Functional Impairment In Patients Research Articles

SymTrak-8 as a Brief Measure for Assessing Symptoms in Older Adults.

Patient- and caregiver-reported 23-item SymTrak scales were validated for monitoring clinically actionable symptoms and impairments associated with multiple chronic conditions (MCCs) in older adults. Items capture physical and emotional symptoms and impairments in physical and cognitive functioning. An abbreviated SymTrak is desirable when response burden is a concern. Develop and validate the 8-item SymTrak. Secondary analysis of SymTrak validation study; 600 participants (200 patient-caregiver dyads; 200 patients without an identified caregiver). Demographic questions, SymTrak, and Health Utility Index Mark 3 (HUI3). SymTrak-8 demonstrated good fit to a one-factor model using confirmatory factor analysis (CFA). Concurrent criterion validity was supported by high standardized linear regression coefficients (STB) between baseline SymTrak-8 total score (independent variable) and baseline HUI3 preference-based overall HRQOL utility score (dependent variable; 0 = death, 1 = perfect health), after adjusting for demographics, comorbid conditions, and medications, with strength comparable to SymTrak-23 (STB = - 0.81 and - 0.84, respectively, for SymTrak-8 and SymTrak-23, when patient-reported; and - 0.60 and - 0.62, respectively, when caregiver-reported). Coefficient alpha (0.74; 0.76) and 24-h test-retest reliability (0.83; 0.87) were high for SymTrak-8 for patients and caregivers, respectively. The convergent correlation between brief and parent SymTrak scales was high (0.94). SymTrak-8 demonstrated approximate normality and a linear relationship with SymTrak-23 and HUI3. Importantly, a 3-month change in SymTrak-8 was sensitive to detecting the criterion (3-month reliable change categories; improved, stable, declined in HUI3 overall utility), with results comparable to SymTrak-23. SymTrak-8 total score demonstrates internal reliably, test-retest reliability, criterion validity, and sensitivity to change that are comparable to SymTrak-23. Thus, patient- or caregiver-reported SymTrak-8 is a viable option for identifying and monitoring the aggregate effect of symptoms and functional impairments in patients with multimorbidity when response burden is a concern.

Cognitive, Behavioral, and Functional Impairments among Traumatic Brain Injury Survivors: Impact on Caregiver Burden.

Background The burden of cognitive, behavioral, and functional impairments after traumatic brain injury (TBI) is still not highlighted much, but its impact on caregivers is socio-economically relevant. The objectives of the study were to assess cognitive, behavioral, and functional impairments in patients of TBI and its impact on caregiver burden. Materials and Methods A descriptive cross-sectional study was conducted using a total enumeration sampling technique. Mini-mental status examination, neuropsychiatric inventory and Rappaport’s disability rating scale were used to assess patients’ cognitive, behavioral, and functional impairments, respectively. Zarit Caregiver Burden Scale was executed to quantify the caregiver burden. Results Fifty patients of TBI and their caregivers were enrolled. Among these, 24% had moderate cognitive impairments. Among behavioral symptoms, 40% had agitation, 24% had depression, 18% had anxiety, and 16% had irritability. Moderate functional disability was reported by 18% of the patients, while 2% reported severe functional disability. Moderate to severe caregiver burden was reported by 8% of caregivers. Patients’ behavioral ( r = 0.507, p < 0.001), functional ( r = 0.473, p = 0.001), and cognitive ( r = –0.438, p = 0.001) impairments had significant correlations with caregiver burden. Conclusion Patients develop cognitive, behavioral, and functional disability after TBI. The caregiver burden increases significantly with cognitive dysfunction, behavioral symptoms, and impaired functional status of patients. Therefore, appropriate support is to be provided to caregivers as well as patients.

Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

Background and objectivesEvidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients.MethodsThis retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models.ResultsThe study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time.ConclusionsDiffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy.

To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer. A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire. The median patient age was 66years (range 53-70years) with a median follow-up time of 44months (36-71months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12months (P<0.001), but gradually plateaued within 36months. Erectile function deterioration was noted in 32 (66.7%) patients 36months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70years (P=0.029), prostate V100 ≥95% (P=0.024), apex V100 ≥95% (P=0.024), apex V150 ≥70% (P=0.009) and apex D90 ≥150Gy (P=0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70years (odds ratio 7.91, P=0.024) and apex V150 ≥70% (odds ratio 7.75, P=0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy. An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.

Effects of exercise combined with whole body vibration in patients with patellofemoral pain syndrome: a randomised-controlled clinical trial

BackgroundPatellofemoral pain is a prevalent condition in the general population, especially in women, and produces functional impairment in patients. Therapeutic exercise is considered an essential part of the conservative management. The use of vibration platforms may help improve strength and function and reduce pain in patients with knee disorders. The aim of this investigation was to determine the effects of adding whole body vibration (vertical, vibration frequency of 40 Hz, with an amplitude from 2 to 4 mm) to an exercise protocol for pain and disability in adults with patellofemoral pain.MethodsA randomised clinical trial was designed, where 50 subjects were randomly distributed into either an exercise group plus whole body vibration or a control group. Pain, knee function (self-reported questionnaire) and range of motion and lower limb functionality were assessed at baseline and at 4 weeks. The experimental group performed 12 supervised sessions of hip, knee and core strengthening exercises on a vibration platform 3 times per week during 4 weeks. The control group followed the same protocol but without vibration stimuli. Differences in outcome measures were explored using an analysis of the variance of 2 repeated measures. Effect sizes were estimated using Square Eta (η2). Significant level was set al P < 0.05.ResultsStatistically significant differences were found after intervention in favour of the experimental group in the between-groups comparison and in the interaction of the experimental group before and after treatment in terms of pain perception (P = 0.000; η2 = 0.63) and function outcomes scores (P = 0.000; η2 0.39 and 0.51 for lower limb functional scale and Kujala scores respectively).ConclusionA 4-week whole body vibration exercise programme reduces pain level intensity and improves lower limb functionality in patellofemoral pain patients and is more effective than exercise alone in improving pain and function in the short-term.Trial registrationClinicalTrials.gov (NCT04031248). This study was prospectively registered on the 24th July, 2019.

The time, mode and markers of pituitary function deterioration in patients with PROP1 mutation. Single centre, longitudinal observation

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Evaluation of the 6-minute walking test as a smartphone app-based self-measurement of objective functional impairment in patients with lumbar degenerative disc disease.

Digital transformation enables new possibilities to assess objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). This study examines the psychometric properties of an app-based 6-minute walking test (6WT) and determines OFI in patients with lumbar DDD. The maximum 6-minute walking distance (6WD) was determined in patients with lumbar DDD. The results were expressed as raw 6WDs (in meters), as well as in standardized z-scores referenced to age- and sex-specific values of spine-healthy volunteers. The 6WT results were assessed for reliability and content validity using established disease-specific patient-reported outcome measures. Seventy consecutive patients and 330 volunteers were enrolled. The mean 6WD was 370 m (SD 137 m) in patients with lumbar DDD. Significant correlations between 6WD and the Core Outcome Measures Index for the back (r = -0.31), Zurich Claudication Questionnaire (ZCQ) symptom severity (r = -0.32), ZCQ physical function (r = -0.33), visual analog scale (VAS) for back pain (r = -0.42), and VAS for leg pain (r = -0.32) were observed (all p < 0.05). The 6WT revealed good test-retest reliability (intraclass correlation coefficient 0.82), and the standard error of measurement was 58.3 m. A 4-tier severity stratification classified patients with z-scores > -1 (no OFI), -1 to -1.9 (mild OFI), -2 to -2.9 (moderate OFI), and ≤ -3 (severe OFI). The smartphone app-based self-measurement of the 6WT is a convenient, reliable, and valid way to determine OFI in patients with lumbar DDD. The 6WT app facilitates the digital evaluation and monitoring of patients with lumbar DDD.

Somatization disorder mediates the association of depression and anxiety with functional impairment in patients with heart failure

ABSTRACT Previous studies have suggested that depression, anxiety, and somatization disorder are strongly associated with diminished functional status. However, research has not tested the mediational models of how depression and anxiety lead to functional impairment. The aim of this study was to examine whether somatization disorder mediates the association of depression and anxiety with functional impairment in heart failure (HF) patients. The self-reported questionnaires were applied to measure depression, anxiety, and somatization disorder. Functional status was evaluated by the NYHA Class. Ordinal logistic regression analysis was performed to examine the association of depression, anxiety, and somatization disorder with functional status. Mediation analysis was conducted to determine indirect effects. Functional impairment was both related to depression (OR = 2.257, 95% CI = 1.534–3.322, P < 0.001) and elevated somatization severity (OR = 1.042, 95% CI = 1.003–1.082, P = 0.032) in HF patients, whereas anxiety was not associated with functional impairment (OR = 0.659, 95% CI = 0.429–1.012, P > 0.05). Mediation analysis indicated that both depression and anxiety have indirect effects on functional impairment as mediated by somatization disorder in HF patients. Additionally, depression has direct effect on functional impairment of the patients.

Physical Activity in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry

A physically active lifestyle reduces the risk of cardiovascular events and functional impairment in patients with peripheral artery disease (PAD). There are limited data on the patterns of physical activity in patients with PAD compared between countries. Self reported physical activity (sedentary vs. not) was obtained at enrolment, 3, 6, and 12 months in the US and Netherlands' cohorts of the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry of patients with new or worsening claudication. Multivariable repeated measures using modified Poisson regression analysis compared the proportion of sedentary participants over time between countries to identify factors that attenuate intercountry differences. Of 1 098 participants, 743 (67.7%) and 355 (32.3%) were recruited from the USA and the Netherlands respectively. Compared with the Netherlands, participants from the US were older (mean age 68.6 vs. 65.3 years; p<.001), more obese (41.3% vs. 20.5%; p<.001), and more likely to be female (41.3% vs. 31.4%; p=.002). There were fewer current smokers (30.1% vs. 52.8%; p<.001) and supervised exercise referrals (1.6% vs. 63.9%; p<.001) in the US compared with the Netherlands. US participants were more sedentary at baseline (43.7% vs. 34.1%; p<.001). Sedentary behaviour decreased after three months in both countries, then diverged with an increase in sedentary participants in the USA. Risk of sedentary behaviour was significantly greater in the USA compared with the Netherlands at 12 months, after adjustment of sociodemographic, lifestyle factors, and comorbidities (relative risk [RR] 1.56, 95% confidence interval [CI] 1.08-2.25; p=.020) but was attenuated after accounting for referral to supervised exercise (RR 1.20, 95% CI 0.67-2.16; p=.54). Referral to supervised exercise was key in explaining the observed difference in the physical activity levels between patients with PAD in the USA and the Netherlands. Further promotion of supervised exercise for PAD may improve physical activity in patients with PAD and modify cultural norms of inactivity in the US.

Evaluation of physical function and its association with body composition, quality of life and biomarkers in cancer cachexia patients

There are currently no approved treatments for cancer cachexia. One of the main barriers to developing a treatment for this indication is the lack of consensus on clinically important tools for assessing functional impairment in this setting. This issue is of critical importance because functional improvement is likely to be required for approval by regulatory agencies. This cross-sectional study aimed to evaluate various functional performance measures and establish their association with body composition, energy expenditure, biomarkers, and patient-reported quality of life (QOL). Physical function, body composition, energy expenditure, cytokines, testosterone, and patient-reported QOL were compared between men with solid tumors with cachexia (CAC; N=48), without cachexia (CNC; N=48), and weight-stable patients without cancer (CON; N=37). Receiver Operator Characteristic curves and multivariate regression were performed to identify functional impairment cut-points and predictors of physical function, respectively. Patients with CAC displayed lower total lean and appendicular lean mass, stair climb power (SCP), upper body strength, and bioavailable testosterone, and displayed higher energy expenditure than CNC or CON (p≤0.03); CAC showed lower handgrip, respiratory quotient, and appetite, and higher cytokines and fatigue than CON (p≤0.032). A cut-point of 336 Watts for SCP provided 78% sensitivity and 77% specificity for classification of CAC (p=0.001); SCP also performed better than other measures tested when compared to CON-derived normatives. Upper body strength exhibited moderate sensitivity and specificity for classification of CAC (p≤0.02). Elevated relative energy expenditure and cytokines negatively predicted, and muscle mass positively predicted, various muscle strength outcomes. Stair climb power and upper body strength may have potential as discriminatory tests for functional impairment in patients with cancer cachexia.

DISABILITY AND EXECUTIVE FUNCTIONS IN SCHIZOPHENIA: A CROSSSECTIONAL STUDY. (RELATION OF DISABILITY WITH EXECUTIVE FUNCTIONS)

The aim of the study was to see if there is any association between disability, positive- negative symptoms and executive functions in patients of schizophrenia.&#x0D; Study had a crossectional design with purposive sampling in 50 patients with schizophrenia. Subjects were assessed using sociodemographic and clinical data sheet, PANSS, IDEAS (disability) and WCST (executive functions).&#x0D; The result of the study revealed that poor executive functioning is responsible for functional impairment in patients with schizophrenia. A significant association was seen between IDEAS and WCST variables in patients of schizophrenia. A significant association was also seen between PANSS (positive and negative score) with IDEAS and WCST variables (disability and executive functions being more strongly associated with negative symptoms). On correlation analysis of socio-demographic and clinical data with IDEAS and WCST variables, a significant correlation (positive) of age and duration of illness was seen with IDEAS. Age and drug dosage were having significant (positive) correlation with WCST variable and education was found to be having significant (negative) correlation with WCST variables.&#x0D; Executive functions and negative symptoms are crucial for functional outcome and independent living and are important target for intervention in order to reduce disability and improve quality of life in patients suffering from Schizophrenia.&#x0D; Keywords: Schizophrenia, Disability, Positive–negative symptoms, Executive functions.

Altered brain function and clinical features in patients with first-episode, drug naïve major depressive disorder: A resting-state fMRI study

Major depressive disorder (MDD) is characterized by heterogeneous clinical performance and neurocognitive impairment. It is important to explore the correlation between global functioning and regional homogeneity (ReHo)/amplitude of low-frequency fluctuation (ALFF) values in MDD patients. 67 first-episode, drug naïve MDD patients and 69 healthy subjects were enrolled in the study. The MATRICS Consensus Cognitive Battery (MCCB) and the Functioning Assessment Short Test (FAST) were used to assess functional impairment in patients. Brain activity was assessed using ReHo and ALFF measurements. The relationship between the clinical features and altered brain function was evaluated using correlation analysis. There were significant differences in the ReHo and ALFF values between MDD patients and healthy subjects. The reduction in ReHo in the left calcarine/lingual gyrus/cuneus was negatively correlated with occupational functioning and the total FAST scores. The reduction in ALFF in the right calcarine/lingual gyrus was positively correlated with the verbal learning aspects of the MCCB. These findings suggest that the altered brain function in the default mode network (DMN) may be related to functional impairments in patients with first-episode, drug naïve major depressive disorder.

Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods.

Background: Acromegaly is a rare disease that requires modern treatment to decrease the risk of mortality, mainly from vascular diseases. Identifying acromegalic patients with increased cardiovascular risk is challenging. Speckle-tracking echocardiography (STE) is a modern, well-validated, and reproducible method of assessing left ventricular longitudinal deformation and providing a sensitive assessment of myocardial contractility. We hypothesized that STE may be useful in evaluating subclinical dysfunction of the left heart in acromegalic patients, especially when a left ventricle (LV) assessment is completed with STE of the left atrium (LA).Purpose: To assess the diagnostic value of speckle-tracking echocardiography in identifying the occurrence of LV and LA functional impairment in patients with acromegaly, in comparison to patients without this rare pituitary disease.Methods: Echocardiographic assessments of LV and LA function using the new STE method were performed in 60 subjects: 30 acromegalic (ACRO group) patients and a CONTROL group with 30 patients matched in terms of age, gender, systolic/diastolic pressure, and history of hypertension for at least 12 months.Results: The ACRO group, compared to the CONTROL group, presented: (1) higher left ventricular mass (left ventricular mass index: 132 vs. 108 g/m2, p < 0.001) and, in consequence, more frequent LV hypertrophy (80.0 vs. 53.3%; p = 0.028); (2) impaired LV systolic function measured by both left ventricular ejection fraction (LVEF) (63.4 vs. 66.9%, p < 0.001) and global longitudinal strain (GLS) (−18.1 vs. −19.4%, p = 0.023); (3) greater LA anteroposterior diameter (40.3 vs. 36.9 mm, p = 0.003) and indexed left atrial volume (37.9 vs. 27.6 ml/m2, p < 0.001); and (4) impaired echocardiographic strain parameters corresponding with LA function.Conclusions: Acromegaly, even in young patients with good blood pressure control, may be associated with left ventricular hypertrophy and subclinical impairment of the left ventricular and left atrial mechanical function, which may be identified by speckle-tracking echocardiography. Further research in this area is necessary to clarify the prognostic value of these phenomena.

Relationship Between Personality Disorders Scales, Pathological Personality Traits, and Six Domains of Functioning in Sample With Alcohol Use Disorder.

BackgroundStudies reveal a functional impairment in patients with personality disorders (PDs), but there is not enough information to form conclusions about this relation in patients with alcohol use disorder (AUD). The aim of this study was to investigate to what extent a personality disorders scales including pathological personality traits (PPTs) predict six domains of functioning in patients with AUD.MethodsIn total, 48 patients with AUD diagnosis, who were treated in the psychiatric clinics, aged 20 to 65 years [M = 37.5; SD = 12.08; 12 (25%) females and 36 (75%) males], filled out the demographic questionnaire, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, Latvian version) and Latvian Clinical Personality Inventory (LCPI v2.1.). All respondents signed the informed consent form.ResultsStepwise regression analysis showed that PD Avoidant scale positively predicts impairment in Cognition and Getting along domains of functioning in AUD patients, but, on the PPTs level, it was found that Social withdrawal along with Irresponsibility and Guilt/Shame positively predict impairment in Cognition domain of functioning, and Social withdrawal along with Depressivity and Irresponsibility positively predict impairment in Getting along domain of functioning. The results of the study showed that PPT Orderliness negatively predicts impairment in Live activities domain of functioning. The PD Dependent scale and PPT Separation insecurity positively predict impairment in Participation domain of functioning.ConclusionsObtained results add deeper insight into understanding of the relationship between personality disorders scales including pathological personality traits and six domains of functioning in patients with AUD.

Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures.

The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements. The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs. The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001). This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.

Decreased Gamma-Band Auditory Steady State Response is Associated With Social Functional Impairment in Patients at Clinical High Risk for Schizophrenia

Decreased Gamma-Band Auditory Steady State Response is Associated With Social Functional Impairment in Patients at Clinical High Risk for Schizophrenia

Effects of 2-year treatment with dimethyl fumarate on cognition and functional impairment in patients with relapsing remitting multiple sclerosis.

A significant proportion of patients with multiple sclerosis (MS) show cognitive impairment. To evaluate the effect of 2-year treatment with oral dimethyl fumarate (DMF) on cognition in relapsing remitting MS (RRMS). In this prospective single-arm study RRMS patients treated with DMF underwent a wide battery of tests, including an extensive neuropsychological evaluation, clinical and patient-reported outcomes (PROs) and quality of life (QoL). Primary endpoints were the proportion of patients with cognitive impairment at baseline and of patients with cognitive worsening over 2years. Overall, 217 patients (74.2% females, mean age 37.3years) receiving DMF were recruited, and 156 (67.2%) completed the study. Of the 49 patients with cognitive impairment at baseline, 34 had 2-year data: 15 (44.1%) patients worsened and 19 (55.9%) did not. The cognitive impairment index improved in one third of patients at 2years. Less than 20% of patients had relapses at 2years (annualized relapse rate: 0.190). Few patients had disability progression. PROs (fatigue, depression, impairment in work/social activities), QoL, and most of neuropsychological tests significantly improved vs. baseline. The 2-year treatment with DMF was associated with slowing of cognitive impairment and with significant improvements in QoL and psychosocial function.

Roles of Trait Mindfulness in Behavioral Activation Mechanism for Patients With Major Depressive Disorder.

Behavioral activation and mindfulness have both been shown to engender improvement of functional impairment in patients with major depressive disorder. In behavioral activation, the practice of engaging with the direct experience of the present moment is central, especially when targeting avoidance. Consequently, mindfulness affects changes of avoidance in behavioral activation. This study was designed to assess exploratory relations among trait mindfulness, avoidance, and functional impairment in behavioral activation mechanism for depression. For 1042 participants with depression only or for depression with anxiety disorders, we used structural equation modeling to examine relations among trait mindfulness, avoidance, and functional impairment. Trait mindfulness non-reactivity, non-judging, and acting with awareness had a direct negative effect on avoidance. Trait mindfulness non-reactivity, trait non-judging, and trait acting with awareness had indirect negative effects on functional impairment. Results show that each trait mindfulness facet exhibited a distinct pattern of relations with avoidance and impairment.

Amphetamine improves rat 5-choice continuous performance test (5C-CPT) irrespective of concurrent low-dose haloperidol treatment.

Cognitive dysfunction mediates functional impairment in patients with schizophrenia, necessitating the timely development of pro-cognitive therapeutics. An important initial step in this process is to establish what, if any, pro-cognitive agents and associated mechanisms can be identified using cross-species translational paradigms. For example, attentional deficits-a core feature of schizophrenia-can be measured across species using the 5-choice continuous performance test (5C-CPT). The psychostimulant, amphetamine, improves human and rodent 5C-CPT performance. Here, we tested whether amphetamine would similarly improve 5C-CPT performance in the presence of dopamine D2 receptor blockade, since pro-cognitive treatments in schizophrenia would virtually always be used in conjunction with D2 receptor antagonists. We established the dose-response effects of amphetamine (0, 0.1, 0.3, or 1.0 mg/kg) and haloperidol (0, 3.2, 10, or 32 μg/kg) on 5C-CPT performance in Long Evans rats, and then tested an amphetamine (0.3 mg/kg) × haloperidol (10 μg/kg) interaction; the low dose was chosen because higher doses exerted deleterious non-specific effects on performance. Amphetamine improved 5C-CPT performance in poorly performing rats by increasing target detection, independent of haloperidol pretreatment. The pro-attentional effects of amphetamine were most likely mediated by dopamine release at D1-family receptors, since they persisted in the presence of acute D2 blockade. Alternative explanations for these findings are also discussed, as are their potential implications for future pro-cognitive therapeutics in schizophrenia.

Functioning in euthymic patients with bipolar disorder: A systematic review and meta-analysis using the Functioning Assessment Short Test.

Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder(BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables. In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. This study reinforces the relevant functional impact of BD in this populationandsuggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.