Cognitions Research Articles

Impact of agitation status during intensive care on functional outcomes and mortality in patients with cardiovascular disease

Abstract Background Agitation in patients during intensive care is a frequent complication. Several studies have reported that restlessness and agitation are risk factors for prolonged intensive care unit (ICU) stay and poor prognosis. Since patients with cardiovascular disease (CVD) requiring intensive care are ageing and thereby easily affected by responses, including changes in mental status, optimal management of sedation and agitation statuses during ICU stay is considered crucial. However, the influence of different agitation levels during CVD treatment in the ICU on clinical outcomes after ICU discharge is still unclear. Purpose To investigate the associations of the agitation level during ICU stay with mortality after ICU admission and functional outcomes at hospital discharge. Methods We studied 2236 patients (mean age 67.8±0.3 years) who were admitted to the ICU of a university hospital for CVD treatment and whose highest Richmond Agitation-Sedation Scale (RASS) ≥0, measured daily during ICU stay. In addition to clinical characteristics, we investigated the incidence of all-cause mortality during hospitalization and after hospital discharge. We also measured functional outcomes at discharge among 1625 patients, including 6 minutes walk distance (6MWD), Mini-Cog test, and Patient Health Questionnaire-2 (PHQ-2) as physical, cognitive, and mental functions, respectively. In statistical analysis, patients were divided into three groups based on the highest RASS levels during ICU stay in each patient (Calm: RASS=0, Restless: RASS=1, Agitation: RASS≥2). Kaplan-Meier analysis with a log-rank test and the multivariate Cox proportional hazard model were used to clarify whether higher agitation levels were associated with all-cause mortality. Moreover, the differences between the agitation levels and functional outcomes at hospital discharge were compared using the analysis of covariance. Results During the median follow-up of 1.9 years, all-cause death occurred in 280 patients (12.5%), with an incidence rate of 5.57/100 person-years. The Restless and Agitation groups showed higher mortality than the Calm group (P<0.001), and higher agitation levels in the ICU were significantly associated with a higher rate of all-cause mortality (adjusted hazard ratio: 1.37, 95% confidence interval: 1.19–1.57, P<0.001). Furthermore, as compared with the Calm group, the Restless and Agitation groups showed significantly lower levels of 6MWD (all P<0.001) and Mini-cog (P=0.004 and P<0.001, respectively) and a higher PHQ-2 (all P<0.001), even after adjusting for clinical confounders. Conclusions Agitation during ICU stay in CVD patients was associated with low functional outcomes at hospital discharge and high mortality rate after discharge, irrespective of agitation level. Detailed information on the agitation status during intensive care may be an important indicator in developing management and treatment strategies for patients with CVD admitted to ICU.

Discrepancy Between Functional Outcomes and Perceived Health post-ICU: A Prospective Cohort Study.

Despite functional impairments, ICU survivors can perceive their quality of life as acceptable. To investigate discrepancies between calculated health, based on self-reported physical, mental and cognitive functioning, and perceived health one year after ICU admission. Data from an ongoing prospective multicenter cohort study, MONITOR-IC, were used. Patient-reported physical, mental and cognitive functioning, and perceived health (EQ-VAS, range 0-100) one year post-ICU of patients admitted to one of eleven participating ICUs between July 2016 and September 2021 were analyzed. The relationship between functional outcomes and perceived health was modeled using linear regression. Calculated health for each patient was estimated using this model and compared to patients' perceived health, the difference reflecting a discrepancy. Based on a minimal clinically important difference of eight points, three groups were defined: patients who rated their health better than calculated (positive discrepancy), patients who rated their health worse than calculated (negative discrepancy), and patients whose perceived health was concordant with their calculated health. 2,545 patients were analyzed, of whom 45.0% (n = 1,146) showed a discrepancy between calculated and perceived health. Patients with a negative discrepancy rated their health significantly lower (median 50, IQR 36 - 66) than patients with a positive discrepancy (median 84, IQR 75 - 90). Importantly, there were no significant differences in physical, mental and cognitive functioning between patients with a negative and positive discrepancy. Patients with a negative discrepancy had a higher education level and were more often unemployed. One year post-ICU, almost half of ICU survivors showed a discrepancy between calculated health and perceived health.

Close relationships with caregivers as protective factor for the mental health and functioning of war-affected Congolese youth

BackgroundSupportive social connections are a crucial determinant of the mental health and adjustment of youth in conflict-torn regions. Conflict-affected youth face particular risks to their well-being due to high levels of trauma exposure and perpetration of violent acts as members of armed groups and post-conflict discrimination. However, little is known about the possible protective role of close relationships with caregivers in the aftermath of trauma. This study examined whether a higher perceived quality of relationships with caregivers would attenuate the associations between exposure to traumatic experiences and four indicators of adjustment (posttraumatic stress symptoms [PTSS], emotional problems, behavioural problems, criminal behaviour) in a sample of 268 war-affected youth (61.2% male, Mage = 16.31 years) living in Bukavu, Democratic Republic of Congo. More than half of the present sample (56.7%) were former members of armed groups.MethodsData were collected using quantitative structured interviews and analyzed through regression models using the PROCESS macro.ResultsHigher cumulative trauma exposure was significantly related to higher levels of PTSS and emotional problems, while more frequent perpetration of war-related violence was significantly related to higher levels of PTSS, behavioural problems, and criminal behavior. The perceived quality of relationships with caregivers significantly moderated the associations between youth’s cumulative trauma exposure and all four outcomes. At higher perceived quality of relationships with caregivers, the associations between trauma exposure and emotional problems, behavioural problems, and criminal behaviour were no longer significant and the association with PTSS was significantly weakened. Higher perceived quality of relationships with caregivers was also directly significantly related to lower levels of mental health problems and criminal behaviour.ConclusionsThe findings suggest that interventions that focus on strengthening relationships with caregivers are crucial for supporting the mental health and functioning of youth who experienced and perpetrated war-related violence.

Exploring mental functions utilised by male youth team-based ball-sport athletes within academy programs: a systematic review and meta-aggregation

Exploring mental functions utilised by male youth team-based ball-sport athletes within academy programs: a systematic review and meta-aggregation

Development of an evaluation list for older adult community-based rehabilitation needs through a Delphi method

Older adults’ functional and intrinsic abilities may decline with increasing age. The positive effects of comprehensive community-based rehabilitation services to maintain physical, mental, and social function are essential. Nevertheless, few tools are available to assess the community-based rehabilitation needs of older adults. Therefore, we aimed to construct a list for the comprehensive evaluation of community-based rehabilitation needs of older adults. The International Classification of Functioning, Disability, and Health (ICF) was used to construct a first draft of the assessment list. From September to November 2023, 18 experts from five provinces and nine tertiary hospitals and institutions of higher education in China participated in this Delphi study. The older adult community-based rehabilitation needs evaluation list included six dimensions and 29 items. The weights of the six dimensions, from high to low, included mental function rehabilitation need (0.30), body function rehabilitation need (0.24), social participation need (0.18), individual activity rehabilitation need (0.14), environmental rehabilitation need (0.09) and rehabilitation information need (0.05). Using the Delphi method, an assessment list of older adult community-based rehabilitation needs based on ICF was developed. Future work should evaluate the list’s reliability and validity and its application in managing community-based rehabilitation for older adults.

Botch improves cognitive impairment after cerebral ischemia associated with microglia-induced A1-type astrocyte activation

Vascular cognitive impairment (VCI) is a clinical syndrome that arises from cerebrovascular issues and associated risk factors, resulting in difficulties in at least one area of cognitive function. VCI has emerged as the second most prevalent type of dementia following Alzheimer's disease, yet there is no effective clinical treatment. Botch, an endogenous Notch1 antagonist, demonstrates neuroprotective effects by inhibiting neuroinflammatory responses mediated through the Notch pathway. While its role in stroke-induced neuroinflammation is well-established, its involvement in VCI remains largely unexplored. This study investigates the role and potential mechanisms of Botch in a rat model of cognitive impairment caused by bilateral common carotid artery occlusion (BCCAO). Firstly, we observed that Botch levels were down-regulated in BCCAO rats, which correlated with increased release of inflammatory cytokines and neuronal damage. Microglia in BCCAO rats released interleukin-1α (IL-1α), tumor necrosis factor-α (TNF-α), and complement component 1q (C1q), leading to the activation of neurotoxic C3+ A1 reactive astrocytes. Then, the down-regulation of Botch exacerbated microglia-mediated inflammation, activated C3+ A1 astrocytes, worsened neuronal damage, and led to a decline in cognitive function. Conversely, the re-expression of Botch alleviated C3+ astrocyte activation, inhibited neuronal damage, and improved mental function. In conclusion, Botch plays a crucial role in inhibiting neuroinflammation induced by type A1 reactive astrocytes. It achieves this by blocking the activation of microglia triggered by the Notch pathway. Ultimately, it inhibits neuronal damage to play a neuroprotective role. These findings suggest that Botch may represent a novel potential target for treating VCI.

Disturbances of Interoception in Schizophrenia – Focus on Neuroimaging

Abstract: The current paper presents the most recent theoretical understanding of interoception (INTC) in light of the predictive processing framework and the Embodied Predictive Interoceptive Coding model and reviews recent experimental data on different interoceptive disturbances in schizophrenia (SCZ) such as lower interoceptive accuracy, nociceptive dysfunction reflected by reduced pain sensitivity, disturbed thermoregulation, impaired gastrointestinal regulation, cardiovascular and respiratory dysfunction, and immune disturbances. The immense clinical implications of these disturbances are discussed in the context of the high rates of morbidity and mortality in SCZ related to suicide and cardiac death. Next, the potential of INTC-related treatments is reviewed, and conclusions are made on the evidence for the use of vagus nerve stimulation, mindfulness-based interventions, and exercise therapy. The neuroimaging perspective is given in a brief account of the INTC-related findings in healthy individuals suggesting the right anterior insula and anterior cingulate cortex as key brain areas for interoceptive awareness, accuracy, and sensibility, by supporting higher-order representation and integration of visceral, and somatosensory interoception with exteroceptive information. In SCZ, on the other hand, neuroimaging research on specific interoceptive abilities is lacking but indirect evidence points to disrupted activation of major INTC network hubs. There is converging evidence of changes in these hubs in terms of both structure and function (volume reductions, aberrant activation, and connectivity). This narrative review identifies several gaps in contemporary INTC-related research in SCZ that need to be addressed in future experimental and clinical studies to elucidate the exact nature of the disturbances of interoceptive abilities in modalities other than cardioception; the interactions between different interoceptive modalities; the association between interoceptive abilities and other mental functions (such as emotion recognition and regulation, decision making, learning, memory, etc.); the efficacy of nonpharmacological and pharmacological INTC-based interventions; and the relation of disturbed interoceptive abilities with brain structure and function.

The techno-politics of computing the mind: Opening the black box of digital psychiatry.

Psychiatry has recently witnessed the launch of digital phenotyping as a new research agenda. According to digital phenotyping's hypothesis, data about a patient's daily behavior can be continuously collected through wearable monitoring devices and used to build software that would send warnings of mental relapse or would tailor treatment choices. The research is exploratory, and the claims upon which it is based are contentious. Drawing on interviews, we followed a research team that aspired to build a digital system that could send such warnings to patients with mental health disorders like depression and epilepsy. This enabled us to learn how a new instrument to measure mental function becomes constructed and what translations take place in this process. Here we pay particular attention to the role of patients as research collaborators. We observed the frictions and debates in the research team between different mental health knowledge regimes, seeing them before they were black-boxed and lost from sight. We aimed to understand how actors anticipate software and data analytics to function alongside physicians and patients, as well as how different accounts reconstitute the 'mental', 'therapy', or the 'social' itself. We discuss several 'dissociations' that occur along the research trajectory regarding: less motivated and underrepresented patients, the role of clinical knowledge derived from patient self-reporting, and the social, political, and economic aspects of a patient's life affecting mental health. In this sense, we want to open the black box of this new behavioral technoscience.

Veterans in Northern Ireland: Evaluation of chronic pain experience, service type, and physical and mental health functioning

Background Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict’s nature and the fact that they were serving as a military and security presence in their home region. Methods A cross-sectional assessment of veterans living in Northern Ireland ( N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Results Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. Conclusions These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD.

Development of core sets for deafblindness using the International Classification of Functioning, Disability, and Health: the perspectives of individuals with lived experience.

The needs of people with deafblindness remain poorly understood and addressed globally. This study is part of a larger body of work to develop Core Sets for deafblindness using the International Classification of Functioning, Disability, and Health (ICF). To determine the perspectives on functioning of individuals with lived experience of deafblindness as they relate to the ICF. Cross-sectional interview study. Global, representing all six regions of the World Health Organization. A diverse cohort of 72 individuals living with deafblindness or as close family members, ranging across the spectrum of severity. Qualitative interviews and focus groups were used to explore six open-ended questions about perceived barriers and facilitators to functioning of body functions and structures, activities and participation, and environmental and personal factors. Data were synthesized using content analysis, and the resulting topics were linked to the ICF codes using established linking methodology prescribed by the World Health Organization's ICF Research Branch. Descriptive statistics summarized all demographic data. The analyses of the transcripts uncovered 2534 meaning units, leading to the identification of 492 corresponding distinct codes from the ICF framework, and spanning across 93.33% of coding categories available. Sensory (b2) and Mental Functions (b1) emerged as the most frequent Body Functions (b) codes. Most categories referred to Activities & Participation, with Mobility (d4) being the most frequently mentioned topic. Services, Systems and Policies (e5) was the most frequently used Environmental factor. Over 93% of the ICF classification categories were accessed to code the data provided by participants, demonstrating the complexity of functioning with deafblindness. This study provides valuable information to shape policy and research by providing representation of lived experience towards the consensus conference for the comprehensive and abbreviated Core Sets for deafblindness. The inclusion of lived experience provides a holistic understanding of the daily challenges faced by individuals living with deafblindness. By being part of this process, they have a voice in shaping the classification system that will be used to describe their experiences, fostering a sense of ownership and empowerment.

5184 Tirzepatide Improved Mental and Psychosocial Health-Related Quality of Life in Adults with Obesity or Overweight: Results from the SURMOUNT-4 phase 3 Trial

Abstract Disclosure: T.M. Gibble: Employee; Self; Employment and stockholder, Eli Lilly and Company. D. Cao: Employee; Self; Employment and stockholder, Eli Lilly and Company. M. Murphy: Employee; Self; Employment and stockholder, Eli Lilly and Company. I. Jouravskaya: Employee; Self; Employment and stockholder, Eli Lilly and Company. B. Liao: Employee; Self; Employment and stockholder, Eli Lilly and Company. Background: Tirzepatide is a once weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved in the U.S. for treatment of type 2 diabetes (T2D) and obesity. In the phase 3 SURMOUNT-4 trial with randomized withdrawal of tirzepatide maximum tolerated dose (MTD) after the first 36 weeks, continuing tirzepatide for a total of 88 weeks led to a mean weight reduction of 25.3% from baseline compared to 9.9% for those who switched to placebo (PBO).[1] This analysis evaluated the effect of tirzepatide versus PBO on mental and psychosocial health-related quality of life (HRQoL) outcomes using the SURMOUNT-4 trial data. Methods: Adults (n=783) with body mass index ≥30 or ≥27 kg/m2 and ≥1 obesity-related complication (excluding T2D) were enrolled in an open-label lead-in period to receive tirzepatide once weekly subcutaneously for 36 weeks, escalated to MTD (10 mg or 15 mg). At week (W) 36, 670 participants were randomized 1:1 to continue tirzepatide MTD (n=335) or were switched to PBO (n=335) for 52 weeks. HRQoL was evaluated from W0 to W88 using the Short Form-36 Version 2 Health Survey (SF-36 v2) acute form and Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), where the last observation before discontinuation was carried forward. Higher scores of SF-36v2 (Mental Component Summary [MCS], role-emotional, and mental health), and IWQOL-Lite-CT (psychosocial composite) reflected better levels of mental function. Least square mean (LSM) changes and estimated treatment differences (ETD) between tirzepatide and PBO were calculated using an analysis of covariance model. Results: LSM changes in mental domain scores for SF-36 v2 and IWQOL-Lite-CT were comparable during lead-in (W0 to W36) between participants randomized to tirzepatide and PBO. Significant improvements were observed from W36 to W88 in SF-36v2 mental domain scores for tirzepatide versus PBO, with LSM scores ( ETD) as follows: MCS, 54.6, 52.9 (1.7, p=0.001); role-emotional, 53.0, 51.1 (1.9, p=0.001), and mental health, 55.4, 52.9 (2.4, p<0.001), respectively. LSM change from W36 to W88 in SF-36 v2 mental domain scores for tirzepatide and PBO were: MCS, 0.1 and -1.6; role-emotional, 0.6 and -1.2, and mental health, 0.3 and -2.1, respectively. Tirzepatide showed significant improvements in IWQOL-Lite-CT psychosocial scores versus PBO from W36 to W88, with LSM scores ( ETD) of 87.7, 75.6 (12.1; p<0.001), respectively. LSM change from W36 to W88 in IWQOL-Lite-CT psychosocial scores for tirzepatide and PBO were 5.1 and -7.0, respectively. Conclusion: In the SURMOUNT-4 trial, adults with overweight or obesity continuing on tirzepatide MTD showed significant and sustained improvements in mental and psychosocial HRQoL compared to those switching to placebo. [1] Sattar N. 59th Annual Meeting European Association for the Study of Diabetes; Oct 2023; Hamburg, Germany. Presentation: 6/1/2024

9229 Tirzepatide Improved Mental and Psychosocial Health-Related Quality of Life in Adults with Obesity or Overweight: Results from the SURMOUNT-4 phase 3 Trial

Abstract Disclosure: T.M. Gibble: Employee; Self; Employment and stockholder, Eli Lilly and Company. D. Cao: Employee; Self; Employment and stockholder, Eli Lilly and Company. M. Murphy: Employee; Self; Employment and stockholder, Eli Lilly and Company. I. Jouravskaya: Employee; Self; Employment and stockholder, Eli Lilly and Company. B. Liao: Employee; Self; Employment and stockholder, Eli Lilly and Company. Background: Tirzepatide is a once weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved in the U.S. for treatment of type 2 diabetes (T2D) and obesity. In the phase 3 SURMOUNT-4 trial with randomized withdrawal of tirzepatide maximum tolerated dose (MTD) after the first 36 weeks, continuing tirzepatide for a total of 88 weeks led to a mean weight reduction of 25.3% from baseline compared to 9.9% for those who switched to placebo (PBO).[1] This analysis evaluated the effect of tirzepatide versus PBO on mental and psychosocial health-related quality of life (HRQoL) outcomes using the SURMOUNT-4 trial data. Methods: Adults (n=783) with body mass index ≥30 or ≥27 kg/m2 and ≥1 obesity-related complication (excluding T2D) were enrolled in an open-label lead-in period to receive tirzepatide once weekly subcutaneously for 36 weeks, escalated to MTD (10 mg or 15 mg). At week (W) 36, 670 participants were randomized 1:1 to continue tirzepatide MTD (n=335) or were switched to PBO (n=335) for 52 weeks. HRQoL was evaluated from W0 to W88 using the Short Form-36 Version 2 Health Survey (SF-36 v2) acute form and Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), where the last observation before discontinuation was carried forward. Higher scores of SF-36v2 (Mental Component Summary [MCS], role-emotional, and mental health), and IWQOL-Lite-CT (psychosocial composite) reflected better levels of mental function. Least square mean (LSM) changes and estimated treatment differences (ETD) between tirzepatide and PBO were calculated using an analysis of covariance model. Results: LSM changes in mental domain scores for SF-36 v2 and IWQOL-Lite-CT were comparable during lead-in (W0 to W36) between participants randomized to tirzepatide and PBO. Significant improvements were observed from W36 to W88 in SF-36v2 mental domain scores for tirzepatide versus PBO, with LSM scores ( ETD) as follows: MCS, 54.6, 52.9 (1.7, p=0.001); role-emotional, 53.0, 51.1 (1.9, p=0.001), and mental health, 55.4, 52.9 (2.4, p<0.001), respectively. LSM change from W36 to W88 in SF-36 v2 mental domain scores for tirzepatide and PBO were: MCS, 0.1 and -1.6; role-emotional, 0.6 and -1.2, and mental health, 0.3 and -2.1, respectively. Tirzepatide showed significant improvements in IWQOL-Lite-CT psychosocial scores versus PBO from W36 to W88, with LSM scores ( ETD) of 87.7, 75.6 (12.1; p<0.001), respectively. LSM change from W36 to W88 in IWQOL-Lite-CT psychosocial scores for tirzepatide and PBO were 5.1 and -7.0, respectively. Conclusion: In the SURMOUNT-4 trial, adults with overweight or obesity continuing on tirzepatide MTD showed significant and sustained improvements in mental and psychosocial HRQoL compared to those switching to placebo. [1]Sattar N. 59th Annual Meeting European Association for the Study of Diabetes; Oct 2023; Hamburg, Germany. Presentation: 6/1/2024

Pelayanan Fisioterapi Melalui Pemeriksaan Mini-Mental State Examination Untuk Menilai Fungsi Kognitif Lansia di RW 8 Kelurahan Tanjung Rejo Kota Malang

Impaired cognitive function is still a serious health problem that can cause psychological and socio-economic impacts in the form of social isolation and financial difficulties, delayed mobility, and worsening of other symptoms as well as reducing quality of life. As a basis for elderly health services, it is hoped that healthy elderly people will remain healthy. by optimizing physical, mental, cognitive and spiritual functions, through promotive and preventive efforts, including elderly empowerment activities. This counseling aims to assess cognitive function using the Mini Mental State Examination (MMSE) in the elderly at Posyandu for the elderly RW 8 Tanjung Rejo, Malang City. The method given is an examination using the Mini Mental State Examination (MMSE) questionnaire. The counseling process went smoothly. The results of the examination showed that the majority of elderly people had normal cognitive conditions. A good lifestyle can reduce the risk of dementia.

Aligning the World Health Organization's (WHO) package of interventions for rehabilitation for cancer with the mission of the International Psycho-Oncology Society's: promoting psychosocial care for all people affected by cancer

Abstract The number of people living with and beyond cancer continues to increase worldwide, bringing significant attention to their rehabilitation needs. Globally, psychosocial services are largely inadequate, with many cancer survivors experiencing unmet psychosocial needs. The World Health Organization (WHO) recognizes rehabilitation as an essential component of universal health coverage to prevent disease-related conditions, while also improving physical and mental functioning and overall well-being. The Package of Interventions for Rehabilitation (PIR) was developed by the WHO to address the global need for rehabilitation across 20 conditions with high prevalence and high levels of associated disability, including cancer. Many aspects of the WHO PIR align with the mission and focus of the International Psycho-Oncology Society (IPOS). This commentary describes the WHO PIR for Cancer and proposes opportunities to advance cancer rehabilitation research, policy, and practice as they align with recent and ongoing initiatives of IPOS.

Effectiveness of a theory-underpinning exercise intervention among community-dwelling (pre)frail older adults: A stepped-wedge cluster-randomized trial

ObjectivesTo evaluate the effectiveness of a theory-underpinning exercise intervention among Chinese community-dwelling (pre)frail older adults, and the impacts of intervening late as opposed to intervening early. MethodsThis was a stepped-wedge cluster-randomized trial. Participants were enrolled from six communities in a county of central China from January to November in 2021 (n = 149). A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented among 149 community-dwelling (pre)frail older adults during the study period. The primary outcomes were frailty and muscle mass, muscle strength and physical performance. Secondary outcomes included physical disability, fear of falling, cognitive function, depressive symptoms, social support and quality of life. Assessments were conducted at baseline and at 12, 24 and 36 weeks. A multilevel regression model was used for statistical analysis. ResultsThe positive effects were statistically significant on frailty (β = −1.166, p = 0.016), muscle mass (β = 1.499, p = 0.005), handgrip strength (β = 14.758, p < 0.001), physical performance (Short Physical Performance Battery, β = 6.043, p < 0.001), physical disability (Activities of Daily Living: β = 0.462, p = 0.043; Instrumental Activities of Daily Living: β = 0.693, p = 0.049;) and fear of falling (β = −1.490, p = 0.003), cognitive function (β = −0.466, p = 0.011), depressive symptoms (β = −0.541, p < 0.001), social support (β = 27.661, p < 0.001), physical (β = 2.413, p = 0.013) and mental (β = 7.837, p < 0.001) components of quality of life at 0-week postintervention, and most of them persisted at 12- and 24-week postintervention. The effectiveness significantly differed by the time of interventions on muscle mass (β = −1.217, p = 0.002), 5-time chair stand test (β = −1.172, p = 0.018), cognitive function (β = 0.600, p = 0.014) and mental component of quality of life (β = −12.679, p = 0.002). ConclusionThe theory-underpinning exercise intervention has positive immediate and persistent effects on frailty, frailty-related characteristics as well as physical, mental and social functioning among Chinese community-dwelling (pre)frail older adults. Late intervention attenuated the significant intervention effect. Trial registrationChinese Clinical Trial Registry ChiCTR2100041981.

A meta-analysis of cognitive flexibility in aging: Perspective from functional network and lateralization.

Cognitive flexibility, the ability to switch between mental processes to generate appropriate behavioral responses, is reduced with typical aging. Previous studies have found that age-related declines in cognitive flexibility are often accompanied by variations in the activation of multiple regions. However, no meta-analyses have examined the relationship between cognitive flexibility in aging and age-related variations in activation within large-scale networks. Here, we conducted a meta-analysis employing multilevel kernel density analysis to identify regions with different activity patterns between age groups, and determined how these regions fall into functional networks. We also employed lateralization analysis to explore the spatial distribution of regions exhibiting group differences in activation. The permutation tests based on Monte Carlo simulation were used to determine the significance of the activation and lateralization results. The results showed that cognitive flexibility in aging was associated with both decreased and increased activation in several functional networks. Compared to young adults, older adults exhibited increased activation in the default mode, dorsal attention, ventral attention, and somatomotor networks, while displayed decreased activation in the visual network. Moreover, we found a global-level left lateralization for regions with decreased activation, but no lateralization for regions with higher activation in older adults. At the network level, the regions with decreased activation were left-lateralized, while the regions with increased activation showed varying lateralization patterns within different networks. To sum up, we found that networks that support various mental functions contribute to age-related variations in cognitive flexibility. Additionally, the aging brain exhibited network-dependent activation and lateralization patterns in response to tasks involving cognitive flexibility. We highlighted that the comprehensive meta-analysis in this study offered new insights into understanding cognitive flexibility in aging from a network perspective.

ВЛИЯНИЕ ИНТЕРАКТИВНОГО ФИЗКУЛЬТУРНОГО КОМПЛЕКСА НА РЕАБИЛИТАЦИЮ ДЕТЕЙ С ЗАДЕРЖКОЙ ПСИХИЧЕСКОГО РАЗВИТИЯ

An urgent issue today is the increase in the number of children with mental retardation. Statistics from the last five years show that more than 20% of children are born with lesions of the central nervous system. Perinatal pathology leads to a delay in mental and motor development and subsequently contributes to the risk of children's academic failure, maladjustment and social deviation. For a comprehensive solution to the problem, rehabilitation methods should be correctly selected, aimed at improving mental functions, developing physical qualities and forming motor skills. The purpose of the study is to study the effectiveness of an interactive physical education complex in the rehabilitation of children with mental retardation. The results obtained made it possible to identify the effectiveness of the use of a non–drug rehabilitation method - an interactive physical education complex for the development of cognitive functions and physical qualities of primary school children with mental retardation. To identify the level of logical thinking, the "Exclusion of excess" method was used, dexterity of movements was assessed by the "Darts" test, communicative activity was identified using a questionnaire for parents using the Makarchuk A.V., Gorinova E.V. method, large hand motor skills were assessed by a functional motor test, fine hand motor skills were assessed by the Grizik T.I., Tymoshchuk L.F. method. In the study of logical thinking in children after the rehabilitation course, an increase in the average values of the indicator was revealed in the main group, there were no changes in the control group. The results of the dexterity assessment test showed that after rehabilitation, the average values of the indicator increased only in the main group where the interactive complex was used. When evaluating communicative activity, it was revealed that when comparing groups, no changes were found in the average values of the indicator, however, the level of social interaction in the main group moved from "average" to "high" on a point scale, in the control group the level remained the same. When evaluating large hand motor skills, it was revealed that after rehabilitation in the main group, in which an interactive physical education complex was used, the average values of the indicator increased and began to correspond to the assessment "good", in the control group the indicator did not change – the assessment "satisfactory". In the study of fine motor skills, an increase in the average values in the main group was revealed: from the level of "poor development" to the level of "insufficiently good development", there were no changes in the control group. Thus, the interactive physical education complex increases the indicators of logical thinking, dexterity of movements, large and small hand motor skills and improves the level of communicative activity.

Effect of Mental Health on Level of Injury and Life Satisfaction among Young Elite Athletes-A Barrier or Augment: An Observational Study

Introduction: Sports injuries can have long-term psychological and physical ramifications. For instance, concussions can affect a person's quality of life by causing a variety of cognitive problems and emotional swings. Joint injuries can also make athletes more susceptible to musculoskeletal issues in the future, which could limit their capacity to exercise and lower their level of enjoyment and general well-being. Gaining a thorough grasp of the mental health and psychological well-being unique to top athletes may help to improve models of treatment and management for this group, which might ultimately lead to improved performance, lower risk of injuries and improve quality of life. Sport professionals, such as coaches, medical personnel, and sport psychologists, need to have this understanding in order to help elite athletes improve their mental wellness by helping them build coping mechanisms. Methods: The study was performed in NIMS University, in 2024. The survey contained information about the purpose and objectives of the study, informed consent, sociodemographic questions, questions related to mental health, life satisfaction and level of injury questionnaires concerning various aspects of well-being (stress level, depression, anxiety, satisfaction, and physical health, level of physical, mental and social functioning). Result: In this study, a total of 258 participants were included in the analysis. The average age of the participants was 19.5 years, with 52.7% of the sample being women and 47.3% men. Conclusion: A distinct set of pressures that elite athletes face might make them more susceptible to mental illness. Important elements include coping with continuous performance pressure from competition, the psychological effects of injuries, life satisfaction, overtraining, and burnout, and intensive public and media scrutiny.

Patient journey, disease burden, and functional disability in patients with axial spondyloarthritis in South Africa: results of International Map of Axial Spondyloarthritis (IMAS)

ObjectiveTo assess the unmet needs of South Africans with axial spondyloarthritis (axSpA) focusing on the patient journey, functional disability, and health-related quality of life.MethodsOne hundred forty-six South African axSpA patients completed the International Map of Axial Spondyloarthritis (IMAS) online survey. Patient journey, functional disability, activities of daily living, and psychological stress were analyzed in relation to socio-demographic characteristics, disease activity, diagnostic delay, extra-musculoskeletal manifestations, and drug therapy.ResultsMajority were female (82.2%) and Caucasian (89.7%) and the mean age of participants, age at onset of initial symptoms, and diagnostic delay were 44.7, 26.7, and 10.8 years, respectively. Participants reported a mean of 3.4 visits to healthcare professionals prior to a definitive diagnosis of axSpA, mostly made by rheumatologists (77.9%). Active disease (BASDAI ≥ 4) was reported by 87%, 69.9% suffered from psychological distress (general health questionnaire-12 score ≥ 3), and more than two-thirds suffered functional limitations in daily, personal, and social activities. Multivariable logistic analysis showed that active disease was more common in females [OR (95% CI) = 4.3 (1.2–15.2)] and was associated with greater functional limitation [OR (95% CI) = 1.1 (1.0–1.2)].ConclusionOf all the regions assessed in the IMAS (n = 5557 participants, 27 countries), South Africans reported the longest delay in diagnosis. The South African patient journey depicts a process burdened with diagnostic challenges and delays, coupled with patients experiencing significant personal and social limitations. These results emphasize the urgent need to establish local diagnostic and treatment guidelines for axSpA in South Africa, to reduce diagnostic delay, and to control disease activity associated with functional limitation in axSpA.Key Points• Axial spondyloarthritis (axSpA) in South Africans is associated with significant limitations in physical, mental, and social functioning.• First study to describe the unmet needs of South African patients with axSpA.

The role of vagal nerve stimulation on psychosocial associated disorders in refractory epilepsy patients.

To determine the effects of vagal nerve stimulation on cognition and epilepsy-associated psychosocial problems in patients with intractable epilepsy, and to assess their relation to seizure decline. The longitudinal study was conducted at Saad Al-Witry Neurosciences Hospital, Baghdad, Iraq, from December 2015 to December 2020, and comprised refractory epilepsy cases with implanted vagal nerve stimulation devices. They were subjected to pre- and post-implantation epilepsy protocol assessment with added neuropsychological evaluation using the Mini-Mental State Examination system. Each case was followed up for 2 years post-implantation. Descriptive data regarding patient records of age, seizure nature, mental functioning level, and vagal nerve stimulation insertion was noted. Data was analysed using SPSS 21. Of the 150 patients, 75(50%) each were males and females, with 70(46.7%) aged <10 years at the time of surgery. Overall, 80(53.3%) patients had partial seizures with secondary generalisation, 70(46.7%) had refractory seizure attacks for <5 years, 78(52%) had attack frequency of 2-5 per day. All 150(100%) patients had had vagal nerve stimulation for >2 years. Post-intervention, 80(53.3%) patients had <2 attacks per day. Mini-Mental State Examination score was >25 in 35(23.3%) patients which post-intervention rose to 64(42.7%). There was evidence of improvement with respect to patient characteristics predictive of vagal nerve stimulation-related cognition and neuropsychological responsiveness in refractory epilepsy.