Impairment In Domains Research Articles

Analysing the effectiveness of cognitive behavioural therapy in university students with ADHD: A systematic review

Background: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adult life. University students with ADHD frequently experience great difficulty with global academic functioning, resulting in higher drop-out rates and, consequently, higher unemployment rates. Objective: This literature review aims to analyse the effectiveness of cognitive behavioural therapy (CBT) interventions to reduce ADHD-related symptoms in university students with ADHD. Materials and methods: A literature search was conducted via EBSCO database in October 2023 using key terms: ADHD OR attention deficit hyperactivity disorder AND cogniti* intervention OR cogniti* therapy AND college student* OR university student*. The inclusion criteria were studies using cognitive behavioural therapy as their primary intervention for individuals with ADHD who are enrolled in university or college and are 18 years or above in age. Results: Seven out of 115 papers were deemed eligible and were included in this review. This review’s studies included four randomized control trials and three before and after open trials. Three key themes were identified through data extraction: intervention design, outcome measures used, and effectiveness of interventions on ADHD-related symptoms. All the studies tailored their CBT intervention toward university students. There was a statistically significant improvement in core domains of ADHD-related impairment, in particular, inattention (N=7), overall executive functions (n=5), and hyperactivity-impulsivity (N=1). Conclusion: While the current findings suggest positive results of CBT for reducing ADHD-related symptoms in university students with ADHD, further research should explore the sustainability of these gains over the long term. Due to the lack of explicit published study on this topic in the United Kingdom, further research should be conducted in the UK to assess the applicability and effectiveness of tailored CBT interventions within the British university environment.

Evidências de validade da Depression, Anxiety and Stress Scale entre trabalhadores de enfermagem brasileiros

Abstract Objectives To investigate the validity evidence of the Depression, Anxiety, and Stress Scale (DASS-21) and to analyze the prevalence of depression, anxiety, and stress symptoms in a sample of Brazilian nursing workers. Methods This was a cross-sectional study with non-probability convenience sampling. A total of 4053 Brazilian nursing workers participated in the study. The psychometric properties of DASS-21 were assessed by analysis of the validity based on the internal structure (factorial, convergent, and discriminant construct validity, invariance of the factorial model, and reliability); relationships with external measures (positive and negative convergent validity of the depression, anxiety, and stress factors with the emotional impairment, job satisfaction, and individual and occupational variables); and response process of the items (analysis of the differential item functioning in distinct subgroups). Data reliability was certified by estimating the ordinal alpha coefficient and the composite reliability. The prevalence of depression, anxiety, and stress symptoms was estimated based on recommendations from the original authors of DASS-21. Results During validation of the internal structure, the confirmatory factor analysis showed that the fit of the sample to the original DASS-21 model was adequate and the strong measurement invariance of the model was confirmed in different groups. Analysis based on external measures showed that the depression, anxiety, and stress factors had positive and moderate-strong correlations with the emotional impairment domain and negative and moderate correlations with the job satisfaction construct. Analysis of the pattern of response to items confirmed the uniformity and stability of the instrument for the sample. Regarding symptoms, the high prevalence of extremely severe levels of depression, anxiety, and stress was highlighted among participants. Conclusion DASS-21 presented adequate validity and reliability to assess depression, anxiety, and stress symptoms among Brazilian nursing workers.

Longitudinal relationship between hip displacement and hip function in children and adolescents with cerebral palsy: A scoping review.

To identify, describe, and synthesize available evidence on the longitudinal relationship between hip displacement and hip function, using the International Classification of Functioning, Disability and Health (ICF) framework, in children and adolescents with cerebral palsy (CP) aged up to 18 years. Five databases were searched systematically from inception to May 2022. Study and sample characteristics, and hip displacement and hip function measures, mapped to the ICF domains, were extracted for narrative synthesis. Twenty-nine studies were included: four longitudinal registry-based studies; 12 prospective studies; 12 retrospective studies; and one randomized controlled trial. Sample size ranged from 11 to 267. Twenty-seven (93%) studies entailed an intervention: surgery (n = 16); rehabilitation (n = 2); nerve block or botulinum neurotoxin A injection (n = 4); and combined surgery and injection (n = 2). Twenty-six studies (90%) reported outcomes at the body structure and function and impairment domain of the ICF; 17 (59%) reported outcomes in the activity domain; and three (10%) included participation measures. The most common hip displacement measure was Reimers' migration percentage (79%). Because of the inclusion of interventions in most studies, and the preponderance of retrospective studies, the relationship between hip displacement and hip function in CP is unclear. More high-quality prospective evidence on the natural history of hip displacement, and its effect on function, is needed to improve population-wide screening of children with CP.

A Cross-Sectional Study on the Quality of Life of Adults With Sickle Cell Disease Followed-Up in Outpatient Clinics: A Single-Center Experience.

Background Sickle cell disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin S, leading to red blood cell deformities, chronic hemolysis, and frequent vaso-occlusive crises (VOC). While advancements in medical care have improved survival rates, adults with SCD continue to face substantial challenges in their quality of life (QoL) due to chronic pain, recurrent VOCs, and various complications. This study aimed to evaluate the health-related quality of life (HRQoL) in adult patients aged 14 years and above with SCD and identify key factors influencing patient outcomes using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Methods A cross-sectional study was conducted at the Prince Sultan Oncology Center, King Salman Northwest Armed Forces Hospital, Tabuk, Saudi Arabia, between December 2019 and May 2020. The study population comprised adult SCD patients attending outpatient clinics. The QoL was assessed using the ASCQ-Me Short Form, which evaluates five domains: emotional impact, social functioning, pain impact, sleep impact, and stiffness impact. Additionally, a nine-item SCD Medical History Checklist was used to evaluate complications and treatments. Data were collected through structured one-on-one interviews. Scores were transformed into T-scores (mean = 50, standard deviation (SD) = ±10) based on standardized guidelines. Inferential analysis was conducted to compare QoL domains between groups stratified by VOC frequency and severity using the Mann-Whitney U test, with a significance threshold of p ≤ 0.05. Results A total of 53 adult SCD patients were surveyed, with the majority aged 25-34 years (50%). Gender distribution was nearly equal, with 50.9% male participants. The prevalence of complications was notable, with 31% reporting chronic pain, 26% reporting gallstones, and 9% reporting avascular necrosis. Laboratory findings revealed a mean hemoglobin level of 8.63 g/dL (SD: 1.59) and an average fetal hemoglobin (HbF) level of 10.59% (SD: 5.64). The frequency of VOCs varied, with 30% of patients reporting no VOC in the past year, while 57% experienced two to three VOCs. Patients with higher VOC frequency (≥4 per year) reported significantly lower scores across all QoL domains except stiffness (p < 0.05). Higher VOC severity was associated with poorer sleep quality and social functioning (p < 0.05). Pain severity was also a critical determinant, with more than 55% of patients rating their last pain episode as severe or extreme. Conclusion The study highlights the significant burden of pain and VOCs on the quality of life in adult SCD patients. Frequent VOCs and chronic complications such as avascular necrosis and gallstones were major contributors to reduced HRQoL. Findings emphasize the need for comprehensive, multidisciplinary care approaches targeting pain management, psychological support, and functional independence. The ASCQ-Me tool proved valuable for identifying specific domains of impairment and guiding patient-centered interventions. Future research should focus on longitudinal studies to explore the efficacy of tailored interventions and address the ongoing challenges faced by this vulnerable population.

Mapping gaps and exploring impairment and disability prevalence in South Asian (SAARC) countries: a scoping review

Despite the considerable health and economic burden of disability in the South Asian (SA) region, there is limited evidence of impairments and disabilities prevalence and the need for Assistive Technologies (ATs). This scoping review aims to synthesise the evidence of the impairments and disabilities in SA countries. This review followed Arksey and O’Malley’s methodological framework. EBSCOhost, EMBASE, PubMed, and Web of Science databases were searched for original research articles from SA countries. In this study, impairment and disability refer to functional limitations restricting individuals from performing activities, including visual, hearing, speaking, cognitive, mobility, and self-care difficulties. The review included full-text, English-language articles addressing any impairment and disability, without restrictions on publication date. This review identified 105 articles distributed over the six impairment and disability domains: visual, hearing, mobility, self-care, speaking, and cognitive. Most evidence originated from India (50.5%) and focused on visual impairments (53.3%). The review identified that heterogeneity in methodologies, case identification definitions, and study settings contributed to variations in prevalence estimation and restricted the comparability within and across countries. Besides, the uneven distribution of studies across countries suggests varying inclinations of countries toward specific impairment and disability domains. The review identified variations in prevalence due to differences in methodologies, definitions, and contexts. The review also identified the uneven distribution of studies, limited evidence on ATs, reliance on self-reported data, and lack of nationally representative research. Future research should use standardised case identification and evidence-based approaches to enhance comparability and minimise response biases.

Cross-cultural Adaptation of the Iranian Version of the Voice Symptom Scale

Background and Objectives: This research aims to evaluate the validity and reliability of the Persian version of the voice symptom scale (VoiSS) questionnaire. We also sought to determine the best cut-off point to classify high-risk populations into controls (participants) and dysphonic patients. Methods: The study was conducted in 3 main steps. The translation process was carried out by a pair of Iranian bilingual speech-language pathologists along with an expert panel. For the validity study, the questionnaire was administered to 268 cases that were suspected of dysphonia. Finally, to assess the reliability, the questionnaire was completed twice in 2 weeks by 40 dysphonia patients. To normalize data generation 107 individuals without dysphonia completed the P-VoiSS, after that the cutoff value of the P-VoiSS was calculated. Results: Cronbach’s α was estimated at 0.914, and for impairment, emotional, and physical domains, it was 0.877, 0.926, and 0.725, respectively. We also estimated intra-cluster correlation (ICC) of 0.984 indicating high reproducibility of the Persian VoiSS questionnaire. The estimated intra-cluster correlation (ICC) for subscale was 0.962 for impairment, 0.989 for emotional, and 0.952 for physical domains. The Mean±SD score of the questionnaire for the healthy group was 10.1±5.9, while it was statistically higher in dysphonia patients (44.1±20.6). The statistical difference was observed in the subscales of the questionnaire between healthy and dysphonia groups (P&lt;0.05). The exploratory factor analysis determined that the Persian VoiSS has three subtest/latent factors like the original form. We also estimate the best cut-point at 20.5. Conclusion: The Persian adaptation of VoiSS is a dependable and effective tool that can be utilized for screening high-risk populations.

Associations of Mild Behavioral Impairment Domains with Brain Volumes in Older Adults

Mild behavioral impairment (MBI) has been associated with global brain atrophy, but the regional neural correlates of MBI symptoms are less clear, particularly among community-dwelling older individuals without dementia. Our objective was to examine the associations of MBI domains with gray matter (GM) volumes in a large population-based sample of older adults without dementia. We performed a cross-sectional study of 1445 community-dwelling older adults in the Atherosclerosis Risk in Communities Study who underwent detailed neurocognitive assessment and brain magnetic resonance imaging in 2011-2013. MBI domains were defined using an established algorithm that maps data collected from informants on the Neuropsychiatric Inventory Questionnaire to the 5 MBI domains of decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal perception/thought content. We performed voxel-based morphometry analyses to investigate associations of any MBI domain symptoms with GM volumes. We additionally performed region-of-interest analyses using adjusted linear regression models to examine associations between individual MBI domains with a priori-hypothesized regional GM volumes. Overall, the mean age of participants was 76.5 years; 59% were female, 21% were of Black race, and 26% had symptoms in at least one MBI domain. Participants with normal cognition comprised 60% of the population, and 40% had mild cognitive impairment. Compared to individuals without any MBI domain symptoms, voxel-based morphometry analyses showed that participants with symptoms in at least one MBI domain had consistently lower GM volumes in the cerebellum and bilateral temporal lobes, particularly involving the hippocampus. In adjusted region-of-interest models, affective dysregulation domain symptoms were associated with lower GM volume in the inferior temporal lobe (β=-0.34; 95% confidence interval=-0.64, -0.04), and impulse dyscontrol domain symptoms were associated with lower GM volume in the parahippocampal gyrus (β=-0.06; 95% confidence interval=-0.11, 0.00). In this community-dwelling population of older adults without dementia, MBI symptoms were associated with lower GM volumes in regions commonly implicated in early Alzheimer's disease pathology. These findings lend support to the notion that MBI symptoms may be useful in identifying individuals at risk for future dementia.

Rabex-5 E3 and Rab5 GEF domains differ in their regulation of Ras, Notch, and PI3K signaling in Drosophila wing development.

Rabex-5 (also called RabGEF1), a protein originally characterized for its Rab5 GEF function, also has an A20-like E3 ubiquitin ligase domain. We and others reported that Rabex-5 E3 activity promotes Ras mono- and di-ubiquitination to inhibit Ras signaling in Drosophila and mammals. Subsequently, we reported that Rabex-5 inhibits Notch signaling in the Drosophila hematopoietic system. Here we report genetic interactions using Rabex-5 transgenes encoding domain-specific mutations that show that Rabex-5 requires an intact E3 domain to inhibit Notch signaling in the epithelial tissue of the developing wing. Surprisingly, we discovered that Rabex-5 with an impaired E3 domain but active Rab5 GEF domain suppresses Notch loss-of-function phenotypes and enhances both Notch duplication phenotypes and activated Ras phenotypes consistent with a model that the Rab5 GEF activity of Rabex-5 might positively regulate Ras and Notch. Positive and negative regulation of developmental signaling by its different catalytic domains could allow Rabex-5 to precisely coordinate developmental signaling to fine-tune patterning. Finally, we report that Rabex-5 also inhibits the overgrowth due to loss of PTEN or activation of PI3K but not activation of AKT. Inhibition of Ras, Notch, and PI3K signaling may explain why Rabex-5 is deleted in some cancers. Paradoxically, Rabex-5 is reported to be an oncogene in other cancers. We propose that Rabex-5 acts as a tumor suppressor via its E3 activity to inhibit Ras, Notch, and PI3K signaling and as an oncogene via its Rab5 GEF activity to enhance Ras and Notch signaling.

European cross-cultural neuropsychological test battery (CNTB) for the assessment of cognitive impairment in multiple sclerosis: Cognitive phenotyping and classification supported by machine learning techniques

BackgroundThe European Cross-Cultural Neuropsychological Test Battery (CNTB) has been proposed as a comprehensive battery for cognitive assessment, reducing the potential impact of cultural variables. In this validation study, we aimed to evaluate the diagnostic capacity of CNTB for the assessment of participants with multiple sclerosis (pwMS) compared to the Neuronorma battery (NN) according to the International Classification of Cognitive Disorders in MS criteria, and to develop machine learning (ML) algorithms to improve the diagnostic capacity of CNTB and to select the most relevant tests. MethodsSixty pwMS and 60 healthy controls (HC) with no differences in sex, age, or years of education were enrolled. All participants completed the CNTB and pwMS were also examined with NN, depression, and fatigue scales. Impaired domains and cognitive phenotypes were defined following ICCoDiMS based on CNTB scores and compared to NN, according to -1SD and -1.5SD cutoff scores. To select the most relevant tests, random forest (RF) was performed for different binary classifications. ResultsPwMS showed a lower performance compared to HC with medium-large effect sizes, in episodic memory, executive function, attention, and processing speed, in accordance with their characteristic cognitive profile. There were no differences in impaired domains or cognitive phenotypes between CNTB and NN, highlighting the role of episodic memory, executive function, attention, and processing speed tests. The most relevant tests identified by RF were consistent with inter-group comparisons and allowed a better classification than SD cutoff scores. ConclusionCNTB is a valid test for cognitive diagnosis in pwMS, including key tests for the most frequently impaired cognitive domains in MS. The use of ML techniques may also be useful to improve diagnosis, especially in some tests with lower sensitivity.

A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values

PurposeThe impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI.MethodsA total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined.ResultsThe questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with generic HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender).ConclusionIn combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.

Sarcopenia and self-reported markers of physical frailty in patients with osteoporosis

SummaryBone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty.PurposeIn older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty.MethodsIn Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018–2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions.ResultsOne-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively.Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95–15.76), p < 0.01).ConclusionsSarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients.

Neurocognitive and social cognitive correlates of social exclusion in psychotic disorders: a 20-year follow-up cohort study.

Little is known about the relationship between social exclusion and cognitive impairment in psychosis. We conducted a long-term cohort study of first-episode psychosis to examine the association between comprehensive measures of cognitive impairment and social exclusion assessed at follow-up. A total of 173 subjects with first-episode psychosis were assessed after a 20-year follow-up for 7 cognitive domains and 12 social exclusion indicators. Associations between sets of variables were modeled using multivariate regression, where social exclusion indicators were the dependent variables, cognitive domains were the independent variables, and age, gender, and duration of follow-up were covariates. The total scores on the measures of cognition and social exclusion were strongly associated (β = - .469, ∆R2 = 0.215). Participants with high social exclusion were 4.24 times more likely to have cognitive impairment than those with low social exclusion. Verbal learning was the cognitive function most related to social exclusion domains, and legal capacity was the exclusion domain that showed the strongest relationships with individual cognitive tests. Neurocognition uniquely contributed to housing, work activity, income, and educational attainment, whereas social cognition uniquely contributed to neighborhood deprivation, family and social contacts, and discrimination/stigma. Neurocognition explained more unique variance (11.5%) in social exclusion than social cognition (5.5%). The domains of cognitive impairment were strongly and differentially related to those of social exclusion. Given that such an association pattern is likely bidirectional, a combined approach, both social and cognitive, is of paramount relevance in addressing the social exclusion experienced by individuals with psychotic disorders.

A Comprehensive Survey on Emerging Assistive Technologies for Visually Impaired Persons: Lighting the Path with Visible Light Communications and Artificial Intelligence Innovations.

In the context in which severe visual impairment significantly affects human life, this article emphasizes the potential of Artificial Intelligence (AI) and Visible Light Communications (VLC) in developing future assistive technologies. Toward this path, the article summarizes the features of some commercial assistance solutions, and debates the characteristics of VLC and AI, emphasizing their compatibility with blind individuals' needs. Additionally, this work highlights the AI potential in the efficient early detection of eye diseases. This article also reviews the existing work oriented toward VLC integration in blind persons' assistive applications, showing the existing progress and emphasizing the high potential associated with VLC use. In the end, this work provides a roadmap toward the development of an integrated AI-based VLC assistance solution for visually impaired people, pointing out the high potential and some of the steps to follow. As far as we know, this is the first comprehensive work which focuses on the integration of AI and VLC technologies in visually impaired persons' assistance domain.

Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales

ObjectiveIntrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DesignCohort study. Setting and ParticipantsA total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. MethodsWe derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0–8; IC2-Liu 2021, range: 0–4; IC3-ICOPE, range: 0–4; IC4-modified ICOPE, range: 0–8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. ResultsAmong 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55–11.96; OR, 5.00; 95% CI, 1.75–14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45–12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18–0.19, P < .05). Conclusions and ImplicationsBaseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.

Unveiling temporal dynamics of PTSD and its functional impairments: A longitudinal study in UK healthcare workers

PTSD has been associated with negative long-term consequences, including social and occupational impairments. Yet, a nuanced understanding of the interplay between PTSD symptoms and distinct domains of impairments on a short-term basis (weeks/ months) at the within-person level remains underexplored. In a large sample (nwave 1 = 1096, nwave 7 = 304) of UK healthcare workers assessed across seven assessment waves during the COVID-19 pandemic (spaced 6 weeks apart), we employed exploratory graphical vector autoregression models (GVAR) models to discern within-person temporal (across time) and contemporaneous (within same time window) dynamics between PTSD symptoms and functional impairment domains. The contemporaneous network highlighted strong co-occurrences between different symptoms and impairments. The temporal network revealed a mutually reinforcing cycle between intrusion and avoidance symptoms. Intrusion symptoms showed the highest out-strength (i.e., most predictive symptom), predicting avoidance symptoms, elevated sense of current threat, and various functional impairments. Avoidance symptoms, elevated after increased levels of intrusions, predicted work impairments that in turn were associated with difficulties in fulfilling other obligations. Our findings underscore the dynamics between perceived threat and intrusions, and the role intrusions may play in predicting a cascade of adverse effects. Targeted interventions aimed at mitigating intrusions may disrupt this negative cycle.

Clinical machine learning predicting best stroke rehabilitation responders to exoskeletal robotic gait rehabilitation

BACKGROUND: Although clinical machine learning (ML) algorithms offer promising potential in forecasting optimal stroke rehabilitation outcomes, their specific capacity to ascertain favorable outcomes and identify responders to robotic-assisted gait training (RAGT) in individuals with hemiparetic stroke undergoing such intervention remains unexplored. OBJECTIVE: We aimed to determine the best predictive model based on the international classification of functioning impairment domain features (Fugl– Meyer assessment (FMA), Modified Barthel index related-gait scale (MBI), Berg balance scale (BBS)) and reveal their responsiveness to robotic assisted gait training (RAGT) in patients with subacute stroke. METHODS: Data from 187 people with subacute stroke who underwent a 12-week Walkbot RAGT intervention were obtained and analyzed. Overall, 18 potential predictors encompassed demographic characteristics and the baseline score of functional and structural features. Five predictive ML models, including decision tree, random forest, eXtreme Gradient Boosting, light gradient boosting machine, and categorical boosting, were used. RESULTS: The initial and final BBS, initial BBS, final Modified Ashworth scale, and initial MBI scores were important features, predicting functional improvements. eXtreme Gradient Boosting demonstrated superior performance compared to other models in predicting functional recovery after RAGT in patients with subacute stroke. CONCLUSION: eXtreme Gradient Boosting may be an invaluable prognostic tool, providing clinicians and caregivers with a robust framework to make precise clinical decisions regarding the identification of optimal responders and effectively pinpoint those who are most likely to derive maximum benefits from RAGT interventions.

QOL-15. PAEDIATRIC LOW-GRADE GLIOMA (PLGG): A LIFELONG DISEASE THAT BEGINS IN CHILDHOOD. EVALUATION AND PROGNOSTICATION OF LONG-TERM PLGG SURVIVOR FUNCTIONAL AND QUALITY OF LIFE OUTCOMES

Abstract BACKGROUND For many patients, PLGG has a chronic disease course with potential for multiple and significant functional deficits and decreased Quality-of-Life (QOL). However, there have been limited large-cohort evaluations or prognostication studies of QOL &amp; functional outcomes. AIMS 1. Large-cohort analysis of long-term PLGG survivor functional &amp; QOL outcomes: combining clinical follow-up assessment with survivor-reported QOL &amp; function. 2. Evaluation of prognostic associations between PLGG variables &amp; functional/QOL outcomes. METHODS Demographic, tumour &amp; treatment factors of PLGG patients diagnosed 1980-2021 at Great Ormond Street Hospital, UK, were retrospectively collected &amp; evaluated prognostically with functional outcomes from last clinical follow-up.Cohort long-term survivors completed prospective QOL(PedsQl Core) &amp; function(PESAT-PT) questionnaires.PedsQL scores were evaluated prognostically with patient/tumour/treatment factors using multivariate logistic regression.PedsQL scores were compared with healthy (N=649) &amp; chronically-ill (N=137) reference populations. RESULTS PLGG cohort (N=814) OS was 94.3%,PFS 76% &amp; median treatments 1 (0-21) at median follow-up 8 years. 42% had 1 functional deficit at last clinical follow-up. Diagnostic age, tumour location, surgical resection, &amp; receipt chemo/radiotherapy were independently associated with functional outcomes. 122 long-term survivors completed prospective questionnaires at median follow-up 21 years. 87% reported dysfunction: physical 60%,visual 50%,neurocognitive 49%,social 25%, endocrine 23%,travel 21%,employment 18%,&amp; hearing 11%. Mean PedsQl scores:Physical 82(0-100), Psychosocial 73(13-100), Total 76(9-100). PLGG survivors had significantly lower mean Total, Physical &amp; Psychosocial PedsQl scores than healthy controls (p0.0001,p0.0003,p0.0001), but comparable to people with chronic illness (p0.60,p0.14,p0.21). No correlation identified between PedsQl scores &amp; number of impaired functional domains. Favourable Total PedsQl scores were associated with surgical resection(OR-5.94,p0.02) &amp; fewer treatment interventions on multivariate analysis(OR-2.8,p0.0005). Adverse PedsQl scores were associated with NF1 (OR-11.82,p0.04), BRAF-V600E mutation(OR-18.55,p0.04), OPGs(OR-12.1,p0.01), &amp; seizures(OR-18.93,p&amp;lt;0.0001). CONCLUSIONS Prognostication of heterogeneous PLGG survivor functional and QOL outcomes is complex but possible, without clear correlation between QOL and functional outcomes. For many, PLGG is a lifelong disease that begins in childhood.

Mild behavioral impairment domains are longitudinally associated with pTAU and metabolic biomarkers in dementia-free older adults.

The mechanisms linking mild behavioral impairment (MBI) and Alzheimer's disease (AD) have been insufficiently explored, with conflicting results regarding tau protein and few data on other metabolic markers. We aimed to evaluate the longitudinal association of the MBI domains and a spectrum of plasma biomarkers. Our study is a secondary analysis of data from NOLAN. The longitudinal association of the MBI domains with plasma biomarkers, including pTau181, was tested using adjusted linear mixed-effects models. The sample comprised 359 participants (60% female, mean age: 78.3, standard deviation: 0.3 years). After 1 year, the MBI domain of abnormal perception was associated with steeper increases in plasma pTau181. Abnormal perception, decreased motivation, and impulse dyscontrol were associated with homocysteine or insulin dysregulation. Apart from the association with plasma pTau181, our results suggest that MBI might also represent metabolic dysregulation, probably contributing to dementia transition among older adults with subjective cognitive decline or mild cognitive impairment. Mild behavioral impairment (MBI) psychosis was associated with steeper increases in plasma p. pTau could be a pharmacological target to treat agitation and psychosis symptoms. MBI domains were linked to metabolic dysregulation involving insulin and homocysteine.

Intrinsic capacity and survival among older adults with gastrointestinal malignancies: The Cancer and Aging Resilience Evaluation registry.

Intrinsic capacity (IC) was introduced by the World Health Organization (WHO) as a marker of healthy aging, and is defined as the combination of an individual's physical, mental, and psychological capacities. This study aimed to assess IC via a patient-reported geriatric assessment (GA) and evaluate its association with survival among older adults with gastrointestinal (GI) malignancies. Data were used from a single-institution prospective registry of older adults undergoing GA before cancer therapy. Key domains of IC (vitality, locomotion, and sensory [hearing and visual], psychological, and cognitive capacities) were captured via GA, and each was given a score of 0 or 1 (0,impaired) to compute the total IC score (range, 0-6, where 6indicatesno impairment and ≤5indicatesimpairment in ≥1 domains). A frailty index (FI) was measured via the deficit accumulation method. Cox regression models and Kaplan-Meier curves were used to examine the impact of IC impairment on survival. The study included 665 patients; the median age was 68 years, 57.4% were men, and 72.9% were White. The median IC score was 4, and 79.3% of participants showed impairment in ≥1 domains of IC. Most commonly impaired domains were locomotion (48.7%) and vitality (43.9%). IC was inversely associated with FI (Spearman coefficient, -0.75; p<.001). IC impairment was associated with inferior overall survival (score, 4-5: adjusted hazard ratio [aHR], 1.7; 95% CI, 1.11-2.48; score, 2-3: aHR, 1.9; 95% CI, 1.30-2.85; score, 0-1: aHR, 1.9; 95% CI, 1.11-2.48). IC impairment is associated with frailty and reduced overall survival in older patients with GI malignancies. GA can be used to screen for IC impairment as recommended by the WHO. The World Health Organization introduced intrinsic capacity as a marker of healthy aging. Intrinsic capacity is the combination of an individual's physical, mental, and psychological capacities. It contains six key domains: vitality, locomotion, and sensory (hearing and visual), psychological, and cognitive capacities. Older adults with cancer are susceptible to a decrease in intrinsic capacity as a result of cancer and the aging process. In this study, we aimed to assess the intrinsic capacity for patients with gastrointestinal cancer and also identify whether there exists any association of intrinsic capacity with overall survival. We identified that approximately 80% of this population had one or more impaired domains, and more intrinsic capacity impairment was associated with reduced overall survival.

Cognitive impairment in schizophrenia is associated with prefrontal-striatal functional hypoconnectivity and striatal dopaminergic abnormalities.

A better understanding of the mechanisms underlying cognitive impairment in schizophrenia is imperative, as it causes poor functional outcomes and a lack of effective treatments. This study aimed to investigate the relationships of two proposed main pathophysiology of schizophrenia, altered prefrontal-striatal connectivity and the dopamine system, with cognitive impairment and their interactions. Thirty-three patients with schizophrenia and 27 healthy controls (HCs) who are right-handed and matched for age and sex were recruited. We evaluated their cognition, functional connectivity (FC) between the dorsolateral prefrontal cortex (DLPFC)/middle frontal gyrus (MiFG) and striatum, and the availability of striatal dopamine transporter (DAT) using a cognitive battery investigating attention, memory, and executive function, resting-state functional magnetic resonance imaging with group independent component analysis and single-photon emission computed tomography with 99mTc-TRODAT. Patients with schizophrenia exhibited poorer cognitive performance, reduced FC between DLPFC/MiFG and the caudate nucleus (CN) or putamen, decreased DAT availability in the left CN, and decreased right-left DAT asymmetry in the CN compared to HCs. In patients with schizophrenia, altered imaging markers are associated with cognitive impairments, especially the relationship between DLPFC/MiFG-putamen FC and attention and between DAT asymmetry in the CN and executive function. This study is the first to demonstrate how prefrontal-striatal hypoconnectivity and altered striatal DAT markers are associated with different domains of cognitive impairment in schizophrenia. More research is needed to evaluate their complex relationships and potential therapeutic implications.