Long-term Decline Research Articles

The effect of the great Kermanshah earthquake on the tuberculosis infection trend: interrupted time series analysis

ObjectivesTuberculosis (TB) presents a substantial danger to populations experiencing crises like earthquakes. This study aims to explore the effect of the Kermanshah earthquake on the trend of TB.MethodsThis cross-sectional study examined tuberculosis data from 2009 to 2020, using monthly diagnoses. Data was collected from the TB research office and registration system. The study employed interrupted time series (ITS) analysis to assess both the immediate and long-term impacts of the earthquake on TB cases.ResultsIn Sarpol-e Zahab, TB cases initially surged after the earthquake, indicating an immediate effect, but then significantly declined compared to pre-earthquake levels, reflecting an effect over time (β0 = 1.39, β1=-0.004, β2 = 0.11 and β3=-0.01, P = 0.001 and Post-intervention linear trend= -0.015, P < 0.001). In Ghasr-e Shirin, the average number of TB cases prior to the earthquake was estimated at 0.58 cases, with a significant monthly decrease of 0.005 cases leading up to the earthquake (P = 0.001). There was no significant immediate change in TB cases during the first month after the earthquake (β2 = 0.008, P = 0.680). Post-earthquake, TB cases dramatically increased (β3 = 0.008, P = 0.001). The monthly trend of TB cases rose significantly by 0.002 (P = 0.001), indicating an effect over time. In Salas-e Babajani, there was no immediate change in TB cases, but there was a significant long-term decline compared to the period before the earthquake (P = 0.001).ConclusionsEarthquake is one of the natural crises that provide the conditions for the increase of TB. Local health policymakers must make plans in these areas to contain TB after the earthquake.

Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection

BackgroundRecovery from SARS CoV-2 infection is expected within 3 months. Long COVID occurs after SARS-CoV-2 when symptoms are present for more than 3 months that are continuous, relapsing and remitting, or progressive. Better understanding of Long COVID illness trajectories could strengthen patient care and support.MethodsWe characterized functional impairments, quality of life (QoL), and cognition among patients who recovered from SARS-CoV-2 infection within 3 months (without Long COVID), after 3 months (Recovered Long COVID), or remained symptomatic (Long COVID). Among 7305 patients identified with previous SARS-CoV-2 infection between March 2020 and December 2021, confirmed in the medical record with laboratory test or physician diagnosis, 435 (6%) completed a single self-administered survey between March 2022 and September 2022. Multi-domain QoL and cognitive concerns were evaluated using PROMIS-29 and the Cognitive Change Index-12.ResultsNearly half the participants (47.7%) were surveyed more than 2 years from initial infection (median = 23.3 months; IQR = 18.6, 26.7) and 86.7% were surveyed more than 1 year from infection. A significantly greater proportion of the Long COVID (n = 215) group, (Current and Recovered combined), had moderate-to-severe impairment in all health domains assessed compared to those Without Long COVID (n = 220; all p < 0.05). The Recovered Long COVID group (n = 34) had significantly lower prevalence of fatigue, pain, depression, and physical and social function impairment compared to those with Current Long COVID (n = 181; all p < 0.05). However, compared to patients Without Long COVID, the Recovered Long COVID group had greater prevalences of fatigue, pain (p ≤ 0.06) and subjective cognitive decline (61.8% vs 29.1%; p < 0.01). Multivariate relative risk (RR) regression indicated Long COVID risk was greater for older age groups (RR range 1.46–1.52; all p ≤ 0.05), those without a bachelor’s degree (RR = 1.33; 95% CI = 1.03–1.71; p = 0.03), and those with 3 or more comorbidities prior to SARS-CoV-2 infection (RR = 1.45; 95% CI = 1.11–1.90; p < 0.01).ConclusionsLong COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities.

Tropical teleconnections through the Amundsen Sea Low impact Antarctic toothfish recruitment within the Ross Gyre

Antarctic toothfish (Dissostichus mawsoni) in the Ross Sea region are believed to spawn predominantly in the northern parts of the Ross Gyre during the austral winter with fluctuations in their recruitment observed. This Lagrangian modelling study attempts to explain these fluctuations and shows how sea-ice drift impacts the buoyant eggs and the overall recruitment of juveniles reaching the Amundsen shelf break. Interannual variations in the Amundsen Sea Low, linked to tropical sea surface temperatures, cause modulations in the sea-ice drift and subsequent recruitment. When the Amundsen Sea Low is weaker, consistent with El Niño conditions, the northward sea-ice drift reduces, and more eggs remain within the Ross Gyre leading to a larger recruitment success. Conversely, recruitment success reduces during La Niña conditions. The sea-ice drift may explain about 80% of the interannual Antarctic toothfish recruitment variability over the period 1975–2016 and is of particular importance during the first year after spawning. These results enable future interannual changes in Antarctic toothfish recruitment success based on remote observations to be anticipated. Our findings suggest that ongoing climate change strengthening of the Amundsen Sea Low, will likely contribute to a long-term toothfish recruitment decline in the Ross Gyre region.

Searching for Stellar Activity Cycles Using Flares: The Short- and Long-timescale Activity Variations of TIC-272272592

We examine 4 yr of Kepler 30 minutes data, and five sectors of Transiting Exoplanet Survey Satellite 2 minutes data for the dM3 star KIC-8507979/TIC-272272592. This rapidly rotating (P = 1.2 day) star has previously been identified as flare active, with a possible long-term decline in its flare output. Such slow changes in surface magnetic activity are potential indicators of solar-like activity cycles, which can yield important information about the structure of the stellar dynamo. We find that while TIC-272272592 shows evidence for both short- and long-timescale variations in its flare activity, it is unlikely physically motivated. Only a handful of stars have been subjected to such long-baseline point-in-time flare studies, and we urge caution in comparing results between telescopes due to differences in bandpass, signal-to-noise ratio, and cadence. In this work, we develop an approach to measure variations in the flare frequency distributions over time, which is quantified as a function of the observing baseline. For TIC-272272592, we find a 2.7σ detection of a sector which has a flare deficit, therefore indicating the short-term variation could be a result of sampling statistics. This quantifiable approach to describing flare-rate variation is a powerful new method for measuring the months-to-years changes in surface magnetic activity, and provides important constraints on activity cycles and dynamo models for low-mass stars.

Alterations in T cell immunity over 6–12 months post-COVID-19 infection in convalescent individuals: a screening study

Acute COVID-19 is a viral infection caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that results in dramatically decreased peripheral blood CD3+T cell count apparently due to alterations of thymic T cell maturation, that can persist long term afterwards. Therefore, we analyzed the levels of peripheral blood TRECs (T-cell receptor excision circles), and investigated the main alterations in peripheral blood T cell subsets in COVID-19 convalescents. We performed molecular quantification of TRECs with “TREC/KREC-AMP PS” kit and flow cytometric analysis of peripheral blood lymphocytes from three groups of patients. The first group contained 109 samples from COVID-19 convalescents (6–12 month post-acute COVID-19) with normal levels of TRECs (TRECn); the second was formed from COVID-19 convalescents (6–12 month post-acute COVID-19) with decreased levels of TRECs (TREClow, n = 29), and healthy control group (HC, n = 18). We noticed no significant differences between all three groups in CD3+T cell relative and absolute numbers. However, CD4+T cell frequencies were decreased in TREClow and TRECn groups compared to HC (40.8% (31.6; 50.1) and 46.4% (40.0; 53.0) vs 53.5% (47.36; 56.9), p 0.001 and р = 0.004, respectively). Furthermore, Th cell levels were decreased in TREClow patients vs HC and TRECn groups (701 cell/1 µL (478; 807) vs 1005 cell/1 µL (700; 1419), р = 0.020, and 876 cell/ 1 µL (661; 1046), р = 0.008, respectively). Finally, both groups of COVID-19 convalescents had increased frequencies of circulating CD8+T cells — 29.4% (20.7; 39.7) in TREClow group, 26.5% (21.1; 32.7) in TRECn group vs 21.3% (17.1; 26.0) in healthy controls (p = 0.024 and р = 0.026, respectively). In TRECn group, CD8+T cell count was elevated vs control range (508 cell/1 µL (372; 622) vs 356 cell/1 µL (247; 531), р = 0.044). Thus, COVID-19 convalescents (6–12 month post-acute COVID-19) showed an imbalance in CD4+and CD8+T cell level even at 6–12 months post-acute SARS-CoV-2 infection, and the observed changes in peripheral blood T cells could be closely related to the alterations in thymic T cell maturation and differentiation. Such a long-term decline in TREC levels in the circulation may have a profound impact on immune system functions and requires immunocorrection therapy.

Sleep Efficiency and Neurocognitive Decline in Atopic Dermatitis: A Systematic Review.

Atopic dermatitis is often accompanied by a lack of sleep efficiency, which may impact neurocognitive functions. This review assesses the association between sleep quality in atopic dermatitis patients and neurocognitive decline. Databases searched included PubMed, Scopus, and Web of Science from inception to 8 January 2024, adhering to PRISMA guidelines. Cross-sectional and longitudinal studies were included. Records were screened and assessed for eligibility, with 13 studies included in the final analysis. From an initial pool of 4,529 records, 13 studies involving 272,868 participants met the inclusion criteria. The review identified a consistent pattern of sleep disruption in individuals with atopic dermatitis, which was associated with various short-term neurocognitive challenges such as impaired focus, decreased sleep efficiency, and lower IQ. Limited evidence was found for potential long-term cognitive decline associated with chronic atopic dermatitis. Lower sleep quality in atopic dermatitis is associated with neurocognitive deficits. While immediate effects are evident, further research is needed to understand potential long-term consequences. Integrating sleep management into atopic dermatitis care is imperative.

Congruent Long-Term Declines in Carbon and Biodiversity Are a Signature of Forest Degradation.

Recent global policy initiatives aimed at reducing forest degradation require practical definitions of degradation that are readily monitored. However, consistent approaches for monitoring forest degradation over the long term and at broad scales are lacking. We quantified the long-term effects of intensive wood harvest on above-ground carbon and biodiversity at fine resolutions (30 m2) and broad scales (New Brunswick, Canada; 72,908 km2). Model predictions for above-ground biomass were highly correlated with independent data (r = 0.77). After accounting for carbon stored in wood products, net CO2 emissions from forests for the region from 1985 to 2020 were 141 CO2e Tg (4.02 TgCO2e year-1; 32% of all reported emissions). We found strong positive correlations between locations with declines in above-ground carbon and habitats for old-forest bird species, which have lost > 20% habitat over 35 years. High congruence between biodiversity and forest carbon offers potential for policy incentives to conserve both objectives simultaneously and slow rates of forest degradation. These methods could be used to track forest degradation for managed forest regions worldwide.

Cancer mortality attributable to air pollution in Slovakia

Abstract Introduction Air pollution is considered one of the most significant global environmental health risks. According to the Global Burden of Disease estimates, fine particulate matter, a key component of ambient air pollution, was the fifth leading risk factor for mortality worldwide in 2015, contributing to 4.2 million deaths (7.6% of total global deaths). In 2019, ambient air pollution was responsible for 4.5 million deaths. This rise is attributed to the growing levels of air pollution and the increasing incidence of NCDs associated with air pollution. Aim This contribution aims to clarify the possible association between environmental air pollution and cancer in Slovakia in the years 2015-2019 overall and by gender and age. Methodology This ecological study focuses on the population of Slovakia from 2015 to 2019. The data used are from the Global Burden of Disease study (IHME, 2019), the Statistical Office of the Slovak Republic and the Slovak Hydrometeorological Institute. Results In 2019, mortality from NCDs related to environmental pollution accounted for 6.6% of total mortality in Slovakia, which is lower than the global average of 8.3%. Cancer mortality attributable to ambient particulate matter pollution (APMP) was lower in 2019 (2.97 per 100,000, CI 95% 4.43-1.76) than in 2015. Higher cancer mortality rates attributable to APMP, were observed mainly in men (7.18 per 100,950, CI % 10.67-4.31 in 2015) and especially in the 80-84 age group (59.49 per 100,000; CI 95 % 94.60-32.20) in 2015 and in men aged 75-79 (510.76 per 510.76 per 100,000) in 2019. Conclusions While Slovakia has experienced a long-term decline in cancer mortality, bucking the global trend, challenges persist due to the country’s relatively poorer outcomes associated with environmental pollution. Addressing environmental pollution remains a critical aspect of ongoing efforts to enhance population health through targeted strategies and policies. Key messages • The significant impact of environmental pollution on cancer mortality underscores the urgent need for targeted interventions and policies to improve public health outcomes in Slovakia. • Cancer mortality attributable to air pollution differs by gender.

Development of a multivariate model predictive of post-adrenalectomy renal function decline in patients with primary aldosteronism: a large-cohort single-center study.

To develop a multivariate liniear model for predicting long-term (> 3 months) post-adrenalectomy renal function decline in patients with primary aldosteronism (PA). The model aims to help identify patients who may experience a significant decline in renal function after surgery. We retrospectively analyzed the clinical data of 357 patients who were diagnosed with PA and underwent adrenalectomy between September 2012 and February 2023. LASSO and multivariate linear regression analyses were used to identify significant risk factors for model construction. The models were further internally validated using bootstrap method. Age (P < 0.001), plasma aldosterone concentration (PAC) measured in the upright-position (PACU, P = 0.066), PAC measured after saline infusion (PACafterNS, P = 0.010), preoperative blood adrenocorticotropic-hormone level (ACTH, P = 0.048), preoperative estimated glomerular filtration rate (eGFR, P < 0.001) and immediate postoperative eGFR (P < 0.001) were finally included in a multivariate model predictive of post-adrenalectomy renal function decline and the coefficients were adjusted by internal validation. The final model is: predicted postoperative long-term (> 3 months) eGFR decline =-70.010 + 0.416*age + 6.343*lg PACU+4.802*lg ACTH + 7.424*lg PACafterNS+0.637*preoperative eGFR-0.438*immediate postoperative eGFR. The predicted values are highly related to the observed values (adjusted R = 0.63). The linear model incorporating perioperative clinical variables can accurately predict long-term (> 3 months) post-adrenalectomy renal function decline.

Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts

Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear. To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajectory prestroke in stroke survivors with the trajectory of individuals without incident stroke over follow-up. The study used harmonized and pooled data from 14 population-based cohort studies included in the Cohort Studies of Memory in an International Consortium collaboration. These studies were conducted from 1993 to 2019 across 11 countries among community-dwelling older adults without a history of stroke or dementia. For this study, linear mixed-effects models were used to estimate trajectories of cognitive function poststroke relative to a stroke-free cognitive trajectory. The full model adjusted for demographic and vascular risk factors. Data were analyzed from July 2022 to March 2024. Incident stroke. The primary outcome was global cognition, defined as the standardized average of 4 cognitive domains (language, memory, processing speed, and executive function). Cognitive domain scores were formed by selecting the most commonly administered test within each domain and standardizing the scores. The study included 20 860 participants (12 261 [58.8%] female) with a mean (SD) age of 72.9 (8.0) years and follow-up of 7.51 (4.2) years. Incident stroke was associated with a substantial acute decline in global cognition (-0.25 SD; 95% CI, -0.33 to -0.17 SD), the Mini-Mental State Examination, and all cognitive domains (ranging from -0.17 SD to -0.22 SD), as well as accelerated decline in global cognition (-0.038 SD per year; 95% CI, -0.057 to -0.019 SD per year) and all domains except memory (ranging from -0.020 to -0.055 SD per year), relative to a stroke-free cognitive trajectory. There was no significant difference in prestroke slope in stroke survivors compared with the rate of decline in individuals without stroke in all cognitive measures. The mean rate of decline without a previous stroke was -0.049 SD per year (95% CI, -0.051 to -0.047 SD) in global cognition. In this cohort study using pooled data from 14 cohorts, incident stroke was associated with acute and accelerated long-term cognitive decline in older stroke survivors.

Regional-scale disturbances drive long-term decline of inshore coral reef fish assemblages in the Great Barrier Reef Marine Park.

Anthropogenic pressure is increasing the variety and frequency of environmental disturbance events, limiting recovery and leading to long-term declines in wild plant and animal populations. Coral reefs and associated fish assemblages are inherently dynamic due to their susceptibility to a host of disturbances, but regional-scale nuances in the drivers of long-term change frequently remain poorly resolved. Here, we examine the effects of multiple potential drivers of change in coral reef fish assemblages across 4 inshore regions of the Great Barrier Reef Marine Park (GBRMP), Australia, over 12-14 years (2007-2021). Each region had a unique disturbance history, in conjunction with long-term changes in physical and habitat variables. Phases of recovery were apparent in the years between disturbance events at all locations, but these were not long enough to prevent substantial declines in reef fish density (by 33%-72%) and species richness (by 41%-75%) throughout the study period. The main drivers of change in fish assemblages varied among regions; however, the most rapid changes followed cyclone and flood events. Limited recovery periods resulted in temporal shifts in fish species composition from typically coral-associated to algae-associated. Most trophic groups declined in density except farmers, grazers, omnivores and parrotfish. No-take marine reserves (NTMRs) had small and inconsistent effects on total fish assemblages, but delivered benefits for fishery-targeted piscivores. Our findings suggest that coral reef responses to local stressors and cumulative escalating climate change impacts are highly variable at regional scales, and that small NTMRs are unlikely to mitigate the impacts of increasingly frequent climatic disturbances. Nearshore coral reefs worldwide are high-value habitats that are either already degraded or vulnerable to degradation and the loss of important fish groups. Global efforts to reduce greenhouse gas emissions must be coupled with effective local management that can support the functioning and adaptive capacity of coral reefs.

Black grouse (Lyrurus tetrix) population status, reasons for decline and potential conservation measures from Western and Central Europe to Fennoscandia: a literature review

The long-term decline of the black grouse population throughout Europe is influenced by many factors that affect populations differently depending on the distribution range, from Central Europe to the Scandinavian countries. Therefore, we analyzed available literature sources to describe the main reasons for the population decline of this species and to suggest conservation measures. In total, 228 pieces of literature from 1955 to 2024 were analyzed for this study. Based on the literature analysis, it is clear that the drivers of population decline differ across the distributional range. In Central Europe, where the population is declining rapidly, habitat loss and forest fragmentation are crucial factors, as is the negative impact of tourism. In Scandinavia, where the population is gradually declining, decreasing breeding success and increasing chick mortality rates are generally considered the main negative factors. However, these factors also affect black grouse populations in Central Europe. It is crucial to acknowledge that a significant proportion of the contributing factors, such as predation and habitat loss, can be attributed to human activities. Therefore, it is necessary to emphasize that environmental protection should work hand in hand with wildlife managers to improve the situation.

Unusual Presentation of Confusion: Hyperammonaemic Hepatic Encephalopathy Due To Intrahepatic Portosystemic Venous Shunt In An Older Patient

Abstract Background Delirium is an acute, usually reversible neuropsychiatric syndrome and often presents as confusion, especially in the older population. Early detection and management of causes is vital to reduce mortality, morbidity, and long-term cognitive status decline. Intrahepatic portosystemic venous shunts are rare vascular malformations. These malformations can be congenital or acquired and may manifest as heart failure, hepatic encephalopathy, or pulmonary hypertension. Methods A 75-year-old man presented to the emergency department with a 5-week history of confusion, daytime somnolence, and fatigue. His physical examination was unremarkable. His symptoms were initially thought to be due to sub-optimally controlled Obstructive Sleep Apnoea. Nevertheless, his confusion progressed further during admission and required admission to the intensive care unit and intubation. Investigations initially showed deranged Liver function tests. Extensive investigations were done, including CT brain, MRI brain, septic screen, Arterial blood gas, and Lumbar puncture, which were all inconclusive. An Electroencephalogram was suggestive of Encephalopathy. His Ammonia level was high (123). Further investigations, Triphasic CT liver, revealed Intrahepatic portosystemic venous shunt and was diagnosed with hyperammonaemic hepatic encephalopathy due to Intrahepatic portosystemic venous shunt. Results Management included the commencement of lactulose, rifaximin, and L-ornithine L-aspartate (LOLA). An IR-guided embolisation of the porto-venous shunt was performed. At two-months review, the patient reported no further episodes of confusion. Conclusion Intrahepatic portosystemic venous shunts should be considered in the differential diagnosis of patients presenting with confusion or other unexplained neurological symptoms, especially in the presence of liver dysfunction. Early diagnosis and appropriate management are crucial for favourable outcomes.

75-Year dynamics of the Black Sea phytoplankton in association with eutrophication and climate change

Based on a database containing species records obtained from 1948 to 2022 and a hydrochemical database, long-term changes in the biomass and taxonomic structure of phytoplankton in the deep-sea basin of the Black Sea were analysed in the stratified period from April to October. Over 75 years, a significant increase in concentration of nitrate, a weak increase in phosphate and a strong decrease in dissolved silicate were observed in the nutricline. The biomass of diatoms and total phytoplankton increased several times during the peak of eutrophication in 1991–1993, then decreased by the 2000s and has again shown an increasing trend in the last 15 years. The number of species dominant in biomass has halved from the 1940s–60s to the 2010s. The primary beneficiaries were the large- and medium-celled diatoms Pseudosolenia сalcar-avis and Proboscia alata, as well as the coccolithophore Emiliania huxleyi, the main dominant species of the last decade. Most noticeable was the increase in the amplitude and duration of the regular annual May–July bloom of E. huxleyi. Over the past three decades, its biomass has increased by more than an order of magnitude, accounting for about 40 % of the total phytoplankton biomass. Development of the large- and medium-celled diatoms, as well as the decrease in biomass of silicoflagellates, can be, at least partly, associated with the long-term decline in dissolved silicate in the upper layers. The trend towards a decrease in dinoflagellate biomass is probably associated with increased mixing intensity in the water column. Over the study period, the total phytoplankton biomass was positively related to nitrate stock in the water column. Short-term period (from one to several years) interannual variability was influenced predominantly by hydrophysical processes, primarily the intensity of winter convection. After cold winters with intense involvement of deep nutrients in the upper layers, the biomass of diatoms, coccolithophores and total phytoplankton increased. Thus, fluctuations in winter weather or local climate reduced or enhanced the effect of eutrophication, sometimes leading to the time gap between the peak in nitrate stock and phytoplankton biomass. The case of the Black Sea illustrates the complex pattern of the response of a marine ecosystem to the simultaneous impacts of anthropogenic and climate changes, leading to significant alterations in the functioning of the biological carbon pump.

Numerical Groundwater Model to Assess the Fate of Nitrates in the Coastal Aquifer of Arborea (Sardinia, Italy)

The Arborea plain in Sardinia (Italy) is classified as a nitrate vulnerable zone (NVZ). In the present study, the individual work steps that are necessary to progress from the existing 3D hydrogeological model to a 3D numerical groundwater model using the interactive finite-element simulation system FEFLOW 7.4 are shown. The results of the transient flow model highlight the influence of the drainage network on the overall groundwater management: the total water volume drained by the ditches accounted for approximately 58% of the annual outflow volume. The numerical transport simulations conducted from 2012 to 2020 using hypothetical field-based nitrate input scenarios globally underestimated the high concentrations that were observed in the NVZ. However, as observed in the field, the computed nitrate concentrations in December 2020 still varied strongly in space, from several mg L−1 to several hundreds of mg L−1. The origin of these remaining local hotspots is not yet known. The modeling of rainfall fluctuations under the influence of climate change revealed a general long-term decline in the groundwater level of several tens of centimeters in the long term and, in conjunction with a zero-nitrate scenario, led to a significant decrease in nitrate pollution. Although hotspots were attenuated, the concentrations at several monitoring wells still exceeded the limit value of 50 mg L−1.

B - 80 The Long-Term Memory Sign in Adults Referred for Neuropsychological Evaluation

Abstract Objective We investigated the clinical utility of the newly described long-term memory (LTM) sign in adults referred for neuropsychological evaluation. Individuals with dementia often report short-term episodic memory decline or no memory decline, but rarely report long-term episodic memory decline. The LTM sign refers to patient self-report of long-term episodic memory decline, that is equivalent to/or greater than, subjective short-term episodic memory decline. Method The LTM sign was endorsed on a pre-visit intake form and established during clinical interview in 568 patients (M age = 63, SD = 14.3) referred for neuropsychological evaluation at a large medical center in the Northwest United States. Results In our sample of 568 patients, 79 (14%) reported the LTM sign. In 79 patients with the LTM sign, 45 were diagnosed with a primary psychiatric disorder (57%), 23 were diagnosed with mild neurocognitive disorder (29%), seven had no cognitive or psychiatric diagnosis (9%), and four had dementia (5%). The LTM sign was most common in those with a history of trauma in childhood or adolescence (52/79, 66%) and substance use disorders (50/79, 63%). Conclusions The LTM sign was rare in dementia, but common in those with a current psychiatric diagnosis. These findings support the literature on episodic memory decline in dementia populations and suggests that encoding of early memories and/or retrieval of old memories is negatively impacted by a current psychiatric disorder, traumatic events in childhood and adolescence, and lifetime history of substance use disorder. The LTM sign is a valuable addition to the clinical interview of neuropsychological patients.

Climatic controls of fire activity in the red pine forests of eastern North America

Large-scale modes of climate variability influence forest fire activity and may modulate the future patterns of natural disturbances. We studied the effects of long-term changes in climate upon the fire regime in the red pine forests of eastern North America using (a) a network of sites with dendrochronological reconstructions of fire histories over 1700–1900 A.D., (b) reconstructed chronologies of climate indices (1700–1900), and (c) 20th century observational records of climate indices, local surface climate and fire (1950s-2021). We hypothesized that (H1) there are states of atmospheric circulation that are consistently associated with increased fire activity, (H2) these states mark periods of increased climatological fire hazard, and (H3) the observed decline in fire activity in the 20th century is associated with a long-term decline in the frequency of fire-prone states.At the annual scale, years with significantly higher fire activity in the reconstructed and modern fire records were consistently associated with the positive phases of the Pacific North American pattern (PNA), either independently or in combination with the positive phase of the El Niño-Southern Oscillation index (ENSO). During years with both ENSO and PNA in their positive state, the region experienced positive mid-tropospheric heights and temperature anomalies resulting in drought conditions. The fire-prone climate states identified in the reconstructed records became less frequent in 1850 but re-emerged in the 20th century. While our study did not demonstrate a direct influence of climate on the observed decrease in fire activity in the 20th century, it does reveal a clear climate signal embedded within the fire history reconstruction of the region over the past centuries. This study underscores the importance of considering large-scale climatic patterns in understanding historical fire regimes and highlights their role for future fire dynamics in the region and shaping ecological effects of future fires.

Historic ocean acidification of Loch Sween revealed by correlative geochemical imaging and high-resolution boron isotope analysis of Boreolithothamniom cf. soriferum

Ocean Acidification (OA) arises from the increase in atmospheric carbon dioxide concentration following the industrial revolution. The ecological and socio-economic consequences of OA were first identified around 10–15 years ago but remain poorly understood. This is particularly true in coastal regions where local processes can have dramatic consequences on pH trends through time, obscuring and compounding the long-term effects from rising atmospheric CO2. Here we explore the possibility of generating long records of coastal ocean pH using the skeletons of widely distributed coralline algae (CA). The skeletons of these slow growing (<1 mm/year) taxa often contain micron-scale heterogeneities, making sampling for high-resolution climate reconstructions using bulk sampling techniques difficult. Here we use laser ablation coupled to inductively coupled plasma mass spectrometers to generate high-resolution 2D images of the element/calcium ratios and boron isotope composition (δ11B) of a sample of Boreolithothamniom cf. soriferum from Loch Sween in Scotland, UK where we have been monitoring temperature since 2004 and pH during 2014. By carefully correlating the geochemical images with a scanning electron microscopy image we can segment them to remove the marginal portions of the skeleton, isolating the central growth axis to generate an age model and growth rate. The δ11B-pH is significantly elevated above the seawater pH in Loch Sween (8.4 to 8.9 vs. 7.9 to 8.1) consistent with other CA that show internal pH elevation. On a seasonal scale, internal pH is negatively correlated with temperature and also exhibits a long-term decline. By removing this temperature effect, internal pH can be correlated to seawater pH during the 2014 monitoring period allowing us to reconstruct a seawater acidification trend from 2004 to 2018 of -0.018 pH units per year, 10x higher than open ocean trends but consistent with contemporaneous monitoring efforts of UK coastal waters. Reconstructed aqueous CO2 suggests that prior to ∼2008 Loch Sween was a sink of CO2 but after this date, particularly during the early summer, it was a substantial CO2 source. Comparison of reconstructed aqueous CO2 with a record of calcification rate of our sample of Boreolithothamniom cf. soriferum suggests this acidification and associated rise in local seawater pCO2 may have freed this sample from carbon limitation leading to a recent increase in calcification.

Risk Factors for Postoperative Delirium Severity After Deep Brain Stimulation Surgery in Parkinson's Disease.

Postoperative delirium (POD) is a serious complication following deep brain stimulation (DBS) but only received little attention. Its main risk factors are higher age and preoperative cognitive deficits. These are also main risk factors for long-term cognitive decline after DBS in Parkinson's disease (PD). To identify risk factors for POD severity after DBS surgery in PD. 57 patients underwent DBS (21 female; age 60.2±8.2; disease duration 10.5±5.9 years). Preoperatively, general, PD- and surgery-specific predictors were recorded. Montreal Cognitive Assessment and the neuropsychological test battery CANTAB ConnectTM were used to test domain-specific cognition. Volumes of the cholinergic basal forebrain were calculated with voxel-based morphometry. POD severity was recorded with the delirium scales Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Nursing Delirium Scale (NU-DESC). Spearman correlations were calculated for univariate analysis of predictors and POD severity and linear regression with elastic net regularization and leave-one-out cross-validation was performed to fit a multivariable model. 21 patients (36.8%) showed mainly mild courses of POD following DBS. Correlation between predicted and true POD severity was significant (spearman rho = 0.365, p = 0.001). Influential predictors were age (p < 0.001), deficits in attention and motor speed (p = 0.002), visual learning (p = 0.036) as well as working memory (p < 0.001), Nucleus basalis of Meynert volumes (p = 0.003) and burst suppression (p = 0.005). General but also PD- and surgery-specific factors were predictive of POD severity. These findings underline the multifaceted etiology of POD after DBS in PD. Valid predictive models must therefore consider general, PD- and surgery-specific factors.

Abstract P344: APOe Genotype Modifies the Association Between Long-Term Blood Pressure Variability and Cognitive Decline/Dementia in Older Adults

We previously reported an increased risk of cognitive decline and dementia with high visit-to-visit long-term blood pressure variability (BPV) in the ASPREE randomized trial of low-dose aspirin, conducted in 19,114 community-dwelling older adults in Australia and the USA who were initially free of significant cognitive impairment and diagnosed dementia at enrollment. Upon completion of the randomized trial phase, ASPREE participants were invited into the ASPREE-eXTension (ASPREE-XT) observational study. In this analysis, we re-examined the risks of cognitive decline and dementia using extended follow-up from ASPREE-XT, and including recently available APOe genotype as an additional covariate. Long-term BPV was estimated in each participant using standard deviation (SD) of the means of three within-visit systolic BPs obtained with a validated automated oscillometric BP monitor from the baseline and first two annual ASPREE visits. During ASPREE and continued into ASPREE-XT, participants underwent annual/biennial standardized cognitive testing (4-test battery). Incident cognitive decline was defined as &gt;1.5 SD decline from baseline score on any cognitive test; incident dementia was a pre-specified secondary endpoint of ASPREE/ASPREE-XT and adjudicated by expert panel using DSM-IV criteria and clinical records. Participants reaching cognitive decline or dementia endpoints during the BPV estimation period were excluded from the analysis. Multivariable Cox proportional hazards regression showed the highest SD tertile of BPV, compared to the lowest SD tertile, remained associated with highest risk of cognitive decline (HR=1.16, 95% CI=1.04-1.30) and dementia (HR=1.27 (95% CI=1.02-1.59) in men, and cognitive decline (HR=1.12, 95% CI=1.01-1.24) in women (see accompanying Table), over a median follow-up of 5.8 years (for cognitive decline) and 6.5 years (for dementia). When APOe genotype was included as an additional covariate in an available subset of the cohort (81%), the presence of APOe4 allele partially attenuated the associations in both sexes, although cognitive decline remained significant in men. Our findings suggest the relationship between high long-term BPV and cognitive decline and dementia is stronger in men than women, but also modified by underlying APOe genotype.