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Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored. We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed \"everyday cognition\" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks. Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures. Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Estimates indicate that 20-70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. Everyday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients.

This survey aimed to inform graduate-level training in clinical psychological assessment by identifying strategies, barriers, and needs of psychologists in managing assessment training activities in the COVID-19 era. A national online survey in English and French was advertised to registered psychologists involved in teaching, training, and/or supervision of clinical psychological assessment in Canada. Quantitative items were summarised, and qualitative data from the survey underwent thematic analysis. Of 164 respondents, 36% endorsed teaching clinical psychology or cognitive assessment courses, and 54% of them said they would adapt teaching to be entirely remote in the context of COVID-19 restrictions. The biggest teaching barriers were perceived as insufficient knowledge of remote clinical assessment methods and inadequate guidance from institutional authorities, while the most significant concerns were perceived ability to effectively meet course objectives and to prepare students for practica. Over three quarters (77%) of respondents indicated being involved in assessment training/supervision in practica or residencies, with 57% of these indicating their activities will be carried out in a blended format. The biggest barriers were clinic closures, on-site training restrictions, and inadequate resources, while concerns were related to threats to assessment validity and to health and safety. Results of this survey provide a snapshot of the state of the field, and the authors offer key considerations for moving forward as psychologists prepare to adapt teaching, training, and supervision activities. The impacts of COVID-19 on clinical psychological assessment training are broad and, although disruptive, present an opportunity for a paradigm shift. Ce sondage visait à éclairer la formation de niveau supérieur en matière d'évaluation psychologique clinique en identifiant les stratégies, les obstacles et les besoins des psychologues dans la gestion des activités de formation en évaluation à l'ère COVID-19. Un sondage national en ligne en anglais et en français a été proposé à des psychologues autorisés qui ont participé à l'enseignement, à la formation ou à la supervision de l'évaluation psychologique clinique au Canada. Les éléments quantitatifs ont été résumés, et les données qualitatives du sondage ont fait l'objet d'une analyse thématique. Sur les 164 répondants, 36 % ont appuyé l'enseignement des cours de psychologie clinique ou d'évaluation cognitive et 54 % d'entre eux ont indiqué qu'ils adapteraient l'enseignement pour qu'il soit entièrement donné à distance dans le contexte des restrictions de la COVID-19. Les plus grands obstacles à l'enseignement ont été perçus comme étant une connaissance insuffisante des méthodes d'évaluation clinique à distance et une orientation inadéquate des autorités institutionnelles, tandis que les préoccupations les plus importantes concernaient la capacité d'atteindre efficacement les objectifs du cours et de préparer les étudiants à la pratique. Plus des trois quarts (77 %) des répondants ont indiqué participer à la formation et à la supervision dans le cadre de stages ou de résidences, 57 % d'entre eux indiquant que leurs activités seront menées dans un format mixte. Les plus grands obstacles étaient les fermetures de cliniques, les restrictions de formation sur place et les ressources inadéquates, tandis que les préoccupations étaient liées aux menaces pesant sur la validité de l'évaluation et sur la santé et la sécurité. Les résultats de ce sondage fournissent un aperçu de l'état du terrain, et les auteurs offrent des considérations clés pour aller de l'avant alors que les psychologues se préparent à adapter les activités d'enseignement, de formation et de supervision. Les répercussions de la COVID-19 sur la formation en évaluation psychologique clinique sont vastes et, bien que perturbatrices, elles offrent l'occasion d'un changement de paradigme. Public Significance Statement COVID-19 has significantly disrupted psychologists' ability to effectively teach and train students in clinical assessment. A survey of Canadian psychologists who are involved in these activities revealed that they do not have enough funding, equipment, or guidance to rapidly adapt their teaching and training in light of COVID-19 public health restrictions. Moving forward, psychologists must consider the ways in which professional training can be redefined to keep up with evolving technologies and demand for virtual assessments.

Background: Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report. Objective: The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample. Design: The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months. Setting: This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada). Patients: A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study. Measurements: Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS [Medication Event Monitoring System]), pharmacy refill data (medication possession ratio [MPR]), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ). Methods: Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively. Results: As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant (P = .052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported adherence (P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously (P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen. Limitations: Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences. Conclusions: Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings. Trial registration: This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011.

Objective:In persons with severe psychiatric disorders, distinct neurocognitive profiles hold differential associations to positive, negative and disorganized symptom dimensions of psychosis. These patterns portend specific functional outcomes, treatment efficacy, and prognoses. Similar associations have not been established in multimorbid samples in which persons present with a complex array of psychiatric symptoms. The objective of this study was to (1) establish neurocognitive profiles in a multimorbid, marginalized sample and (2) investigate their pattern(s) of association with psychiatric symptom dimensions and psychosocial outcomes.Participants and Methods:Participants (n=370; Mage = 45 years; 74% male) were precariously housed, substance-using adults with multimorbidity, recruited from Single-Room Occupancy hotels and a community court within the Downtown Eastside of Vancouver, BC, Canada. Data were collected as part of a longitudinal examination consisting of annual, bi-annual, and monthly neurocognitive, psychosocial, and psychiatric assessments. Neurocognitive scores were combined into five cognitive domains (Attentional Control [AC]; Processing Speed [PS]; Fluid Reasoning [Problem Solving and Reversal Learning; Gf]; Encoding and Retrieval [ER]; and Decision Making [DM]) and submitted to a latent profile analysis. The resulting profiles capturing neurocognition were validated on sociodemographic and clinical variables. Finally, the profiles were compared across previously validated, population-distinct factors derived from the Positive and Negative Syndrome Scale (PANSS), as well as on measures of psychosocial functioning.Results:An optimal goodness-of-fit was reached for a three-profile model (BLRT=127.86, p=.01). Profile 1 (n=207, 55.9%) showed stronger neurocognition (all p<.05), with a within-profile strength in Gf (p<.001). With the exception of ER, Profile 2 (n=109, 29.5%) exhibited inferior neurocognition across all indicators compared to Profile 1 (all p <.05); yet showed a relative, within-profile strength in Gf (p < .01). Profile 3 (n=54, 14.6%) generally displayed comparable impairments to Profile 2. Additionally, their performance on Gf was remarkably low compared to Profiles 1 and 2 (p<.001). Psychiatrically, compared to Profile 1, Profile 2 exhibited more positive/disorganized symptoms and general psychopathology, as well as higher total PANSS (all p <.05), whereas Profile 3 showed the poorest insight/awareness (p<.01). Profiles 2 and 3 had lower levels of adaptive functioning and work productivity compared to Profile 1 (all p<.01).Conclusions:Three neurocognitive profiles were detected in a sample of precariously housed adults with multimorbidity: one profile of comparatively higher neurocognitive capacity, with less symptoms of psychosis and better psychosocial functioning; a second profile of comparatively poorer neurocognition and psychosocial functioning, with more symptoms of psychosis; and a third profile with a severe deficit in fluid reasoning and poor insight and awareness. Given their poor insight, the third profile may be comprised of particularly vulnerable persons at greater risk of unmet healthcare needs. Interventions to improve these individuals' understanding of their personal health risks might facilitate their capacity to access services. Conversely, individuals from Profile 2 may benefit from outreach programs focusing on medication access and adherence to address their symptoms of psychosis. In sum, our findings suggest that the confluence of neurocognition and psychiatric symptoms may implicate unique treatment approaches and outcomes in precariously-housed persons with multimorbid conditions.

There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence.MethodsKidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence.ResultsOur sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors.ConclusionsPoorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L’Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.

Objective We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision‐making (Cluster 3), and an intermediary group with a relative decision‐making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. Method Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract‐Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole‐brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. Results Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. Conclusions In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population. Three groups with distinct neurocognitive profiles have been identified in a cohort of marginally housed persons with comorbid physical and mental illnesses. The lowest functioning group exhibited bilateral frontal and interhemispheric alterations in white matter diffusion. Weak associations between white matter diffusion and cortical gray matter morphology were also observed.

False-belief reasoning, defined as the ability to reason about another person's beliefs and appreciate that beliefs can differ from reality, is an important aspect of perspective taking. We tested 266 individuals, at various ages ranging from 3 to 92 years, on a continuous measure of false-belief reasoning (the Sandbox task). All age groups had difficulty suppressing their own knowledge when estimating what a naïve person knew. After controlling for task-specific memory, our results showed similar false-belief reasoning abilities across the preschool years and from older childhood to younger adulthood, followed by a small reduction in this ability from younger to older adulthood. These results highlight the relative similarity in false-belief reasoning abilities at different developmental periods across the lifespan.

We compared aspects of verbal memory and executive functioning in 51 community-dwelling persons with chronic kidney disease (CKD) and 55 healthy controls matched on age and education. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Scale (CES-D), and illness variables included glomerular filtration rate (GFR) and hemoglobin. Findings indicate that persons with CKD exhibited poorer performance on measures of memory (CVLT-II) and executive functioning (DKEFS Trailmaking Test B and Color-Word Interference Tests) in comparison with healthy controls. Furthermore, performance decrements were magnified in older CKD participants on measures of verbal memory and inhibition. Nearly half of CKD participants aged 61 and older exhibited significant impairments in verbal memory and inhibition in comparison to matched controls. Cognitive performance in CKD was not associated with measures of illness severity. The differences observed were not accounted for by depressive symptoms, which were only weakly associated with cognitive performance, and negatively associated with age. Findings highlight the need for further exploration of the etiologies and functional consequences of the neuropsychological presentation of CKD. (JINS, 2007, 13, 344–353.)