Neuropsychiatric symptoms (NPS) are common in hereditary ataxias as a part of the cerebellar cognitive affective syndrome. In Friedreich ataxia (FRDA), one of the most common hereditary ataxias, depressive symptoms were previously reported, but little is known about other NPS. We aimed to study the presence and severity of a broad range of NPS in individuals with FRDA and assess the relationship between the NPS and the disease severity, cognition, and quality of life and to examine the concordance between the NPS reported by the patients and by their informants. Mild Behavioral Impairment Checklist (MBI-C), a questionnaire designed for screening NPS in the early stages of neurodegenerative diseases, was administered to informants of individuals with FRDA and healthy controls and to people with FRDA themselves. Compared to healthy controls, patients with FRDA scored significantly higher in the total MBI-C score, emotion dysregulation domain (corresponding to depression and anxiety), and decreased motivation domain. When assessed by caregiver, the total MBI-C score and several NPS domains correlated with activities of daily living. Only psychotic symptoms were related to ataxia severity and general cognition. When endorsed by patients, only the relation between few MBI-C domains and quality of life was observed. We found slight to moderate agreement between informant-rated and patient-rated scores. NPS, particularly emotion dysregulation and decreased motivation, are common and clinically relevant in FRDA and should receive more attention due to their potential impact on quality of life and the possibility of therapeutic intervention.
- Klíčová slova
- Cerebellum, Friedreich ataxia, MBI-C, Neuropsychiatric symptoms,
- MeSH
- činnosti denního života MeSH
- deprese etiologie MeSH
- dospělí MeSH
- Friedreichova ataxie * psychologie komplikace MeSH
- kognice MeSH
- kvalita života * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- průzkumy a dotazníky MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- úzkost 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
IMPORTANCE: Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. OBJECTIVE: To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. EXPOSURE: Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. MAIN OUTCOMES AND MEASURES: Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. RESULTS: The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. CONCLUSIONS AND RELEVANCE: In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.
- MeSH
- cyklonové bouře * statistika a číselné údaje MeSH
- domy s pečovatelskou službou * statistika a číselné údaje MeSH
- hospitalizace statistika a číselné údaje MeSH
- lidé MeSH
- Medicare statistika a číselné údaje MeSH
- pečovatelské domovy statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- urgentní služby nemocnice statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Florida MeSH
- Spojené státy americké MeSH
BACKGROUND: Mild behavioral impairment (MBI) has been commonly reported in early Alzheimer's disease (AD) but rarely using biomarker-defined samples. It is also unclear whether genetic polymorphisms influence MBI in such individuals. We thus aimed to examine the association between the cognitive status of participants (amnestic mild cognitive impairment (aMCI-AD) vs cognitively normal (CN) older adults) and MBI severity. Within aMCI-AD, we further examined the association between APOE and BDNF risk genetic polymorphisms and MBI severity. METHODS: We included 62 aMCI-AD participants and 50 CN older adults from the Czech Brain Aging Study. The participants underwent neurological, comprehensive neuropsychological examination, APOE and BDNF genotyping, and magnetic resonance imaging. MBI was diagnosed with the Mild Behavioral Impairment Checklist (MBI-C), and the diagnosis was based on the MBI-C total score ≥ 7. Additionally, self-report instruments for anxiety (the Beck Anxiety Inventory) and depressive symptoms (the Geriatric Depression Scale-15) were administered. The participants were stratified based on the presence of at least one risk allele in genes for APOE (i.e., e4 carriers and non-carriers) and BDNF (i.e., Met carriers and non-carriers). We used linear regressions to examine the associations. RESULTS: MBI was present in 48.4% of the aMCI-AD individuals. Compared to the CN, aMCI-AD was associated with more affective, apathy, and impulse dyscontrol but not social inappropriateness or psychotic symptoms. Furthermore, aMCI-AD was related to more depressive but not anxiety symptoms on self-report measures. Within the aMCI-AD, there were no associations between APOE e4 and BDNF Met and MBI-C severity. However, a positive association between Met carriership and self-reported anxiety appeared. CONCLUSIONS: MBI is frequent in aMCI-AD and related to more severe affective, apathy, and impulse dyscontrol symptoms. APOE and BDNF polymorphisms were not associated with MBI severity separately; however, their combined effect warrants further investigation.
- Klíčová slova
- Alzheimer’s disease, Mild behavioral impairment, Mild cognitive impairment, Neuropsychiatric symptoms,
- MeSH
- Alzheimerova nemoc * diagnostické zobrazování epidemiologie genetika MeSH
- apolipoproteiny E genetika MeSH
- genotyp MeSH
- kognitivní dysfunkce * diagnostické zobrazování epidemiologie genetika MeSH
- lidé MeSH
- mozkový neurotrofický faktor genetika MeSH
- neuropsychologické testy MeSH
- polymorfismus genetický genetika MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- apolipoproteiny E MeSH
- mozkový neurotrofický faktor MeSH
We examined the effect of Winter Storm Uri on daily direct-care nurse staffing levels in 1,173 Texas nursing homes (NHs) from February 13th to 19th, 2021. We used data from Payroll-Based Journaling and the Care Compare website. Linear mixed effects models were used to estimate the linear and non-linear change in staffing. During Winter Storm Uri, Texas NHs experienced a linear decrease in daily staffing levels with subsequent non-linear increase for registered nurses (RNs; p < .001) and certified nursing assistants (CNAs; p < .001), and staffing increased linearly for licensed practical nurses (LPNs; p < .001). Compared to 1 week before the storm, Texas NHs reported lower staffing levels across all three types of staff, but most dramatically among LPNs and CNAs. In supplemental analyses, urban and lower quality NHs fared slightly poorer than rural and higher-quality NHs. Winter storms pose a particular challenge to NHs and their ability to maintain direct-care nurse staffing levels.
- Klíčová slova
- disaster medicine, disaster preparedness, staffing shortages,
- MeSH
- lidé MeSH
- pečovatelské domovy MeSH
- personální obsazení a rozvrh * MeSH
- pomocní ošetřovatelé * MeSH
- pracovní síly MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Texas MeSH
Innovative memory paradigms have been introduced to capture subtle memory changes in early Alzheimer's disease (AD). We aimed to examine the associations between different indexes of the challenging Memory Binding Test (MBT) and hippocampal volume (HV) in a sample of individuals with subjective cognitive decline (SCD; n = 50), amnestic mild cognitive impairment (aMCI) due to AD (n = 31), and cognitively normal (CN) older adults (n = 29) recruited from the Czech Brain Aging Study, in contrast to traditional verbal memory tests. Both MBT free and cued recall scores in immediate and delayed recall conditions were associated with lower HV in both SCD and aMCI due to AD, whereas in traditional verbal memory tests only delayed recall scores were associated with lower HV. In SCD, the associations with lower HV in the immediate recall covered specific cued recall indexes only. In conclusion, the MBT is a promising test for detecting subtle hippocampal-associated memory decline during the predementia continuum.
- Klíčová slova
- Alzheimer’s disease, challenging tests, free and cued verbal memory, medial temporal lobe atrophy, mild cognitive impairment, semantic memory binding, subjective cognitive decline,
- MeSH
- demence * diagnóza MeSH
- hipokampus MeSH
- kognice MeSH
- krátkodobá paměť MeSH
- lidé MeSH
- rozpomínání * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
We established a Geriatrics Workforce Enhancement Program (GWEP) clinic to enhance resident training on comprehensive preventive care and chronic disease management, and to increase the number of older patients who received Medicare Annual Wellness Visit (AWV) preventive services. A total of 1,104 patients were tracked at baseline and during the intervention period. Patients were grouped into two categories: Adult (aged 55-64) and Senior (aged 65+). Clinical quality measures were monitored by electronic health record and tracked through monthly reports at baseline (May 2018) and during the intervention period (July 2018-June 2019). In the Senior group, the proportion of patients receiving the Medicare AWV increased after GWEP began (p <.001). Additionally, the Senior group showed significant improvements in the frequency of body mass index assessments (p = .04), colorectal cancer screenings (p < .001), advance directive documentation (p < .001), cognitive screenings (p < .001), and pneumococcal vaccinations (p < .001). In the Adult group, a trending increase was seen in influenza vaccinations (p = .06). Curricular innovations including the establishment of a GWEP clinic in our residency outpatient center, development of new educational materials, and use of a nurse coordinator resulted in significant improvements in the percentage of older adults who received the Medicare AWV benefit and preventive health performance metrics.
- Klíčová slova
- Medicare annual wellness visit, preventative health,
- MeSH
- geriatrie * výchova MeSH
- lidé MeSH
- Medicare * MeSH
- pracovní síly MeSH
- senioři MeSH
- služby preventivní péče MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené státy americké MeSH
BACKGROUND: Memory tests using controlled encoding and cued recall paradigm (CECR) have been shown to identify prodromal Alzheimer's disease (AD), but information about the effectiveness of CECR compared to other memory tests in predicting clinical progression is missing. OBJECTIVE: The aim was to examine the predictive ability of a memory test based on the CECR paradigm in comparison to other memory/non-memory tests for conversion to dementia in patients with amnestic mild cognitive impairment (aMCI). METHODS: 270 aMCI patients from the clinical-based Czech Brain Aging Study underwent a comprehensive neuropsychological assessment including the Enhanced Cued Recall test (ECR), a memory test with CECR, two verbal memory tests without controlled encoding: the Auditory Verbal Learning Test (AVLT) and Logical memory test (LM), a visuospatial memory test: the Rey-Osterrieth Complex Figure test, and cognitive testing based on the Uniform Data Set battery. The patients were followed prospectively. Conversion to dementia as a function of cognitive performance was examined using Cox proportional hazard models. RESULTS: 144 (53%) patients converted to dementia. Most converters (89%) developed dementia due to AD or mixed (AD and vascular) dementia. Comparing the four memory tests, the delayed recall scores on AVLT and LM best predicted conversion to dementia. Adjusted hazard ratios (HR) of immediate recall scores on ECR, AVLT, and LM were similar to the HR of categorical verbal fluency. CONCLUSION: Using the CECR memory paradigm in assessment of aMCI patients has no superiority over verbal and non-verbal memory tests without cued recall in predicting conversion to dementia.
- Klíčová slova
- Alzheimer’s disease, memory, mild cognitive impairment, verbal fluency,
- MeSH
- Alzheimerova nemoc * diagnóza MeSH
- kognitivní dysfunkce * psychologie MeSH
- krátkodobá paměť MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- progrese nemoci MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Older adults with subjective cognitive decline (SCD) are at an increased risk of progression to mild cognitive impairment (MCI) or dementia. However, few have examined the specific cognitive tests that are associated with progression. OBJECTIVE: This study examined performance on 18 neuropsychological tests among participants with SCD who later progressed to MCI or dementia. METHODS: We included 131 participants from the Czech Brain Aging Study that had SCD at baseline. They completed a comprehensive neuropsychological battery including cognitive tests from the Uniform Data Set 2.0 enriched by the verbal memory test Rey Auditory Verbal Learning Test (RAVLT) and Rey-Osterrieth Complex Figure Test (ROCFT). RESULTS: Fifty-five participants progressed: 53% to non-amnestic MCI (naMCI), 44% to amnestic MCI (aMCI), and 4% to dementia. Scoring one SD below the mean at baseline on the RAVLT 1 and RAVLT 1-5 was associated with 133% (RAVLT 1; HR: 2.33 [1.50, 3.62]) and 122% (RAVLT 1-5; HR: 2.22 [1.55, 3.16]) greater risk of progression to MCI or dementia over 3.84 years on average. Worse performance on the RAVLT 5, RAVLT 1-5, RAVLT 30, and ROCFT-Recall was associated with progression to aMCI whereas worse performance on the RAVLT 1, TMT B, and Boston Naming Test was associated with progression to naMCI. CONCLUSION: At baseline, lower verbal memory performance was most strongly associated with progression to aMCI whereas lower executive or language performance was most strongly associated with progression to naMCI.
- Klíčová slova
- Cognitive aging, immediate recall, subjective memory complaints, verbal memory,
- MeSH
- demence * diagnóza MeSH
- kognice MeSH
- kognitivní dysfunkce * diagnóza psychologie MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- senioři MeSH
- testy paměti a učení MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
We compared attitudes toward aging of students from several health professions (N = 1,156: 286 medical, 275 pharmacy, 213 undergraduate nursing, 160 graduate nursing, 139 Internal Medicine residents, 49 physical therapy, and 34 physician assistant), and assessed the construct validity of the Image of Aging Scale. Physical therapy and graduate nursing students reported more positive attitudes toward aging in comparison to all other health professions (all p <.001). Differences in attitudes were not strongly affected by demographic variables, clinical exposure, desire to pursue primary care, or interest in providing care to older adults. The Image of Aging Scale yielded good internal reliability and adequate construct validity for health professions students. Health professions students' attitudes toward aging largely reflect the students' professional training, rather than student characteristics or career goals. The Image of Aging Scale is a robust measure of attitudes toward aging in health professions students and in older adults.
- Klíčová slova
- Ageism, attitudes about older patients, geriatrics workforce enhancement program, student attitudes,
- MeSH
- geriatrie * výchova MeSH
- lidé MeSH
- postoj zdravotnického personálu MeSH
- postoj MeSH
- průzkumy a dotazníky MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- stárnutí MeSH
- studenti lékařství * MeSH
- studenti ošetřovatelství * MeSH
- studium ošetřovatelství bakalářské * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, U.S. Gov't, P.H.S. MeSH
This study evaluated beliefs regarding 25 content areas essential to the primary care of older adults and attitudes toward aging held by first-yearmedical students and Internal Medicine residents. A survey of 136 medical students and 61 Internal Medicine residents was conducted at an academic health-center. Beliefs were assessed by the 25-item Geriatrics Clinician-Educator Survey. Gap scores reflecting the difference in ratings between self-rated importance and knowledge were calculated. Attitudes toward aging was assessed by the Images of Aging Scale. Students and residents expressed similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students reported larger gap scores in areas that reflected general primary care (e.g., chronic conditions, medications), whereas residents reported larger gap scores in areas that reflected specialists' expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward aging did not differ appreciably between students and residents. Our findings suggest that primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations--particularly those requiring specialists' knowledge of or requiring sensitive discussion with older adults-were rated as less important and were less well-mastered.
- Klíčová slova
- Attitudes, geriatrics education, primary care,
- MeSH
- geriatrie * výchova metody MeSH
- kultura MeSH
- kurzy a stáže v nemocnici metody MeSH
- lidé MeSH
- postoj zdravotnického personálu MeSH
- primární zdravotní péče * metody normy MeSH
- senioři MeSH
- stárnutí psychologie MeSH
- studenti lékařství psychologie MeSH
- zdraví - znalosti, postoje, praxe MeSH
- zdravotní služby pro seniory * organizace a řízení normy MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
