Ambulatory Assessment Research Articles

New Trends in Digital Technology-Based Psychological and Educational Assessment.

The emergence of digital technology in the field of psychological and educational measurement and assessment broadens the traditional concept of pencil and paper tests. New assessment models built on the proliferation of smartphones, social networks and software developments are opening up new horizons in the field. This study is divided into four sections, each discussing the benefits and limitations of a specific type of technology-based assessment: ambulatory assessment, social networks, gamification and forced-choice testing. The latest developments are clearly relevant in the field of psychological and educational measurement and assessment. Among other benefits, they bring greater ecological validity to the assessment process and eliminate the bias associated with retrospective assessment. Some of these new approaches point to a multidisciplinary scenario with a tradition which has yet to be created. Psychometrics must secure a place in this new world by contributing sound expertise in the measurement of psychological variables. The challenges and debates facing the field of psychology as it incorporates these new approaches are also discussed.

DMD Genotypes and Motor Function in Duchenne Muscular Dystrophy: A Multi-institution Meta-analysis With Implications for Clinical Trials.

Clinical trials of genotype-targeted treatments in Duchenne muscular dystrophy (DMD) traditionally compare treated patients with untreated patients with the same DMD genotype class. This avoids confounding of drug efficacy by genotype effects but also shrinks the pool of eligible controls, increasing challenges for trial enrollment in this already rare disease. To evaluate the suitability of genotypically unmatched controls in DMD, we quantified effects of genotype class on 1-year changes in motor function endpoints used in clinical trials. More than 1,600 patient-years of follow-up (>700 patients) were studied from 6 real-world/natural history data sources (UZ Leuven, PRO-DMD-01 shared by CureDuchenne, iMDEX, North Star UK, Cincinnati Children's Hospital Medical Center, and the DMD Italian Group), with genotypes classified as amenable to skipping exons 44, 45, 51, or 53, or other skippable, nonsense, and other mutations. Associations between genotype class and 1-year changes in North Star Ambulatory Assessment total score (ΔNSAA) and in 10-m walk/run velocity (Δ10MWR) were studied in each data source with and without adjustment for baseline prognostic factors. The studied genotype classes accounted for approximately 2% of variation in ΔNSAA outcomes after 12 months, whereas other prognostic factors explained >30% of variation in large data sources. Based on a meta-analysis across all data sources, pooled effect estimates for the studied skip-amenable mutation classes were all small in magnitude (<2 units in ΔNSAA total score in 1-year follow up), smaller than clinically important differences in NSAA, and were precisely estimated with standard errors <1 unit after adjusting for nongenotypic prognostic factors. These findings suggest the viability of trial designs incorporating genotypically mixed or unmatched controls for up to 12 months in duration for motor function outcomes, which would ease recruitment challenges and reduce numbers of patients assigned to placebos. Such trial designs, including multigenotype platform trials and hybrid designs, should ensure baseline balance between treatment and control groups for the most important prognostic factors, while accounting for small remaining genotype effects quantified in this study.

Daily activity diversity and daily working memory in community-dwelling older adults.

Cross-sectional and long-term longitudinal studies have shown that engagement in diverse activities benefits cognitive performance in older age, but it is unknown whether the beneficial effect holds within persons on a daily basis. This study examines the within-person association between activity diversity and working memory on the same day and its time-lagged directionality between days. It also examines the effects of potential moderators on the within-person association, including age, education, processing speed, and crystallized intelligence, to understand who may benefit more from daily activity diversity. We examined smartphone-based ambulatory assessment data from 150 community-dwelling older adults (aged 65-91 years) from Switzerland. Participants reported their present activity and completed a working memory task (i.e., numerical updating) seven times per day over 15 days. Activity diversity was calculated on a daily level and scores of working memory were averaged within a day. Age, education, processing speed, and crystallized intelligence were assessed in the laboratory at baseline. Multilevel models showed that, within persons, higher daily activity diversity was positively associated with higher daily working memory. Moreover, the prior day's greater activity diversity led to that day's higher working memory, but not vice versa. There were no moderating effects of age, education, and crystallized intelligence, but partial evidence of a moderating effect of processing speed. Our results on within-person concurrent and time-lagged associations between daily activity diversity and daily working memory strengthen the existing evidence on the beneficial effect of activity diversity on older adults' cognitive performance. Results are discussed in the context of cognitive reserve theory. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones.

The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an "ambulatory" cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Across 3 studies, we adapted "complex span" tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed.

Charting everyday activities in later life: Study protocol of the mobility, activity, and social interactions study (MOASIS).

Prominent theories of aging emphasize the importance of resource allocation processes as a means to maintain functional ability, well-being and quality of life. Little is known about which activities and what activity patterns actually characterize the daily lives of healthy older adults in key domains of functioning, including the spatial, physical, social, and cognitive domains. This study aims to gain a comprehensive understanding of daily activities of community-dwelling older adults over an extended period of time and across a diverse range of activity domains, and to examine associations between daily activities, health and well-being at the within- and between-person levels. It also aims to examine contextual correlates of the relations between daily activities, health, and well-being. At its core, this ambulatory assessment (AA) study with a sample of 150 community-dwelling older adults aged 65 to 91 years measured spatial, physical, social, and cognitive activities across 30 days using a custom-built mobile sensor ("uTrail"), including GPS, accelerometer, and audio recording. In addition, during the first 15 days, self-reports of daily activities, psychological correlates, contexts, and cognitive performance in an ambulatory working memory task were assessed 7 times per day using smartphones. Surrounding the ambulatory assessment period, participants completed an initial baseline assessment including a telephone survey, web-based questionnaires, and a laboratory-based cognitive and physical testing session. They also participated in an intermediate laboratory session in the laboratory at half-time of the 30-day ambulatory assessment period, and finally returned to the laboratory for a posttest assessment. In sum, this is the first study which combines multi-domain activity sensing and self-report ambulatory assessment methods to observe daily life activities as indicators of functional ability in healthy older adults unfolding over an extended period (i.e., 1 month). It offers a unique opportunity to describe and understand the diverse individual real-life functional ability profiles characterizing later life.

Heart Rate Variability's Association with Positive and Negative Affect in Daily Life: An Experience Sampling Study with Continuous Daytime Electrocardiography over Seven Days.

Heart rate variability has been found to be related to emotional processing and emotional responses. Studies that investigated these relationships were mostly lab-based or cross-sectional. Only limited research used intensive longitudinal data, in particular investigating within-individual processes in real-life settings. This study addresses the applicability of ambulatory-assessed electrocardiograms in combination with the experience sampling methodology by investigating the associations of various HRV measures with affective states on within- and between-individual levels. A total of 26 participants aged 18-29 years (23 females) wore electrocardiograms continuously for seven days. The participants received seven prompts per day and answered questions about their affective wellbeing. The heart rate and heart rate variability measures differed between body positions and activity classes. The heart rate and ratio of low-to-high-frequency heart rate variability were consistently associated with positive affect on a within-individual (state-like) level. These associations were mainly driven by the items of feeling "enthusiastic" and "happy". No associations were found with negative affect. Overall, we found evidence that the dominance of the sympathetic nervous system over the parasympathetic nervous system was associated with higher levels of positive affect on a within-individual (state-like) level. Suggestions for the application of ambulatory electrocardiogram assessment in the study of the association between autonomous nervous system activity and ecological momentary assessment-based variables are discussed.

Multidimensional Biomechanics-Based Score to Assess Disease Progression in Duchenne Muscular Dystrophy

(1) Background: Duchenne (DMD) is a rare neuromuscular disease that progressively weakens muscles, which severely impairs gait capacity. The Six Minute-Walk Test (6MWT), which is commonly used to evaluate and monitor the disease's evolution, presents significant variability due to extrinsic factors such as patient motivation, fatigue, and learning effects. Therefore, there is a clear need for the establishment of precise clinical endpoints to measure patient mobility. (2) Methods: A novel score (6M+ and 2M+) is proposed, which is derived from the use of a new portable monitoring system capable of carrying out a complete gait analysis. The system includes several biomechanical sensors: a heart rate band, inertial measurement units, electromyography shorts, and plantar pressure insoles. The scores were obtained by processing the sensor signals and via gaussian-mixture clustering. (3) Results: The 6M+ and 2M+ scores were evaluated against the North Star Ambulatory Assessment (NSAA), the gold-standard for measuring DMD, and six- and two-minute distances. The 6M+ and 2M+ tests led to superior distances when tested against the NSAA. The 6M+ test and the 2M+ test in particular were the most correlated with age, suggesting that these scores better characterize the gait regressions in DMD. Additionally, the 2M+ test demonstrated an accuracy and stability similar to the 6M+ test. (4) Conclusions: The novel monitoring system described herein exhibited good usability with respect to functional testing in a clinical environment and demonstrated an improvement in the objectivity and reliability of monitoring the evolution of neuromuscular diseases.

How Is Variety in Daily Life Related to the Expression of Personality States? An Ambulatory Assessment Study

People differ in the way they live their daily lives. For some people, daily life is characterized by multiple and diverse experiences, while others have more stability and routine in their lives. However, little is known about how variety in daily life relates to the expression of personality states. The present study examined within-person associations between variety in social partners, places, and activities with state expression. Data came from an ambulatory assessment study ( N = 962, Mage = 25.49) with four assessments per day over a period of six consecutive days. The results of the multilevel modeling analyses suggest that variety in daily life is associated with some, but not all, state expressions. For instance, on days when participants experienced a greater variety in activities, they reported being less neurotic and conscientious, but also more agreeable. In addition, the links between all social partners, places, and activities with the expression of the state were examined simultaneously to obtain more detailed information on the multifaceted nature of situation-state expression links. We conclude that variety in daily life has both theoretical and empirical relevance for the expression of personality states.

Filling gaps in the nomological networks for dominance and affiliation by examining self-informant agreement on momentary interpersonal behavior

Interpersonal functioning involves an interplay of subjective perceptions and overt behavior. This study examines alignment between self and informant perceptions of momentary behavior to enrich the nomological networks for the domains of dominance and affiliation. We studied a sample of romantic couples ( N = 210 individuals) who rated their own and their partner’s interpersonal behavior during a 21-day ambulatory assessment (AA) protocol. We used multi-level structural equation modeling to estimate self-informant agreement on averages and variability of dominance and affiliation (between-person level) and on situational shifts in behavior (within-person level). We also examined convergence between self- and informant reported behavior measured by AA with cross-sectional self-report trait dominance, affiliation, and interpersonal problems. Results showed no self-informant agreement on dominance measured by AA, but moderate to strong agreement on affiliation at the between- and within-person levels. Self- and informant reported average affiliation measured by AA correlated with self-reports of trait affiliation, but only AA self-reports correlated with affiliation problems. Both self- and informant report dominance variability, and informant report affiliation variability, correlated with self-report interpersonal distress. Evidence for (mis)alignment in how dominance and affiliation are perceived by self and others have important implications for the role of these behaviors in everyday interpersonal functioning.

Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke.

The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.

Do expectations determine postoperative disability in women with endometriosis? Study protocol for a clinical mixed-methods observational cohort study

IntroductionOverall, 20%–30% of women with endometriosis report endometriosis-related disability after successful laparoscopy. This indicates a potential impact of psychological factors, such as expectations, on treatment outcomes. It is already known...

PS-C23-1: EFFECT OF OMEGA3,6,9 BLENDED OIL ON CIRCADIAN VARIATIONS OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND CAD

Flaxseed oil is considered to be a rich source of Alpha-Linolenic Acid(ALA), along with Lignans, fibers, protein, vitamins,s, and minerals. A number of studies have proved the beneficial role of ALA, EPA, and DHA found in flaxseed on health. Besides providing nutrition, they have anti-inflammatory, antihypertensive and cardioprotective properties. However pure flaxseed oil does not have oxidative stability due to which it could not be stored for long-term edible use. The blending process can be an alternative method for Partial hydrogenation, therefore we used this process to reduce the percentage of unsaturated linoleic and linolenic acids of Flaxseed oil with Palm oil in a stabilized ratio which helps in maintaining the overall oxidative stability and proper ratio of Omega 3, omega 6 and omega 9 content in the Blended product. Aim of this study was to access the effect of blended flaxseed oil on 24 hour seven day circadian variations of blood pressure in subjects with essential hypertension. Many Studies have proved that Chronobiological analysis of blood pressure by four to Seven-day continuous ambulatory blood pressure monitoring and assessment of CHAT (circadian hyper amplitude tension) is the best marker for cardiovascular function. We registered 100 subjects with Coronary Artery Disease (Group1) and Essential hypertension (Group2) and 100 control subjects with CAD/ Hypertension. Group 1 and 2 participants were supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of six months while the control group was not given any BFO (They were using their routine edible oil). Twenty-four hour seven days continuous ambulatory blood pressure monitoring was done initially, after three months and after six months of supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that optimized doses of blended flaxseed oil have the required amount of ALA and essential fatty acids as per guidelines of AHA, Blended flaxseed oil administration can be a potent antihypertensive and helps in the synchronization of cardiac rhythms, and an effective vegetarian source in maintaining Omega 3 and omega 6 ratios.

Heart Rate Variability and Perceived Stress in Teacher Training: Facing the Reality Shock With Mindfulness?

The beginning of the career of teachers is a demanding phase. In the combined roles of teacher and trainee, and in the shift from academic to practical learning, trainee teachers have to acquire competencies in teaching as well as coping with stress. In this phase, the phenomenon of "reality shock" is widely observed. A mindfulness training was developed to support teacher trainees during their first year. This intervention study investigated perceived and physiological stress at teachers' career start and the stress reducing effects of the mindfulness training in this phase. In a quasi-experimental design, 19 out of 42 participants from this sample underwent mindfulness-based stress reduction training and a wait-list control group (N = 23) underwent a compact course after post measurements. We measured physiological stress parameters and perceived stress at 3 different time points. Heart rate signals were acquired in ambulatory assessment sequences, including teaching, rest periods, and cognitive tasks. The data were analyzed in linear mixed-effects models. We found high physiological stress in the very beginning of teacher training, which attenuated over time. The mindfulness intervention only led to a greater reduction in heart rate (d = .53 to .74) in situations where the intervention group had shown higher heart rate levels initially, but not in heart rate variability. However, the mindfulness group significantly reduced (d = .63) their perceived stress and maintained (d = .55) this improvement, while the control group maintained a highly elevated perceived stress level throughout. The mindfulness training could reduce subjective stress, which otherwise seems to be a long-lasting aspect of beginning teachers' "reality shock". Indications of a superior reduction of physiological stress in demanding situations were weak, while generally, undue physiological stress seems to be a temporary phenomenon in the initial phase of teacher induction.

Ambulatory assessment to predict problem anger in trauma-affected adults: Study protocol.

Problem anger is common after experiencing a traumatic event. Current evidence-driven treatment options are limited, and problem anger negatively affects an individual's capacity to engage with traditional psychological treatments. Smartphone interventions hold significant potential in mental health because of their ability to deliver low-intensity, precision support for individuals at the time and place they need it most. While wearable technology has the capacity to augment smartphone-delivered interventions, there is a dearth of evidence relating to several key areas, including feasibility of compliance in mental health populations; validity of in vivo anger assessment; ability to predict future mood states; and delivery of timely and appropriate interventions. This protocol describes a cohort study that leverages 10 days of ambulatory assessment in the form of ecological momentary assessment and a wearable. Approximately 100 adults with problem anger will complete four-hourly in vivo mobile application-delivered micro-surveys on anger intensity, frequency, and verbal and physical aggression, as well as other self-reported mental health and wellbeing measures. Concurrently, a commercial wearable device will continuously record indicators of physiological arousal. The aims are to test the feasibility and acceptability of ambulatory assessment in a trauma-affected population, and determine whether a continuously measured physiological indicator of stress predicts self-reported anger intensity. This study will contribute new data around the ability of physiological indicators to predict mood state in individuals with psychopathology. This will have important implications for the design of smartphone-delivered interventions for trauma-affected individuals, as well as for the digital mental health field more broadly.

INSIGHTS INTO HEALTH-RELEVANT INTERPERSONAL DYNAMICS IN AGING COUPLES FROM THE LAB AND DAILY LIFE

Abstract Emerging research demonstrates that long-term and daily health indicators are closely linked in aging partners. Yet, not much is known about exactly how partners get under each other’s skin. This symposium investigates different positive and negative interpersonal contexts, including physical intimacy, positive and negative emotional experiences, and couple conversations (e.g., conflict, recounting distressing memories, discussing enjoyable topics), and their link with neuroendocrine and cardiovascular markers. The four talks feature a variety of study designs ranging from laboratory research to ambulatory assessment methods which recruited couples in midlife and old age. Kolodziejczak et al. use ambulatory assessment data to examine links between (experienced and wished for) physical intimacy, affect, and cortisol in older couples. Pauly et al. pool data from three ambulatory assessment aging studies to analyze how own and partner positive and negative affective states are intertwined with everyday cortisol secretion in old age. Wilson et al. invited middle-aged to older couples to engage in two different conversations (recounting a difficult memory, conflict) and investigated concurrent changes in affect and cardiovascular activity. Meier and colleagues make use of automated language analysis to examine how positive and negative emotion word use during a positive and negative conversation in the laboratory relates to cardiovascular reactivity in middle-aged couples. The discussion by Christina Röcke will delineate insights gained from these four papers, discuss their strengths and limitations, and outline directions for future inquiry.

LONG-TERM ALCOHOL CONSUMPTION AND STABILITY OF DAILY WORKING MEMORY PERFORMANCE IN OLD AGE

Abstract Mixed evidence of associations of alcohol consumption with cognitive aging suggested that low to moderate alcohol consumption predicts more favorable cognitive outcomes than abstinence, whereas higher consumption operates as risk factor for cognitive decline. Daily short-term fluctuations of cognitive performance have also been established as risk factor for subsequent cognitive decline. Bringing these two lines of research together, our study analyzed associations of long-term trajectories of alcohol consumption with ambulatory assessments (7 days, 6 beeps per day) of working memory (WM) performance in participants (N = 155, aged 66-69 and 86-89) followed-up from a long-term (&amp;gt;20 years) longitudinal aging study. Overall, the findings do not support the “risk-view”, because long-term alcohol consumption patterns were not found to be predictive of either individual levels or intra-individual momentary fluctuations of WM performance. Follow-up analyses will examine the combined effects of alcohol consumption with further risk factors, such as long-term declines in health.

DO FRIENDS GET UNDER THE SKIN? DAILY INTERACTIONS AND CARDIOVASCULAR FUNCTIONING AMONG BLACK AND WHITE AMERICANS

Abstract Scarce research has examined racial differences in cardiovascular health in the context of social interactions. This study investigated whether (a) friend interactions were associated with better cardiovascular functioning, and (b) such associations vary among Black and White adults. This study employed dual assessment techniques—ecological momentary assessments (EMA) and ambulatory physiological assessments—to examine the co-occurrence of social interactions and cardiovascular functioning. Multilevel models revealed no racial differences in ambulatory HRV and frequency of friend interactions throughout the day. Findings revealed a between-person link of friend interactions and better HRV in the overall sample. Race-stratified models found a within-person link between friendship interaction and worse HRV and a between-person link between friendship interaction and better HRV for Blacks but not for Whites. Findings suggest friend interactions are more salient for Blacks’ cardiovascular health and may serve as a modifiable factor for preventing cardiovascular diseases.

UNDERSTANDING MOBILITY, HEALTH, AND WELL-BEING OF OLDER ADULTS USING SENSING TECHNOLOGIES

Abstract Mobility has been identified as one important ingredient to older adults’ health and well-being and is considered a high priority in the global agenda of healthy and active aging. However, mobility is still a relatively understudied concept in aging research. This symposium, including three empirical studies and one concept paper, presents how different sensing technologies can be utilized to examine mobility, health and well-being in older adults. Using infrared motion sensors and contact sensors, Wu and colleagues examine indoor mobility and show its associations with physical, cognitive, and mental health in community-dwelling older adults living alone. Luo and colleagues use a custom-built mobile GPS sensor and a smartphone-based ambulatory assessment to examine daily mobility and well-being in community-dwelling older adults. They find that a day with larger life space area, more time spent in passive transport modes, and higher number of different locations is associated with higher daily life satisfaction. Similarly, using a GPS sensor combined with a smartphone-based ecological momentary assessment, Kamalyan and colleagues examine life-space mobility, social interactions, and well-being in older adults with and without HIV. They show that prior day’s at-home time is negatively associated with current day’s happiness and that prior day’s social interactions diminishes this association. Jansen presents a project combining sensor-based movement data, GPS-based geolocation data, and experience sampling to investigate relations between life-space mobility and social participation and the role of cultural and climatic differences across several European countries. Hans-Werner Wahl will discuss all papers from an ecological and contextualized aging perspective.

DAILY ACTIVITY DIVERSITY AND DAILY WORKING MEMORY IN COMMUNITY-DWELLING OLDER ADULTS

Abstract Research has shown that diverse activity engagement has positive effects on cognitive functioning in older age. However, it is unknown whether the positive effect holds within persons across days and across people. We examined daily within-person association between activity diversity and working memory in older age and effects of potential moderators therein. We examined 16-day smartphone-based ambulatory assessment data from 150 older adults (aged 65+). Participants reported their present activities and completed working memory tasks seven times per day. Within persons, higher daily activity diversity was positively associated with higher daily working memory. Moreover, the prior day’s activity diversity led to that day’s higher working memory, but not vice versa. We did not find any moderating effects of age, education, or fluid and crystallized intelligence. Our results strengthen the evidence on the beneficial effect of activity diversity on cognitive performance. Results are discussed in the context of cognitive reserve theory.

Anesthesia-Induced Intraprocedural Downgrading of Mitral Regurgitation During Transcatheter Edge-to-Edge Repair

During transcatheter edge-to-edge repair (TEER), the reduction of functional mitral regurgitation (FMR) severity, compared with baseline evaluation, is not uncommon. Because the procedural strategies are mainly guided by the location and severity of the regurgitant jets, intraprocedural downgrading (ID) of regurgitation severity could affect the procedural strategy and the results. The aim of this study was to evaluate the prevalence of ID during TEER and to compare early and midterm outcomes in patients with and without ID. All patients with moderate-to-severe or severe FMR who underwent TEER in San Raffaele Hospital between 2018 and 2020 were evaluated in this single-center, retrospective study. ID was defined as mild (1+) or moderate (2+) regurgitation degree during intraprocedural evaluation. The outcomes, assessed at discharge and at 2 years of follow-up, were all-cause mortality, heart failure hospitalization, and recurrence of mitral regurgitation >2+. The final study cohort included 55 patients: 42% presented with ID. At discharge, 85.5% of patients achieved regurgitation reduction to 2+ or less: 100% in patients with ID versus 75% in patients without ID, p <0.009. At 2 years, no significant difference in the incidence of all-cause mortality, heart failure hospitalization, and the recurrence of mitral regurgitation >2+ between patients with ID or without ID was found. In conclusion, ID is frequent during TEER in FMR. No baseline characteristics were found to identify this group of patients. In patients with ID, the combination of live intraprocedural imaging and baseline ambulatory assessment of regurgitant jets seems effective in the procedural guiding to achieve a successful and durable mitral repair.