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That always happens sometimes
\"Max is not exactly a perfect kid. From sunup through his school day and right until bedtime, he's goofy, disorganized, and generally uncontainable--much to the frustration of those around him. But when a little enthusiasm and creativity are in order, you can count on Max to save the day!\"--Provided by publisher.
Book
Magic and Memory
In this article, I examine the nature of Dido’s magic ritual in Aeneid 4, reading it as a magic ritual aimed at inducing forgetfulness. I argue that in burning his belongings, Dido intends to forget Aeneas and not to destroy him; for this purpose, I study this episode in the light of non-literary sources and of the poetic tradition concerning love magic and the obliteration of memory.
Journal Article
Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication
PurposePatient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population.MethodsWe conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication.ResultsWe identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians.ConclusionsOur review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
Journal Article
Remote Computerized Cognitive Test Battery Reflects Subjective Cognitive Complaint
Background Recent advances in the treatment of dementia have accelerated the need for sensitive markers of very early cognitive decline. Here, we look at the utility of primary and secondary cognitive test metrics obtained using a remotely proctored, computerized test battery in a longitudinal study of cognitively healthy older participants. Specifically, we are looking for cognitive markers related to subjective cognitive complaints. Method We assessed 309 cognitively healthy older participants from Northern California (62‐89 y.o., 113 F, edu 15.2 yr, 220 white) using the California Cognitive Assessment Battery (CCAB) at five timepoints across 30 months. Three traditional aggregate factors were created from CCAB test scores as defined in previous publications. Four novel cognitive factors were determined in a previous study by exploratory factor analysis on a separate cohort of 90 subjects (30‐62 y.o.), and include selected timing and other secondary metrics that are not components of the traditional aggregate factors. Cognitive factor scores were compared to subjective memory complaints defined using the Cognitive Failures Questionnaire (CFQ). We used linear mixed model (LMM ; lme4 in R) analyses and latent class mixed models (LCMM ; lcmm & flexmix in R) to analyze this longitudinal dataset. Result LMM analyses showed that the novel Memory, Visuospatial/Executive, and Incidental Speed factors, plus a traditional PACC‐R factor were significantly correlated with elevated CFQ subscores (see Table). No factor showed significant interactions of elevated CFQ with either test learning (based on a baseline two‐day test‐retest session) or in factor declines across 30 months. The LCMM analyses showed mixed results, with the lcmm analysis producing no reliable latent models that separate participants with elevated CFQ scores from those without. However, the flexmix analysis reliably classified subjects into 2 groups primarily separated by vocabulary, age, and race; but with group membership only weakly correlating with elevated CFQ. Conclusion Our findings showed that novel cognitive factors defined using CCAB were related to participants’ subjective complaints, such as forgetfulness. Such cognitive markers could potentially be used as partial early markers of cognitive decline. Work is ongoing to validate the use of these novel metrics in larger, more diverse populations and within clinical (MCI) populations.
Journal Article
The outcome‐representation learning model of decision‐making capacity in mild cognitive impairment
Background The decision‐making capacity of persons with mild cognitive impairment (MCI) has not been fully explored. This study aimed to examine the decision‐making capacity in MCI using the outcome‐representation learning model. Method 52 persons with MCI and 49 healthy controls were recruited in the study. The Iowa Gambling Task (IGT) was administered to measure decision‐making under ambiguity situations. Five parameters, including the reward learning rate, the punishment learning rate, forgetfulness, win perseverance and deck perseverance, were included in the outcome‐representation learning (ORL) model to capture changes in decision‐making abilities in MCI patients. Result Individuals with MCI exhibited reduced learning from losses outcomes and similar learning from wins outcomes compared to healthy controls. Additionally, MCI individuals exhibited less susceptibility to forgetfulness in the IGT compared to controls, suggesting that memory fading of choices made by MCI patients was not improved. Although MCI individuals still favored high‐win frequency decks like controls, their preference appeared to dimmish from the first to second completion of the IGT. Conclusion The findings suggest that individuals with mild cognitive impairment have difficulty in learning lessons from decision‐making failures in complex contexts. It offers a potential novel computational neurocognitive marker for mild cognitive impairment.
Journal Article
Role of ApoE polymorphism in Dementia
Background ApoE polymorphism especially APOE ε4 play a central role in AD pathophysiology through Aβ‐dependent and Aβ‐independent neuropathogenic pathway in the Alzheimer’s disease. Method A cross‐sectional study was performed on non diseased and diseased subjects with stroke from outpatient services of Neurology department of Institute of Human Behavior & Allied Sciences (IHBAS), New Delhi (India). Subjects diagnosed with various dementias including Alzheimer’s disease, non AD dementias and dementia with Behavior & Psychological symptoms were taken. APOE genotyping was done in all subjects by ARMS‐PCR method. Result The most common allele APOE ε3ε3 was observed across all dementia groups (AD, non AD dementia. Dementia with BPSD & forgetfulness, whereas ε2ε4 was least commonly observed. Multivariable logistic regression analysis showed that the presence of APOE ε4 genotyping is significantly increasing the risk of AD three times more as compared to other alleles (Adjusted Odds Ratio: 3.07, 95% CI: 1.39 ‐ 6.78). The age and gender did not emerge out as significant contributors in AD. In group of AD with BPSD, the most common Behavior & Psychological symptoms observed was paranoid & delusional ideation. Conclusion APOE ε4 is a risk factor for Alzheimer's disease.
Journal Article
Advanced glycation end products (AGEs) involvements in the development of frank Alzheimer’s disease (FAD)
Background AGEs is one of the Maillard’s reaction products (MRPs) found in over‐processed common diets, causing food‐nutrients abnormal modifications. Some MRPs are potentially toxic or carcinogenic. MRPs present in stages: initial, intermediate and final. The aim of this presentation is to state roles played by AGEs in the development of AD as recent findings. Method Through threaded literature review Result 1) MRPs and disease causing associations were first recognized by Swedish scientists in 2002 and involvement of AGEs in development of AD in 2010; 2) MRPs include: N'fructoselysine (furosine), 5‐ Hydroxymethyl furfural (HMF), acrylamide, heterocyclic amines and melanoidins; 3) some neurotransmitters are modified amino acids, known as monoamines; 4) some other neurotransmitters are unmodified amino acids; 5) certain short chain amino acids (peptides) function as neuromodulators, by being able to alter a neuron’s response to a neurotransmitter, or block its release; 6) a neurotransmitter’s effect depends upon its concentration, the types and numbers of receptors and ion channels on the receiving cells' membranes; 7) neurotransmitters affect each other’s levels, the same neurotransmitter can even have opposite effects on different types of cells; 8) AD is due to depleted Acetylcholine (Ach) neurotransmitter in the brain, causing imbalance. Ach coordinates functions in the brain by enhancing nerve transmission in a horizontal direction and also inhibiting transmission in a vertical direction; 9) Ach can both inhibit and stimulate because it can bind two types of receptors: on basket cells (to decrease levels of GABA production and stimulate horizontal nerve transmission) and on bipolar cells (to increase GABA production and strengthen the inhibition of vertical transmission). Conclusion How AGEs disrupts some of these functions to contribute to the development of AD (typified by ‘forgetfulness and difficult‐thinking’) will be discussed.
Journal Article
Monitoring night‐time safety in households with dementia using ambient sensing technologies: a rule‐based decision algorithm
Background Dementia impairs cognitive abilities such as memory and decision‐making, significantly affecting activities of daily living. As the condition progresses, confusion, forgetfulness, and wandering become increasingly common, with wandering occurring in approximately 60% of people living with dementia (PLwD). Night‐time wandering poses substantial safety risks and increases caregiver burden. Despite its prevalence, there is a lack of effective tools to monitor and address these risks. Method We developed a system that leverages ambient sensing technologies, including door sensors, in‐home motion detectors, and under‐mattress sleep sensors (Figure 1a‐b), combined with automated algorithms to monitor night‐time safety. Using a rule‐based decision model, the system analyses sequences of door usage and motion patterns to identify potential safety risks, such as leaving the house at night or leaving doors open. The algorithm underwent rigorous multi‐stage testing, including living lab evaluation, synthetic data simulation, retrospective analysis, and prospective validation. Results Validation was conducted across 94 households over 365 nights, totalling 297,297 monitoring hours. At least one night‐time safety alert was triggered in 33 households, while no abnormal events were recorded in 61 households. Two hundred alerts were generated across 142 nights, with an average time outside 2 hours and 40 minutes per event. Of these alerts, 91.2% were validated as night‐time going out events, with 14.9% representing routine activities. Conclusion This study demonstrates the algorithm's effectiveness in timely, accurate night‐time safety monitoring. Implementing it has the potential to enhance safety and reduce caregiver burden for PLwD in clinical and home care settings.
Journal Article
Cognitive Manifestations of Racemose Neurocysticercosis: A Two Case Report
Background Neurocysticercosis (NCC) is a central nervous system infection caused by the larval form of the tapeworm Taenia solium, endemic in Latin America and Asia. It can present as intraparenchymal or racemose (rNCC) forms, with symptoms including epilepsy, headaches, and intracranial hypertension. We present two cases of rNC from Chile with significant cognitive symptoms. Method First case is a 79‐year‐old male farmer with suspected normal pressure hydrocephalus (NPH). Symptoms included progressive forgetfulness, disorientation, gait disorder, and headache over four years. Investigations included a magnetic resonance of the brain (MRI) that revealed multiple subarachnoid cysts and hydrocephalus compatible with rNCC. Cerebrospinal fluid (CSF) analysis showed pleocytosis, hyperproteinorrhacia, and hypoglycorrhachia. Blood Enzyme‐Linked ImmunoSorbent Assay (ELISA) and CSF Western blot (WB) confirmed cysticercosis. He was treated with corticosteroids, albendazole, and praziquantel over a month. Follow‐up neuroimaging showed decreased ventricular widening and cysts volume. Second case is a 58‐year‐old male from Santiago who presented with confusion, agitation, disconnection episodes, and headache over two months. An MRI revealed signs of basal meningitis and interhemispheric and anterior cistern cysts with leptomeningeal enhancement. CSF had pleocytosis, hyperproteinorrhacia, and hypoglycorrhachia. ELISA and WB confirmed cysticercosis. He began treatment with albendazole and corticosteroids, completing 30 days. Follow‐up MRI confirmed almost complete resolution of the lesions. Result Both cases presented with prominent cognitive features, with the first case resembling NPH and the second case presenting as a subacute confusional state/rapidly progressive dementia. Corticosteroids plus antiparasitic drugs led to significant improvements in MRI abnormalities, with no major complications. Although the cognitive symptoms showed considerable improvement, they did not completely resolve. Conclusion Although rare, rNCC should be considered as a differential diagnosis for a wide range of neurological conditions in regions where NCC is common. Atypical clinical findings and headache should be regarded as warning signs. T2 and T1 gadolinium‐enhanced MRI sequences were essential in assessing these cases. CSF showed a characteristic profile, and blood ELISA and CSF WB were able to confirm the diagnosis. Treatment with antiparasitic drugs combined with corticosteroids appears to be effective and well tolerated. Further research is necessary to improve the diagnosis and treatment of rNCC.
Journal Article
Feasibility of a Need‐Based Framework for Identifying Cognitive and Physical Needs in People Living with Cognitive Changes
Background This study evaluated the feasibility of a need‐based framework to identify and address the cognitive (C) and physical (P) care needs of home care clients living with cognitive changes, including Alzheimer's disease and other dementias. Such lay‐friendly frameworks are particularly beneficial in settings where clinical diagnoses are unavailable or impractical. This initial implementation focused on creating a practical tool to support personalized care planning. Method The study was conducted in four phases: Initial Stakeholder Feedback Input was collected from professional caregivers, family members, client care managers, staffing managers, and general managers to refine the cognitive‐physical (C‐P) need framework. Pilot Testing The framework was tested with clients across three offices [Nebraska (N = 12), Milwaukee (N = 7), and Sacramento (N = 7)]. Care managers rated clients using reverse numerical scales ranging from C4 (most severe cognitive needs, e.g., severe memory loss and disorientation) to C1 (least severe; e.g., mild forgetfulness) and P4 (most severe physical needs, e.g., total dependance for all daily tasks) to P1 (least severe, e.g., able to complete all personal care tasks without hands‐on support), demonstrating the diversity of care needs and the interplay between cognitive and physical requirements. Scientific Advisory Board (SAB) Review The model was presented to a SAB including neurologists, geriatricians, and gero‐psychologists for feedback. Result Findings from the pilot test revealed significant variability in client profiles, underscoring the framework's capacity to capture diverse care needs. Feedback from care teams highlighted the utility of the framework for settings where clinical diagnoses are unavailable. Based on the SAB recommendations, the framework was updated to include an emotional/behavioral (E) component, creating the C‐P‐E profile. Suggestions included expanding the list of example symptoms corresponding to the varying levels of physical and cognitive changes and reversing the numerical levels such that 1 indicates the highest severity. Conclusion This need‐based framework provides a scalable tool for dementia care, with strong potential for enhancing care planning in non‐clinical settings. Future research will validate the expanded C‐P‐E framework, including psychometric testing for reliability and inter‐rater consistency, ensuring its applicability as a practical tool for diverse care environments.
Journal Article