Functional Assessment Questionnaire Research Articles

Longitudinal trajectories of general cognitive and daily functions in data-driven subtypes of MCI: A longitudinal cohort analysis of older adults

ObjectivesTo derive data-driven subtypes of mild cognitive impairment (MCI) and characterize the complicated changes of general cognitive and daily functions over time in MCI subtypes. MethodsA total of 813 subjects diagnosed as MCI at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were included. Data-driven MCI subtypes were derived from group-based multi-trajectory modeling (GBMTM) analyses using longitudinal measurement scores in the cognitive domains of visuospatial function, language, and executive function. General cognitive and daily functions were measured by the Mini-Mental State Examination (MMSE) and the Functional Assessment Questionnaire (FAQ), respectively, whose longitudinal trajectory changes were depicted by Linear mixed models. ResultsThree MCI subtypes were derived, which were defined as “Cognitive decline group”, “Mild cognitive decline group” and “No cognitive decline group”. The “Mild cognitive decline group” had the highest percentage in the sample (46.2 %), followed by the “No cognitive decline group” (35.2 %). Patients in the “Cognitive decline group” had the highest mean age (74.69 years) at baseline, the highest APOE ε4 carriers (63.2 %), and the greatest dementia conversion rate (77.0 %). The changes in MMSE and FAQ score trajectories were fastest in the “Cognitive decline group” in the first 36 months and most slowly in the “No cognitive decline group”. ConclusionMCI individuals could be subdivided into more fine-grained cognitive subtypes, and identifying these distinct MCI subtypes and their different trajectories of cognitive decline may have important prognostic value for improving clinical course prediction.

The Effect of Video-Based Action Observation Training and Live Action Observation Training on Motor Function, Activity Participation, and Secondary Outcome Measures in Children With Spastic Diparetic Cerebral Palsy: A Randomized Controlled Study.

This study aimed to investigate the effects of Video-Based Action Observation Training and Live Action Observation Training on motor function, activity participation, and secondary outcome measures in children with spastic diparetic cerebral palsy (CP). Thirty-nine children with spastic diparetic cerebral palsy, aged 5-14 years, with Gross Motor Function Classification System I-III, were distributed in equal numbers to any of the Video-Based Action Observation Training (conventional physiotherapy + Video-Based Action Observation Training), Live Action Observation Training (conventional physiotherapy + Live Action Observation Training), and control (conventional physiotherapy) groups through stratified randomization. For 8 weeks, action observation training groups received 20 minutes of conventional physiotherapy followed by 20 minutes of action observation training, and the control group received 40 minutes of conventional physiotherapy. Primary outcome measures were Gross Motor Function Measurement and Child and Adolescent Scale of Participation, secondary outcome measures were Pediatric Berg Balance Scale, timed-up-and-go test, five times sit-to-stand test (FTSST), Gillette Functional Assessment Questionnaire (GFAQ), and 1-minute walk test (1MWT). Improvements were observed in all other evaluation parameters of the groups except Gross Motor Function Measurement-lying and rolling (P = .066) in the Live Action Observation Training Group, and lying and rolling (P = .317) and crawling and kneeling (P = .063) motor subtests and Gillette Functional Assessment Questionnaire-walking scale (P = .513) in the control group. Comparisons of the increases in all other measurements between the groups, except for the dimensions of Gross Motor Function Measurement-lying and rolling (P = .172), were statistically significant (P < .05) and this difference was in favor of action observation training. It was found that 2 different AOTs applied in addition to conventional physiotherapy in children with spastic diparetic cerebral palsy were more effective on all outcomes than was conventional physiotherapy alone.

The Gait Outcomes Assessment List (GOAL) questionnaire: Test-retest reliability and validity in children with cerebral palsy in Türkiye

BackgroundMost questionnaires provide little information about children's or parents' views on functioning and do not attempt to understand their priorities or expectations. The Gait Outcomes Assessment List (GOAL) questionnaire was developed to fill this gap by identifying the most important goals of the patient and family for a gait intervention. Research questionTo investigate the test-retest reliability and concurrent and discriminant validity of the GOAL questionnaire in children with cerebral palsy (CP) in Türkiye. MethodsIn this study, we included 81 children with CP aged 5–18 years and their families. The parent and child version 5.0 of the GOAL was used. Standardized item, domain and total (across all domains) GOAL scores were calculated for each participant. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC). The Gillette Functional Assessment Questionnaire (FAQ) was used for validation. ResultsThe mean age of the children was 10.4 ± 3.3 years (range 5–18), and 64.2 % were boys. The test–retest reliability was excellent for the GOAL-Child and GOAL-Parent total GOAL scores (ICC: 0.97 for the child and ICC: 0.96 for the parent). All standard errors of measurement (SEMs) for domain scores and total scores were fewer than 20 points. The children's total scores on the GOAL questionnaire showed a significant difference between the GMFCS levels (p <0.001). The parents’ total scores on the GOAL questionnaires also showed a significant difference between the GMFCS levels (p <0.001). There were moderate positive correlations between the GOAL child and parent questionnaire total scores and the FAQ walking level according to Spearman’s rho (GOAL child and FAQ walking rho: 0.66, p<0.001; GOAL parent and FAQ walking rho: 0.58, p<0.001). SignificanceThe results demonstrate that the child and parent versions of the GOAL 5.0 are valid and reliable for the comprehensive assessment of Turkish children with CP.

Progressive cervical cord atrophy parallels cognitive decline in Alzheimer’s disease

Alzheimer’s disease (AD) is characterized by progressive episodic memory dysfunction. A prominent hallmark of AD is gradual brain atrophy. Despite extensive research on brain pathology, the understanding of spinal cord pathology in AD and its association with cognitive decline remains understudied. We analyzed serial magnetic resonance imaging (MRI) scans from the ADNI data repository to assess whether progressive cord atrophy is associated with clinical worsening. Cervical cord morphometry was measured in 45 patients and 49 cognitively normal controls (CN) at two time points over 1.5 years. Regression analysis examined associations between cord atrophy rate and cognitive worsening. Cognitive and functional activity performance declined in patients during follow-up. Compared with controls, patients showed a greater rate of decline of the anterior–posterior width of the cross-sectional cord area per month (− 0.12%, p = 0.036). Worsening in the mini-mental state examination (MMSE), clinical dementia rating (CDR), and functional assessment questionnaire (FAQ) was associated with faster rates of cord atrophy (MMSE: r = 0.320, p = 0.037; CDR: r = − 0.361, p = 0.017; FAQ: r = − 0.398, p = 0.029). Progressive cord atrophy occurs in AD patients; its rate over time being associated with cognitive and functional activity decline.

Assessing the clinical meaningfulness of slowing CDR-SB progression with disease-modifying therapies for Alzheimer disease.

For many patients and caregivers, a major goal of disease-modifying treatments (DMT) for Alzheimer disease (AD) dementia is to extend independence in instrumental and basic activities of daily living (IADLs and BADLs). The goal of this study was to estimate the effect of treatments on the time remaining independent in IADLs and BADLs. Participants at the Knight Alzheimer Disease Research Center were selected who were potentially eligible for recent DMT trials: age ≥ 60 years at baseline, clinical diagnosis of very mild or mild AD dementia (global Clinical Dementia Rating® (CDR®) score 0.5 or 1), biomarker confirmation of amyloid pathology, and at least one follow-up CDR assessment within 5 years. For IADLs, a subset of the Functional Assessment Questionnaire (FAQ) was examined that rated the degree of independence in the following: paying bills, driving, remembering medications and appointments, and preparing meals. For BADLs, the Personal Care domain of the CDR was used. Mixed-effects logistic and ordinal regression models were used to examine the relationship between CDR Sum Boxes (CDR-SB) and the individual functional outcomes and their components. The change in CDR-SB over time was estimated with linear mixed effects models. 282 participants were followed for an average of 2.9 years (SD 1.3 years). For 50% of individuals, loss of independence in IADLs occurred at CDR-SB>4.5 and in BADLs at CDR-SB>11.5. For individuals with a baseline CDR-SB=2, treatment with lecanemab would extend independence in IADLs for 10 months (95% CI 4-18 months) and treatment with donanemab in the low/medium tau group would extend independence in IADLs by 13 months (95% CI 6-24 months). Independence in ADLs can be related to CDR-SB and used to demonstrate the effect of AD treatments in extending the time of independent function, a meaningful outcome for patients and their families.

Assessing the Swallowing Function in Children with Spinal Muscular Atrophy: An Easily Accessible and Objective Multidimensional Approach.

Spinal muscular atrophy (SMA), a genetic neuromuscular disease caused by lack of survival of motor neuron (SMN) protein, is characterized by muscular atrophy and respiratory and bulbar dysfunction. While swallowing disorders are common, they remain poorly studied. Our study aimed to explore 1) intraoral pressure measurements with the Iowa Oral Performance Instrument system and the reliability of a Swallowing Function Assessment Questionnaire (SFAQ) in healthy controls, and 2) evaluate their use as swallowing function biomarkers and the evolution of swallowing function over time in children with SMA. We recruited 53 healthy children and 27 SMA patients all treated with SMN gene modulator therapy. Participants completed the SFAQ and underwent at least one measurement of maximal oral pressures (lingual, labial, and masseter). Mean oral normalized pressure index were lower (all sites p < 0.001) and mean SFAQ scores were higher (p < 0.001) in patients compared with healthy controls. Pressure evolution over 1 year in SMA patients for all three oral sites did not show significant differences. SFAQ scores correlated negatively with oral pressures at all three sites in patients. Both tools provided new insights on the oral and pharyngeal phase of swallowing in SMA patients. In SMA patients, muscle strength in certain crucial anatomical regions during swallowing is weaker than in healthy children.

A Brief Mind-body Intervention Is Feasible and May Prevent Persistent Pain After Acute Orthopaedic Traumas: A Randomized Controlled Trial.

Approximately 20% to 50% of patients develop persistent pain after traumatic orthopaedic injuries. Psychosocial factors are an important predictor of persistent pain; however, there are no evidence-based, mind-body interventions to prevent persistent pain for this patient population. (1) Does the Toolkit for Optimal Recovery after Injury (TOR) achieve a priori feasibility benchmarks in a multisite randomized control trial (RCT)? (2) Does TOR demonstrate a preliminary effect in improving pain, as well as physical and emotional function? This pilot RCT of TOR versus a minimally enhanced usual care comparison group (MEUC) was conducted among 195 adults with an acute orthopaedic traumatic injury at risk for persistent pain at four geographically diverse Level 1 trauma centers between October 2021 to August 2023. Fifty percent (97 of 195) of participants were randomized to TOR (mean age 43 ± 17 years; 67% [65 of 97] women) and 50% (98) to MEUC (mean age 45 ± 16 years; 67% [66 of 98] women). In TOR, 24% (23 of 97) of patients were lost to follow-up, whereas in the MEUC, 17% (17 of 98) were lost. At 4 weeks, 78% (76 of 97) of patients in TOR and 95% (93 of 98) in the MEUC completed the assessments; by 12 weeks, 76% (74 of 97) of patients in TOR and 83% (81 of 98) in the MEUC completed the assessments (all participants were still included in the analysis consistent with an intention-to-treat approach). The TOR has four weekly video-administered sessions that teach pain coping skills. The MEUC is an educational pamphlet. Both were delivered in addition to usual care. Primary outcomes were feasibility of recruitment (the percentage of patients who met study criteria and enrolled) and data collection, appropriateness of treatment (the percent of participants in TOR who score above the midpoint on the Credibility and Expectancy Scale), acceptability (the percentage of patients in TOR who attend at least three of four sessions), and treatment satisfaction (the percent of participants in TOR who score above the midpoint on the Client Satisfaction Scale). Secondary outcomes included additional feasibility (including collecting data on narcotics and rescue medications and adverse events), fidelity (whether the intervention was delivered as planned) and acceptability metrics (patients and staff), pain (numeric rating scale), physical function (Short Musculoskeletal Function Assessment questionnaire [SMFA], PROMIS), emotional function (PTSD [PTSD Checklist], depression [Center for Epidemiologic Study of Depression]), and intervention targets (pain catastrophizing, pain anxiety, coping, and mindfulness). Assessments occurred at baseline, 4 and 12 weeks. Several outcomes exceeded a priori benchmarks: feasibility of recruitment (89% [210 of 235] of eligible participants consented), appropriateness (TOR: 73% [66 of 90] scored > midpoint on the Credibility and Expectancy Scale), data collection (79% [154 of 195] completed all surveys), satisfaction (TOR: 99% [75 of 76] > midpoint on the Client Satisfaction Scale), and acceptability (TOR: 73% [71 of 97] attended all four sessions). Participation in TOR, compared with the MEUC, was associated with improvement from baseline to postintervention and from baseline to follow-up in physical function (SMFA, baseline to post: -7 [95% CI -11 to -4]; p < 0.001; baseline to follow-up: -6 [95% CI -11 to -1]; p = 0.02), PROMIS (PROMIS-PF, baseline to follow-up: 2 [95% CI 0 to 4]; p = 0.045), pain at rest (baseline to post: -1.2 [95% CI -1.7 to -0.6]; p < 0.001; baseline to follow-up: -1 [95% CI -1.7 to -0.3]; p = 0.003), activity (baseline to post: -0.7 [95% CI -1.3 to -0.1]; p = 0.03; baseline to follow-up: -0.8 [95% CI -1.6 to -0.1]; p = 0.04), depressive symptoms (baseline to post: -6 [95% CI -9 to -3]; p < 0.001; baseline to follow-up: -5 [95% CI -9 to -2]; p < 0.002), and posttraumatic symptoms (baseline to post: -4 [95% CI -7 to 0]; p = 0.03; baseline to follow-up: -5 [95% CI -9 to -1]; p = 0.01). Improvements were generally clinically important and sustained or continued through the 3 months of follow-up (that is, above the minimum clinically important different [MCID] of 7 for the SMFA, the MCID of 3.6 for PROMIS, the MCID of 2 for pain at rest and pain during activity, the MCID of more than 10% change in depressive symptoms, and the MCID of 10 for posttraumatic symptoms). There were treatment-dependent improvements in pain catastrophizing, pain anxiety, coping, and mindfulness. TOR was feasible and potentially efficacious in preventing persistent pain among patients with an acute orthopaedic traumatic injury. Using TOR in clinical practice may prevent persistent pain after orthopaedic traumatic injury. Level I, therapeutic study.

Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline

ObjectiveUnderstanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline. MethodsLongitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation. ResultsApathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller. ConclusionIndividual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.

Are tactile function and body awareness of the foot related to motor outcomes in children with upper motor neuron lesions?

Somatosensory function can be reduced in children with Upper Motor Neuron (UMN) lesions. Therefore, we investigated relationships between somatosensory functions of the foot and motor outcomes in children with UMN lesions. In this cross-sectional study, we assessed the Tactile Threshold (TT) with monofilaments and body awareness with Tactile Localisation Tasks for spatial-related action (TLTaction) and structural-related perception (TLTperception) body representation at the foot sole. Furthermore, we assessed four motor outcomes: the Selective Control Assessment of the Lower Extremity (SCALE), the modified Timed Up and Go test (mTUG), the Gillette Functional Assessment Questionnaire (FAQ), and the Functional Mobility Scale (FMS). Spearman's correlations (ρ) were applied to assess relationships between the somatosensory function of the foot sole and the applied motor outcomes. Thirty-five children with UMN lesions, on average 11.7 ± 3.4 years old, participated. TLTperception correlated significantly with all lower limb motor outcomes (|ρ|=0.36-0.57; p < 0.05), but TLTaction (|ρ|=0.00-0.27; p = 0.15-0.97, and TT did not (|ρ|=0.01-0.83; p = 0.73-0.94). TLTperception correlated strongly with the Gross Motor Function Classification System (|ρ|=0.62; p = 0.001) in children with cerebral palsy (n = 24). Assessing structural body representation of the foot sole should be considered when addressing lower limb motor impairments, including gait, in children with upper motor neuron lesions. Our results suggest that the assessment of tactile function and spatial body representation may be less related to lower limb motor function.

Longitudinal trajectory effects of different MCI subtypes on general cognitive and daily functions in a population-based cohort of older adults

ObjectivesTo identify different mild cognitive impairment (MCI) phenotypes based on substantial relative impairment in specific cognitive domains and then characterize the complex process of general cognitive and daily functions over time in older adults with these MCI subtypes. MethodsA total of 1020 participants with MCI at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were recruited. MCI subtypes were obtained based on neuropsychological tests in five cognitive domains: memory (M), visuospatial function (V), language (L), processing speed (P), and executive function (E). General cognitive function and daily function were measured by the Mini-Mental State Examination (MMSE) and the Functional Assessment Questionnaire (FAQ), respectively. Linear mixed models were fitted to curve their trajectories across different MCI subtypes. ResultsConsidering visuospatial function, subtypes were MO (memory impaired only), M&V (memory and visuospatial function impaired) and M&nV (memory impaired and visuospatial function non-impaired). Similar subtypes and naming rules were obtained based on language, executive function, and processing speed. Further, depending on the number of relative impaired cognitive domains M&S and M&M were obtained. Participants with MO had the highest prevalence in the sample (53.4 %), followed by M&nV (31.1 %). Participants with M&V had the highest mean age (74.69 years) at baseline and the greatest dementia conversion rate (53.2 %). The MMSE and FAQ score trajectories changed most slowly in participants with MO while fastest in those with M&V. Obvious different trajectories of both MMSE and FAQ scores were observed across different subtypes based on visuospatial function and executive function. ConclusionCompared to MO, individuals with multi-dimensional cognitive impairment have worse general cognitive and daily functions, especially for those with M&V.

Apathy in Lewy body disease and its effects on functional impairment over time.

Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.

The validity and reliability of the Turkish version of the functional mobility scale in patients with cerebral palsy.

Objectives: The aim of this study was to investigate the validity and reliability of the Turkish version of the Functional Mobility Scale (FMS) in patients with cerebral palsy. Patients and methods: The validity and reliability study was conducted with 100 cerebral palsy patients (66 males, 34 females; mean age: 6.4±2.7 years; range, 2 to 18 years) between July 2015 and July 2018. The translation of the FMS was performed according to international standards. For test-retest reliability, 54 patients were reevaluated one week after the initial test with the Turkish version of the FMS, and Cohen's weighted kappa values were analyzed. The validity of the scale was assessed by correlating the FMS with the Gross Motor Function Classification System and the Gillette Functional Assessment Questionnaire Walking Scale. Twenty patients were evaluated by two researchers for interobserver reliability. Results: The kappa coefficients for test-retest reliability were 0.90 for FMS 5 m, 0.92 for FMS 50 m, and 0.91 for FMS 500 m. An evaluation of the validity revealed a significant correlation between FMS and the Gross Motor Function Classification System for all distances (r=-0.95, r=-0.96, and r=-0.92 for 5, 50, and 500 m, respectively; p <0.001), as well as the Gillette Functional Assessment Questionnaire Walking Scale (r=-0.95, r=-0.94, and r=-0.91 for 5, 50, and 500 meters, respectively; p <0.001). The kappa coefficients related to interobserver reliability were 0.73 for 5 m, 0.69 for FMS 50 m, and 0.81 for FMS 500 m. Conclusion: The Turkish version of the FMS can be considered a valid and reliable instrument for the assessment of cerebral palsy patients.

Adaptive functioning and neurodevelopment in patients with Dravet syndrome: 12-month interim analysis of the BUTTERFLY observational study

ObjectiveThe BUTTERFLY observational study aims to elucidate the natural trajectory of Dravet syndrome (DS) and associated comorbidities in order to establish a baseline for clinical therapies. We present the 12-month interim analysis of the study. Materials and methodsPatients with a genetically confirmed diagnosis of DS were enrolled in the study. Adaptive functioning and neurodevelopmental status were measured using the Vineland Adaptive Behavior Scale, Third Edition (Vineland-III), Bayley Scales of Infant Development, Third Edition (BSID-III), and Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Executive function, ambulatory function and locomotor activities, and overall clinical status were measured using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) scale, Gillette Functional Assessment Questionnaire (Gillette FAQ), and Clinician or Caregiver Global Impression of Change scales (CGI-C or CaGI-C) respectively. ResultsOverall, 36 patients were enrolled across three age groups, with 35 patients completing at least part or all of one post-baseline visit through Month 12. Significant improvements in receptive communication, as assessed by Vineland-III and BSID-III raw scores, and in verbal comprehension subtests, as assessed by WPPSI-IV raw scores, were observed in BUTTERFLY patients for the all-patient group. Many patients performed on the impaired end of the BRIEF-P Global Executive Composite scale at baseline suggesting difficulties in executive function, and no significant change was observed in BRIEF-P scores for the all-patient group. Most patients performed in the dynamic range of the Gillette FAQ at baseline, and no significant change was observed in Gillette FAQ scores for the all-patient group. Lastly, there was significant improvement observed in the CaGI-C scores for the all-patient group. SignificanceThis BUTTERFLY interim analysis shows small improvements in communication skills along with stability in other developmental abilities across patients with DS enrolled in the study from baseline to Month 12.

Associations of musculoskeletal dysfunction, time to brake, and patient reported outcomes following lower extremity trauma

IntroductionInability to drive a motor vehicle due to lower extremity injury is a major inconvenience. Timing of safe return to driving has not been much studied. Objective measurements such as time to brake (TTB) have been proposed; however, utility and concordance of functional outcome measurements have not been previously evaluated. The purpose of this project is to measure these parameters and to assess for associations with ability to safely return to driving, improving the ability of clinicians to assess for measurements of driving readiness without specifically measuring TTB. MethodsA prospective, cohort study of 232 patients with complex lower extremity injuries to the pelvis, acetabulum, hip, femur, knee, tibia, ankle, and foot was performed. Time to brake (TTB) was measured once weightbearing was allowed. Function was assessed by the Musculoskeletal Function Assessment (MFA) questionnaire, and pain, mobility, and physical functions, via patient reported outcome measurement information system (PROMIS) surveys. ResultsPatients with longer TTB had significantly elevated MFA scores indicating increased musculoskeletal dysfunction post-injury. As the MFA score increased by 1 point, TTB increased by 0.013 s (p<0.001). PROMIS metrics were also significantly associated with patients experiencing more pain and worse mobility as TTB increased. DiscussionMany patients continue to exhibit musculoskeletal dysfunction several months post-treatment for complex lower extremity injuries. Patients with better PROMIS metrics and MFA scores, and shorter TTB are more appropriate to return to driving. Surgeons may be better informed about safe driving ability by considering these measurements. Level of EvidenceII

Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial

ObjectiveThis study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients.MethodsForty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise.ResultsAt baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the “emotional aspect” domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the “alternate biceps (bilateral)” exercise.ConclusionFunctional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis.Trial registration: ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1.

Digital Cognitive Assessment Leveraging the Boston Process Approach Can Flag Emergent Cognitive Decline in Individuals with Subtle and Mild Functional Disability

AbstractBackgroundEarly detection of Mild Cognitive Impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD) is key to optimal management. Digital tests allow for the reliable capture of meaningful, process‐based neuropsychological test parameters that traditional paper/pencil measures fail to detect, thus enabling earlier detection. We assessed how subtle functional decline relates to process features extracted from the digital Clock Drawing Test (dCDT) and the digital Trail Making Test‐Part B (dTrB).Methods629 community dwelling participants (58.5% female) were assessed with the Functional Assessment Questionnaire (FAQ), the MMSE, the digital clock drawing test (dCDT) and the digital Trail Making Test‐Part B (dTrB). Three FAQ groups were constructed: FAQ = 0‐2 (minimal functional disability, n = 490); FAQ = 3‐5 (subtle functional disability, n = 90); FAQ = 6‐8 (mild functional disability, n = 49).ResultsParticipants with minimal functional disability were younger (p = 0.027) and scored better on the MMSE (p = 0.001) than other groups. Groups were equated for education. dCDT command/copy component placement was more accurate among participants with minimal functional disability compared to other groups (command dCDT p = 0.001 versus mild functional disability; copy dCDT p = 0.006 versus both subtle and mild functional disability). On the dTrB, participants with minimal disability drew faster than those with subtle or mild disability (mean stroke velocity, p = 0.001). Analyses for percent pen lift time found no difference between participants with minimal versus subtle disability; however, both groups differed from participants with mild disability (p = 0.001). Optimal group classification using stepwise nominal regression with the minimal functional disability group as the reference was achieved using dCDT copy component placement and dTrB mean stroke velocity (X 2 = 28.37, p = 0.001), where dTrB mean velocity entered first (X 2 = 17.73, p = 0.001) followed by dCDT copy component placement (X 2 = 11.19, p = 0.004). Both variables contributed comparably to group classification (Wald statistic range 5.82‐8.88, p = 0.012, respectively).ConclusionsThe digital assessment described above, targeting executive, scanning, visuoconstructional and motor domains, captures highly nuanced, discrete behaviors with precision/ operationalism heretofore unattainable. Consequently, it is reasonable to posit that digital cognitive assessments leveraging the Boston Process Approach can both objectively detect emergent cognitive impairment and infer its likely impact on functional activities, critical for practical assessment in clinical care.

Apathy and dysfunction in Lewy Body Disease

AbstractBackgroundStudies in Alzheimer’s disease and frontal temporal lobe dementia have shown high prevalence and persistence of apathy at different disease stages and its strong association with functional decline. Here we use well‐established methods to examine the relationship between apathy and function in a cohort of well‐characterized patients with Lewy Body Disease (LBD) who had regular assessments over time.MethodSample includes participants in the National Alzheimer’s Coordinating Center Uniform Data Set (NACC‐UDS, 9/2005‐12/2019) who had at baseline (1) cognitive status of mild cognitive impairment (MCI) or dementia, (2) presumed etiologic diagnosis of LBD, and (3) ≥1 follow‐up. Baseline diagnosis of Parkinson’s disease (PD) was assessed. Apathy was identified using clinician judgment. Participants’ function was measured using the Functional Assessment Questionnaire (FAQ). Multivariable linear mixed model (LMM) was used to estimate relationships between apathy, cognitive status (baseline MCI vs dementia), and function over time.ResultThe sample included 339 participants with MCI and 748 with dementia. Average age = 72.7±8.3, 74% male, 86% non‐Hispanic white, 15.4±3.4 years of education, baseline MMSE = 23.7±5.8, with 3.4±1.7 years of follow‐up. Proportion of participants who reported difficulty with function at baseline ranged according to task complexity from 48% (Heating water, making a cup of coffee, turning off stove after use) to 85% (Assembling tax records, business affairs, or papers); with total FAQ = 13.0±9.1. Presence of apathy increased from 52% at baseline to 60% at visit 4. Across all follow‐ups, 24% of the participants were never apathetic, 13.7% had apathy intermittently (&lt;50% of all visits), 28.3% persistently (≥50% of all visits), and 34.0% were apathetic at all visits. LMM estimation results showed that, compared to participants who were never apathetic, FAQ was 3.8±0.8 points higher, i.e., greater dysfunction, at baseline in participants who were always apathetic, and 3.3±0.7 points higher in those who had intermittent/persistent apathy (both p&lt;0.001). Rate of functional decline was 0.41±0.3 points faster each year in those always apathetic compared to never apathetic (p&lt;0.1).ConclusionApathy is highly prevalent in individuals with LBD. Independent of cognitive status, more persistent apathy was strongly associated with worse function.

Translation and adaptation of a questionnaire for assessing cognitive domains based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders ‐ DSM‐5 for neurocognitive disorders

AbstractBackgroundThe Cognitive Domains and Functional Assessment Questionnaire (QACDF) assesses cognitive and functional decline based on the DSM‐5 criteria for Neurocognitive Disorders¹. The QACDF has two versions, one for the patient and another for the informant. It is composed of 30 items, each assessed by a likert scale. This questionnaire has appropriate semantic characteristics for the Brazilian older adult population.MethodThe objective of this study was to translate, adapt and assess the semantic, idiomatic, experiential and conceptual equivalence of the QACDF. Firstly, the QADCF original version in Portuguese was translated to English by two Bilingual translators, a non‐specialist linguist and a specialist in the field. After this, the two translators (T1 and T2) together with a mediator translator synthesized the translations in a common version (T3). Then, the T3 version was back‐translated into Portuguese by a Bilingual translator, blind to the original version². The three versions (original, translated and back‐translated) were assessed by a committee of specialists. The committee was composed of the initial translators, an English native speaker, an expert in the methodology and the main researchers.ResultThe QACDF Items were adjusted to conceive equivalent expressions for the target language, as well as to assess cognitive domains and the functionality of daily living of English speakers. Semantic, idiomatic, experiential and conceptual equivalence were debated by the committee until consensus was reached.ConclusionThe translation of the instrument followed the proposed methodology by Beaton et col. However, while the Brazilian Portuguese versions have been assessed by two pilot studies, pilot studies are still needed to further adjust the questionnaires for English speakers.

The evaluation of translated neuropsychological assessments tools for the early detection of mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs)

AbstractBackgroundThe incidence of mild cognitive impairment (MCI), particularly in low and middle‐income countries (LMICs) has been noticeably on the rise. With the high cost of dementia care, the need for tools that aid with the early detection of MCI is becoming of high importance, especially in LMICs. As a part of screening for MCI, many tests have been proposed evaluating for impairments in cognitive, behavioral, and functional domains, which are important for ruling out and evaluating for any reversible causes. While useful, most of these tests were developed in the west, limited works exist reporting the appropriateness and experience of using such tests for patients from LMICs.MethodIn this work, we aim to evaluate the use of translated digital assessment for detecting MCI in an Arabic‐speaking population in Palestine. For this purpose, we developed a digital test covering three cognitive, behavioral, and functional domains, where MMSE and the Neuropsychiatric Inventory ‐ Questionnaire (NPI‐Q) together with two functional assessment questionnaires were translated to Modern Standard Arabic (MSA) and presented in a digital interface. Upon the development and translation of the digital tests, field testing was conducted to check for use experience and appropriate patient comprehension of the questions to match their intended use.ResultFollowing the implementation of the digital assessment tools, quantitative and qualitative data was collected summarizing the user experience, where numerous limitations were noted. Despite being asked in their native language, several patients expressed the need for more clarifying questions. While all patients were Arabic speakers, some patients required the use of simpler terminology that matches their local dialects. Other patients reported the lack of relevance of certain questions, regarding the activities of daily living in the functional assessments. Overall, the patient’s experience and comprehension of questions varied with their age and literacy level.ConclusionDespite the high prevalence of dementia in LMICs, there are limited available neuropsychological assessment tools that are fit for the local cultural and linguistic. The findings suggest the need for the development of culturally and linguistically appropriate assessments to ensure appropriate patient comprehension, and avoid misdiagnosis of patients.

The hidden toll of war: a comprehensive study of orthopedic injuries in Yemen

BackgroundYemen has been experiencing a protracted civil war and humanitarian crisis since 2015, which has resulted in many war-related injuries. However, there is a lack of data on the epidemiology, characteristics, and outcomes of these injuries, especially the orthopedic ones. This study aimed to describe the war-related orthopedic injuries in Yemen and their impact on the patients’ health and function.MethodsThis was a retrospective study based on medical records and trauma registries of 3930 patients who were admitted to three major trauma centers in Sana’a city with war-related orthopedic injuries from January 2015 to December 2020. We collected data on demographics, injury mechanisms, injury types and locations, surgical procedures, complications, mortality, and functional outcomes using the Musculoskeletal Function Assessment questionnaire. We used descriptive and inferential statistics to analyze the data and performed a logistic regression analysis to identify the factors associated with mortality.ResultsMost of the patients were young males and civilians who suffered from complex and severe injuries involving multiple body regions, especially the lower extremities. The main mechanisms of injury were gunshot wounds, blast injuries, and landmine explosions. The patients required multiple surgical procedures and implants, and had high rates of complications and mortality. The most common complications were infection, nonunion, malunion, and amputation. The most common cause of death was sepsis. The functional outcomes were poor, as indicated by the high mean MFA score. The logistic regression analysis showed that older age, blast injuries, spine injuries, vascular injuries, and infection were significant predictors of mortality.ConclusionThis study provides valuable information on the war-related orthopedic injuries in Yemen and their impact on the patients’ health and function. It also identifies some areas for future research, such as exploring the risk factors for infection and nonunion/malunion, evaluating the effectiveness and cost-effectiveness of different surgical procedures and implants, assessing the long-term outcomes and quality of life of the patients, and developing novel strategies to enhance bone and soft-tissue healing.