Global Function Research Articles

A - 76 Associations between Proportion of Life Spent in the U.S. and Cognitive Performance in Spanish-Speaking Older Latino Immigrants: Preliminary Findings from the Boston Latino Aging Study

Abstract Objective Latinos represent the largest immigrant demographic in the U.S. and are the second-fastest growing minority group. Older Latinos face an increased risk of dementia compared to their non-Hispanic white counterparts. However, there is a notable scarcity of research examining how immigration-related factors among Latinos influence their vulnerability to cognitive decline and dementia. We explored the associations between the proportion of life spent in the U.S. and cognitive performance in older Latino immigrants. Method 116 Spanish-speaking participants (mean age: 68.8 ± 8.6, educational attainment: 10.5 ± 4.8, 79% female, MMSE: 25.4 ± 3.8) from the Boston Latino Aging Study were included. The adapted Preclinical Alzheimer’s Cognitive Composite-5 (PACC5), comprising the Mini-Mental State Examination-MMSE, Symbol Digit Modalities Test, NEUROPSI-Historias, Free-and-Cued-Selective-Reminding-Test, and Semantic Fluency was used to assess cognition. Spearman’s correlations examined the association between the proportion of life spent in the U.S. (number of years in the U.S./age) and cognition, controlling for age and education. Results The proportion of life spent in the U.S. (mean: 41.6 ± 22.7 years) did not significantly correlate with PACC5 performance (ρ = 0.02, p > 0.05). Nonetheless, there was a significant association with global cognitive function (MMSE ρ = 0.19, p = 0.04). Conclusions Our initial results did not reveal a correlation between the duration of time spent in the U.S. and the PACC5. However, a higher percentage of years lived in the U.S. correlated with better global cognition. Future studies utilizing larger cohorts are necessary to gain a comprehensive understanding of cognitive health in elderly Latinos, including investigating the effects of immigration-related factors.

B - 87 The Moderating Effects of Current Substance Use on the Relationship between Neighborhood Deprivation and Cognitive Abilities

Abstract Objective Numerous studies have illustrated the importance of social determinants of health (SDH) on neuropsychological outcomes (Zuelsdorff, 2020); however, what moderates this relationship is poorly understood. One factor that negatively affects neuropsychological outcomes is substance use (Volkow et al., 2016). This study, the first to our knowledge, examines the intersection between a composite measure of SDH, the Area Deprivation Index (ADI; Kind et al., 2018), and current substance use (CSU). We hypothesized that CSU would moderate SDH’s effect on neuropsychological test performance. Method This sample is 236 diverse adults (M age = 55; 64% female; 44% White) who completed a neuropsychological examination in an outpatient neuropsychology clinic between 2017–2023. The composite measure of SDH was the ADI (Kind et al., 2018), which uses 17 socioeconomic indicators. Test scores were converted to z-scores for six cognitive domains (processing speed, attention, executive functioning, language, visuospatial abilities, and memory) and a global cognitive function score. CSU was self-reported use of tobacco, alcohol, and marijuana. Regressions were used to test the hypothesized interaction. Results Results partially supported CSU’s moderation of ADI and cognition. CSU only moderated the relationship between ADI and memory functioning (b = −0.08,p = 0.008); the indirect association between ADI and memory ability was stronger for those who endorsed CSU, even after controlling for covariates. Conclusions Findings demonstrate the interaction between CSU and ADI in predicting memory abilities. Analyses suggest using substances compounds the detrimental effects of neighborhood deprivation on memory, independent of demographic factors. Such results underscore the importance of considering socioecological factors in neuropsychological evaluations and test development.

Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial.

Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear. This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty. This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ≥60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes. In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes. VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817.

Impact of blood glucose on cognitive function in insulin resistance: novel insights from ambulatory assessment

Background/objectivesInsulin resistance (IR)-related disorders and cognitive impairment lead to reduced quality of life and cause a significant strain on individuals and the public health system. Thus, we investigated the effects of insulin resistance (IR), and blood glucose fluctuations on cognitive function under laboratory and free-living conditions, using ecological momentary assessment (EMA).Subjects/methodsBaseline assessments included neuropsychological tests and blood analysis. Individuals were classified as either insulin-sensitive (<2) or insulin-resistant (≥2), based on their Homeostatic Model Assessment (HOMA-IR) values. Continuous glucose monitoring (CGM) using a percutaneous sensor was performed for 1 week. Using multiple linear regression, we examined the effects of HOMA-IR and CGM metrics on cognitive domains. Working memory (WM) performance, which was assessed using EMA, 4 times a day for 3 consecutive days, was matched to short-term pre-task CGM metrics. Multilevel analysis was used to map the within-day associations of HOMA-IR, short-term CGM metrics, and WM.ResultsAnalyses included 110 individuals (mean age 48.7 ± 14.3 years, 59% female, n = 53 insulin-resistant). IR was associated with lower global cognitive function (b = −0.267, P = 0.027), and WM (b = −0.316; P = 0.029), but not with executive function (b = −0.216; P = 0.154) during baseline. EMA showed that higher HOMA-IR was associated with lower within-day WM performance (β = −0.20, 95% CI −0.40 to −0.00). CGM metrics were not associated with cognitive performance.ConclusionsThe results confirm the association between IR and decrements in global cognitive functioning and WM, while no effects of CGM metrics were observed, making IR a crucial time point for intervention. Targeting underlying mechanisms (e.g., inflammation) in addition to glycemia could be promising to minimize adverse cognitive effects. Registered under https://drks.de/register/de identifier no. DRKS00022774.

"Mastectomy for individuals with gender dysphoria below 26 years of age: A systematic review and meta-analysis".

Gender dysphoria (GD) refers to psychological distress associated with the incongruence between one's sex and one's gender. In response to GD, birth-registered females may choose to undergo mastectomy. In this systematic review, we summarize and assess the certainty of the evidence on the effects of mastectomy. We searched MEDLINE, Embase, PsycINFO, Social Sciences Abstracts, LGBTQ+ Source, and Sociological Abstracts through June 20, 2023. We included studies comparing mastectomy to no mastectomy in birth-registered females under 26 years of age with GD. Outcomes of interest included psychological and psychiatric outcomes, and physical complications. Pairs of reviewers independently screened articles, abstracted data, and assessed risk of bias of the included studies. We performed meta-analysis and assessed the certainty of the evidence using the GRADE approach. We included 39 studies. Observational studies (n=2) comparing mastectomy to chest binding provided very low certainty evidence for the outcome of GD. One observational study comparing mastectomy to no mastectomy provided very low certainty evidence for the outcomes global functioning and suicide attempts, and low certainty evidence for the outcome non-suicidal self-injury (aOR 0.47 [95% CI 0.22 to 0.97]). Before-after (n=2) studies provided very low certainty evidence for all outcomes. Evidence from case series (n=34) studies ranged from high to very low certainty. Case series studies demonstrated high certainty evidence for the outcomes of death, necrosis, and excessive scarring; however, these are limited in methodological quality. In comparative and before-after studies the evidence ranged from low to very low certainty.

Effects of sodium benzoate on cognitive function in neuropsychiatric disorders: a systematic review and meta-analysis.

PROSPERO, identifier CRD42023457462.

Improved heart rate variability in postmenopausal women following short-term combined exercise training

Imbalances in cardiac autonomic nervous systems are associated with cardiovascular risk factors and poor cardiac outcomes. Heart rate variability (HRV) is a practical and reproducible measure of cardiac autonomic nervous system function. Exercise training promotes positive adjustments in HRV. However, previous studies have reported mixed results. Therefore, this study aimed to investigate the effects of short-term combined exercise training on heart rate variability in post-menopausal women. Thirty-four women aged 50-80 years, at least 12 months post-menopause, were divided into a control (CON) group and an exercise (EX) training group. The participants in the exercise group underwent a 2-week of combined exercise program consisting of aerobic, strength, flexibility, and balance exercises. HRV was recorded using an Actiheart device, before and after the final exercise intervention in a sitting position. The significant main effects of time and group were found in the parameter of SDNN (p time = 0.039; p group = 0.026). Post-hoc analysis showed a borderline increase in SDNN in the EX group (POST: 48.79 ± 17.88 VS 44.54 ± 17.39, p = 0.055). No significant change was observed in the CON group (POST: 35.55 ± 13.51 VS 33.17 ± 8.74, p = 0.288). Statistical analysis of other HRV components revealed no significant results (all P &gt; 0.05). In conclusion, a 2-week of combined exercise training program, including aerobic, resistance, balance, and flexibility exercises improves global cardiac autonomic function in post-menopausal women. Keywords: combined exercise training, heart rate variability, blood pressure, menopause, and women

An improved sand cat swarm optimization with lens opposition-based learning and sparrow search algorithm

The sand cat swarm optimization (SCSO) is a recently proposed meta-heuristic algorithm. It inspires hunting behavior with sand cats based on hearing ability. However, in the later stage of SCSO, it is easy to fall into local optimality and cannot find a better position. In order to improve the search ability of SCSO and avoid falling into local optimal, an improved algorithm is proposed - Improved sand cat swarm optimization based on lens opposition-based learning and sparrow search algorithm (LSSCSO). A dynamic spiral search is introduced in the exploitation stage to make the algorithm search for better positions in the search space and improve the convergence accuracy of the algorithm. The lens opposition-based learning and the sparrow search algorithm are introduced in the later stages of the algorithm to make the algorithm jump out of the local optimum and improve the global search capability of the algorithm. To verify the effectiveness of LSSCSO in solving global optimization problems, CEC2005 and CEC2022 test functions are used to test the optimization performance of LSSCSO in different dimensions. The data results, convergence curve and Wilcoxon rank sum test are analyzed, and the results show that it has a strong optimization ability and can reach the optimal in most cases. Finally, LSSCSO is used to verify the effectiveness of the algorithm in solving engineering optimization problems.

Regional impairment of left ventricular longitudinal strain in aortic regurgitation

BackgroundAortic regurgitation (AR) has an important impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) in the assessment of its severity and prognosis. Our purpose was to assess if the direct impact of the regurgitant jet on the myocardial wall could affect regional longitudinal strain.MethodsEighty patients with chronic moderate/severe AR were retrospectively studied. Patients were considered to have a jet-related longitudinal strain reduction when the myocardial segments directly impacted by the jet had their longitudinal strain reduced by at least 30% compared to nonaffected segments. AR severity, left ventricular (LV) size and function were compared according to the presence/absence of this regional pattern. For those who underwent surgery, postoperative regional and global LV function was also analyzed.ResultsA pattern of regional longitudinal strain impairment was identified in 43% of patients, with a regional reduction (in median) of 10 percentage points in absolute strain values in the segments impacted by the jet, compared to nonaffected segments. In the subgroup who underwent surgery, this pattern became attenuated after surgery. Patients with regional longitudinal strain impairment were less likely to improve GLS after surgery (10% vs. 38% improved GLS by at least 2.5%, P = 0.049).ConclusionsTo our knowledge, this study identifies for the first time, a link between the location of the impact of the regurgitant jet in AR and regional longitudinal strain impairment. The presence of this regional pattern might be associated with worse postoperative LV recovery.

Trajectory of Cognitive Decline After Incident Heart Failure Hospitalization: Findings From the REGARDS Study.

Cognitive impairment is common among adults with heart failure (HF) and associated with poor outcomes. However, less is known about the trajectory of cognitive decline after a first HF hospitalization. We examined the rate of cognitive decline among adults with incident HF hospitalization compared with those without HF hospitalization. The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective longitudinal study of 23 894 participants aged ≥45 years free of HF at baseline. HF hospitalization was expert adjudicated. Changes in global cognitive function (primary outcome) were assessed with the Six-Item Screener (range, 0-6). Secondary outcomes included change in Word List Learning (range, 0-30), Word List Delayed Recall (WLD; range, 0-10), and Animal Fluency Test (range, 0+). Segmented linear mixed-effects regression models were used. Over 5 years, mean scores across all 4 cognitive tests declined for all participants regardless of HF status. Those with incident HF hospitalization experienced faster declines in the Six-Item Screener versus those who were HF free (difference, -0.031 [95% CI, -0.047 to -0.016]; P<0.001), a finding that persisted in fully adjusted models. Those with incident HF hospitalization did not experience faster declines in Word List Learning, Word List Delayed Recall, or Animal Fluency Test scores compared with those without HF hospitalization. Participants with hospitalization for HF with preserved, compared with reduced, ejection fraction had faster decline in Animal Fluency Test. Global cognitive decline occurred faster among adults with incident HF hospitalization compared with those who remained free of HF hospitalization. This pattern was not seen for the other cognitive domains.

Global reliability assessment of coupled transmission tower-insulator-line systems considering soil-structure interaction subjected to multi-hazard of wind and ice

This study aims to assess the global reliability of coupled transmission tower-insulator-line systems considering soil-structure interaction (CTTILSs-SSI) subjected to multi-hazard of wind and ice. Firstly, two simplified models of CTTILSs-SSI under stochastic wind and ice loads are established, and their governing equations are derived through the Lagrange equation. On this basis, a global reliability assessment framework of CTTILSs-SSI is proposed based on the improved maximum entropy method, in which the global performance function of CTTILSs-SSI is defined via the state variable description method. Finally, a practical ultra-high voltage overhead transmission line located on the icing zone is chosen to illustrate the proposed framework. Moreover, to investigate the influence of soil-structure interaction (SSI) and soil types on the global reliability of transmission tower-insulator-line systems (TTILSs), the global reliability of CTTILSs-SSI with various soil types is compared with that of a fixed base system. The results indicate that under the in-plane wind and ice loads, the global failure probability of TTILSs is almost zero, and it is essentially not affected by the SSI effect and soil types. However, under the out-of-plane wind and ice loads, the global failure probability of CTTILSs-SSI is higher than that of the fixed base system, and the global failure probability of CTTILSs-SSI increases as the soil stiffness decreases. Accordingly, it may be more reasonable to consider the SSI effect into the global reliability analysis of TTILSs subjected to ice and out-of-plane wind loads, particularly when the soil is soft.

Maternal Accommodation of Adolescent Body Dysmorphic Disorder: Clinical Correlates and Association with Treatment Outcomes.

Family accommodation (FA) is widely-recognised as an important clinical phenomenon in obsessive-compulsive disorder (OCD) and anxiety disorders, and is related to poorer treatment outcomes. However, FA has not been quantitatively explored in Body Dysmorphic Disorder (BDD). The aim of this study was to investigate the patterns and correlates of maternal accommodation in adolescent BDD, and its association with treatment outcomes. Participants were 131 adolescents with BDD and their mothers who completed the Family Accommodation Scale-Parent Report (FAS-PR) as part of routine clinical practice in a National and Specialist Service for Young People at the Maudsley Hospital, London. Seventy-six (58%) young people received specialist cognitive behavioural therapy for BDD and had post-treatment data available. All mothers engaged in at least one form of accommodation. Providing reassurance (98.5%) and assisting avoidance (88.5%) were the most commonly endorsed behaviours. Levels of accommodation were positively associated with clinician-rated BDD symptom severity (r = 0.18, p = 0.041) and maternal symptoms of anxiety, depression and stress (r = 0.41, p < 0.001), and negatively associated with child global functioning (r = -0.38, p < 0.001). Maternal accommodation did not predict treatment outcomes (β = 0.055, p > 0.05). The findings indicate that maternal accommodation is common and has important clinical correlates, but does not impact on treatment response. Consequently, the relationship between maternal accommodation and BDD symptoms may differ to that evidenced in paediatric OCD. Future longitudinal research exploring maternal and paternal accommodation, and assessing variables of interest at multiple time-points throughout treatment, is needed to advance understanding of the role of FA in adolescent BDD.

Implications of Global Lung Function Initiative Spirometry Reference Equations in Northeast Asian Patients With COPD

Accurate spirometry interpretation is critical in the diagnosis and management of chronic obstructive pulmonary disease (COPD). With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012-GLI and race-neutral 2022-GLI reference equations compared to Choi's reference equations, which is derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD. What are the effects of applying race-specific 2012-GLI, race-neutral 2022-GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD STUDY DESIGN AND METHODS: Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were utilized for re-analyses using 2012-GLI, 2022-GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined. Although there was strong concordance in COPD diagnosis comparing 2012-GLI, and 2022-GLI reference equations to Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012-GLI and 2022-GLI reference equations, respectively). Relationships between FEV1 percent-predicted values calculated using 2012-GLI, 2022-GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV1 and FVC percent-predicted were observed among the reference equations used, except for slower annual decline rate of FEV1 in Choi's equation compared to 2022-GLI race-neutral equation. Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.

Energy Element Method for Three-Dimensional Vibration Analysis of Stiffened Plates with Complex Geometries

A novel numerical method, the energy element method, is proposed for the three-dimensional vibration analysis of stiffened plates with complex geometries. The problem is modeled in a cuboidal domain, and a cuboidal energy element is developed for the simulation of the structural components. To simulate the energy distribution of the structure, stiffened plates are treated as discrete energy systems, where variable stiffness is used to characterize their energy distribution in a cuboidal domain and a global admissible function is used to approximate their vibrational behavior. With extended interval integral, Gauss quadrature, variable stiffness, and Legendre polynomials used for numerical integration in the cuboidal domain, the cuboidal energy element can offer sufficient precision with sufficient Gauss points for simulating the strain energy of stiffened plates with complex geometries. The Gauss–Legendre quadrature will provide accurate integration results if the integral domain is cuboidal. Otherwise, small cuboidal energy elements are generated with denser Gauss points to capture the geometric boundaries. As the numerical model is constructed on a standard geometric domain, all energy functionals and computational procedures are standard. Three-dimensional vibration problems are investigated for variously shaped stiffened plates with straight or curvilinear stiffeners. The present results are compared with analytical, numerical, and experimental results published in the literature.

P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women. Methods: A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (&lt; 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals. Results: The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p &lt;0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p&lt;0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)]. Conclusions: Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.

On the Galois and Flat Cohomology of Unipotent Algebraic Groups over Local and Global Function Fields. II

On the Galois and Flat Cohomology of Unipotent Algebraic Groups over Local and Global Function Fields. II

Cyclic base change of cuspidal automorphic representations over function fields

Let $G$ be a split semisimple group over a global function field $K$. Given a cuspidal automorphic representation $\Pi$ of $G$ satisfying a technical hypothesis, we prove that for almost all primes $\ell$, there is a cyclic base change lifting of $\Pi$ along any $\mathbb {Z}/\ell \mathbb {Z}$-extension of $K$. Our proof does not rely on any trace formulas; instead it is based on using modularity lifting theorems, together with a Smith theory argument, to obtain base change for residual representations. As an application, we also prove that for any split semisimple group $G$ over a local function field $F$, and almost all primes $\ell$, any irreducible admissible representation of $G(F)$ admits a base change along any $\mathbb {Z}/\ell \mathbb {Z}$-extension of $F$. Finally, we characterize local base change more explicitly for a class of toral representations considered in work of Chan and Oi.

Efficacy of rTMS Combined with Cognitive and Language Training in People Living with Alzheimer's Disease: A Systematic Review.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method that has been suggested as a possible treatment method for cognitive impairment in patients with Alzheimer's Disease (pwAD), similar to multidomain cognitive training (CT). The effectiveness, however, of combining these techniques for pwAD remains controversial due to the variability in rTMS parameters, differences in CT protocol designs-many of which neglect the language domain-and the inclusion of patients at various stages of Alzheimer's Disease (AD) and with different types of dementia. The current review aims to evaluate the cognitive benefits of combining rTMS with CT, including language training, for individuals with mild to moderate AD. An extensive literature search was conducted in PubMed, Google Scholar, and the Cochrane Library with relevant terms, resulting in nine studies with a total of 290 participants [190 in the Active Group (AG) and 100 in the Control Group (CG)]. The comprehensive review of the articles revealed that the combined treatment improved global cognitive function, as well as neurocognitive, neuropsychiatric, and quality of life in the AG. Nevertheless, these results should be interpreted cautiously, given the relatively small number of existing studies on this specific combination.

Performance of cut-offs of the ASAS Health Index to discriminate between treatment groups in patients with axial spondyloarthritis in the TICOSPA trial

ObjectiveTo test trial and longitudinal known group discrimination of thresholds of meaning for improvement and health states of the ASAS Health Index (ASAS HI) in patients with active axSpA treated in a randomized study. MethodsData from baseline and week 48 from the tight-controlled, treat-to-target trial TICOSPA study were used. The performance of different thresholds to assess change or health states of the ASAS HI were evaluated between arms and against changes in patients’ relevant outcomes and various external responder criteria. Analyses were performed by comparing the mean values t-tests or proportion of responders of continuous and dichotomous external criteria respectively. Trial discrimination of the ASAS HI thresholds were assessed by odds ratios and Phi coefficient in a large number of potential ASAS HI thresholds. Differences in health states in relevant external outcomes between ASAS HI responders and non-responders was assessed by comparing the best performing improvement and state thresholds by using t-tests and chi-square, as appropriate. Missing data on outcomes was handled by non-responder imputation (NRI). ResultsAll 160 patients had available ASAS HI data. Trial discrimination was larger for absolute ASAS HI change of ≥2.0, ≥2.5, and ≥3.0 points followed by ASAS HI 20 % improvement. Odds ratio ranged between 1.27 and 1.75 for absolute and between 1.0 and 1.64 for relative improvement outcomes. Longitudinal discrimination of ASAS HI improvement ≥30 % or ≥ 3.0 points had a larger reduction in patient global and disease activity and reached more often remission compared to patients with no significant improvement in global functioning. Patients who achieved ASAS HI ≤ 5.0 compared with patients who did not achieve such states were more likely to have ASAS partial remission, ASDAS inactive disease or ASDAS low activity at week 48. ConclusionsThe data-driven thresholds of the ASAS HI identified in a longitudinal observational setting perform well in the context of a randomized trial.

Effectiveness of Vortioxetine Treatment on Depression and Cognitive Functions in Patients with Alzheimer's Disease: A 12-Month, Retrospective, Observational Study.

This study aimed to assess the effectiveness of vortioxetine for improving depressive symptoms, cognitive performance, daily and global functioning in patients with Alzheimer's disease (AD) and major depressive disorder (MDD) in real-world clinical practice. We retrospectively identified 46 AD patients who had received treatment for 12 months with vortioxetine. Drug effects were evaluated at baseline, 4, 8, and 12 months. The primary endpoint was change from baseline in the Hamilton Depression Rating Scale (HDRS) and in the Cornell Scale for Depression in Dementia (CSDD) to month 12. Cognitive and daily and global functioning changes were also evaluated. Significant baseline-to-endpoint improvement in depressive symptom severity was observed (p < 0.0001). At month 12, the least-square mean (standard error) change score from baseline was -10.48 (±0.42) on the HDRS and -9.04 (±0.62) on the CSDD. Significant improvements in cognitive performance were observed for the Rey Auditory Verbal Learning Test, the Symbol Digit Modalities Test, the Letter Fluency Test, the Category Fluency Test, and the Trail Making Test-A. Patients also experienced significant improvements in daily and global functioning. Vortioxetine was safe and well tolerated. Patients with AD and MDD receiving vortioxetine showed meaningful improvements in depressive symptoms, cognitive performance, and daily and global functioning over the 12-month treatment period.