Measure Of Reserve Research Articles

Cognitive interventions for memory and psychological well-being in aging and dementias.

The human lifespan has expanded drastically in the last few centuries, due to improvements in sanitation, medicine, and nutrition, but with this increase in longevity comes higher rates of cognitive pathology such as mild cognitive impairment (MCI) and dementia; the latter is estimated to reach more than 75 million people by 2030. Pathology risk is related to measures of executive function, lifestyle factors (e.g., education, occupation, and leisure activities), and cognitive reserve. One way of building cognitive reserve may be to structure the environment to encourage lifelong engagement and learning, and since a pharmacological "cure" for dementia remains elusive, non-pharmacological approaches such as physical activity, social engagement, and cognitive stimulation are becoming increasingly essential to preserving and protecting brain health. Here, we describe our recent research into Reminiscence Therapy (RT) to promote cognitive and psychological function in old age and early dementia. We review the Recall Initiative, which involved brain imaging and behavioral indices of memory pre- and post-RT. We also report results from a pilot study-AIM WARM-in which RT was combined with physical activity, specifically walking, for early-stage dementia. Finally, we outline our future directions for tailored reminiscence interventions in combination with other activities (e.g., yoga and meditation) for different groups, namely early Alzheimer's disease, Semantic Dementia, and older individuals in the prison system.

Frailty as a predictor of poor outcomes among patients awaiting liver transplant: a systematic review and meta-analysis.

This review sought to evaluate the significance of a functional assessment for liver transplant candidates, i.e., frailty, in the pre-transplant setting and its association with mortality and morbidities. Liver transplantation (LT) remains the treatment of choice for patients with end-stage liver disease. Due to the shortage of organs for LT, a careful selection of suitable recipients is essential. Frailty, a measure of physiologic reserve and increased vulnerability to stressors, was initially used in geriatrics and then introduced to the field of transplantation for better patient selection. PubMed, Scopus, and Web of Science databases were reviewed up until January 2023. The search terms included: "frail*", "liver", and "transplant*". A Meta-analysis was conducted for the hazard ratios (HRs) obtained from the COX regression models. Fifty-five studies were included in this review; ten were included in the meta-analysis. The prevalence of frailty varied from 2.82% to 70.09% in the studies. Meta-analysis showed that overall frailty had a significant association with mortality (pooled adjusted HR [95%CI]: 2.66 [1.96-3.63]). Subgroup analyses revealed that both the Liver Frailty Index and Fried Frailty Index were significantly associated with mortality. Furthermore, these studies have demonstrated that this population's frailty is associated with ascites, hepatic encephalopathy, and esophageal varices. According to emerging evidence, frailty is associated with increased morbidity and mortality of the patients on the LT waiting list. Further randomized trials are required to determine the efficacy and safety of variable interventions in the frail population.

Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study

BackgroundThe purpose of this manuscript is to introduce reserve and resilience as novel concepts in chronic kidney disease (CKD) research and present baseline data from a unique prospective cohort study designed to characterize recovery from functional decline after a health event.MethodsThe Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study recruited a national, prospective cohort of Veterans ≥70 years old with an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2, prior nephrology care, and at high risk for hospitalization. Electronic health record data were paired with telephone surveys. Self-reported measures of reserve included physical, psychological, and cognitive capacity and environmental resources. We calculated counts (frequencies) and medians (25th, 75th percentiles) for baseline measures of reserve. The study’s longitudinal follow-up of physical function every 8 weeks or following an acute care encounter, which will be used to define resilience, is ongoing.ResultsParticipants had a median (25th, 75th percentile) age of 76.3 (72.8, 81.4) years and eGFR of 23.4 (18.2, 28.8) ml/min/1.73 m2; 23.3% were Black, and 97.4% were male, 91.6% had hypertension, 67.4% had diabetes mellitus, 46.0% had coronary heart disease, and 39.8% had heart failure. Baseline measures of physical, psychological, and cognitive domains showed low reserve on average, but with wide ranges.ConclusionsDespite similar levels of kidney function, older adults participating in PREPARED had a wide range of measures of reserve in other health domains. Non-renal measures of reserve may be important indicators of capacity of CKD patients to recover after acute care encounters.

Connectome-based predictive modelling of cognitive reserve using task-based functional connectivity.

Cognitive reserve supports cognitive function in the presence of pathology or atrophy. Functional neuroimaging may enable direct and accurate measurement of cognitive reserve which could have considerable clinical potential. The present study aimed to develop and validate a measure of cognitive reserve using task-based fMRI data that could then be applied to independent resting-state data. Connectome-based predictive modelling with leave-one-out cross-validation was applied to predict a residual measure of cognitive reserve using task-based functional connectivity from the Cognitive Reserve/Reference Ability Neural Network studies (n = 220, mean age = 51.91 years, SD = 17.04 years). This model generated summary measures of connectivity strength that accurately predicted a residual measure of cognitive reserve in unseen participants. The theoretical validity of these measures was established via a positive correlation with a socio-behavioural proxy of cognitive reserve (verbal intelligence) and a positive correlation with global cognition, independent of brain structure. This fitted model was then applied to external test data: resting-state functional connectivity data from The Irish Longitudinal Study on Ageing (TILDA, n = 294, mean age = 68.3 years, SD = 7.18 years). The network-strength predicted measures were not positively associated with a residual measure of cognitive reserve nor with measures of verbal intelligence and global cognition. The present study demonstrated that task-based functional connectivity data can be used to generate theoretically valid measures of cognitive reserve. Further work is needed to establish if, and how, measures of cognitive reserve derived from task-based functional connectivity can be applied to independent resting-state data.

Neural similarity across task load relates to cognitive reserve and brain maintenance measures on the Letter Sternberg task: a longitudinal study.

The aging process is characterized by change across several measures that index cognitive status and brain integrity. In the present study, 54 cognitively-healthy younger and older adults, were analyzed, longitudinally, on a verbal working memory task to investigate the effect of brain maintenance (i.e., cortical thickness) and cognitive reserve (i.e., NART IQ as proxy) factors on a derived measure of neural efficiency. Participants were scanned using fMRI while presented with the Letter Sternberg task, a verbal working memory task consisting of encoding, maintenance and retrieval phases, where cognitive load is manipulated by varying the number of presented items (i.e., between one and six letters). Via correlation analysis, we looked at region-level and whole-brain relationships between load levels within each phase and then computed a global task measure, what we term phase specificity, to analyze how similar neural responses were across load levels within each phase compared to between each phase. We found that longitudinal change in phase specificity was positively related to longitudinal change in cortical thickness, at both the whole-brain and regional level. Additionally, baseline NART IQ was positively related to longitudinal change in phase specificity over time. Furthermore, we found a longitudinal effect of sex on change in phase specificity, such that females displayed higher phase specificity over time. Cross-sectional findings aligned with longitudinal findings, with the notable exception of behavioral performance being positively linked to phase specificity cross-sectionally at baseline. Taken together, our findings suggest that phase specificity positively relates to brain maintenance and reserve factors and should be better investigated as a measure of neural efficiency.

Proxy measures of cognitive reserve and trajectories of gait and cognitive decline in older adults

AbstractBackgroundLifestyle interventions are an emerging area of interest in dementia prevention. Education, physical activity, and social interactions are potentially modifiable lifestyle factors that are considered proxies of cognitive reserve. People with greater cognitive reserve could be protected against decline in gait and cognition, two interrelated problems associated with dementia, by coping better with age‐ or pathology‐related brain changes. We examined whether decline in gait and cognitive functions are different in those with higher versus lower levels of education, physical activity, and social interactions.MethodGait and cognitive performance in 1,095 LonGenity study participants (mean age = 75.4±6.7 years) that were free of dementia at baseline were examined up to 12 years. Gait speed was measured during usual pace (single‐task walking, STW‐speed) and walking‐while‐talking (WWT‐speed). Cognitive performance was measured with standard neuropsychological tests and a standardized composite global cognitive measure was derived. Years of education, number of blocks walked per day, living with someone and engaging in paid or volunteer work (markers of social interactions) were obtained from self‐report. Linear mixed‐effects models adjusted for sex, parental longevity, cognitive impairment, and global health were used to examine age‐associated changes in gait and cognition in those with and without greater cognitive reserve.ResultSTW‐speed and WWT‐speed did not vary as a function of education, physical activity, or social interactions. Greater number of blocks walked per day was associated with slower decline in global cognition, Trail Making Test (TMT)‐A, TMT‐interference, digit symbol substitution, logical memory, figure recall, free recall, category and phonemic fluency tests. Higher education was associated with slower decline in global cognition, TMT‐interference, TMT‐A and figure copy task. Living with someone was associated with slower decline in global cognition, digit symbol substitution and logical memory. Paid or volunteer work was associated slower decline in global cognition.ConclusionHaving higher education, more physical activity and social interactions appear to protect against cognitive, but not gait decline, potentially by building up cognitive reserve. The multifaceted etiology and relatively earlier decline of gait may render it less influenced by potentially modifiable risk factors in late life than cognition.

Abstract 15103: Stratifying Coronary Artery Disease (CAD) GWAS Loci Using Cardiac Perfusion Positron Emission Tomography to Identify Loci for Coronary Microvascular Disease

Introduction: Coronary Microvascular Disease (CMVD), defined as disease of the coronary pre-arterioles, arterioles, and capillaries, accounts for 30-50% of the burden of Ischemic Heart Disease (IHD). CAD GWAS studies have identified more than 235 loci, however, the populations enrolled represent heterogeneous IHD with inclusion criteria that include ischemia without confirmation of obstructive CAD (Ischemia with non-obstructed Coronary Arteries). Hypothesis: We hypothesize that CAD GWAS studies are really IHD GWAS studies and a subset of patients enrolled have CMVD as the etiology of their ischemia. Thus several CAD GWAS loci may be CMVD loci. Here we use quantitative measures of myocardial blood flow (MBF) and MBF reserve (MBFR) from cardiac Perfusion PET studies to stratify known CAD loci for CMVD. Methods: We performed a genomic association study for 235 known CAD loci in 383 samples of European (EUR) and 539 samples of African ancestry (AFR) in the Penn Medicine Biobank using clinical Rubidium-82 PET using REGENIE software. Models were adjusted for age, sex, age 2 , age x sex, 5 principal components, and batch corresponding to phenotype extraction. We examined regions within 250kb of known CAD loci for association with PET-derived MBF and MBFR. Bonferroni corrected P-value &lt; 2.13e-4 was considered significant. Results: We found 40 loci in patients of AFR ancestry and 11 CAD loci in patients of EUR ancestry that were significantly associated with MBFR, including several genes which are known to play a role in microvasculature function and angiogenesis (VEGFa, FLT1, and FGF1). Stress MBF values have been shown to reflect epicardial CAD. We found 28 loci in patients of AFR ancestry and 12 loci in patients of EUR ancestry which were significantly associated with stress MBF and are mostly distinct from loci associated with MBFR. One notable exception is PRDM16 which was highly significant in both phenotypes. Conclusions: Our study sub-stratified variants previously associated with CAD to identify those that may be involved in CMVD. Several genes known to be involved in microvasculature function (VEGFa, FLT1, and FGF1) were putative CMVD genes. PRDM16 was associated with stress MBF and MBFR. This work prioritizes CAD loci for further study of mechanisms of CMVD.

Abstract 14666: Coronary Arterial Calcification Influences Fractional Flow Reserve: Comparison of Guide Wire Type FFR With Vasodilator and FFRangio Without Vasodilator

Introduction: Fractional flow reserve (FFR) measures percutaneous coronary intervention (PCI) performance. FFR was determined by guide wire (GW)-type FFR. It is now evaluated by computed tomography (CT; FFRCT) or invasive coronary angiography (FFRangio; CathWorks, USA), whereby coronary arteries are traced on a conventional angiogram from three different angles to form three-dimensional images; the calculated FFR is FFRangio. In contrast to GW-type FFR, FFRangio does not need a vasodilator drug (e.g. nicorandil) load or GW. Hypothesis: Coronary calcification may influence the effect of vasodilator drugs, causing a difference between FFRangio and GW-type FFR depending on coronary calcium score (CCS). Methods: FFRangio and GW-type FFR (SJN, Zeon, ACIST) were simultaneously evaluated at catheter examinations in 11 coronary arteries from 9 patients before PCI (six males, mean age 72±11 years). Nicorandil (2 mg) was directly injected when measuring GW-type FFR. Cardiac CT was performed to measure CCS. Results: The correlation coefficients between FFR magnitude (=mean of FFRangio and GW-type FFR) and CCS in all vessels, and a vessel with FFR measurement, were -0.845 and -0.843, respectively. The correlation coefficients between difference in FFRangio minus GW-type FFR and CCS in all vessels, and a vessel with FFR measurement, were 0.627 and 0.752, respectively. The greater the CCS of both all vessels and a vessel in FFR measurements, the smaller the FFR. The greater the CCS of both all vessels and a vessel with FFR measurement, the greater the difference in FFRangio minus GW-type FFR (Figures). This may indicate the greater the CCS, the smaller the vasodilation effect of a direct nicorandil injection. Conclusions: Of GW-type FFR, FFRangio, and FFR CT, only GW-type FFR requires a vasodilator injection. Coronary arteries, known to cause blooming artifacts and impair the accuracy of FFRCT, also influence vasodilator effects, especially with borderline FFR (0.75-0.80).

Abstract 11503: Obesity-Related Biomarkers Associations With HFpEF and Exercise Intolerance

Background: Obesity and adiposity are associated with risk of heart failure with preserved ejection fraction (HFpEF), yet the role of adipokines and other obesity related pathways as contributors to HFpEF remains unclear. Objectives: We sought to examine the association of obesity and obesity related biomarkers including adipokines, inflammatory markers, and insulin resistance with HFpEF and specific cardiac and extracardiac organ reserve measures among patients who underwent CPET. Methods: We studied 509 consecutive patients with LVEF ≥ 50% and NYHA class II - III symptoms, who underwent clinically indicated CPET with invasive hemodynamic monitoring. Fasting blood samples at the time of CPET were used to assay obesity-related biomarkers, including leptin, adiponectin, resistin, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), glucose and insulin to estimate insulin resistance (HOMA-IR). We examined the association of biomarkers with physiologic HFpEF and exercise traits using multivariable regression models. Results: Among 509 patients (mean age 55 years, 61% women, 38% obese), 223 met hemodynamic criteria for HFpEF. Obesity was associated with more than 2-fold higher odds of HFpEF (OR 2.08, 95% CI 1.38-3.14). We found that higher levels of leptin, hsCRP and HOMA-IR were associated with greater odds of HFpEF (P ≤ 0.01, Figure 1). By contrast, resistin and adiponectin were not associated with HFpEF (P&gt;0.05). In secondary analyses, we observed associations of obesity related biomarkers with measures of impaired exercise capacity, such as lower peak VO 2 (P&lt;0.05), higher blood pressure response (leptin, HOMA-IR), and impaired heart rate response (hsCRP, HOMA-IR, IL-6, resistin). Conclusions: Obesity related biomarkers were associated with HFpEF and impaired exercise capacity. These findings highlight potential pathways underlying the association of obesity and cardiometabolic disease with development of HFpEF.

Educational attainment, structural brain reserve and Alzheimer's disease: a Mendelian randomization analysis.

Higher educational attainment is observationally associated with lower risk of Alzheimer's disease. However, the biological mechanisms underpinning this association remain unclear. The protective effect of education on Alzheimer's disease may be mediated via increased brain reserve. We used two-sample Mendelian randomization to explore putative causal relationships between educational attainment, structural brain reserve as proxied by MRI phenotypes and Alzheimer's disease. Summary statistics were obtained from genome-wide association studies of educational attainment (n = 1 131 881), late-onset Alzheimer's disease (35 274 cases, 59 163 controls) and 15 measures of grey or white matter macro- or micro-structure derived from structural or diffusion MRI (nmax = 33 211). We conducted univariable Mendelian randomization analyses to investigate bidirectional associations between (i) educational attainment and Alzheimer's disease; (ii) educational attainment and imaging-derived phenotypes; and (iii) imaging-derived phenotypes and Alzheimer's disease. Multivariable Mendelian randomization was used to assess whether brain structure phenotypes mediated the effect of education on Alzheimer's disease risk. Genetically proxied educational attainment was inversely associated with Alzheimer's disease (odds ratio per standard deviation increase in genetically predicted years of schooling = 0.70, 95% confidence interval 0.60, 0.80). There were positive associations between genetically predicted educational attainment and four cortical metrics (standard deviation units change in imaging phenotype per one standard deviation increase in genetically predicted years of schooling): surface area 0.30 (95% confidence interval 0.20, 0.40); volume 0.29 (95% confidence interval 0.20, 0.37); intrinsic curvature 0.18 (95% confidence interval 0.11, 0.25); local gyrification index 0.21 (95% confidence interval 0.11, 0.31)]; and inverse associations with cortical intracellular volume fraction [-0.09 (95% confidence interval -0.15, -0.03)] and white matter hyperintensities volume [-0.14 (95% confidence interval -0.23, -0.05)]. Genetically proxied levels of surface area, cortical volume and intrinsic curvature were positively associated with educational attainment [standard deviation units change in years of schooling per one standard deviation increase in respective genetically predicted imaging phenotype: 0.13 (95% confidence interval 0.10, 0.16); 0.15 (95% confidence interval 0.11, 0.19) and 0.12 (95% confidence interval 0.04, 0.19)]. We found no evidence of associations between genetically predicted imaging-derived phenotypes and Alzheimer's disease. The inverse association of genetically predicted educational attainment with Alzheimer's disease did not attenuate after adjusting for imaging-derived phenotypes in multivariable analyses. Our results provide support for a protective causal effect of educational attainment on Alzheimer's disease risk, as well as potential bidirectional causal relationships between education and brain macro- and micro-structure. However, we did not find evidence that these structural markers affect risk of Alzheimer's disease. The protective effect of education on Alzheimer's disease may be mediated via other measures of brain reserve not included in the present study, or by alternative mechanisms.

Sex-Specific Protective Effects of Cognitive Reserve on Age-Related Cognitive Decline: A 5-Year Prospective Cohort Study.

Females have a higher age-adjusted incidence of Alzheimer disease than males but the reasons for this remain unclear. One proposed contributing factor is that, historically, females had less access to education and, therefore, may accumulate less cognitive reserve. However, educational attainment is confounded by IQ, which in itself is a component of cognitive reserve and does not differ between sexes. Steeper age-related cognitive declines are associated with increased risk of dementia. We, therefore, evaluated the moderating effects of 2 proxies for cognitive reserve, education and IQ, on the steepness of age-related declining cognitive trajectories in unimpaired older males and females. The Tasmanian Healthy Brain Project, a long-term cohort study, recruited healthy Australians aged 50-80 years without cognitive impairment. Baseline cognitive reserve was measured using educational history and IQ, measured by the Wechsler Test of Adult Reading, Full Scale Predicted IQ (WTAR-FSIQ). Cognitive trajectories for language, executive function, and episodic and working memory over 5 years were extracted from neuropsychological assessments. The adjusted effects of education, estimated IQ, and APOE allelic variant on cognitive trajectories were compared between males and females. Five hundred sixty-two individuals (mean [SD] age 60 [6.7] years; 68% male; 33% APOE ε4+) were followed up over 5 years with 1,924 assessments and 24,946 cognitive test scores (annualized attrition rate 6.6% per year). Estimated IQ correlated with years of education (p < 0.001). Estimated IQ interacted with sex to moderate age-related cognitive trajectories (p = 0.03; adjusted for education); lower IQ males experienced steeper declining trajectories than higher IQ males, but lower IQ females had similar steepness of declining trajectories to higher IQ females. Education was not associated with rate of cognitive decline (p = 0.67; adjusted for WTAR-FSIQ). There were no significant differences in age-related cognitive trajectories between APOE genotypes in either sex. IQ, a measure of cognitive reserve, predicted the steepness of declining cognitive trajectories in males only. Education did not explain as much variation in cognitive trajectories as IQ. Our findings do not support the hypothesis that historical sex disparities in access to education contribute to the higher female incidence of Alzheimer disease.

Determination of [N-13]-ammonia extraction fraction in patients with coronary artery disease by calibration to invasive coronary and fractional flow reserve

BackgroundThis study presents a new extraction fraction (EF) model based on physiological measures of invasive coronary flow reserve (CFR) and fractional flow reserve (FFR) in patients with suspected coronary artery disease (CAD) and normal index microcirculatory resistance (IMR). To ascertain the clinical relevance of the new EFs, flow measurements using the newly patient-determined EFs were compared to flow measurements using traditional animal-determined EFs. Methods39 patients were retrospectively selected that included a total of 91 vascular territories with invasive coronary angiography physiological measures. [N-13]-ammonia dynamic rest/adenosine-stress PET imaging was conducted in all patients and absolute myocardial flow was estimated using four published compartmental models. The extraction fraction during hyperemic flow was iteratively estimated by maximizing the agreement between invasive CFR and FFR with the non-invasive analogs myocardial flow reserve (MFR) and relative flow reserve (RFR) at similar physiological states, respectively. ResultsUsing the new patient-determined EFs, agreement between CFR vs MFR for Model 1 and 2 was moderate and poor for Model 3 and 4. All models showed moderate agreement for FFR vs RFR. When using published models of animal-determined EFs, agreement between CFR vs MFR remained moderate for Model 1 and 2, and poor for Model 3 and 4. Similarly, all models showed moderate agreement for FFR vs RFR using animal-determined EF values. None of the observed differences were statistically significant. ConclusionsFlow measurements using extraction fraction correction for [N-13]-ammonia based on calibration to invasive intracoronary angiography physiological measures in patients with CAD were not discordant from those reported in the literature. Either patient-determined or traditional animal-determined EF correction, when used with the appropriate flow model, yields moderate agreement with invasive measurements of coronary flow reserve and fractional flow reserve.

SHORTER TELOMERE LENGTH IS ASSOCIATED WITH LOWER ANTRAL FOLLICLE COUNT AND POORER IN VITRO FERTILIZATION OUTCOMES IN WOMEN OF ADVANCED REPRODUCTIVE AGE

To determine if telomere length in peripheral blood mononuclear cells (PBMCs) is associated with ovarian reserve measures and in vitro fertilization (IVF) outcomes in women of advanced reproductive age.

Longitudinal cognitive change and duration of Alzheimer’s disease stages in relation to cognitive reserve

The relationship of cognitive reserve and measures of reserve with longitudinal cognitive change and the duration of preclinical, prodromal, and mild Alzheimer disease (AD) dementia remains to be fully characterized. In our study, 660 β-amyloid-positive participants staged with preclinical AD, prodromal AD, and dementia due to AD from the Alzheimer’s Disease Neuroimaging Initiative were selected. Cognitive reserve and brain reserve were defined by conventional proxies or the residual method at baseline. We evaluated the utility of these reserves in predicting longitudinal cognitive change by mixed effects models and used a multi-state model to estimate stage duration stratified by reserve groups. Corrected for age, sex, and APOE-ε4 status, reserve was associated with cognitive decline, and the effects changed depending on the specific measures of reserve and the stage of AD. Reserves defined by the residual method were stronger predictors of cognitive change than those defined by conventional proxies. The estimated time from preclinical to mild AD dementia varied from 15–24 years based on the different reserve groups, and we observed a linear trend for the longest duration in individuals with high cognitive reserve/high brain reserve, followed by those with high cognitive reserve/low brain reserve, low cognitive reserve/high brain reserve, and low cognitive reserve/low brain reserve. This study showed a reduced risk of cognitive decline for individuals with higher level of reserve regardless of methods for measuring reserve. Interindividual differences in reserve may be important for clinical practice and trial design.

Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age.

Frailty is a measure of physiological reserve that has been demonstrated to be a discriminative predictor of worse outcomes across multiple surgical subspecialties. Anterior cervical discectomy and fusion (ACDF) is one of the most common neurosurgical procedures in the United States and has a high incidence of postoperative dysphagia. To determine the association between frailty and dysphagia after ACDF and compare the predictive value of frailty and age. 155,300 patients with cervical stenosis (CS) who received ACDF were selected from the 2016-2019 National Inpatient Sample (NIS) utilizing International Classification of Disease, tenth edition (ICD-10) codes. The 11-point modified frailty index (mFI-11) was used to stratify patients based on frailty: mFI-11 = 0 was robust, mFI-11 = 1 was prefrail, mFI-11 = 2 was frail, and mFI-11 = 3 + was characterized as severely frail. Demographics, complications, and outcomes were compared between frailty groups. A total of 155,300 patients undergoing ACDF for CS were identified, 33,475 (21.6%) of whom were frail. Dysphagia occurred in 11,065 (7.1%) of all patients, and its incidence was significantly higher for frail patients (OR 1.569, p < 0.001). Frailty was a risk factor for postoperative complications (OR 1.681, p < 0.001). Increasing frailty and undergoing multilevel ACDF were significant independent predictors of negative postoperative outcomes, including dysphagia, surgically placed feeding tube (SPFT), prolonged LOS, non-home discharge, inpatient death, and increased total charges (p < 0.001 for all). Increasing mFI-11 score has better prognostic value than patient age in predicting postoperative dysphagia and SPFT after ACDF.

Moderating Role of Cognitive Reserve Markers Between Childhood Cognition and Cognitive Aging: Evidence From the 1946 British Birth Cohort.

As the population ages, differences in cognitive abilities become more evident. We investigated key genetic and life course influences on cognitive state at age 69 years, building on previous work using the longitudinal Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Multivariable regressions investigated the association between 4 factors: (1) childhood cognition at age 8 years; (2) a Cognitive Reserve Index (CRI) composed of 3 markers: (i) educational attainment by age 26 years, (ii) engagement in leisure activities at age 43 years, and (iii) occupation up to age 53 years; (3) reading ability assessed by the National Adult Reading Test (NART) at age 53 years; and (4) APOE genotype in relation to cognitive state measured at age 69 years with Addenbrooke's Cognitive Examination, third edition (ACE-III). We then investigated the modifying role of the CRI, NART, and APOE in the association between childhood cognition and the ACE-III. The analytical sample comprised 1,184 participants. Higher scores in childhood cognition, CRI, and NART were associated with higher scores in the ACE-III. We found that the CRI and NART modified the association between childhood cognition and the ACE-III: for 30 additional points in the CRI or 20 additional points in the NART, the simple slope of childhood cognition decreased by approximately 0.10 points (CRI = 70: marginal effects (MEs) 0.22, 95% CI 0.12-0.32, p < 0.001 vs CRI = 100: MEs 0.12, 95% CI 0.06-0.17, p < 0.001; NART = 15: MEs 0.22, 95% CI 0.09-0.35, p = 0.001, vs NART = 35: MEs 0.11, 95% CI 0.05-0.17, p < 0.001). The association between childhood cognition and the ACE-III was nonsignificant at high levels of the CRI or NART. Furthermore, the e4 allele of the APOE gene was associated with lower scores in the ACE-III (β = -0.71, 95% CI -1.36 to -0.06, p = 0.03) but did not modify the association between childhood cognition and cognitive state in later life. The CRI and NART are independent measures of cognitive reserve because both modify the association between childhood cognition and cognitive state.

A study to correlate serum anti mullerian hormone, basal follicle stimulating hormone and antral follicle count in primary infertility as a measure of ovarian reserve

A study to correlate serum anti mullerian hormone, basal follicle stimulating hormone and antral follicle count in primary infertility as a measure of ovarian reserve

EDSS 0 is not normal: Multiple sclerosis disease burden below the clinical threshold

Little to no above-threshold deficits may be evident in early multiple sclerosis (MS). The Expanded Disability Status Scale (EDSS) is a standard measure of neurologic function, with an EDSS score of 0 defined as “neurologically normal.” The topographical model of MS proposes that sub-threshold disease is compensated for by functional reserve. In this short report, we found that physically high-challenge measures of balance and upper extremity coordination reveal sub-threshold deficits in patients with EDSS score of 0 compared with healthy controls. Challenge task performance was correlated with imaging markers of both lesional burden of disease and a volumetric measure of brain reserve.

Comparison of Diagnostic Accuracy Measures of Vessel Fractional Flow Reserve and Diastolic Pressure Ratio for Fractional Flow Reserve: A Single-Center Pooled Analysis of FAST EXTEND and FAST II Studies

Comparison of Diagnostic Accuracy Measures of Vessel Fractional Flow Reserve and Diastolic Pressure Ratio for Fractional Flow Reserve: A Single-Center Pooled Analysis of FAST EXTEND and FAST II Studies

Cognitive Reserve and Related Constructs: A Unified Framework Across Cognitive and Brain Dimensions of Aging.

Cognitive reserve and related constructs are valuable for aging-related research, but consistency and clarification of terms is needed as there is still no universally agreed upon nomenclature. We propose a new set of definitions for the concepts of reserve, maintenance, and resilience, and we invoke parallel concepts for each that are applicable to cognition and to brain. Our definitions of reserve and resilience correspond reasonably well to dictionary definitions of these terms. We demonstrate logical/methodological problems that arise from incongruence between commonly used conceptual and operational definitions. In our view, cognitive reserve should be defined conceptually as one’s total cognitive resources at a given point in time. IQ and education are examples of common operational definitions (often referred to as proxies) of cognitive reserve. Many researchers define cognitive reserve conceptually as a property that allows for performing better than expected cognitively in the face of aging or pathology. Performing better than expected is demonstrated statistically by interactions in which the moderator is typically IQ or education. The result is an irreconcilable situation in which cognitive reserve is both the moderator and the moderation effect itself. Our proposed nomenclature resolves this logical inconsistency by defining performing better than expected as cognitive resilience. Thus, in our usage, we would test the hypothesis that high cognitive reserve confers greater cognitive resilience. Operational definitions (so-called proxies) should not conflate factors that may influence reserve—such as occupational complexity or engagement in cognitive activities—with cognitive reserve itself. Because resources may be depleted with aging or pathology, one’s level of cognitive reserve may change over time and will be dependent on when assessment takes place. Therefore, in addition to cognitive reserve and cognitive resilience, we introduce maintenance of cognitive reserve as a parallel to brain maintenance. If, however, education is the measure of reserve in older adults, it precludes assessing change or maintenance of reserve. Finally, we discuss consideration of resistance as a subcategory of resilience, reverse causation, use of residual scores to assess performing better than expected given some adverse factor, and what constitutes high vs. low cognitive reserve across different studies.