Geriatric Depression Scale Score Research Articles

Abstract WP193: A Pilot Study of Expanded Home-Based Telerehabilitation After Stroke

Introduction: High doses of activity-based rehabilitation therapy help but many patients do not receive this, e.g., due to access, cost, and low compliance. Home-based telerehabilitation (TR) can address these issues. A prior study found 6 weeks of TR targeting arm motor deficits after stroke comparably efficacious vs. therapy delivered in-clinic. Here, we evaluated a program expanded in TR dose and scope. Methods: Adults with stroke and arm motor deficits saw a licensed OT/PT who performed a live exam then supervised home-based TR (6 days/week, 1 hour/day) through games, exercises, and education. New features examined herein included (a) extending therapy to 12 weeks, (b) treating both arm and leg motor deficits, (c) augmented reality games, (d) wireless smart devices, (e) ingesting a daily experimental (placebo) pill, (f) using functional objects, (g) evaluating social networks, and (h) automated actionable reports. Results: Patients (n=13) were median age 61 [IQR=52-65.5], and 129 [52-486] days post-stroke. Patients initiated therapy on 79.9% of the 72 assigned days and completed >30 min on 65.7% of days, for a 12-week total therapy dose of 50.4 [33.3 - 56.7] hours. Non-compliant days during weeks 7-12 were double those of weeks 1-6. Modified Rankin scores improved by 1 level in 6/13 patients, 3 of whom were > 3month post-stroke. Fugl-Meyer motor scores increased by 6 [2.5-12.5] points in the arm and 1 [-0.5 - 5] point in the leg, mainly in weeks 1-6. Geriatric Depression Scale scores fell from 3 [1-5] at baseline (3/13 with depression) to 1 [0-4] (0/13 with depression) at week 12. Augmented reality gaming and functional objects were well received. Communication with smart devices was challenging. The experimental pill was taken, with photo verification, on 90.9% of days. Enrollees had large social networks. Automatic reports reliably notified study personnel when compliance was low or behavioral scores were concerning. Conclusions: High doses of home-based TR targeting arm and leg motor deficits are feasible and improve functional outcomes, motor deficits, and mood. The current system automates experimental pill ingestion and actionable reports to clinicians. Compliance declined over time, suggesting the need for novel approaches to extended periods of TR.

Preoperative Depression and Plasma Cortisol Levels as Predictors of Delirium after Cardiac Surgery

Background: Delirium is common in old patients who undergo cardiac surgery, and it is associated with adverse outcomes. The genesis of delirium is thought to be multi-factorial, but it is still not well understood. Symptoms of depression and elevated cortisol level have been described in some previous studies as factors associated with delirium, suggesting a shared pathophysiology. Aims: The objective of the present study was to determine whether preoperative depression symptoms and increased cortisol level represent risk factors for delirium after cardiac surgery. Methods: We performed a prospective cohort study in 183 patients aged >50 years undergoing elective cardiac surgery. The Geriatric Depression Scale (GDS) was used to assess patients for depressive symptoms before surgery. Preoperative plasma cortisol levels were available in 145 participants. Delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) during the first 7 days after surgery. Spearman correlation was used for correlations between GDS, Mini-Mental State Examination (MMSE), Charlson comorbidity index, and age. Binary logistic regression was used to determine whether GDS and cortisol levels predict postoperative delirium. Results: Delirium occurred in 60 patients out of 183 (32.8%) included and lasted 2.3 days (SD 1.36). GDS was correlated with age (p = 0.001) and comorbidity index (p = 0.003) and inversely correlated with MMSE score (p < 0.001). Higher preoperative GDS scores were associated with incidence of delirium in the postoperative period (p = 0.002). The association was significant after controlling for age, MMSE score, history of stroke, and Charlson comorbidity index (p = 0.045). Preoperative cortisol level was not associated with the development of postoperative delirium. Conclusion: Our results suggest that a higher preoperative depression score is associated with an increased risk of postoperative delirium. On the other hand, preoperative plasma cortisol level does not seem to be a predictor of delirium after surgery. Further studies are needed to determine the potential of preoperative depression treatment to prevent postoperative delirium.

Dissatisfaction with life and absence of leisure time activity: clues to overt depression and occult suicide risk in elderly individuals without significant disabling disease.

Depression is a major public health problem in all ages. Besides other chronic physical diseases, it is one of the most common psychiatric disorders observed in the elderly. In this study, it was aimed to determine the prevalence of depressive symptoms and related factors and to draw attention to occult suicide probability in elderly people without significant disabling disease. Individuals aged 65 and over, who were randomly selected from a family healthcare centre, were enrolled into the study. Geriatric Depression Scale (GDS) was used to assess prevalence of depression and Suicide Probability Scale (SPS) for risk of suicide. There were 323 elderly (F/M: 150/173). Mean age was 73.3 ± 6.1 years. The majority had chronic physical illnesses (77.7%). Mean GDS and SPS scores were 11.07 ± 4.6 and 62.91 ± 8.24, respectively. Prevalence of depression was 27.6%. In multivariable logistic regression analysis, living without a spouse (P = 0.047, Exp(B) = 1.744, 95% CI = 1.008-3.01), dissatisfaction with life (P ˂ 0.001, Exp(B) = 5.327, 95% CI = 3.02-9.36) and having no leisure time activity (P = 0.047, Exp(B) = 1.846, 95% CI = 1.009-3.37) were found to be the independent predictors of presence of depression, as indicated by GDS. In logistic regression analysis, dissatisfaction with life (P ˂ 0.001, Exp(B) = 2.631, 95% CI = 1.53-4.50) was found to be an independent predictor of high SPS scores. In elderly individuals without overt disabling disease, dissatisfaction with life, absence of leisure time activities, and a life without a partner seem to significantly increase the likelihood of overt depression. On the other hand, there is occult increase in suicide risk in the presence of dissatisfaction with their lives in the elderly.

Impacts of hippocampal blood flow on changes in left ventricular wall thickness in patients with chronic heart failure

BackgroundAlthough depressive symptoms increased mortality and hospitalization in chronic heart failure (CHF) patients, the underlying mechanism remains unclear. The aim of this study was to investigate whether an alteration in hippocampal perfusion, which is the neural substrate of depressive symptoms, is associated with changes in cardiac structures and/or functions in CHF patients. MethodsWe used baseline data of 70 CHF patients (66.8 ± 8.9 yrs, 32.5% women), including cerebral blood flow (CBF) in the hippocampus, geriatric depression scale (GDS) scores and echocardiographic parameters, in the Brain Assessment and Investigation in Heart Failure Trial (B-HeFT) (UMIN000008584). Echocardiography was repeated at 3.1 ± 0.5 years after the baseline evaluation. We first tested voxel-wise regression model with hippocampal CBF as dependent variable and each of echocardiographic parameter change as independent variable, adjusted for age and sex. Structural equation modeling was used to test a mediation effect of cognitive test scores on associations between hippocampal perfusion and changes in cardiac structures and/or functions. ResultsBaseline anterior hippocampal CBF was negatively correlated with changes in left ventricular posterior wall thickness (PWT) (P < 0.05 with family-wise error corrections). An existence of depressive symptoms was positively correlated with the baseline anterior CBF and negatively with the PWT changes (P < 0.05, both). There were both direct effects of the baseline anterior hippocampal CBF on PWT thinning and effects mediated through the depressive symptoms (P < 0.05, both). ConclusionsThis study provides the first evidence that the alteration in hippocampal perfusion may lead to changes in cardiac structures via increase in depressive symptoms in CHF patients.

Neighborhood Ties Reduced Depressive Symptoms in Older Disaster Survivors: Iwanuma Study, a Natural Experiment.

Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = −0.39; 95% confidence interval: −0.72, −0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.

Home-Visiting Cognitive Intervention for the Community-Dwelling Elderly Living Alone.

Background and PurposeThe elderly living alone feel lonelier and more isolated than do those live with others, and they are at higher risk for cognitive decline and depression. This study aimed to assess whether a home-visiting cognitive intervention (HCI) can have positive effects on cognitive improvement for the elderly who living alone.MethodsHCI was conducted from April 2016 to November 2019. Every elder who lived alone and 2 matched partners met for 8 weeks once a week. The partners visited participants' home and did the HCI which composed of cognitive training and cognitive stimulation activities. The Mini-Mental State Examination-dementia screening (MMSE), Geriatric Depression Scale (GDS), the Korean version of instrumental activities of daily living (K-IADL), and the Social Support Scale (SSS) were evaluated before and after HCI to compare the effect of HCI.ResultsA total of 258 participants showed significant improvements in MMSE, GDS, K-IADL, and SSS. The MMSE and GDS scores were significantly improved after HCI in both the normal cognition (NC, n=210) and cognitive impairment (CI, n=48) groups. The cognitive effect of HCI for CI was higher than for NC. Among the NC, the magnitude of cognitive improvement was greater in the higher educated group (above 7 years) than in the other groups.ConclusionsActive cognitive interventions could provide possible benefits to improve cognition, emotion, and functional abilities. Regular cognitive-care services like HCI are necessary to reduce dementia risk for the elderly who live alone in the community.

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke.

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from -4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.

Do Sarcopenia Risk Factors Vary with Its Stages?

The European Working Group on Sarcopenia in Older People (EWGSOP) categorizes sarcopenia into three stages: presarcopenia, sarcopenia, and severe sarcopenia. However, we have minimal understanding of risk-factor influence on sarcopenia and its stages. The current study aims to identify and determine whether risk factors vary with sarcopenia stage. A total of 104 adults, aged 55 yr and older, participated in the study. Included risk factors were age; female gender; body-mass index (BMI); Rapid Assessment of Physical Activity score; alcohol consumption; cigarette smoking; presence of type-2 diabetes mellitus; percentage of skeletal mass; Geriatric Depression Scale score; quadriceps and grip strength; gait speed; strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC F); and physical performance. We use binary logistic regression to determine the odds ratio (OR) for risk factors during different sarcopenia stages. Female gender and BMI show a significant OR in presarcopenia and sarcopenia stages. Percentage of skeletal mass associates only in presarcopenia, whereas quadriceps and grip strength, depression, and SARC F are significant in the sarcopenia stage. Low physical performance is the only risk factor that is significant in the severe sarcopenia stage (p ≤ 0.05). We identify risk factors present at different sarcopenia stages and find risk-factor change with increasing syndrome severity

Differences in performance on English and Hebrew versions of the MoCA in Parkinson's patients

IntroductionThe Montreal Cognitive Assessment (MoCA), an instrument widely used for cognitive screening in Parkinson's disease (PD), is validated in Hebrew and English. However, it remains unknown whether the scores are comparable. MethodsThe MoCA was analyzed in 483 Ashkenazi Jewish PD patients in Tel-Aviv and New York who had MoCA ≥21. Each section of the MoCA was compared between English and Hebrew. Linear regression models were used to test the association between MoCA performance and language. ResultsTotal MoCA scores were lower in Hebrew than in English (25.4 versus 26.1; P = 0.007), even after adjustment for age, sex, PD duration, genotype, levodopa equivalent dose, the Unified Parkinson's Disease Rating Scale (UPDRS-III), and Geriatric Depression Scale score in a linear model (P < 0.001). However, when language sections were removed from the total, scores were similar between the languages (Hebrew 23.7 versus English 23.4, P = 0.111). ConclusionThe language section of the MoCA may be more difficult in Hebrew. The comparability of MoCA in different languages requires further evaluation.

Eel's Head Powder Reduces Mild-Moderate Depression in Geriatric Individual: Result from Randomized Controlled Trial Study.

Depression is one of the major problems, and the prevalence is higher among the elderly. The underlying mechanism of depression among this set of the population is multifactorial, and one of the most important factors in the pathophysiology of depression is the level of brain serotonin. Protein deficiency is linked to tryptophan deficiency that is known to be the essential material for the synthesis of serotonin. This randomized controlled trial looked for the effectiveness of eel's head powder administration on plasma tryptophan level and geriatric depression scale (GDS) scores among the elderly population who suffered from depression. The subjects were divided into three intervention groups, including groups that were given 2-week course of 5 mg/kg BW eel's head powder, 10 mg/kg BW eel's head powder, and placebo, respectively. There was a significant difference in plasma tryptophan level and geriatric depression scale between the 10 mg/kg BW group and 5 mg/kg BW group. There was also a significant difference between those given 10 mg/kg BW eel's head powder and those receiving placebo; however, no such difference was found between those in the 5 mg/kg BW eel's head powder group and placebo group. Eel's head powder administration could increase plasma tryptophan level and reduce geriatric depression scale score among older individuals who suffered from depression. Administration of 10 mg/kg BW eel's head powder was significant in increasing plasma tryptophan level and reducing GDS score.

Posturographic measures did not improve the predictive power to identify recurrent falls in community-dwelling elderly fallers

OBJECTIVE:This study aimed to evaluate if posturography can be considered a recurrent fall predictor in elderly individuals.METHODS:This was a cross-sectional study. A total of 124 subjects aged 60 to 88 years were evaluated and divided into two groups—the recurrent fallers (89) and single fallers (35) groups. Patients' sociodemographic characteristics were assessed, and clinical testing was performed. The functional test assessment instruments used were timed up and go test (TUGT), Berg Balance Scale (BBS), five times sit-to-stand test, and Falls Efficacy Scale (to measure fear of falling). Static posturography was performed in a force platform in the following three different situations—eyes open (EO), eyes closed (EC), and EO dual task.RESULTS:There were significant differences between the single and recurrent fallers groups regarding the fear of falling, the Geriatric Depression Scale score, the mean speed calculated from the total displacement of the center point of pressure (COP) in all directions with EO, and the root mean square of the displacement from the COP in the mediolateral axis with EC. Based on the hierarchical logistic regression model, none of the studied posturographic variables was capable of significantly increasing the power of differentiation between the recurrent and single fallers groups. Only TUGT with a cognitive distractor (p<0.05) and the BBS (p<0.01) presented with significant independent predictive power.CONCLUSION:TUGT with a cognitive distractor and the BBS were considered recurrent fall predictors in elderly fallers.

The Relationship Among Leisure Activities, Depression and Quality of Life in Community-Dwelling Elderly Koreans.

Objectives:This study aimed to identify the relationship among leisure activities, depression, and quality of life of community-dwelling elderly in Korea.Methods:We assessed 100 community-dwelling older adults. Leisure participation and leisure exploration were assessed by using the leisure participation for the elderly. Depression was measured using the Korean version of the Short Form of Geriatric Depression Scale, and quality of life was assessed using EQ-5D. Statistical analysis was performed using the independent-sample t test, the chi-square test, Spearman correlation analysis, and multiple regression analysis.Results:EQ-5D scores of the depression group were significantly higher (p < .01). Geriatric Depression Scale (GDS) and EQ-5D scores showed a significant correlation with leisure participation and leisure exploration. Furthermore, leisure satisfaction was a significant factor in depressive symptoms (β = -.320, p < .01). There was a significant correlation between depression or quality of life and leisure activities corresponding to games, social activities, cultural activities, outings, and information and communication.Conclusion:This study showed that leisure participation and leisure exploration of the elderly were significantly related to depression and quality of life. Social, emotional, active, and productive activities were the leisure activities that positively affected depression and quality of life.

Effect of Integrated Cognitive Intervention Therapy in Patients with Mild to Moderate Alzheimer's Disease.

Background and PurposeThe effect of the integrated program comprising cognitive training, art therapy, and music therapy has not been extensively studied in patients with Alzheimer's disease (AD). The present study investigated the effect of integrated cognitive intervention therapy on cognition, and activity of daily life (ADL), and mood in patients with mild to moderate AD.MethodsIn this study, the data of 59 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer disease and Related Disorders Association (NINCDS-ADRDS) criteria of probable AD among those who registered at the Centenarian's Good Memory Program in Goyang from September 2014 to August 2019 were collected. We statistically analyzed the scores of Korean version of a Mini-Mental Status Examination (K-MMSE), Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Seoul-Instrumental Activities of Daily Living (S-IADL) of the same patients before and after the use of integrated cognitive intervention therapy.ResultsK-MMSE slightly increased from 18.7±4.5 to 19.7±5.0 (p<0.001) and KDSQ-C improved from 14.5±7.6 before therapy to 12.6±7.2 after therapy (p=0.001). Mean S-IADL score improved from 17.6±7.6 before therapy to 15.7±9.5 after therapy (p<0.001). Additionally, mean GDS score before the therapy was 5.6±3.5 that improved to 4.2±3.0 after the therapy (p<0.001). Mean BAI score decreased from 8.4±10.3 before therapy to 5.9±8.4 after therapy (p=0.001).ConclusionsIn conclusion, this study demonstrated the possibility that the use of an integrated cognitive therapy improved cognition, ADL, and mood (depression and anxiety) in patients with mild to moderate ADs.

Exercise and Horticultural Programs for Older Adults with Depressive Symptoms and Memory Problems: A Randomized Controlled Trial.

Depressive symptoms and memory problems are risk factors for dementia. Exercise can reduce these in older people, and horticultural activity can benefit people with dementia. This study assessed the efficacy of exercise and horticultural interventions for community-dwelling older adults with depressive symptoms and mild memory decline. In this randomized controlled trial, older adults (n = 89) were assigned to exercise, horticultural, or control groups. Exercise and horticultural programs included 20 weekly 90-min sessions. The control group attended two 90-min classes. Outcomes were assessed at baseline, and then 6- and 12-months post-intervention. Primary outcome measures were the Geriatric Depression Scale-15 (GDS-15) and Wechsler Memory Scale-Revised. Walking speed, two-minute walking test scores, social network, life space, and subjective daily physical activity were secondary outcome measures. Compared with the control group, the exercise group obtained higher immediate and delayed recall logical memory scores, and the increase in immediate recall scores remained 12-months post-intervention. Two-minute walking performance improved in the exercise group, but not after 12 months. GDS-15 scores showed no significant improvements. The horticultural and control groups showed no differences. Exercise may improve memory, while horticultural activity may not. The effects of exercise and horticultural interventions on depressive symptoms remain unclear.

Factors associated with preferences for elderly care mode and choice of caregivers among parents who lost their only child in a central China city.

It is forecasted that the figure of families in China who lost their only child will reach 10 million by 2035. Traditional Chinese culture places these families in a particularly disadvantaged position for elderly care. It is quite important to understand the elderly care needs of the parents. The cluster sampling method was used to select the parents who lost their only child in Wuhu city, China. Univariate and multivariate logistic regression analysis models were carried out to analyze factors influencing the parents' preferences for elderly care mode and choice of caregivers. The Geriatric Depression Scale score (P < 0.001) was significantly associated with the parents' preferences for elderly care mode. Parents with different sex, marital status and grandchildren status had different preferences for their choice of caregivers. The number of chronic diseases and Geriatric Depression Scale scores were significantly associated with preferences for choice of caregivers. These parents should have a preferential policy of check in to a nursing home and simplify the check-in procedure. The parents should receive prompt for depression and stay in the community for elderly care. The government should guarantee that spouseless parents have priority in enjoying nurse/nursing home worker services. The government should support the development of volunteer services. Geriatr Gerontol Int 2020; 20: 112-117.

Serious Game iDO: Towards Better Education in Dementia Care

We describe the iDO serious game developed during implementation of the Innovative Digital Training Opportunities on Dementia for Direct Care Workers (IDO) project. The project targets formal and informal caregivers of persons with dementia in order to improve caregiver knowledge and competences skills with a non-traditional source of training. This paper describes the steps faced to define the iDO caregiver behavior improvement model, design of game mechanics, development of game art and game characters, and implementation of gameplay. Furthermore, it aimed to assess the direct impact of the game on caregivers (n = 48) and seniors with early signs of dementia (n = 14) in Lithuania measured with the Geriatric Depression Scale (GDS) and Dementia Attitudes Scale (DAS). The caregivers’ GDS scores showed a decrease in negative answers from 13.4% (pre-game survey) to 5.2% (post-game survey). The seniors’ GDS scores showed a decrease in negative answers from 24.9% (pre-game survey) to 10.9% (post-game survey). The overall DAS scores increased from 6.07 in the pre-game survey to 6.41 in the post-game survey, statistically significant for both caregivers and seniors (p &lt; 0.001), respectively. We conclude that the game aroused positive moods and attitudes for future caregivers of persons with dementia, indicating a more relaxed status and a decreased fear in accomplishing the caring process.

Frailty, physical function and affective status in elderly patients on hemodialysis

ObjetivesTo analyze depression, cognition, and physical function change in older adults on hemodialysis at 12-month follow-up, depending on frailty status. DesignOngoing cohort study. Participants117 patients older than 69 years on hemodialysis; 75 men. MeasurementsFrailty was measured with the frailty phenotype, disability in basic and instrumental activities of daily living with the Barthel and Lawton index respectively, physical function with the Short Physical Performance Battery (SPPB), cognitive status with the Mini Cognitive Examination, and depression with the Yesavage´s Geriatric Depression Scale (GDS), at hemodialysis initiation and after 12-month follow-up. Inflammatory and nutrition profile was determined with C-reactive protein (CRP), albumin, and haemoglobin levels. ResultsThe mean age of the participants was 78.1 years; 63 (53.8 %) were frail. Frail participants had a higher 12-month mortality risk compared to the non frail ones, hazard ratio 2.6 (95 % CI 0.9–7.9). Frail 12-month survivors presented an improvement in median GDS scores (10 to 9; p = .009). There was no change in frail survivors from SPPB ≤ 6 to SPPB > 6 and a shift in 29.3 % of non-frail survivors from SPPB > 6 to SPPB ≤ 6 (p = .007) after 12-month follow-up. Median CRP and haemoglobin levels improved in frail 12-month survivors from 13.9 to 8.3 mg/dL (p = .019) and 9.9–11.1 g/dL (p < .001) respectively. ConclusionsFrail older adults that initiate hemodialysis present higher mortality than the non-frail ones at 12-month follow-up. Frail patients that survive improve physical function, depression and inflammatory profile compared to the non frail ones.

IMPROVING THE MEASUREMENT OF EXERCISE SELF-EFFICACY TO INFORM INNOVATIVE REHABILITATION TREATMENTS

Exercise self-efficacy (ESE) is a consistent determinant of exercise behavior but barriers to ESE remain unexplored in medically-complex older adults. This study explored 1) concordance between Physical Therapist’s (PT’s) and patients’ rating of their confidence to exercise; and 2) Whether patient demographic and clinical variables (e.g., depression) were related to confidence ratings. Data were collected as part of a clinical demonstration project, “Live Long Walk Strong,” a PT intervention to prevent mobility decline. Patients (N=35) had a mean age of 78.26 +/- 11.12, were 86% male, 80% White, and manifested an average of 5.63+/-1.96) chronic conditions. They had an average of 3.46+/-5.00, falls in the previous year and a mean M=4.97 (SD=2.96), Geriatric Depression Scale score of 4.97+/-2.96. Patients and PT’s rated exercise confidence (1= not at all to 5 = extremely). Participants’ and PT’s confidence ratings of the patient were highest for exercise in the clinic, followed by at home, and continuing after PT, and were moderately correlated (r = .41-.52, p < .001). PT confidence was associated with younger age (r =.48, p < .001) and lower depression (r = -.35, p = < .05), whereas these variables were not significantly associated with patient confidence. In qualitative analysis patients cite barriers to exercise: (1) physical health such as pain, fatigue, balance/previous falls, weakness; (2) memory and cognition; (3) time; (4) past experiences with PT; (5) poor social support; (6) low self-efficacy. In sum, older adults and PT’s generally agree in their confidence ratings, but barriers to ESE differ.

Suicidal ideation is common in autosomal dominant Alzheimer's disease at-risk persons.

To study the frequency of suicidal ideation and its association with clinical and neurobiological correlates among cognitively intact autosomal dominant Alzheimer's disease (ADAD) at-risk individuals. In a cross-sectional study of 183 ADAD at-risk individuals (91 mutation carriers and 92 noncarriers), we compared the frequency of suicidal ideation among carriers and noncarriers. Linear mixed-effects models with family-level random effects evaluated the relationships between geriatric depression scale (GDS), neuropsychiatric inventory-questionnaire (NPI-Q), and suicidal ideation scores among all ADAD at-risk individuals. An interaction term was added to the regression models to evaluate the interactions of suicidal ideation and mutation status on neuropsychiatric symptoms. Twenty-six (14.20%) ADAD at-risk individuals (13 [14.28%] carriers and 13 [14.13%] noncarriers) had suicidal ideation. The frequency of suicidal ideation did not differ between carriers and noncarriers. Suicidal ideation was associated with higher GDS among all ADAD at-risk individuals. When stratified into mutation carrier status, noncarriers with suicidal ideation had higher GDS than carriers. There was no statistically significant association between suicidal ideation and NPI-Q among ADAD at-risk individuals. Awareness of mutation status, neuropsychological performances, and cerebrospinal fluid AD biomarkers were not associated with suicidal ideation among carriers and noncarriers. Suicidal ideation is common among cognitively intact ADAD at-risk individuals. While ADAD at-risk individuals with suicidal ideation have greater depressive symptoms, noncarriers with suicidal ideation have higher GDS scores than carriers. Interestingly, awareness of the mutation status was not associated with suicidal ideation in our study. Early identification of suicidal thoughts can facilitate timely interventions to prevent suicidal behaviours. Keywords autosomal dominant Alzheimer's diseasedominantly inherited Alzheimer's networkneuropsychiatric symptomssuicidal ideation.

92Transcatheter aortic valve implantation improves cerebral blood flow and cognitive function in elderly patients with aortic stenosis - Brain perfusion SPECT imaging study

Abstract Background Cognitive impairment and depression are commonly noted in elderly frail patients with severe aortic stenosis (AS). However, their mechanisms and reversibility after treatment remain remain to be examined. Purpose In this study, we examined whether transcatheter aortic valve implantation (TAVI) increases cerebral blood flow (CBF) in cognitive/emotional brain areas, such as the hippocampus, in the elderly patients with severe AS. Methods We examined consecutive 15 right-handed patients with severe AS who were eligible for TAVI (median age 83.2 years, 12 (80%) women). We evaluated the following assessments both at baseline and 3 months after TAVI. Frailty was evaluated based on Fried scale, which consists of 5 items, including gait speed, cognitive function, weight loss, exhaustion, and inactivity. Frail and pre-frail were defined as greater than 3 and 1∼2 in the scale, respectively. Cognitive and emotional status were evaluated with Logical Memory (LM) II, Mini Mental State Examination (MMSE), and geriatric depression scale (GDS). Lower LM II (less than 4 points) and MMSE (less than 24 points) and higher GDS (more than 6 points) indicate worse memory, general cognitive function, and depressive symptoms, respectively. CBF images were recorded with 99mTc single-photon emission computed tomography and were analyzed using SPM12. Briefly, CBF images were firstly normalized to the standard Montreal Neurological Institute space. Then, a voxel-wise parametric analysis was conducted between normalized CBF images at baseline and those after TAVI (P&lt;0.005 at each voxel). Continuous variables were presented as mean ± standard error (SE). Normality was assessed using the Shapiro-Wilk test. Continuous variables were compared with the use of paired t test. Linear mixed-model analysis was performed to evaluate changes in neuropsychological tests and CBF over time. Results In the present study, all patients were not robust but pre-frail (47.3%) or frail (53.7%). LM II score was significantly improved at 3 months after TAVI compared with baseline (baseline, 8.7 vs. 3 months, 13.8, P&lt;0.01) (Figure A), whereas no significant changes in MMSE or GDS scores were noted (baseline, 24.6 vs. 3 months, 25.2 for MMSE; baseline, 4.3 vs. 3 months, 4.2 for GDS). Importantly, although no patients showed clinical symptoms or signs for transient ischemic attack or stroke after TAVI, CBF in the local regions, including the right hippocampus, was significantly increased after TAVI compared with baseline (P&lt;0.005 at each voxel) (green arrowheads) (Figure B). Furthermore, CBF in the right hippocampus were positively correlated with LM II scores (P=0.017) (Figure C). Figure 1 Conclusions These results provide the first evidence that TAVI improves cerebral perfusion (especially that in the hippocampus) and cognitive functions in elderly patients with severe AS.