Measure Of Reserve Research Articles

Frailty and associated outcomes in patients with transthyretin cardiac amyloidosis

Abstract Introduction Despite older age at diagnosis, the prevalence and clinical impact of frailty, an age-related geriatric syndrome, in patients with transthyretin cardiac amyloidosis (ATTR-CA) is poorly described. Purpose To determine: (1) the prevalence of frailty in ATTR amyloidosis patients; (2) the clinical frailty phenotype in ATTR amyloidosis (3) the independent and incremental prognostic value of frailty. Methods All consecutive patients diagnosed with ATTR-CA who underwent frailty assessment at two high-volume tertiary care centres from September 2019 to April 2023 were included in the study. Functional assessment was performed with the Rockwood Clinical Frailty Scale (CFS), an established frailty screening tool that stratifies patients on a nine-point scale ranging from 1 (very well) to 9 (terminally ill) providing a useful measure of physiological reserve. Frailty was defined as CFS >4. Functional status was further categorized as follows: 'non-frail' (CFS 1-3), ‘mild’ frailty (CFS 4-5), and 'moderate-to-severe' frailty (CFS 6-9). Logistic regression analysis was used to identify factors associated with CFS 6-9. Cox regression analysis was used to determine the independent and incremental prognostic value of frailty. Results The study comprised 880 patients with ATTR-CA (719 [81.7%] with wt-ATTR-CA, 85 [9.7%] with p.(V142I) hATTR-CA and 76 [8.6%] with a non-p.(V142I) hATTR-CA. Overall, 43.0% (N=378) were considered ‘non-frail’ (CFS 1-3). Prevalence of ‘mild’ frailty (CFS 4-5) was 41.4% (N=364), while prevalence of 'moderate-to-severe' frailty (CFS 6-9) was 15.7% (N=138). Frail patients were older, more symptomatic and with advanced disease stage as assessed with the National Amyloidosis Centre (NAC) staging system. At logistic regression analysis, age, female gender, non-p.(V142I) variants and NAC stage were associated with 'moderate-to-severe' frailty. Over a median 22 months, 16.8% died, with mortality rising with higher CFS levels. At Cox multivariable analysis, CFS was strongly associated with mortality (CFS 4-5 vs 1-3: Hazard Ratio [HR] 2.821, 95% C.I. 1.724-4.613; CFS 6-9 vs 1-3: HR 6.179, 95% C.I. 3.694-10.335, overall p-value<0.001), along with NAC stage and age. The addition of CFS to the NAC staging system significantly improved the goodness-of-fit of the model (X2: 73.26, p<0.00001), and significantly improved the discriminatory ability of the NAC alone (Figure, Harrell’s C statistics: 0.78, 95% C.I. [0.72-0.83] vs 0.69, 95% C.I. [0.64-0.75], p<0.0001). CONCLUSION Frailty is highly prevalent in patients with ATTR-CA, with up to 57% of patients living with some degree of frailty. Older age, female gender, non-p.(V142I) hATTR-CA variants and advanced disease stage were independently associated with moderate to severe frailty. Frailty was independently associated with all-cause mortality after adjusting for known predictors and increased the global predictivity of the NAC Score.Survival by Frailty Status and NAC

Quantifying brain health in acute ischemic stroke through effective reserve.

To quantify brain health using a measure of reserve that incorporates pre-existing pathology. We analyzed two retrospective ischemic stroke cohorts (GASROS and SALVO) with neuroimaging and 90-day modified Rankin Scores (mRS) available. White matter hyperintensity (WMHv), brain, and intracranial volumes were automatically extracted, and brain parenchymal fraction (BPF) calculated. The latent variable effective reserve (eR) was modeled using age, WMHv, and BPF or brain volume in GASROS. Models were compared using Bayes Information Criterion (BIC). The best model's eR estimates were categorized into quartiles and evaluated in SALVO. GASROS included 476 (median age: 65.8; 65.3% male) and SALVO included 43 (median age: 69.2; 62.8% male) patients. Inverse associations between eR and mRS was seen in both models, with brain volume outperforming BPF (path coefficients: -0.67, -0.48, respectively; p < 0.001; |ΔBIC| = 362). Quartile-based eR stratification in SALVO showed a similar inverse trend, with worse outcomes in the low reserve group (mRS≤2 - highest vs lowest quartile: 85/90% vs 59/45% for GASROS/SALVO). Expanding the concept of eR, highlights its clinical translational potential. The strong link between higher eR and better outcomes underscores its value as a protective brain health metric.

Prognostic utility of the modified albumin-bilirubin score among patients undergoing curative-intent surgery for gallbladder cancer

BackgroundGallbladder cancer (GBC) has been associated with high rates of recurrence and dismal prognosis even after curative-intent resection. The prognostic utility of the modified albumin-bilirubin (mALBI) score among individuals undergoing curative-intent resection for GBC has not been determined. MethodsPatients who underwent radical resection for GBC between 2000 and 2022 were identified from an international, multi-institutional database. Preoperative albumin and bilirubin levels were used to calculate the mALBI score. The relationship among mALBI score, overall survival (OS), and recurrence-free survival (RFS) was examined. ResultsAmong 269 patients who underwent radical resection for GBC, 161 (59.9%) had mALBI grade 1, 48 (17.8%) had grade 2a, 47 (17.5%) had grade 2b, and 13 (4.8%) had mALBI grade 3. After surgery, compared with patients with a low mALBI grade (grade 1/2a), individuals with a high mALBI grade (grade 2b/3) had worse 5-year OS (54.4% vs 19.2%, respectively; P < .001) and RFS (42.0% vs 17.8%, respectively; P < .001). On multivariable analysis, after controlling for relevant clinicopathologic variables, individuals with a high mALBI score remained independently associated with higher risks of death and recurrence (OS: hazard ratio [HR], 2.38 [95% CI, 1.50–3.79]; RFS: HR, 2.12 [95% CI 1.41–3.20]) versus patients with a low mALBI score after curative-intent resection for GBC. Of note, mALBI score was associated with incrementally worse survival within T2, T3, and N+ categories, whereas classic American Joint Committee on Cancer subclassifications failed to distinguish patients with long-term survival. ConclusionThe mALBI score presents a simple, objective measure of hepatic functional reserve and may be a useful prognostic tool for patients undergoing curative-intent resection for GBC.

Can a Surgical Vulnerability Score Predict Outcomes of Hip Reconstruction in Children with Severe Neuromuscular Disability?

Abstract Background Hip surgery is often necessary for children with severe neuromuscular disabilities to avoid chronic pain resulting from hip migration. This study correlated the Surgical Vulnerability Score (SVS), a novel measure of physiological reserve, with reconstructive hip surgery outcomes to improve shared surgical decision-making. Materials and methods Sixty-eight cases performed by a single surgeon were retrospectively evaluated. Cases were graded according to physiological vulnerability using the SVS, which was then correlated with two outcomes: length of hospital stay (LOS) and severity of postoperative complications. The Gross Motor Function Classification System (GMFCS) level was used as a baseline comparison. Sub-analysis compared results for patients who underwent only a femoral varus derotation osteotomy (VDRO) (n = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) (n = 20). Results Results showed that a higher SVS was associated with increased LOS (p = 0.001) and severity of postoperative complications (p = 0.0008). A greater GMFCS level was not associated with either LOS (p = 0.246) or the severity of postoperative complications (p = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS (p = 0.483) or severity of complications (p = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS (p = 0.0002) and severity of complications (p = 0.0001). Conclusions The SVS can aid surgical decision-making and prepare the child’s family for surgery. Early intervention and fixation using only a VDRO may lead to better outcomes, underscoring the importance of hip surveillance programs in the early identification of migrating hips.

Soft skills and their relationship with life satisfaction and cognitive reserve in adulthood and older age

Soft skills are key factors for success in multiple contexts of daily life, as well as for life satisfaction, but little is known about their role in late adulthood and older age. In this study, we aimed to investigate the relationships of soft skills, as defined by the World Economic Forum, with two indicators of successful/healthy aging: life satisfaction and cognitive reserve. A sample of 435 adults aged 50 and over completed self-reported measures of soft skills, life satisfaction, and cognitive reserve. As control, fluid (reasoning) and crystalized (vocabulary) intelligence were assessed too, along with socio-demographic characteristics. A series of regression analyses showed that soft skills were positively related to both life satisfaction and, to a lower extent, cognitive reserve, above and beyond gender, age, and both fluid and crystallized intelligence. Interestingly, these associations were independent from participants’ age. Overall, these results highlight the importance of considering soft skills also over the middle-late adult life course, due to the potential role of these individual qualities in supporting an individual’s well-being and an active and engaged lifestyle, with implications for the promotion of a healthy aging.

Association of Frailty With Clinical and Financial Outcomes Following Liver Transplantation.

Frailty, a measure of physiological aging and reserve, has been validated as a prognostic indicator of mortality in patients with cirrhosis. However, large-scale analyses of the independent association of frailty with clinical and financial outcomes following liver transplantation (LT) are lacking. Adults (≥18 years) undergoing LT were identified in the 2016-2020 National Readmissions Database. Frailty was defined using the binary Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable linear and logistic regression models were developed to evaluate the independent association of frailty with in-hospital mortality, perioperative complications, and costs. Of an estimated 34 442 patients undergoing LT, 8265 (24%) were frail. After adjustment, frailty was associated with greater odds of mortality (adjusted odds ratio [AOR] 1.80; 95% Confidence Interval [CI]: 1.49-1.18), postoperative length of stay (β+11 days; 95% CI:+10,+12), and hospitalization costs (+$86 880; 95% CI:+75 660,+98 100), as well as a two-fold increase in relative risk of nonhome discharge (AOR 2.17, 95% CI: 1.90-2.49). Frailty is associated with an increased risk of in-hospital mortality, complications, and resource utilization among LT recipients. As the proportion of frail LT patients continues to rise, our findings underscore the need for novel risk-stratification and individualized care protocols for such vulnerable patients.

Gait Speed Reserve in the general population-based 'Good Aging in Skåne' cohort study-distribution and associated factors.

Gait Speed Reserve (GSR) expresses a difference between fast and comfortable gait speed and may have an impact on everyday functioning. It was also hypothesized as a useful proxy measure of physiological reserve. However, height-normalizing values of GSR and its associated factors have not been evaluated in a general population of older adults. Therefore, we aimed to investigate the distribution of height-normalized GSR (HN-GSR) in an elderly population-based cohort from urban and rural areas (n = 4342) aged 60-93 years and evaluate associated physiological and lifestyle factors. Using linear mixed models, we identified gender and nine modifiable factors as significantly associated with HN-GSR across four age groups. Better handgrip strength, cognition and standing balance, higher physical activity level, larger calf circumference, and less smoking had positive associations with HN-GSR, while female gender, more leg pain, higher weight and, alcohol consumption had opposite effects. The Marginal R2 imply that this model explained 26% of the variance in HN-GSR. Physical activity and handgrip strength varied across age groups in impact on HN-GSR. The differences were however comparatively minor. In this large cohort study of older adults, we proposed for the first time that factors associated with HN-GSR represented multi-domain features that are in line with previous findings reported for GSR. Measuring HN-GSR/GSR may help clinicians identify early physiological impairments or unhealthy lifestyle habits, especially among older women, and may also have safety implications in daily life. Further work is needed to find out if measuring HN-GSR/GSR may be useful in identifying adverse health outcomes and overall physiological reserve.

O-256 Evaluation of Anti-Mullerian hormone levels in reproductive age severely obese women six months after bariatric surgery

Abstract Study question Do serum levels of anti-Müllerian hormone (AMH) change in women of reproductive age following weight loss induced by bariatric surgery? Summary answer Following six months post-bariatric surgery, despite substantial weight loss, both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy patients exhibited consistent AMH levels. What is known already Obesity negatively affects fertility, IVF outcomes, and potentially AMH) levels. AMH correlates to the number of growing follicles and is currently the best measure of ovarian reserve. Bariatric surgery (BS) has been considered as the most effective method to achieve sustainable weight loss. Many studies have demonstrated that there is an increase of spontaneous pregnancies and a reduction in complications during pregnancy or delivery post-bariatric surgery. Despite these benefits, the specific impact of BS on ovarian reserve and AMH levels remains unclear. Several studies have already considered the effects of surgery-induced weight loss on ovarian reserve, often showing conflicting results. Study design, size, duration This prospective study included 22 obese women in reproductive age with BMI ≥ 40 or ≥ 35 kg/m2 with at least one obesity-related comorbidity at baseline and 6 months after undergoing either sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB). Participants/materials, setting, methods Women aged 20–34 years with a median BMI of 41.53 kg/m² were included at baseline. Two medical consultations occurred: one preoperatively and another 6 months postoperatively. Each session included body weight and height measurements, as well as serum AMH testing using the Elecsys® AMH kit (Diagnostics Roche) and the electrochemiluminescence method - Cobas (Diagnostics Roche). Patients were divided into two groups: group 1 underwent RYGB, while group 2 underwent sleeve gastrectomy. Main results and the role of chance After six months post-bariatric surgery, all participants exhibited a significant reduction in BMI, with the median dropping from 41.53 kg/m² to 29.56 kg/m², representing a substantial 28.82% decrease (p &amp;lt; 0.001). In Group 1, the median BMI decreased from 38.51 kg/m² to 29.27 kg/m², a statistically significant reduction of 27.30% (p = 0.003). Group 2 also saw a significant drop, from 42.53 kg/m² to 30.10 kg/m², reflecting a 29.23% reduction (p = 0.003). Contrastingly, no significant changes in AMH levels were noted six months post-bariatric surgery. The median AMH level slightly decreased from 3.02 ng/mL to 2.95 ng/mL, a non-significant 2.32% reduction (p = 0.783). In Group 1, the median AMH level increased insignificantly from 2.54 ng/mL to 2.92 ng/mL, a 14.96% rise (p = 0.424). In Group 2, there was a non-significant 6.88% decrease, from 3.20 ng/mL to 2.98 ng/mL (p = 0.722). Pre-surgery, 12 patients reported regular menstrual cycles, while 10 reported irregular cycles. After six months, a significant increase (p = 0.021) in patients with regular menstrual cycles was observed, with 19 reporting regular cycles, while only 3 continued to experience irregular cycles. Limitations, reasons for caution Several limitations of the study should be considered, including the small sample size and the relatively short six-month follow-up period. It would be valuable to compare the study participants with a control group of women who achieved weight loss through diet and exercise. Wider implications of the findings The convergence of BS and fertility is an area of significant interest and clinical impact. This study suggests that BS has no significant impact on AMH levels or ovarian reserve in short-term. However, extending the study’s follow-up period would provide valuable insights into the long-term effects on ovarian reserve. Trial registration number not applicable

P-574 Anti-Müllerian hormone: A novel marker for ovarian torsion?

Abstract Study question Can measuring plasma AMH levels assist in diagnosing ovarian torsion? Summary answer AMH levels show fluctuations during the acute phase of ovarian torsion, potentially aiding in clinical diagnosis. What is known already Anti-Müllerian Hormone (AMH), a measure of the ovarian follicular reserve, might fluctuate upon ovarian ischemia as per the “burnout theory,” where ovarian ischemia triggers primordial follicle recruitment and increased follicular growth. Accordingly, ultrasound indicators of ovarian torsion include the presence of small follicles at the ovarian periphery. Our hypothesis suggests that ovarian ischemia from torsion could alter serum AMH levels, offering diagnostic value. Study design, size, duration A prospective observational study was conducted in a single tertiary care center between 2021-2023. The study analyzed serum AMH levels in 17 patients aged 12-45 admitted with acute abdominal pain and undergoing diagnostic laparoscopy due to suspected ovarian torsion. Patients with AMH levels below the 5th percentile were excluded. Participants/materials, setting, methods Patients with suspected ovarian torsion underwent diagnostic laparoscopy based on clinical and sonographic criteria. Peripheral blood samples collected upon admission and on the first postoperative day were used to measure plasma AMH levels. AMH levels were compared between patients with confirmed ovarian torsion and those without this diagnosis. Main results and the role of chance Demographic characteristics were similar between the groups. Patients diagnosed with ovarian torsion showed higher pre- and postoperative AMH levels than those without torsion (4.33∓1.58 vs. 2.8∓1.28 ng/ml, p = 0.08 and 4.16∓1.52 vs. 2.71∓1.3 ng/ml, p = 0.09, respectively), but these differences were not statistically significant. However, the change in AMH levels from pre- to postoperative was more significant in patients with ovarian torsion compared to those without (0.66∓0.34 vs. 0.21∓0.18, p = 0.01). Limitations, reasons for caution • Small study size • High variability in basal AMH levels in women of reproductive age Wider implications of the findings These results suggest that ovarian ischemia might influence AMH secretion, potentially serving as part of diagnostic evaluations. Ongoing studies aim to validate AMH as a biomarker for ovarian torsion, aiming to reduce unnecessary surgeries, lower patient risks, and minimize healthcare costs. Trial registration number 0151-21-RMB

Assessment of MR blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity under general anesthesia in children with moyamoya.

Moyamoya is a progressive, non-atherosclerotic cerebral arteriopathy that may present in childhood and currently has no cure. Early diagnosis is critical to prevent a lifelong risk of neurological morbidity. Blood-oxygen-level-dependent (BOLD) MRI cerebrovascular reactivity (CVR) imaging provides a non-invasive, in vivo measure of autoregulatory capacity and cerebrovascular reserve. However, non-compliant or younger children require general anesthesia to achieve BOLD-CVR imaging. To determine the same-day repeatability of BOLD-CVR imaging under general anesthesia in children with moyamoya. Twenty-eight examination pairs were included (mean patient age = 7.3 ± 4.0years). Positive and negatively reacting voxels were averaged over signals and counted over brain tissue and vascular territory. The intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, and Bland-Altman plots were used to assess the variability between the scans. There was excellent-to-good (≥ 0.59) within-day repeatability in 18 out of 28 paired studies (64.3%). Wilcoxon signed-rank tests demonstrated no significant difference in the grey and white matter CVR estimates, between repeat scans (all p-values > 0.05). Bland-Altman plots of differences in mean magnitude of positive and negative and fractional positive and negative CVR estimates illustrated a reasonable degree of agreement between repeat scans and no systematic bias. BOLD-CVR imaging provides repeatable assessment of cerebrovascular reserve in children with moyamoya imaged under general anesthesia.

The impact of ovarian endometrioma and endometriotic cystectomy on anti-Müllerian hormone, and antral follicle count: a contemporary critical appraisal of systematic reviews.

Currently, three crucial questions regarding the reliability of ovarian reserve measures in women with ovarian endometrioma during the reproductive age are being discussed. Firstly, the effects of endometriotic cystectomy on short and long-term ovarian reserve. Secondly, the accuracy of serum anti-Müllerian hormone (AMH) and antral follicle count (AFC) in estimating ovarian reserve in these cases. Thirdly, the impact of endometrioma itself on the ovarian reserve over time in such cases. The purpose of the present review is to critically assess available systematic reviews and meta-analyses that have explored these questions. Nine eligible reviews were found following a systematic search on PubMed.com and similarly assessed. These reviews varied considerably regarding the level of evidence, as per an identical comprehensive scoring system. Moderate to high-quality evidence demonstrates that endometriotic cystectomy, by the stripping technique, adversely affects ovarian reserve in the short and long term, up to 9-18 months post-surgery. Damage to ovarian reserve was considerable but more pronounced in bilateral cases than unilateral cases, equivalent to 39.5% and 57.0%, respectively. Repeat endometriotic cystectomy is detrimental to ovarian reserve. The impact of endometrioma diameter on ovarian reserve before or after surgery is still unclear. Moderate to high-quality evidence, relying on simultaneous assessment of both ovarian reserve measures, shows that AMH is sensitive while AFC is not in cases undergoing ovarian cystectomy. AMH should be the biomarker of choice for counseling and managing women with endometrioma in their reproductive age, especially before surgery. While there is some evidence to show that endometrioma per se may harm ovarian reserve, this evidence is not robust, and there is good-quality evidence to challenge this notion. It is necessary to conduct further targeted RCTs, systematic reviews, and meta-analyses based on solid methodological grounds to increase the level of evidence, refine quantitative estimates, investigate open questions, and decrease heterogeneity.

Urinary benzophenone-3 concentrations and ovarian reserve in a cohort of subfertile women

ObjectiveTo evaluate the association between urinary benzophenone-3 concentrations and measures of ovarian reserve (OR) among women in the Environment and Reproductive Health (EARTH) Study seeking fertility treatment at Massachusetts General Hospital in Boston, Massachusetts. DesignProspective cohort study. MethodsWomen from the EARTH cohort contributed spot urine samples before assessment of OR outcomes. Antral follicle count (AFC) and day-3 follicle stimulating hormone (FSH) levels were evaluated as part of standard infertility workups during unstimulated menstrual cycles. Quasi-Poisson and linear regression models were used to evaluate the association of specific gravity (SG)-adjusted urinary benzophenone-3 concentrations with AFC and FSH, respectively, with adjustment for age and physical activity. In secondary analyses, models were stratified by age. Sensitivity analyses assessed for confounding by season by restricting to women with exposure and outcome measured in the same season and stratifying by summer vs. non-summer months and for confounding by sunscreen use by restricting to women who filled out product questionnaires and adjusting for and stratifying by average sunscreen use score. ResultsThe study included 142 women (mean age ± SD, 36.1 ± 4.6; range, 22-45 years) enrolled between 2009 and 2017 with both urinary benzophenone-3 and AFC and 57 women with benzophenone-3 and FSH measurements. Most women were white (78%) and highly educated (49% with a graduate degree). Women contributed a mean of 2.7 urine samples (range, 1-10) with 37% contributing 2 or more samples. Benzophenone-3 was detected in 98% of samples. Geometric mean (GM) SG-corrected urinary benzophenone-3 concentration was 85.9 μ g/L (geometric standard deviation 6.2). There were no associations of benzophenone-3 with AFC and day-3 FSH in the full cohort. In stratified models, a 1-unit increase in log GM benzophenone-3 was associated with AFC 0.91 (95% CI, 0.86, 0.97) times lower among women ≤35 years old and was associated with FSH 0.73 (95% CI, 0.12, 1.34) IU/L higher among women >35 years old. Effect estimates from models stratified by season and sunscreen use were null. ConclusionIn main models, urinary benzophenone-3 was not associated with OR. However, younger may be vulnerable to potential effects of benzophenone-3 on AFC. Further research is warranted.

299 Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multi-center Analysis of 31,776 Patients

INTRODUCTION: Although unplanned readmission is a postoperative outcome metric associated with significant morbidity and financial burden, precise assessment tools for its prediction are yet to be developed. The Revised Risk Analysis Index (RAI) has been recently endorsed as a robust frailty index for predicting surgical outcomes. Hence, the RAI could potentially be utilized to help improve prediction unplanned readmission in patients undergoing intracranial tumor resection (ITR). METHODS: Data of patients undergoing ITR were obtained from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from the years 2012-2019 using the ICD-9 and ICD-10 codes, indicating ITR. Baseline characteristics, preoperative clinical status, and outcomes were compared between patients with and without unplanned readmission. Frailty, as a measure of baseline physiological reserve, was calculated using the RAI. Univariate and multivariate logistic regression analyses were performed to identify independent associations between unplanned readmissions and patient characteristics. RESULTS: The unplanned readmission rate of this cohort (N = 31,776) was 10.8% (N = 3,420). Among the readmitted patients, 958 required unplanned reoperation. Multiple characteristics were significantly different between the readmitted and non-readmitted patients, including age, BMI, comorbidities, and RAI groups (p &lt; 0.05). The most common causes of unplanned readmission were infection (9.4%), seizures (6%), and pulmonary embolism (4%). Patient characteristics identified as reliable predictors of unplanned readmission, included age, body mass index (BMI), functional status, diabetes, hypertension, hyponatremia, and their RAI score (p &lt; 0.05). In multivariate analysis, RAI “frail” patients had an unplanned readmission odds ratio (OR) of 1.3(95%CI; 1.2-1.4), and RAI “severely frail” patients had an OR of 1.6 (95%CI; 1.3-2.1) (p &lt; 0.001). CONCLUSIONS: The RAI is a reliable pre-operative frailty index for predicting unplanned readmission following ITR. Utilizing the RAI to identify high risk patients may decrease unplanned readmission through implementation of appropriate management guidelines.

Brain reserve affects the expression of cognitive reserve networks.

Cognitive reserve (CR) explains differential susceptibility of cognitive performance to neuropathology. However, as brain pathologies progress, cognitive decline occurs even in individuals with initially high CR. The interplay between the structural brain health (= level of brain reserve) and CR-related brain networks therefore requires further research. Our sample included 142 individuals aged 60-70 years. National Adult Reading Test intelligence quotient (NART-IQ) was our CR proxy. On an in-scanner Letter Sternberg task, we used ordinal trend (OrT) analysis to extract a task-related brain activation pattern (OrT slope) for each participant that captures increased expression with task load (one, three, and six letters). We assessed whether OrT slope represents a neural mechanism underlying CR by associating it with task performance and NART-IQ. Additionally, we investigated how the following brain reserve measures affect the association between NART-IQ and OrT slope: mean cortical thickness, total gray matter volume, and brain volumes proximal to the areas contained in the OrT patterns. We found that higher OrT slope was associated with better task performance and higher NART-IQ. Further, the brain reserve measures were not directly associated with OrT slope, but they affected the relationship between NART-IQ and OrT slope: NART-IQ was associated with OrT slope only in individuals with high brain reserve. The degree of brain reserve has an impact on how (and perhaps whether) CR can be implemented in brain networks in older individuals.

Laparoscopically confirmed endometriosis and anti-Müllerian hormone levels: Findings from the Nurses' Health Study II

ObjectiveAnti-Müllerian hormone is a reliable measure of ovarian reserve associated with menopause timing and fertility. Previous studies have observed that individuals with endometriosis have lower anti-Müllerian hormone levels than those without. However, sample sizes have been small and information is limited regarding the long-term influence of endometriosis on anti-Müllerian hormone levels among the general population, which may have important implications for menopause timing and chronic disease risk. MethodsAmong 1961 premenopausal women in the Nurses' Health Study II who provided a blood sample and had not been pregnant in the last 6 months, we used generalized linear models to determine the association between laparoscopically-confirmed endometriosis and log-transformed plasma anti-Müllerian hormone level, adjusted for age (continuous and squared) and other potential confounding variables. ResultsParticipants were on average 40 years old (interquartile range 37–42 years) at blood draw. Women with endometriosis diagnosed prior to blood draw (n = 119) had a lower mean anti-Müllerian hormone level (1.6 ng/mL [SD = 2.3]) than women without known endometriosis (n = 1842) (2.8 ng/mL [SD = 3.0]). In multivariable adjusted models, women with endometriosis had 29.6 % lower anti-Müllerian hormone levels (95 % CI: −45.4, −9.2 %) than women without. This association was greater among women with a body mass index of 25 kg/m2 or more (percent difference: −44.0 % (−63.7, −13.8)), compared to those with a body mass index of under 25 kg/m2 (percent difference: −19.8 % (−41.7, 10.4)), but did not vary by parity or infertility history. ConclusionsLower anti-Müllerian hormone levels in women with endometriosis may be one mechanism through which endometriosis influences risk of infertility, younger age at menopause, and cardiovascular disease.

Algal symbiont diversity in Acropora muricata from the extreme reef of Bouraké associated with resistance to coral bleaching.

Widespread coral bleaching has generally been linked to high water temperatures at larger geographic scales. However, the bleaching response can be highly variable among individual of the same species, between different species, and across localities; what causes this variability remains unresolved. Here, we tracked bleached and non-bleached colonies of Acropora muricata to see if they recovered or died following a stress event inside the semi-enclosed lagoon of Bouraké (New Caledonia), where corals are long-term acclimatized to extreme conditions of temperature, pH and dissolved oxygen, and at a nearby control reef where conditions are more benign. We describe Symbiodiniaceae community changes based on next-generation sequencing of the ITS2 marker, metabolic responses, and energetic reserve measures (12 physiological traits evaluated) during the La Niña warm and rainy summer in 2021. Widespread coral bleaching (score 1 and 2 on the coral colour health chart) was observed only in Bouraké, likely due to the combination of the high temperatures (up to 32°C) and heavy rain. All colonies (i.e., Bouraké and reference site) associated predominantly with Symbiodinaceae from the genera Cladocopium. Unbleached colonies in Bouraké had a specific ITS2-type profile (proxies for Symbiodiniaceae genotypes), while the bleached colonies in Bouraké had the same ITS2-type profile of the reef control colonies during the stress event. After four months, the few bleached colonies that survived in Bouraké (B2) acquired the same ITS2 type profiles of the unbleached colonies in Bouraké. In terms of physiological performances, all bleached corals showed metabolic depression (e.g., Pgross and Rdark). In contrast, unbleached colonies in Bouraké maintained higher metabolic rates and energetic reserves compared to control corals. Our study suggests that Acropora muricata enhanced their resistance to bleaching thanks to specific Symbiodiniaceae associations, while energetic reserves may increase their resilience after stress.

The Advanced BRain Imaging on ageing and Memory (ABRIM) data collection: Study design, data processing, and rationale.

To understand the neurocognitive mechanisms that underlie heterogeneity in cognitive ageing, recent scientific efforts have led to a growing public availability of imaging cohort data. The Advanced BRain Imaging on ageing and Memory (ABRIM) project aims to add to these existing datasets by taking an adult lifespan approach to provide a cross-sectional, normative database with a particular focus on connectivity, myelinization and iron content of the brain in concurrence with cognitive functioning, mechanisms of reserve, and sleep-wake rhythms. ABRIM freely shares MRI and behavioural data from 295 participants between 18-80 years, stratified by age decade and sex (median age 52, IQR 36-66, 53.20% females). The ABRIM MRI collection consists of both the raw and pre-processed structural and functional MRI data to facilitate data usage among both expert and non-expert users. The ABRIM behavioural collection includes measures of cognitive functioning (i.e., global cognition, processing speed, executive functions, and memory), proxy measures of cognitive reserve (e.g., educational attainment, verbal intelligence, and occupational complexity), and various self-reported questionnaires (e.g., on depressive symptoms, pain, and the use of memory strategies in daily life and during a memory task). In a sub-sample (n = 120), we recorded sleep-wake rhythms using an actigraphy device (Actiwatch 2, Philips Respironics) for a period of 7 consecutive days. Here, we provide an in-depth description of our study protocol, pre-processing pipelines, and data availability. ABRIM provides a cross-sectional database on healthy participants throughout the adult lifespan, including numerous parameters relevant to improve our understanding of cognitive ageing. Therefore, ABRIM enables researchers to model the advanced imaging parameters and cognitive topologies as a function of age, identify the normal range of values of such parameters, and to further investigate the diverse mechanisms of reserve and resilience.

Cognitive Reserve, Physical Reserve, and Cognitive Efficiency of Older People Living in the Sardinian Blue Zone. An Exploratory Study.

This study mainly intended to disentangle the role played by physical reserve as a mediator of the relationship between cognitive reserve and global cognitive functioning in older people aging well. A sample of 120 67-101-year-old community-dwellers was recruited in the Sardinian Blue Zone, an area characterized by the extreme longevity of its inhabitants. Each respondent completed a battery of tests examining cognitive functioning, perceived physical health, cognitive reserve, and physical reserve (objectively assessed through accelerometric-derived measures). Significant associations were found among measures of cognitive reserve, physical reserve, perceived physical health, and cognition. Besides, two mediational analyses pointed out that physical reserve and distinct indexes of cognitive reserve explained 18% and 32% of the variance associated with global cognitive functioning. In conclusion, the combination of high cognitive reserve and more preserved motor functioning seems to contribute to the maintenance of healthy cognition in older people aging well.

Association of cognitive reserve with cognitive function and quality of life in the years following a diagnosis of dementia: initial findings from the IDEAL study

AbstractBackgroundEffects of brain pathology or ageing on cognitive function are moderated by an individual’s ability to optimise or maximise the use of the brain’s resources to perform tasks, and is a concept known as cognitive reserve. In dementia, cognitive reserve may reflect the capacity to provide a buffer against effects of dementia‐related brain pathology, resulting in a delay in signs and symptoms of dementia. Studies have found that a higher level of education may not only lead to a delay in the onset of dementia, but impact on the rate of cognitive decline following a diagnosis. Here we investigate whether a latent measure of cognitive reserve at diagnosis impacts on cognitive function or quality of life in the years following a diagnosis.MethodWe used longitudinal data from 1545 individuals with mild‐to‐moderate dementia participating in the IDEAL study. Assessments took place on entry, and at 12 and 24 months. A latent measure of cognitive reserve was created based on education, social class and engagement in social and cognitive activities. Latent growth curve models were used to look for associations of cognitive reserve at diagnosis with cognitive function and quality of life in the years following diagnosis.ResultA higher cognitive reserve was associated with higher cognitive function at the time of diagnosis, but following diagnosis individuals with a higher cognitive reserve had a faster rate of decline in cognitive function. Whilst higher cognitive reserve was associated with a higher quality of life at the time of diagnosis, there was no association between cognitive reserve and change in quality of life in the years following diagnosis.ConclusionThose with a higher cognitive reserve at baseline are more likely to decline in cognitive function at a greater rate following diagnosis suggesting that it may be possible to identify individuals who may decline more quickly based on their education, social class and social and cognitive activities later in life.

FC34: Cognitive reserve and depressive burden in older adults: variation according to reserve measurement

Objective:Individual differences in the timing of dementia have been attributed to cognitive reserve (CR), thought to reflect lifelong engagement in stimulating experiences, which provide resilience against brain pathology. In older adults, dementia and depression are closely related, and some studies have linked CR with depression risk in old age. It is unclear if different ways of operationalizing CR exhibit similar association with old-age depression. We examined the association of two measures of CR with depressive burden in older adults: activity-based CR, capturing engagement in stimulating activities using proxy variables, and residual-based CR, indicating residual variance in cognition, not explained by the brain status.Methods:We used data on 354 adults aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, followed for 15 years. Residual-based reserve was computed from a regression predicting episodic memory with a brain-integrity index incorporating six structural neuroimaging markers (white- matter hyperintensities volume, whole-brain gray matter volume, hippocampal volume, lateral ventricular volume, lacunes, and perivascular spaces), age, and sex. Activity-based reserve incorporated education, work complexity, social network, and leisure activities. Depressive burden was captured over the follow- up with the Montgomery-Åsberg Depression Rating Scale and time until clinically relevant level of symptoms (&gt;6) was modelled using Cox proportional hazard models.Results:Preliminary results indicate that, upon minimal adjustment (age, sex, brain integrity status), top tertiles (ref: bottom tertile) of both activity-based (HR: 0.77; 95% CI: 0.61-0.98) and residual-based CR (HR: 0.62; 95% CI: 0.44-0.98) were associated with a lower risk of depressive burden onset over 15 years. Upon further adjustment for anthropometrics, health behaviors, and chronic disease burden, the association of activity-based CR was attenuated, whereas residual-based CR preserved its effect on depressive burden (HR [fully adjusted model]: 0.59; 95% CI: 0.40-0.88). Next steps include evaluating the ability of reserve measures to attenuate the association of brain integrity with depressive burden using interaction analysis.Conclusion:Preliminary findings suggest that CR may be linked with depression development in older adults, although the association may vary depending on measurement of reserve. Association of activity- based reserve may be attributed to somatic disease pathways.