhký vysoce kvalitní rozkrájený tabák. Kromě tabáku obsahuje snus různé potravinářské příchutě a soli, které ovlivňují jeho chuť a prodlužují trvanlivost. Snusování je jedním ze způsobů jak požít nikotin, aniž by se uživatel vystavoval riziku vedlejších účinků dalších látek vznikajících při kouření spalovaného tabáku. Množství přijatého nikotinu u kuřáků cigaret a u vyznavačů snusování je přibližně stejné. Podle množství užívaného snusu, jeho „síle“ a době, po kterou snus v ústech působí, však uživatel snusu může absorbovat nikotinu výrazně více než kuřák cigaret. Konzumace snusu je poměrně běžná i mezi sportovci, a to i na úrovni vrcholových závodníků a olympioniků. Psychoaktivní látka, jako je nikotin, zvyšuje bdělost, zlepšuje koordinaci a příznivě ovlivňuje kognitivní výkon. Pokud by byl prokázán pozitivní vliv na sportovní výkonnost, lze předpokládat, že Světová antidopingová agentura WADA by zasáhla a snus zařadila mezi zakázané látky či postupy. V současnosti je snus součástí sledovacího programu WADA. Produkty typu snus nejen ze Skandinávie jsou na českém trhu běžně dostupné. Alternativou jsou nikotinové sáčky. Ty již tabák neobsahují, zato však obsahují účinnou látku – nikotin. Po několikaletém váhání vstoupila v platnost novela zákona č. 65/2017 Sb (41) o ochraně zdraví před škodlivými účinky návykových látek, která obsahuje zákaz prodeje nikotinových sáčků dětem a mládeži do 18 let. Vzhledem k závažným zdravotním rizikům je stále třeba varovat před jakoukoliv formou konzumace tabákových či nikotinových výrobků.
Classic snus is a pouch filled with moistened tobacco that the user puts in his mouth, usually between his upper lip and gum. The main ingredient in snus in today’s products is special moist, high-quality, sliced tobacco. In addition to tobacco, snus contains various food flavors and salts that envelop its flavor and extend its durability. Snusing is one way to ingest nicotine without exposing the user to the risk of side effects from other substances that occur when smoking combusted tobacco. The amount of nicotine ingested by cigarette smokers and snusers is about the same. However, depending on the amount of snus used, its "strength" and the length of time the snus stays in the mouth, a snus user can absorb significantly more nicotine than a cigarette smoker. Snus consumption is also quite common among athletes, even at the level of top athletes and Olympians. A psychoactive substance such as nicotine increases alertness, improves coordination, and favorably affects cognitive performance. If a positive effect on athletic performance was proven, it can be assumed that the World Anti-Doping Agency (WADA) would intervene and include snus among prohibited substances or procedures. Currently, snus is part of WADA’s surveillance program. Snus products not only from Scandinavia are commonly available on the Czech market. Nicotine pouches are an alternative. They no longer contain tobacco, but they do contain the active ingredient nicotine. After several years of hesitation, an amendment to Act No. 65/2017 Coll. on Health Protection against the Harmful Effects of Addictive Substances, which includes a ban on the sale of nicotine pouches to children and youth under 18 years of age, came into force. Due to the serious health risks, there is still a need to warn against any form of consumption of tobacco or nicotine products.
- Klíčová slova
- nikotinové sáčky,
- MeSH
- bezdýmný tabák * zákonodárství a právo MeSH
- doping ve sportu MeSH
- lidé MeSH
- návykové chování MeSH
- nikotin farmakologie škodlivé účinky MeSH
- sportovci MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
