Impairments In Everyday Functioning Research Articles

A 2-Year Longitudinal Randomized Control Trial of Speed of Processing Cognitive Training in Aging Adults with HIV-Associated Neurocognitive Disorder: Results of the Think Fast Study.

Nearly 40% of people with HIV (PWH) experience HIV-associated Neurocognitive Disorder (HAND). In this 3-group efficacy study, 216 PWH 40 + years with HAND or borderline HAND were randomized to either: (1) 10h of SOP training (n = 70); (2) 20h of SOP training (n = 73), or (3) 10h of Internet navigation training (n = 73; contact control group). Participants were administered a measure of SOP [i.e., the Useful Field of View Test (UFOV®)] at baseline, at posttest immediately after training, and at year 1 and year 2 follow up. Intent-to-treat linear mixed-effect models with subject-specific intercept and slope were fitted to estimate between-group mean differences at the follow-up time-points. At the post-intervention time-point, small beneficial SOP training effects were observed for the 10-h group in UFOV® total (d = 0.28, p = 0.002). Effects were of larger magnitude for the 20-h group in these same outcomes [UFOV® total (d = 0.43, p < 0.001)]. These results indicated better benefit with more training. No intervention effect was observed at year 1. At year 2, beneficial effects of small magnitude were observed again in the 10-h group [UFOV® total (d = 0.22, p = 0.253)] with larger small-to-moderate magnitude in the 20-h group [UFOV® total (d = 0.32, p = 0.104)]. This study suggests that SOP training can improve a key indicator of this cognitive performance and that treatment gains are small-to-moderate over a two-year period. Prior literature suggests slower SOP is predictive of impairment in everyday functioning in older PWH; such an approach could potentially improve everyday functioning in PWH.

Facilitating Clinical Use of the Amsterdam Instrumental Activities of Daily Living Questionnaire: Normative Data and Diagnostic Cutoff Values

AbstractBackgroundThe Amsterdam Instrumental Activities of Daily Living Questionnaire(A‐IADL‐Q) measures impairments in everyday functioning in the context of dementia. To facilitate interpretation and clinical implementation of the A‐IADL‐Q, we aimed to generate demographically‐adjusted norm scores and a clinical cutoff value.MethodCross‐sectional data were used from Dutch Brain Research Registry(N = 1,064; mean (M) age = 62±11year; 69.5% female) European Medial Information Framework‐Alzheimer’s Disease(EMIF‐AD) 90+ (N = 63; Mage = 92±2year; 52.4% female), and European Prevention of Alzheimer’s Dementia Longitudinal Cohort Study(EPAD‐LCS)(N = 300; Mage = 62±7year; 71.7% female)(Table 1). Norm scores were generated using a I) linear regression model approach; and II) Box‐Cox Power Exponential(BCPE) model approach (the latter falling within the generalized model for location shape and size(GAMLSS) framework). For both methods, different combinations of the variables age, sex and education were tested (including polynomial age and age*education interaction) and the best model was selected based on the lowest Aikake Information Criteria(AIC) value. Next, diagnostic contrast was generated using an independent memory clinic sample (the Amsterdam Dementia Cohort(ADC)(N = 2,123, Mage = 64±8year, 46.1% female)(Table 1), including people with dementia (both Alzheimer’s Disease(AD) and non‐AD). The optimal cut‐off value for cognitively healthy versus dementia was determined, and corresponding diagnostic accuracy was calculated using area under the receiver operating curves(AUC‐ROC). This optimal cutoff was then applied to different diagnostic contrasts, including mild cognitive impairment(MCI) and subjective cognitive decline(SCD).ResultThe best suitable normative model was the linear regression model, including cubic polynomial for age, education, and age*education interaction. This model was considered superior to the best BCPE model, which had infinitely large residuals due to bad model fit. The optimal cutoff to distinguish normal functioning from dementia, based on bootstrap average estimates of the Youden Index, was 1.82 standard deviation(SD) below the population mean, resulting in an AUC of 0.97[95%CI 0.98‐0.98]). Normative data are made publicly available in an online tool(Fig.1).ConclusionWe established demographically adjusted norm scores for the A‐IADL‐Q using a large representative sample, and provided an optimal cutoff value for cognitively healthy versus dementia, with outstanding accuracy. Our results, captured in the online tool, can help clinicians to interpret A‐IADL‐Q scores more easily by allowing comparison of functioning against a reference population.

The Engagement Challenge: Feasibility and Acceptability of Cognitive Remediation for Teenagers in the Care of Youth Protection Services

Background: History of childhood maltreatment is recognized as an important risk factor for the development of mental health and cognitive difficulties. Cognitive difficulties are associated with impairments in everyday functioning in different domains such as school or work. To date, no study has evaluated the feasibility and acceptability of cognitive remediation therapy (CRT) for teenagers with a history of childhood maltreatment. Objective: The objective was to assess the acceptability and feasibility of the CIRCuiTS program for teenagers in youth protection services and to explore the preliminary effect on clinical and neuropsychological outcomes. Methods: Ten participants were first assessed with clinical and neuropsychological measures. They then received a mean of 16 CRT sessions with the CIRCuiTS program adapted for teenagers. The same measures as a baseline were repeated directly after the end of treatment, as well as 3-months and 1-year post-treatment. Descriptive statistics were used to assess feasibility and acceptability, while the preliminary effect of CIRCuiTS was assessed with Reliable Change Indices (RCIs). Results: CIRCuiTS was considered acceptable by both participants and therapists for the attractiveness of the program, its easiness of use and understanding, and its cultural adaptability. However, the feasibility was limited, with only 50% of participants having completed CIRCuiTS. This was mostly explained by contextual factors. RCIs revealed significant improvements in several neuropsychological domains, as well as a decline in other domains. Conclusion: This pilot study highlights challenges that must be addressed to promote engagement with CRT for teenagers in the care of youth protection services.

Digital cognitive training in children with attention-deficit/hyperactivity disorder: a study protocol of a randomised controlled trial

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders and is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning. Children with ADHD are developmentally...

Cognitive disorders and sleep disturbances in long COVID

HintergrundIn den letzten 2 Jahren der COVID-19(„coronavirus disease 2019“)-Pandemie ist das Wissen um Langzeitfolgen der Erkrankung, das sog. „Long-COVID“, rapide gewachsen. Es bleiben jedoch noch viele Fragen offen, v. a. was die Ursachen überdauernder Beschwerden und ihre Prognose betrifft. Kognitive Störungen und Schlafstörungen gehören zu den häufig beklagten Beschwerden. Beide gehen mit starkem Leidensdruck und deutlicher Alltagsbeeinträchtigung einher.Ziel der ArbeitWie ist die Datenlage zum Auftreten kognitiver Störungen und Schlafstörungen bei Long-COVID? Welches sind Einflussfaktoren und was ist bekannt zum Verlauf und zu möglichen zugrunde liegenden Mechanismen? Welche Therapieoptionen gibt es?Material und MethodeIn einem narrativen Review werden die wichtigsten Befunde zu kognitiven Störungen und Schlafstörungen bei Long-COVID dargestellt. Es wird ein Überblick gegeben über die Kohortenstudien mit Daten zu Prävalenz und Einflussfaktoren beider Symptomkomplexe. Es werden derzeitige Kenntnisse und Hypothesen zu pathophysiologischen Mechanismen dargestellt und ein Ausblick auf Behandlungsansätze gegeben.ErgebnisseEtwa ein Fünftel der Betroffenen berichtet mehr als 3 Monate nach einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion über kognitive Einschränkungen, etwa ein Drittel über Schlafstörungen, wobei es neben insomnischen auch zu hypersomnische Beschwerden kommt. Kognitive Störungen und Schlafstörungen treten bei Betroffenen aller Schweregrade auf. Es gibt Hinweise auf eine Besserung kognitiver Defizite im Verlauf, allerdings sind weitere Längsschnittstudien notwendig.DiskussionNeben der Prognose sind die zugrunde liegenden Krankheitsmechanismen noch unzureichend verstanden. Zudem besteht großer Forschungsbedarf zur Wirksamkeit und zu spezifischen Wirkfaktoren therapeutischer Interventionen.

The association of momentary sad moods, concurrent productive behaviour, and global functional outcomes: a 30-day ecological momentary assessment study of people with bipolar illness

ABSTRACT Background Previous weekly sampling studies found that persistent sad moods are associated with disability in bipolar illness. However, those data were collected retrospectively. We examined the momentary quality of activities (productive, unproductive, and passive recreation) in an ecological momentary assessment (EMA) study and related sadness at each survey to quality of momentary activities and overall everyday functioning. Methods Participants with bipolar illness (N = 91) were sampled three times per day for 30 days. Each survey queried participants as to where they were, with whom, what they were doing, and their mood state. Activities were characterised according to predetermined criteria and related to momentary sadness. Observer ratings of everyday functioning were related to daily reports of sadness and activities. Results Sadness was associated with the quality of activities. Momentary reports of unproductive activities were associated with the most sadness (p < .001), followed by passive recreation, and productive activities. Momentary sadness and momentary unproductive activities correlated with observer ratings of competence in work, everyday activities, and social outcomes (p < .001). Using both predictors led to the best model. Conclusions This study on the course of sad moods in people with bipolar illness to EMA found that momentary sadness correlatesdwith the quality of concurrent activities and that both sadness and the quality of everyday activities predicted observer ratings of everyday functioning. Although we cannot determine the causal direction, these findings support the hypothesis that momentary sadness leads to reductions in productive activities and impairments in everyday functioning.

Compulsive Internet Use Scale: Psychometric Properties and Associations With Sleeping Patterns, Mental Health, and Well-Being in Lithuanian Medical Students During the Coronavirus Disease 2019 Pandemic.

Background: The increase in problematic Internet use (PIU) among medical students and resident doctors during the coronavirus disease 2019 (COVID-19) pandemic may be leading to significant impairments in everyday functioning, including sleeping patterns, anxiety, depressive symptoms, and overall well-being. The Compulsive Internet Use Scale (CIUS) has been developed to assess the severity of PIU, however, it has not been elucidated whether this scale is also applicable to medical students and resident doctors. The first aim of this study was to explore the psychometric properties of the Lithuanian version of the CIUS. The second aim was to examine associations between subjectively reported mental health symptoms and PIU during the COVID-19 pandemic.Methods: A total of 524 medical students and resident doctors (78.60% women, mean age 24 [SD 3] years old) participated in an online survey between December 2020 and February 2021. Participants completed the CIUS, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Assessment-7 (GAD-7), and the WHO—Five Well-Being Index questionnaire (WHO-5).Results: The confirmatory factor analysis (CFA) suggested brief versions (CIUS-5, CIUS-7, and CIUS-9) rather than the original (CIUS-14) version of the CIUS questionnaire as reliable and structurally stable instruments that can be used to measure compulsive Internet use severity in the sample of medical students and resident doctors. The most prevalent online behaviors were social media use (90.1%), online shopping (15.6%), and online gaming/gambling (11.3%). Students with higher CIUS scores reported significantly lower academic achievements during the 6 months (r = 0.12–0.13; p < 0.006), as well as more severe depressive and anxiety symptoms, worsened sleep quality, and lower sense of well-being (r = 0.21–0.41; p's < 0.001). Both, during workdays (d = 0.87) and weekend (d = 0.33), students spent more time online than resident doctors (p's < 0.001).Conclusion: The brief, 5-, 7-, and 9-item versions of the Lithuanian CIUS are reliable and valid self-report screening instruments for evaluating the severity of PIU symptoms among the medical student population. Symptoms of PIU during the COVID-19 period were associated with worsened self-reported mental health and everyday functioning.

Assessment of executive functions as a measure of impairments in everyday functioning in persons with HIV

ABSTRACT Persons with HIV can often present cognitive disorders such as those related to executive functioning, which could affect the daily life activities. The present study was designed to explore the predictive relationship between executive functions according to Miyake’s model and the basic and instrumental skills of everyday functioning in a group of persons with HIV (PWH). Participants were recruited from outpatient treatment Hospital and assessed using a neuropsychological battery, a modified version of the Lawton and Brody basic and instrumental activities of daily life (ADL) scale and the Hospital Anxiety and Depression Scale (HADS). The results showed a low score in the executive function and significant relationship between executive functioning and the instrumental skills of the patients, with set-shifting being one of the most powerful predictors. The processes of executive functioning, particularly set-shifting, are related to the level of functioning in the skills required for independent living in the community, but not the skills of independent living in the home. This study seems to suggest the utility of assessing executive functions as a preventive measure for the development of dependencies in normal daily instrumental skills and as the focus of interdisciplinary interventions.

Relationships Among History of Psychosis, Cognition and Functioning in Later-Life Remitted Major Depression

ObjectiveThis study tested the hypotheses that, in older adults with remitted major depression, a history of psychotic features and poorer neuropsychological performance would be independently associated with poorer everyday functioning, but that neuropsychological performance would explain more of the variance in functioning than history of psychotic features. MethodsThis cross-sectional study included 73 patients aged 50 years or older with remitted psychotic major depression or nonpsychotic major depression. The dependent variables were subjective and objective measures of function. The independent variables were history of psychotic features during one or more major depressive episodes in the previous 10 years and neuropsychological performance. Linear regression models examined the association of independent variables with function, controlling for pertinent covariates. Effect sizes were calculated for the magnitude of difference in function between the patient participants and an age- and gender-matched nonpsychiatric group, and distribution of functioning scores were compared between groups. ResultsIn separate models, history of psychotic features and poorer processing speed, executive function, and verbal learning were independently associated with poorer participant-reported functioning and performance-based functioning. However, the association of psychotic features with functioning was no longer statistically significant when tested in the same models as neuropsychological measures. Effect sizes of the difference in functioning between patients and the nonpsychiatric group were significantly larger for the remitted psychotic than the remitted nonpsychotic depression group; functioning scores were more heterogeneous in the remitted psychotic depression group. ConclusionPatients with remitted psychotic depression exhibit greater, and clinically important, impairment in everyday functioning than those with remitted nonpsychotic depression. Neuropsychological impairment appears to contribute to this relationship.

OS3.3 Development of an EORTC questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumours: phase I-III

Abstract BACKGROUND In brain tumour patients, impairments in every day functioning can impact quality of life, and are therefore an important outcome in both clinical trials and practice. One way to measure every day functioning is with an activities of daily living (ADL) questionnaire. Instrumental ADL (IADL) are the cognitively more complex activities, that are essential to function autonomously within society. Cognitive decline may therefore negatively impact IADL, making these activities particularly relevant to brain tumour patients. The aim of this study is to develop a reliable and valid questionnaire to measure IADL in primary malignant and metastatic brain tumour patients. MATERIAL AND METHODS The questionnaire development study followed the standard European Organisation for Research and Treatment of Cancer (EORTC) four phase methodology: (I) generation of activities list, (II) construction of item list, (III) pre-testing, and (IV) field testing. This report covers phases I-III. To ensure cross-cultural validity, participants were recruited from different countries (The Netherlands, United Kingdom, Italy, Austria and Japan). In phase I, potential activities were identified based on a literature review and in-depth interviews with patients, proxies and healthcare professionals. In phase II, activities were turned into items, and translated into all required languages by the EORTC Translation Unit. In phase III, the item list was pre-tested in patient-proxy dyads. In accordance with predetermined decision rules to reduce items, final items were selected, and preliminary psychometric properties (i.e. factor structure, validity, reliability) were assessed. RESULTS Phase I (N=44 dyads) resulted in 59 IADL activities which were converted into 59 items in phase II. In phase III, N=85 dyads completed and reviewed this item list. The item list was subsequently reduced to 32 items. An exploratory factor analysis indicated several items measuring similar underlying constructs (e.g. domestic life and using computer/smartphone) showing acceptable to good (α≥0.7) internal consistency (range α=0.69–0.89). Seven items were less related to these underlying constructs (e.g. work or managing your own medication), and therefore single items. Construct validity, measured with known-group comparisons analyses between cognitively impaired and unimpaired patients, showed significant differences in scores between the two groups on some scales and several single items. CONCLUSION The currently developed EORTC IADL-BN32 questionnaire can be a valuable asset in assessing IADL functioning in brain tumour patients, but further validation in phase IV is required and is planned.

Autism symptoms, depression, and active social avoidance in schizophrenia: Association with self-reports and informant assessments of everyday functioning

Autistic traits are a feature of schizophrenia and has been found to impair social functioning and social cognition. Other influences on social outcomes in schizophrenia include depression and social avoidance. However, challenges in self-assessment of abilities and functioning (i.e., introspective accuracy) and self-assessment bias also contribute to disability. Depression has been studied for its association with introspective accuracy and bias, but autistic traits have not. Participants were 177 patients with schizophrenia who self-reported their everyday functioning and social cognitive ability as well as their depression. All were rated with the PANSS and a separate rater generated all-sources ratings of everyday functioning and social cognitive ability. Correlations between self-reported everyday functioning and social cognitive ability, ratings of everyday functioning and social cognitive ability, and the discrepancies between those ratings were examined for correlations with depression, autistic features and social avoidance. Accuracy was defined by the absolute value of the difference between self-reports and all-sources ratings and bias was defined by the direction of discrepancy (positive vs. negative). There was a statistically significant difference between sources on every measure. Bias was not directional on average, but patients with the lowest levels of depression overestimated their abilities on every measure and those with the highest depression underestimated. Autistic traits were associated with impairments in everyday functioning and underestimation of those impairments, while social avoidance was associated with impaired social functioning and accurate self-assessment. Features of schizophrenia have differential implications for impaired functioning and self-assessment, with autistic features and low levels of depression associated with consistent self-assessment biases.

Conceptualizing and Assessing Everyday Functioning in the Context of HIV-Associated Neurocognitive Disorders.

Combination antiretroviral therapy has reduced the rates of severe HIV-associated neurocognitive disorders (HAND), but the prevalence of milder forms of HAND that can affect everyday functioning remains high. As HIV-infected adults approach near-normal life expectancies, they may become increasingly susceptible to declines in everyday functioning secondary to a variety of physical and mental factors, including HAND. Although impairments in everyday functioning are a hallmark of HAND diagnoses and can adversely influence quality of life, there are no gold standard measures of this fundamentally important and complex construct. This chapter provides a brief review of the various self-report, clinician-rated, and performance-based methods by which everyday functioning is measured in the setting of HIV disease, including global activities of daily living and specific domains of medication adherence, financial management, automobile driving, and vocational functioning.

Staff perceptions of borderline personality disorder and recovery: A Q-sort method approach.

This study was the first to explore how staff that work with people diagnosed with borderline personality disorder (BPD) perceive recovery in this client group. These views are important because of the crucial role that staff play in the care of people with BPD, and the challenges that staff experience with these clients. A Q methodology design was used, containing 58 statements about recovery. Twenty-nine mental health staff sorted recovery statements according to perceived importance to recovery in BPD. There were two different viewpoints about recovery in BPD. A medically oriented group viewed coping with symptoms and behaviours specific to BPD as being most important to recovery, whereas participants who were more well-being oriented viewed achieving overall well-being that was universally valued regardless of diagnosis as more important. Both groups reported that engaging in socially valued activities such as work and education was not an important aspect of recovery and that people with BPD could be considered to have recovered despite continued impairments in everyday functioning. Staff perceptions of recovery in BPD can differ, which poses risks for consistent team working, a particularly important issue in this client group due to the relational difficulties associated with the diagnosis. Multidisciplinary teams working with people diagnosed with BPD therefore need to find a forum to promote a shared understanding of each patient's needs and support plans. We advocate that team formulation is a promising approach to achieve more consistent ways of working within teams. Findings Multidisciplinary teams working with people with borderline personality disorder should use team formulations to create a shared understanding of individual patient's needs and goals for recovery, so they can deliver a consistent approach to care. Recovery questionnaires should be used to develop an understanding of a patient's individual recovery goals. Limitations Opportunity sampling was utilized in recruitment, and the sample was not representative of the general population of staff working with borderline personality disorder. Although views from a wide range of professions were sampled in this research, the views of psychiatrists were not represented.

T235. SELF ASSESSMENT OF SOCIAL COGNITIVE ABILITY IN SCHIZOPHRENIA: ASSOCIATION WITH SOCIAL COGNITIVE TEST PERFORMANCE, INFORMANT ASSESSMENTS OF SOCIAL COGNITIVE ABILITY, AND EVERYDAY OUTCOMES

BackgroundImpairments in self-assessment are commonly found in people with schizophrenia and impairments in introspective accuracy (IA) predict impaired functional outcome. previous studies have suggested mis-estimation of cognitive and functional skills predict impairment in everyday functioning at least as much as ability scores. In this study, we examined self-assessment of social cognitive ability and related these self-assessments to assessments of social cognition from informants, to performance on tests of social cognitive ability, and to everyday outcomes. The difference between self-reported social cognitive abilities and informant ratings was our measure of IA.MethodsPeople with schizophrenia (n=135) performed 8 tests of social cognitive abilities. They also rated their social cognitive abilities on the Observable Social Cognition Rating Scale (OSCARs). High contact informants also rated social cognitive ability and everyday outcomes, while unaware of the patients’ other scores. Social competence was also measured with a performance-based assessment and clinical ratings of negative symptoms were also performed.ResultsPatient reports of their social cognitive abilities were uncorrelated with performance on social cognitive tests and with three of the four domains of everyday functional outcomes. IA, in specific overestimation of performance compared to informant ratings, predicted impaired everyday functioning across all four functional domains. IA scores predicted functional outcomes even when the influences of social cognitive performance, social competence, and negative symptoms were considered in regression models. Thus, self-assessment of social cognition had a relatively specific impact social outcomes.DiscussionMis-estimation of social cognitive ability was a more important predictor of social and nonsocial outcomes in schizophrenia than performance on social cognitive tests. These results suggest that consideration of IA is critical when attempting to assess causes of everyday disability and when implementing interventions aimed at disability reduction.

Repeated cortisol administration does not reduce intrusive memories – A double blind placebo controlled experimental study

PTSD is a severe mental disorder, which may develop after exposure to traumatic events and is characterized by intrusive memories. Intrusions are sudden brief sensory memories of the traumatic event, that cause immense distress and impairment in every day functioning. Thus, the reduction of intrusive memories is one of the main aims of PTSD therapy. Recently, the glucocorticoid cortisol has been proposed as a pharmacological option to reduce intrusive memories, because cortisol is known to have memory retrieval inhibiting effects. However, the research on the effects of cortisol administration on intrusive memories is not conclusive. The aim of the present study was to examine if repeated cortisol administration inhibits intrusions and recognition memory in an experimental study using the trauma film paradigm. In a randomized double-blind placebo controlled design participants were exposed to a traumatic film (known to induce intrusions in healthy participants) and received either a low dose of cortisol (20mg) or placebo on the three days following "trauma exposure". Intrusive memories were assessed with an Electronic Diary and an Intrusion Triggering Task. Furthermore, we assessed explicit memory for the traumatic film clip with a recognition test. Contrary to our predictions, the cortisol group did not report fewer intrusions than the placebo group nor did it show diminished performance on the recognition test. Our results show that sole cortisol administration after a traumatic experience cannot reduce intrusive re-experiencing.

Health status and mobility limitations are associated with residential and employment status in schizophrenia and bipolar disorder

IntroductionSchizophrenia (SCZ) and bipolar disorder (BP) are linked to multiple impairments in everyday functioning which share cognitive and symptom risk factors. Other risk factors for critical aspects of every day functioning (e.g., gainful employment; residential independence) such as physical health have not been evaluated, despite poor health in SCZ and BP. MethodsWe analyzed 20-year follow-up data from the Suffolk County Mental Health Project cohort of consecutive first admissions with a psychotic disorder to 12 psychiatric facilities in Suffolk County, NY, between September 1989 and December 1995. Both 20-year symptom, health, and cognition data, and the 20-year course of weight gain were included as predictors of employment and residence status. ResultsThe analysis sample consisted of 122 participants with SCZ ad BP, with SCZ participants less likely to work or live independently. Correlational analyses showed symptoms and cognition predicted vocational outcomes in both samples. The effect of diagnosis was significant for both gainful employment and independence in residence. After consideration of diagnosis, mobility and negative symptoms predicted gainful employment in both samples, but there were no additional predictors of residential independence. Prospective analysis of BMI found that baseline BMI, but not changes during the 20-year follow up, predicted labor force participation. DiscussionHealth status limitations were associated with residential and, particularly, employment status independent from other, previously established predictors of everyday outcomes, including cognition and symptoms. The importance of health status limitations for predicting outcome was confirmed in both SCZ and BP, with schizophrenia representing the more impaired group.

DECLINE IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING IS MORE MARKED IN BEHAVIOURAL VARIANT FRONTOTEMPORAL DEMENTIA THAN IN ALZHEIMER’S DISEASE

Different subtypes of dementia show different levels of impairment in everyday functioning. However, there has been little focus on the decline of individual daily activities over time, and how these might vary between subtypes of dementia. The objective of this study was to assess and compare the trajectories of decline of 10 individual instrumental activities of daily living (IADLs) (bills; taxes; shopping; hobbies; using kitchen appliances; preparing a meal; keeping track of current events; paying attention; remembering appointments; travelling) between behavioural variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). This study included data from the Uniform Data Set of the National Alzheimer's Coordinating Center (NACC), which collects annual data on demographics, neuropsychological testing, clinical diagnosis, and assessments such the Functional Assessment Questionnaire (FAQ). The dataset was locked in November 2012, and data were extracted up to that occasion. There were a maximum of eight data points for each patient. Independent t-tests were used to assess variations in everyday functioning between dementia types at baseline. Linear mixed effect modelling was performed to explore the longitudinal functional decline between dementia subtypes. The model included random intercepts for subject IDs to account for any correlation between the repeated measures within subjects. In total, data from 3351 patients (306 bvFTD and 3045 AD) were analysed. At baseline, bvFTD patients were impaired to a greater degree with bills (mean difference, d=0.8, p<0.001), taxes (d=0.8, p<0.001), shopping (d=0.6, p<0.001), hobbies (d=0.7, p<0.001), using kitchen appliances (d=0.5, p<0.001), meal preparation (d=0.7, p<0.001), current events (d=0.4, p<0.01), paying attention (d=0.6, p<0.001), and travel (d=0.6, p<0.01) compared to AD patients. BvFTD patients were more impaired on the total FAQ (mean=20.1, standard deviation, sd=10.4) than AD patients (mean=15.2, sd=12.0). Longitudinally, analysing all time points together using linear mixed model, bvFTD patients had lower scores than AD patients on everyday activities (coeff.=-3.95, 95% CI:2.45–5.44, p<0.001). Findings from this study can have important implications for clinical practice in aiding the management of different dementia subtypes, by understanding in depth how different IADLs deteriorate throughout the disease across different types of dementia.

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool.

BackgroundAssessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.Methods and findingsThe construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.ConclusionsThis evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

Lurasidone versus treatment as usual for cognitive impairment in euthymic patients with bipolar I disorder: a randomised, open-label, pilot study

Cognitive impairment is present in euthymic patients with bipolar disorder and correlates with impairments in everyday functioning. We aimed to examine the efficacy of lurasidone adjunctive therapy compared with treatment as usual (TAU) in improving cognition. For this randomised, open-label, pilot study, we recruited patients aged 19-65 years with euthymic bipolar I disorder from the Mood Disorder Centre in UBC Hospital (Vancouver, Canada). We included patients who were taking lithium, or valproate, or an atypical antipsychotic, or a combination of these for mood stabilisation and who showed reduced cognitive functioning (SD≤ -0·25 relative to demographics-corrected norms) on either the Trail Making Test-B or the California Verbal Learning Test-II. Patients were randomly assigned using a randomised block design with a block size of four to TAU or lurasidone adjunctive therapy (20-80 mg/day) for 6 weeks. A research coordinator masked to group allocation administered the International Society for Bipolar Disorders Battery for Assessment of Neurocognition (ISBD-BANC) at baseline and at endpoint. The primary outcome was change in global cognition score, which consisted of the mean demographics-corrected t-score value of the several ISBD-BANC measures, analysed in all patients who completed both tests. This trial is registered on ClinicalTrials.gov, number NCT02147379. Between July 2, 2014, and Oct 19, 2015, 34 patients were randomly allocated to lurasidone adjunctive therapy (17 patients) or TAU (17 patients). Two patients from each group did not complete the study. The mean lurasidone dose was 48·24 (SD 15·90) mg/day. Lurasidone adjunctive therapy was more effective than TAU in improving the primary efficacy measure of ISBD-BANC global cognition score (mean difference 2·92 [95% CI 0·27-5·57]; time × treatment interaction F=5·09; p=0·032). The between-group effect size (0·82) on baseline versus study-end difference scores in the ISBD global cognition score was of moderate to large magnitude. The magnitude of benefit with lurasidone adjunctive therapy in improving global cognition (effect size 0·46) was greater compared with the improvement observed in the TAU group (0·04). Adverse events were reported by nine (60%) patients in the luradisone group and two (13%) in the TAU group. Our results provide some preliminary evidence for the efficacy of lurasidone in improving cognition in euthymic patients with bipolar I disorder. The strengths of this study were the characterisation of the sample and use of tests sensitive to cognitive impairment in bipolar disorder. Its limitations were the sample size and inability to completely control for other medication use. Larger double-blind trials are warranted to investigate this further. Sumitomo Dainippon Pharma.

Internet Addiction Based on Personality Characteristics in Medical Students

Background: The Internet has become a fundamental part of modern life, it has given rise to various problematic behaviors. Some of these behaviors, such as prolific use of social media, frequent email checking, excessive online gaming, online buying and gambling, and viewing pornography cause significant impairment in everyday functioning of some individuals. Different researchers studied psychological aspects like impulsive compulsive spectrum, anxiety and depression in internet addicts. Objectives: The aim of this study is to examine the relationship between internet addictions and different aspects of personality in medical students. Methods: In this cross, sectional study the purpose was to assess all 687medical students of medical faculty of Shiraz University of Medical Sciences. 364 students showed their contention for participating in the study by filling the consent form. Finally 278 valid questionnaires were collected. They responded to the demographic questions in the questionnaire such as age, sex, marital status, student accommodation, entrance year to university, student residence place and also internet addiction test was performed and NEO five-factor inventory short form (NEO-FFI) was filled. Results: 55 of participants show internet addiction, with distribution of 51.4 mild, 2.9 moderate and 0.4 severe addiction. Internet addiction and personality traits of extraversion (The correlation coefficient = -0.118, P = 0.05), agreeableness (The correlation coefficient = -0.379, P = 0.001) and conscientiousness (The correlation coefficient = -0.21, P = 0.001), showed significant negative correlation, but its correlation with neuroticism (The correlation coefficient = +0.2, P = 0.001) was significantly positive. Internet addiction scores among students in semester five and eleven prior to the comprehensive basic science test (26.52±9.8) and comprehensive pre-internship test (28.57±19.2) were higher than the other academic years. Conclusions: The prevalence of Internet addiction in this study was higher compared to similar studies in other fields which led to the concerns regarding the extent of the problem. More internet addiction among students in 4th and 10th semester reveals the need for being efficiently trained in order to deal with stress in critical condition and also to maintain positive academic performance. Correlation of some aspects of personality traits with internet addiction, suggested initial assessment of medical students� personality by screening tools and identification of populations at risk. This may prove a need for favorable methods for initiation of prevention. © 2016, Shiraz University of Medical Sciences.