Objective Cognitive Function Research Articles

Socioeconomic Inequalities in Frailty in Hong Kong, China: A 14-Year Longitudinal Cohort Study.

The prevalence of frailty varies among socioeconomic groups. However, longitudinal data for the association between subjective social status and frailty is limited. In this study, we examined whether subjective social status was associated with incident frailty. Data were obtained from a 14-year cohort of Chinese men and women (n = 694) aged 65 years and older who participated in the MrOs study—a longitudinal study on osteoporosis and general health in Hong Kong. Subjective social status at baseline (2001–2003) was assessed using a 10-rung self-anchoring scale. Incident frailty at the 14-year follow-up (2015–2017) was defined as proposed by Fried and colleagues. Ordinal logistic regressions were used to examine the association between subjective social status (high, middle, or low) and incident frailty. After adjustment for age, sex, marital status, objective socioeconomic status, medical history, lifestyle, mental health, and cognitive function, subjective social status at baseline was negatively associated with risk of developing frailty over time (OR 2.3, 95% CI 1.2–4.6). In sex-stratified analysis, the social gradient in frailty was only found in men. Social inequality in frailty in men but not in women supports interventions specific to gender inequality and frailty.

Decreasing postoperative cognitive deficits after heart surgery: protocol for a randomized controlled trial on cognitive training

BackgroundThe occurrence of postoperative cognitive deficits, especially after heart surgery, has been demonstrated in several studies. These deficits can clearly be noticed by the patients and by their close relatives in daily life. Furthermore, postoperative cognitive deficits can decrease quality of life in social functioning and earning capacity. The aim of this study is to investigate whether early postoperative cognitive training can reduce subjective and objective postoperative cognitive deficits.MethodsThe proposed study is a multicenter, two-arm, randomized controlled trial involving 144 elderly patients undergoing elective heart-valve surgery with extracorporeal circulation. Patients will be assigned to either a training group or a control group. The intervention involves paper-and-pencil-based cognitive training, which is conducted for 36 min over a period of 18 days. The training starts about 1 week after surgery and is carried out during the hospitalized rehabilitation phase. The control group will not receive cognitive training or a placebo intervention. A detailed assessment of psychological functions and health-related quality of life prior to surgery at discharge from rehabilitation and 3 and 12 months after discharge will be performed. The primary outcome of this trial is the training effect on objective cognitive functions at discharge from rehabilitation. Secondary outcomes are the training effect on objective and subjective cognitive functions (3 and 12 months after discharge), depression, health-related quality of life, and the impact of perioperative cerebral ischemia on the training effect. Perioperative cerebral ischemia will be measured with postoperative magnetic resonance imaging including diffusion-weighted sequences.DiscussionShould it be shown that our cognitive training can improve postoperative cognitive deficits and quality of life, one possibility could be to integrate this intervention into early rehabilitation. Furthermore, we hope that the investigation of perioperative ischemia by diffusion-weighted magnetic resonance imaging will improve our understanding of neurobiological factors influencing the course of postoperative cognitive plasticity.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00015512. Retrospectively registered on 21 September 2018.

Plasma luteinizing hormone level affects the brain activity of patients with polycystic ovary syndrome

ObjectiveCognitive function has been reported to be impaired in women with polycystic ovary syndrome (PCOS). This study aimed to investigate the effect of PCOS on brain activity and explore the relationship between brain activity and sex hormone levels in women with PCOS (WPCOS). MethodsTwenty-one women aged 18–45 years old with new-diagnosed PCOS were enrolled. Plasma levels of six sex hormones including luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were tested during the 2–5 days of their menstrual periods. Twenty-seven healthy controls (HC) were recruited. Every subject underwent a resting-state functional magnetic resonance imaging (fMRI). The amplitude of low-frequency fluctuation (ALFF) of the whole brain was evaluated followed by the functional connectivity (FC) analysis. Finally, the correlation between the ALFF, FC of the significant areas and the plasma hormone levels were analyzed. ResultsThe patients showed increased ALFF value in the left inferior temporal gyrus (ITG.L) and decreased ALFF value in the left inferior occipital gyrus (IOG.L) as well as the superior frontal gyrus (SFG.R, P < 0.005). For the FC analysis, patients showed decreased FC in SFG.R with the right middle frontal gyrus (MFG.R, P < 0.05). The FC between SFG.R and MFG.R was negatively correlated with LH level (R=-0.594, P = 0.005) and with the LH/FSH ratio (R=-0.521, P = 0.015). ConclusionPCOS can induce changes in activities of brain regions responsible for visuospatial working memory, face processing and episodic memory. The reduced functional connectivity within the right frontal lobe is related with the high LH level in WPCOS.

Role of depressive symptoms in subjective memory complaint in older adults with mild cognitive impairment.

To explore the independent relationship between depressive symptoms and subjective memory complaint (SMC) amongst older adults with mild cognitive impairment (MCI) after adjusting for objective cognitive function and other important confounding factors. subjective memory complaint is a core symptom of MCI and is often the primary reason for older adults with MCI to seek for medical help. Improving subjective memory amongst older adults with MCI is important to enhance their quality of life and potentially delay further cognitive decline. Depressive symptoms, which are highly prevalent neuropsychiatric symptoms amongst older adults with MCI, may be one of the reasons that affect an individual's self-perception of memory function. However, there is a dearth of studies to provide a thorough evaluation of the independent relationship between depressive symptoms and SMC amongst older adults with MCI. A descriptive correlational study. A consecutive sample (N=154) of adults aged over 60years was recruited from a community healthcare centre between June and September 2016. MCI was detected using the Montreal Cognitive Assessment. Depressive symptoms and subjective memory were measured using the Geriatric Depression Scale and Memory Inventory for the Chinese, respectively. Hierarchical regression was performed to explore the relationship between SMC and depressive symptoms, with control over objective cognitive function, socio-demographic and health-related confounding factors. After controlling objective cognitive function and other confounding factors, SMC was independently associated with depressive symptoms (standardised β=0.336, p<.001). This psychological status even explained for a greater variance (R2 =8.8%) for SMC compared with objective cognitive function (R2 =2.4%). subjective memory complaint was independently associated with depressive symptoms in older adults with MCI. Early detection and management of depressive symptoms are highly important amongst this clinical cohort. Early detection and prompt treatment of depressive symptoms is a highly prioritised care agenda in managing SMC in older adults with MCI.

Cognitive Performance and Psychological Distress in Breast Cancer Patients at Disease Onset.

ObjectiveMany cancer patients complain about cognitive dysfunction. While cognitive deficits have been attributed to the side effects of chemotherapy, there is evidence for impairment at disease onset, prior to cancer-directed therapy. Further debated issues concern the relationship between self-reported complaints and objective test performance and the role of psychological distress.MethodWe assessed performance on neuropsychological tests of attention and memory and obtained estimates of subjective distress and quality of life in 27 breast cancer patients and 20 healthy controls. Testing in patients took place shortly after the initial diagnosis, but prior to subsequent therapy.ResultsWhile patients showed elevated distress, cognitive performance differed on a few subtests only. Patients showed slower processing speed and poorer verbal memory than controls. Objective and self-reported cognitive function were unrelated, and psychological distress correlated more strongly with subjective complaints than with neuropsychological test performance.ConclusionThis study provides further evidence of limited cognitive deficits in cancer patients prior to the onset of adjuvant therapy. Self-reported cognitive deficits seem more closely related to psychological distress than to objective test performance.

Integrating Geriatric Assessment and Genetic Profiling to Personalize Therapy Selection in Older Adults with Acute Myeloid Leukemia (AML)

Introduction: Geriatric assessment can predict the risk of toxicities of chemotherapy in older adults. Genetic risk categories correlate with survival following intensive chemotherapy in AML. Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative precision medicine approach to personalize therapy selection in older adults with AML. We report results of a pre-planned interim analysis of a pragmatic phase II trial using such strategy that has an overarching goal to reduce early mortality (NCT03226418). Methods: Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for intensive chemotherapy (Table 1). Additional assessment included Karnofsky Performance Scale (KPS), Patient Health Questionnaire-9 (PHQ-9), and Mini Nutritional Assessment-Short Form (MNA). Genetic profiling for therapy selection relied on karyotyping and followed the 2017 European LeukemiaNet criteria. While available mutation test results were incorporated to risk stratify, the study did not require to wait for the results prior to therapy initiation given an anticipated turnaround time of 1-2 weeks for mutation test results. Therapy selection followed the algorithm demonstrated in Figure 1. Patients with good or intermediate-risk AML received intensive chemotherapy such as 7+3 +/- gemtuzumab or midostaurin if determined to be fit. Patients with high-risk AML received low-intensity chemotherapy such as a hypomethylating agent with or without novel drugs, or CPX 351 if they were fit and met the FDA-approved indications. Patients with organ dysfunction (e.g. creatinine ≥2 mg/dl) and those requiring chemotherapy for other malignancy received low-intensity chemotherapy. Chemotherapy at diagnosis or follow up could be administered in community oncology settings. Patients were followed for assessment of quality of life, functional and oncologic outcomes. Results: Between July 2017-June 2019, a total of 31 patients (including 1 MDS patient considered screen failure) were enrolled. The pre-planned interim analysis results are based on the first 27 AML patients. Baseline characteristics included a median age of 70 years (range 60-84 years), 56% female, 96% white, and a median KPS of 80% (range 60-100%). As presented in Table 1, over half of the patients had ≥3 comorbidities, impairment in objective physical function (short physical performance battery) and Montreal Cognitive Assessment. Additionally, 67% had poor nutritional status (MNA score of ≤11) and 26% had abnormal depression screen (PHQ-9 score of ≥10). Risk categories included adverse (64%), intermediate (16%), and good-risk AML (20%). Patients had one or more of the following mutations: FLT3 ITD (11%), NPM1 (22%), biallelic CEBPA (4%), IDH1 (15%), IDH2 (8%), RUNX1 (15%), ASXL1 (22%), and TP53 (19%). Three patients received intensive chemotherapy; CPX 351 (n=2) or 7+3+ gemtuzumab (n=1). Other patients received decitabine or azacitidine alone (n=16), azacitidine and venetoclax (n=5) or decitabine and midostaurin (n=3). The median time from diagnosis to therapy initiation was 7 days (0-20 days) whereas the median time from enrollment to therapy initiation was 2 days (range 0-9). Mortality at 30 days from diagnosis was 3.7% (95% confidence interval, CI 0.7-18.3%) and at 90 days was 29.6% (95% CI 15.9-48.5%). Mortality compared favorably to an unmatched historical cohort of patients ≥60 years treated at our center between 2011-2016, where 30-day mortality was 30% (95% CI 22-40%) and 90-day was 41% (95% CI 32-52%) (Future Oncol. 2019;15:1989-95). Conclusions: Our model to personalize AML therapy selection represents an innovative approach to precision medicine that incorporates both geriatric assessment for patient profiling and genetic profiling of leukemia cells. Geriatric assessment demonstrated high frequency of impairment in objective physical and cognitive function. Patients were able to start therapy within a median of 2 days following enrollment. Pragmatic aspects of the trial included broad eligibility criteria and co-management of patients with community oncologists. Our pre-planned interim analysis data appear promising with lower rates of early mortality compared to unmatched historical controls. Disclosures Bhatt: Pfizer: Consultancy; CSL Behring: Consultancy; Agios: Consultancy; Abbvie: Consultancy; Partner therapeutics: Consultancy; Incyte: Consultancy, Research Funding; Tolero Pharmaceuticals: Research Funding; National Marrow Donor Program: Consultancy. Al-Kadhimi:Celldex Biotech: Other: Stocks; Seattle Genetics: Other: Stocks. Armitage:Oncology Analytics: Consultancy; Partner Therapeutics: Consultancy; Samus Therapeutics: Consultancy; Ascentage: Consultancy; Tesaro bio: Membership on an entity's Board of Directors or advisory committees; Union Pacific: Consultancy. Holstein:GSK: Consultancy; Genentech: Membership on an entity's Board of Directors or advisory committees; Sorrento: Consultancy; Celgene: Consultancy; Takeda: Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees. Gundabolu:Samus Therapeutics: Research Funding; Jazz pharmaceuticals: Consultancy; Pfizer: Consultancy; Novartis: Consultancy. OffLabel Disclosure: Single agent azacitidine and decitabine as well as decitabine in combination with midostaurin are not approved by the US FDA for acute myeloid leukemia.

DIRECTIONALITY BETWEEN COGNITION AND DEPRESSIVE SYMPTOMS: A LONGITUDINAL CROSS-LAGGED PANEL ANALYSIS

Background and Objectives: The relationship between objective and subjective cognitive function and depressive symptoms is complex and potentially multidirectional. This longitudinal prospective study examined the directionality of their relationship among a community sample of older people with no known diagnosis or treatment for dementia or depression. Research Design and Methods: We examined the temporal relationship between objective cognitive functioning, subjective cognitive complaints, and depressive symptoms in 1,814 community-dwelling older people at baseline and one-year follow-up using regression and two-wave cross-lagged panel analyses, after controlling for demographic and health confounders. Results: Cross-lagged analysis showed that depressive symptoms at follow-up were directly predicted by baseline subjective cognitive complaints, but not baseline objective cognitive functioning. The effect differed across objective cognitive functioning levels. In people with clinically significant cognitive impairment at baseline, objective cognitive decline but not baseline subjective cognitive complaints predicted depressive symptoms. In people with mild objective cognitive impairment at baseline, baseline subjective complaints but not objective cognitive decline predicted depressive symptoms. Discussion and Implications: The effects of objective and subjective cognitive decline on depressive symptoms varied across older people with different levels of cognitive impairment. Awareness and insight of one’s cognitive status may contribute to the development/progression in depressive symptom in people with mild cognitive impairment. Mechanisms unrelated to appraisal may be involved in increased depressive symptoms among older persons with significant objective cognitive impairment.

ASSOCIATION BETWEEN SUBJECTIVE AND OBJECTIVE COGNITIVE FUNCTION IN CHINA

Although subjective cognitive decline is considered as a potential symptomatic indicator of cognitive decline, little is known regarding the relationships in older adults in China. Using the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 data, we examined the association between subjective cognitive function, perceived memory decline, and objective cognitive function among adults aged 50 or older (N=13,367) in China. Objective cognitive function was measured by immediate and delayed recall test, digit span test, and verbal fluency test. Multivariate linear regression models were used to account for sociodemographic, psychosocial, and health-related factors. We found worse subjective cognitive function was associated with poorer working memory and verbal fluency. Greater perceived memory decline was also associated with poorer working memory but not with verbal fluency. Psychosocial factors including social cohesion and social support attenuated the relationships between subjective cognitive function, perceived memory decline, and objective cognitive performance.

SOCIAL AND PSYCHOLOGICAL FACTORS AND COGNITIVE FUNCTION: FINDINGS FROM INTERNATIONAL SURVEYS

This symposium examines how social and psychological factors including formal schooling, subjective memory, and neuropsychological symptoms impact cognitive function among older adults in China and the U.S. The first paper used the WHO’s Study on global AGEing and adult health Wave-1 data to examine the relationship between subjective cognitive function, perceived memory decline, and objective cognitive function among older adults in China. The results showed worse subjective cognitive function was associated with poorer working memory and verbal fluency, whereas greater perceived memory decline was associated only with poorer working memory. Furthermore, using data from the Health and Retirement Study, the second paper applied group-based trajectory modeling to assess dual trajectories of subjective memory impairment and objective cognitive decline. Four distinct dual-trajectory typologies were identified, suggesting complex co-occurring changes in subjective memory and objective cognition in older adults. The third paper characterized the trajectories of three neuropsychological symptoms (pain, insomnia, and depression) prior to dementia onset. Using data from the National Health and Aging Trends Study, the study found older adults with dementia exhibit distinct trajectory of depression before dementia onset than those without dementia. Trajectories of pain and insomnia did not differ before dementia onset. The last paper examined the effect of education on cognitive decline among lower educated older adults using data from the Longitudinal Study of Older Adults in Anhui Province, China. Results suggest that older adults with some formal schooling had slower cognitive decline; the gap in cognition between the literate and illiterate widened with age.

The impact of chemotherapy on cognitive function: a multicentre prospective cohort study in testicular cancer.

The causal link between chemotherapy and cognitive impairment is unclear. We studied testicular cancer patients' objective and subjective cognitive function longitudinally, comparing a surgery group with a surgery + chemotherapy group, addressing prior methodological issues using a computerized test to limit assessment issues, and controlling for confounding variables. Prospectively, of 145 patients from 16 centres with sufficient data, n = 61 receiving surgery + chemotherapy (etoposide and cisplatin ± bleomycin, BEP/EP; or single agent carboplatin) were compared to n = 41 receiving surgery alone. CogHealth assessed six objective cognitive tasks. The Cognitive Failures Questionnaire assessed self-perceived cognitive dysfunction. The Functional Assessment of Chronic Illness Therapy-Fatigue and the Hospital Anxiety and Depression Scale assessed psychological influences. Linear mixed models compared changes from baseline (< 6 months post-surgery/pre-chemotherapy) to follow-up (12-18 months post-baseline), controlling covariates. There were no significant interaction effects for five objective cognitive function tasks suggesting that changes over time were not due to group membership. However, psychomotor function (controlling for age) and physical well-being were significantly worse for the chemotherapy versus the surgery group at baseline, with groups converging by follow-up. Groups showed no differences in subjective cognitive dysfunction. The chemotherapy group showed higher anxiety, poorer functional well-being and worse fatigue compared to the surgery-only group at baseline, but not by follow-up. For both groups, emotional well-being, functional well-being and anxiety significantly improved over time. No substantive differences in objective or subjective cognitive dysfunction in either group persisted 12-18 months post-baseline. Patients undergoing chemotherapy for testicular cancer differ from findings in breast cancer populations. ClinicalTrials.gov Identifier: ACTRN12609000545268.

Computerized programs for cancer survivors with cognitive problems: a systematic review.

This study aimed to review and identify characteristics and lessons learned from studies on computerized cognitive interventions for cancer survivors (CSs) with cognitive dysfunction, exploring the content and results of interventions. Studies were collected from the CINAHL, Web of Science, PubMed, and PsycINFO databases. Seven articles that met the inclusion criteria were included. Reviewed studies measured objective cognitive function, subjective cognitive function, and psychological aspects. Computerized interventions for CSs with cognitive decline were effective for executive function, memory, working memory, and speed of thought in the domain of objective cognitive function. Some subjective cognitive functions also showed significant improvement. Computerized cognitive interventions have a positive impact on objective, subjective, and psychological aspects of cognitive problems. Further research needs to include more men as well as different cancer types. Programs also should include more than one target domain. Future researchers need to develop mobile applications that can effectively use computerized cognitive interventions. Results of this study should help provide optimal approaches to develop and apply effective computerized-cognitive-intervention programs. Health care providers need to be involved in these types of interventions and methods to encourage CSs to proactively practice cognitive-function training need to be developed.

The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans.

Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effects of a dyadic strength-based empowerment program on the health outcomes of people with mild cognitive impairment and their family caregivers: a randomized controlled trial.

PurposeAs an intermediate prodromal stage of dementia, mild cognitive impairment (MCI) causes functional, emotional, and social challenges for both of the person with MCI (PwMCI) and their family caregiver. However, major attention has only been placed on the PwMCI’s for cognitive training. This study evaluated a more comprehensive intervention, which integrated both strength-based and empowerment approaches, to address their complex needs in a dyadic fashion.Patients and methodsThis randomized controlled trial allocated 103 MCI patient-caregiver dyads to receive a 14-week dyadic strength-based empowerment program (D-StEP-MCI, n=52) or usual care (n=51). The D-StEP-MCI program consisted of group-based session to the PwMCI, home-based dyadic sessions, and telephone follow-up, with the activities supported the care dyads to navigate their own strengths and resources for integration, together with the trained skills, to optimize role and social engagement in everyday life. Dyadic health outcomes in terms of subjective and objective cognitive function, and neuro-psychiatric symptoms of PwMCI, stress in symptom management of their family caregivers, and depression of the dyads were evaluated at baseline, after the D-StEP-MCI and at 3 months thereafter.ResultsBy using general estimating equation, the D-StEP-MCI significantly improved the cognitive function, subjective memory, and mood status of the PwMCI, and the positive changes were maintained at the 3-month endpoints. It also has significantly positive effects on caregivers’ stress in symptom management and level of depression.ConclusionOur findings showed the health benefit of combining strength-based and empowerment approach in supporting the disease adaptation of PwMCI and caregiver in a dyadic fashion. This study also supports the use of a social interaction approach to optimize the everyday engagement of the PwMCI.

A comparative subjective and objective cognitive function analysis in women with preeclampsia and women with eclampsia

A comparative subjective and objective cognitive function analysis in women with preeclampsia and women with eclampsia

An Exploration of the Oryza sativa L. Cyanidin-3-glucoside on the Cognitive Function in Older Adults with Subjective Memory Impairment

ObjectiveCyanidin-3-glucoside (C3G), is a component of anthocyanin, have been considered to positively influence cognition and be beneficial for the prevention and treatment of dementia. We aimed to assess the safety and efficacy of cyanidin-3-glucoside-rich Oryza sativa L. (black rice) extract on cognitive function. MethodsA 12-weeks double-blind randomized, placebo controlled trial assessed safety and cognitive outcomes in participants with subjective memory impairment (n=48) following consumption of 6 black rice extract capsules or a placebo. Cognitive function was assessed using the ADAS-cog and the CERAD-K. Subjective memory impairment also assessed. Safety was assessed by hematologic blood test, urine analysis, and participant reports of adverse events. ResultsThere was significant improvement on subjective memory in intervention group. There was no statistically significant difference in objective cognitive outcomes following 12 weeks of consuming black rice extract. ADAS-cog scores, however, trended toward improvement in the intervention group compared to the placebo group. There was no adverse event. Conclusion Although significant improvement in objective cognitive function was not proved, we found that C3G-rich Oryza sativa L. extract improves subjective memory in this study. Therefore the results may be informative of the possible effectiveness of the C3G-rich Oryza sativa L. on cognitive function.

Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

BackgroundAcute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients’ expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia. ObjectiveThis report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia. MethodsWe performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients’ expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global ‘cognitive discrepancy’ composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed). ResultsPatients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = −1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. Underestimation of cognitive capacity during hypoglycaemia was more pronounced for patients with younger age (β = 0.5, p = 0.02), higher verbal IQ (β = 0.5, p = 0.03), and more hypoglycaemia-related shakiness (β = 0.4, p = 0.03). LimitationsThe modest sample size limits the generalizability of the findings. ConclusionsPatients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.

Subjective cognitive functioning and associations with psychological distress in adult brain tumour survivors.

The impact of brain tumour on subjective cognitive function (SCF) has received little attention despite the implications of these perceptions for quality of life. SCF consists of two related yet distinct components, perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA). This study compared the SCF of adult brain tumour survivors and healthy controls and examined demographic, illness-related, and psychological factors associated with SCF. Sixty-five adult survivors with primary brain tumour (age, 22-75years), and 65 age- and sex-matched controls were recruited. Participants with brain tumour completed the Brief Test of Adult Cognition by Telephone, Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), ratings of physical symptoms, Depression Scale of the Depression Anxiety Stress Scales-21 (DASS-Depression), and Generalized Anxiety Disorder-7 (GAD-7) scale. Controls completed the FACT-Cog, DASS-Depression, and GAD-7. Adult brain tumour survivors reported significantly greater PCI and lower PCA than controls, after accounting for anxiety. Higher PCI was significantly related to fatigue, pain, treatment-related side-effects, anxiety, and depression. Lower PCA was significantly associated with fatigue, pain, poorer objective cognitive function, lower education, anxiety, and depression. Anxiety uniquely accounted for 9-14% of variance in SCF. Adult brain tumour survivors were found to experience poorer SCF than healthy controls after accounting for anxiety. SCF was related to multiple factors after brain tumour; however, an independent association with anxiety was identified. These findings highlight the potential value of psychological interventions targeting anxiety and cognitive effects to improve quality of survivorship after brain tumour.

Lack of clinically relevant correlation between subjective and objective cognitive function in ICU survivors: a prospective 12-month follow-up study

BackgroundCognitive impairment and psychological distress are common in intensive care unit (ICU) survivors. Early identification of affected individuals is important, so intervention and treatment can be utilized at an early stage. Cognitive Failures Questionnaire (CFQ) is commonly used to screen for subjective cognitive function, but it is unclear whether CFQ scores correlate to objective cognitive function in this population.MethodsBetween 2014 and 2018, 100 ICU survivors aged 18–70 years from the general ICU at the Karolinska University Hospital, Solna, were included in the study. Out of these, 58 patients completed follow-up at 3 months after ICU discharge, 51 at 6 months, and 45 at 12 months. Follow-up included objective cognitive function testing using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and subjective cognitive function testing with the self-rating Cognitive Failures Questionnaire (CFQ), as well as psychological self-rating with the Post-Traumatic Stress Symptoms Scale-10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS).ResultsThe prevalence of cognitive impairment as measured by four selected CANTAB tests was 34% at 3 months after discharge, 18% at 6 months, and 16% at 12 months. There was a lack of significant correlation between CANTAB scores and CFQ scores at 3 months (r = − 0.134–0.207, p > 0.05), at 6 months (r = − 0.106–0.257, p > 0.05), and at 12 months after discharge (r = − 0.070–0.109, p > 0.05). Correlations between CFQ and PTSS-10 scores and HADS scores, respectively, were significant over the follow-up period (r = 0.372–0.710, p ≤ 0.001–0.023). In contrast, CANTAB test scores showed a weak correlation with PTSS-10 and HADS scores, respectively, at 3 months only (r = − 0.319–0.348, p = 0.008–0.015).ConclusionWe found no clinically relevant correlation between subjective and objective cognitive function in this cohort of ICU survivors, while subjective cognitive function correlated significantly with psychological symptoms throughout the follow-up period. Treatment and evaluation of ICU survivors’ recovery need to consider both subjective and objective aspects of cognitive impairment, and subjective reports must be interpreted with caution as an indicator of objective cognitive function.

Acupuncture versus cognitive behavioral therapy for cognitive impairment in cancer survivors with insomnia: Implications for personalized medicine.

11522 Background: Cognitive impairment is a prevalent condition among cancer survivors that lacks effective treatment and can be maintained and exacerbated by poor sleep. This study explored whether treating insomnia with acupuncture or Cognitive Behavioral Therapy for Insomnia (CBT-I) improves subjective and objective cognitive functions in cancer survivors. Methods: We analyzed cognitive outcomes from a pragmatic randomized trial comparing acupuncture versus CBT-I for cancer survivors with insomnia. Analysis was limited to those reporting cognitive impairment at baseline. Acupuncture and CBT-I were delivered over 8 weeks. Perceived cognitive ability was assessed using the Brown Attention-Deficit Disorder Scale (BADDS). Objective cognitive function was evaluated with the Buschke Selective Reminding Test (BSRT). All outcomes were evaluated at baseline, Week 8 (end of intervention), and Week 20 (12 weeks post-intervention). Results: Among 99 cancer survivors, mean age was 60.4 years, 56.6% were women, and 26.3% were non-white. The most common cancer types were breast (31.3%) and prostate (19.2%). Perceived cognitive ability improved in both acupuncture and CBT-I groups at weeks 8 and 20 relative to baseline (all P &lt; 0.001). No significant between-group differences were noted in BADDS total score (p = 0.28), but the CBT-I group demonstrated a better BADDS attention subscale score than the acupuncture group at weeks 8 and 20 (p = 0.031). With regards to objective cognitive functions assessed by BSRT, acupuncture improved attention (p = 0.017), learning (p = 0.040), and memory (p = 0.0020) at Week 8, whereas CBT-I only improved attention at Week 20 (p = 0.0002); between-group differences were not statistically significant. Conclusions: Among cancer survivors with insomnia, both acupuncture and CBT-I improved cognitive impairment relative to baseline, but their relative effects differed: the CBT-I group showed slightly better subjective attention, whereas the acupuncture group may have improved objective memory. Further investigation of these two therapies may lead to effective and personalized interventions for cancer survivors. Clinical trial information: NCT02356575.

Prechemotherapy Levels of Plasma Dehydroepiandrosterone and Its Sulfated Form as Predictors of Cancer-Related Cognitive Impairment in Patients with Breast Cancer Receiving Chemotherapy.

Study ObjectiveDehydroepiandrosterone (DHEA) and its sulfated form (DHEAS)—jointly referred to as DHEA(S)—are neurosteroids known to regulate brain development and function that have been found to be positively correlated with cognitive function. It is unknown whether prechemotherapy plasma DHEA(S) levels are associated with the onset of cancer‐related cognitive impairment (CRCI). The objective of this study was to evaluate whether an association exists between prechemotherapy plasma DHEA(S) levels and onset of CRCI in patients with breast cancer receiving chemotherapy.DesignMulticenter, prospective cohort study.SettingTwo specialized cancer centers in Singapore.PatientsEighty‐one patients with early‐stage breast cancer (stages I–III) who had no prior exposure to chemotherapy and/or radiotherapy and were scheduled to receive anthracycline‐based or taxane‐based chemotherapy treatment with curative intent.Measurements and Main ResultsPatients completed assessments for self‐perceived and objective cognitive function at three time points: prechemotherapy (T1), during chemotherapy (T2), and after chemotherapy (T3). Plasma samples were collected prior to chemotherapy, and DHEA(S) levels were quantified by using ultra–high‐performance liquid chromatography–tandem mass spectrometry. Multivariable logistic regression was used to adjust for clinically important factors and to evaluate the association between prechemotherapy plasma DHEA(S) levels and CRCI. Mean ± SD age was 48.9 ± 9.3 years, with 27.8% of patients experiencing clinically significant cognitive impairment based on global Functional Assessment of Cancer Therapy–Cognitive Function scores. The mean ± SD prechemotherapy plasma DHEAS and DHEA levels were 1.61 ± 0.91 μmol/L and 19.21 ± 13.13 nmol/L, respectively. Prechemotherapy DHEAS levels were found to be associated with impairment in the self‐perceived cognitive domains of verbal fluency (adjusted odds ratio [OR] 0.27, 95% confidence interval [CI] 0.08–0.96) and mental acuity (adjusted OR 0.25, 95% CI 0.08–0.74). Conversely, DHEA levels were not associated with impairment in any cognitive subdomains.ConclusionOur findings suggest that patients with higher prechemotherapy DHEAS levels had lower odds of developing self‐perceived cognitive impairment. Future studies are required to further investigate the effect of DHEA(S) on specific cognitive domains and to validate our findings in independent cohorts.