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Prognosis : a memoir of my brain
\"When Sarah Vallance is thrown from a horse and suffers a jarring blow to the head, she believes she's walked away unscathed. The next morning, things take a sharp turn as she's led from work to the emergency room. By the end of the week, a neurologist delivers a devastating prognosis: Sarah suffered a traumatic brain injury that has caused her IQ to plummet, with no hope of recovery. Her brain has irrevocably changed. Afraid of judgment and deemed no longer fit for work, Sarah isolates herself from the outside world. She spends months at home, with her dogs as her only source of companionship, battling a personality she no longer recognizes and her shock and rage over losing simple functions she'd taken for granted. Her life is consumed by fear and shame until a chance encounter gives Sarah hope that her brain can heal. That conversation lights a small flame of determination, and Sarah begins to push back, painstakingly reteaching herself to read and write, and eventually reentering the workforce and a new, if unpredictable, life. In this highly intimate account of devastation and renewal, Sarah pulls back the curtain on life with traumatic brain injury, an affliction where the wounds are invisible and the lasting effects are often misunderstood. Over years of frustrating setbacks and uncertain triumphs, Sarah comes to terms with her disability and finds love with a woman who helps her embrace a new, accepting sense of self.\"--Amazon.com.
Book
A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis
Objective:
To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention – Memory, Attention, and Problem Solving Skills for Persons with Multiple Sclerosis (MAPSS-MS) – for persons with multiple sclerosis on cognitive performance, memory strategy use, self-efficacy for control of symptoms and neuropsychological competence in activities of daily living (ADL).
Design:
A randomized controlled single-blinded trial with treatment and wait list control groups.
Setting:
Southwestern United States.
Subjects:
Convenience sample of 61 persons (34 treatment, 27 wait list control) with multiple sclerosis (mean age 47.9 years, SD 8.8).
Intervention:
The eight-week MAPSS-MS intervention program included two components: (a) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and (b) a computer-assisted cognitive rehabilitation program with home-based training.
Outcome measures:
A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) and self-report instruments (use of memory strategies, self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL) were completed at baseline, two months (after classes), and at five months.
Results:
Both groups improved significantly (P < 0.05) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL. There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies.
Conclusions:
The MAPSS-MS intervention was feasible and well-accepted by participants. Given the large relative increase in use of compensatory strategies by the intervention group, it holds promise for enhancing cognitive function in persons with multiple sclerosis.
Journal Article
Orthostatic blood pressure reduction as a possible explanation for memory deficits in dialysis patients
Cognitive impairment is prevalent in patients with chronic kidney disease (CKD), but its underlying mechanisms are obscure. Here, we test the hypothesis that exaggerated orthostatic blood pressure reduction mediates the effects of renal failure on global cognition and memory. A total of 160 study subjects were recruited, including 80 dialysis patients and 80 controls. Global cognition was evaluated using the Montreal Cognitive Assessment (MoCA), and episodic memory was evaluated using the auditory verbal learning test (AVLT). Autonomic function was evaluated via the low-frequency to high-frequency ratio (LF/HF) through heart rate variability analysis. Compared with the controls, the dialysis patients had significantly lower MoCA and AVLT scores (including learning memory, short recall memory, and delayed recall memory) (all p < 0.001). They also showed exaggerated orthostatic systolic blood pressure reductions (all p ≤ 0.001). The maximum orthostatic systolic blood pressure reduction was independently and negatively associated with short (β = -0.05, p = 0.029) and delayed (β = -0.05, p = 0.035) recall memory in dialysis patients but not in controls. Mediation analysis demonstrated that maximum orthostatic systolic blood pressure reduction mediates 13.8% of the effect of end-stage renal disease (ESRD) on short recall memory (p = 0.04). After adjustment for LF/HF, the negative association between maximum orthostatic blood pressure reduction and short recall score remained significant (p = 0.049), while the association between maximum orthostatic blood pressure reduction and delayed recall score became nonsignificant, with a marginal p value of 0.062. Our study reveals that exaggerated orthostatic blood pressure reduction is a possible explanation for ESRD-associated memory deficits.
Journal Article
Differences in quantitative methods for measuring subjective cognitive decline – results from a prospective memory clinic study
ABSTRACTBackgroundCognitive complaints occur frequently in elderly people and may be a risk factor for dementia and cognitive decline. Results from studies on subjective cognitive decline are difficult to compare due to variability in assessment methods, and little is known about how different methods influence reports of cognitive decline. MethodsThe Subjective Memory Complaints Scale (SMC) and The Memory Complaint Questionnaire (MAC-Q) were applied in 121 mixed memory clinic patients with mild cognitive symptoms (mean MMSE = 26.8, SD 2.7). The scales were applied independently and raters were blinded to results from the other scale. Scales were not used for diagnostic classification. Cognitive performances and depressive symptoms were also rated. We studied the association between the two measures and investigated the scales’ relation to depressive symptoms, age, and cognitive status. ResultsSMC and MAC-Q were significantly associated ( r = 0.44, N = 121, p = 0.015) and both scales had a wide range of scores. In this mixed cohort of patients, younger age was associated with higher SMC scores. There were no significant correlations between cognitive test performances and scales measuring subjective decline. Depression scores were significantly correlated to both scales measuring subjective decline. Linear regression models showed that age did not have a significant contribution to the variance in subjective memory beyond that of depressive symptoms. ConclusionsMeasures for subjective cognitive decline are not interchangeable when used in memory clinics and the application of different scales in previous studies is an important factor as to why studies show variability in the association between subjective cognitive decline and background data and/or clinical results. Careful consideration should be taken as to which questions are relevant and have validity when operationalizing subjective cognitive decline.
Journal Article
Cognitive rehabilitation in the elderly: Effects on memory
This study reports the effects of a 12-week multimodular cognitive
rehabilitation training program on memory performance in two groups of
older adults. In the Memory Training module, participants were instructed
on the nature of memory and how to improve memory performance; internal
and external strategies were described and practiced over the training
sessions. Memory performance was assessed by four tests: Alpha Span,
Brown-Peterson, Hopkins Verbal Learning Test − Revised (HVLT-R), and
Logical Stories. One group received training on entry into the study
(Early Training Group, ETG), the other after a 3-month delay (Late
Training Group, LTG). The results showed no training-related improvement
in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R),
or recognition memory (HVLT-R). While the most direct analyses of a
training effect (analyses of covariance) rarely demonstrated significant
effects, exploratory analyses provided some evidence for a training
benefit in several measures of secondary memory (Logical Stories; HVLT-R)
and strategic processing (Brown-Peterson; Logical Stories; HVLT-R).
Positive results were largely restricted to the ETG, possibly because the
LTG lost motivation as a consequence of their delayed training. The
results need to be treated with caution, but are promising for the
rehabilitation of memory functioning in older adults (JINS, 2007,
13, 132–142.)
Journal Article
Sentence Comprehension in Adolescents With Down Syndrome and Typically Developing Children: Role of Sentence Voice, Visual Context, and Auditory-Verbal Short-Term Memory
The authors evaluated the roles of auditory-verbal short-term memory, visual short-term memory, and group membership in predicting language comprehension, as measured by an experimental sentence comprehension task (SCT) and the Test for Auditory Comprehension of Language—Third Edition (TACL-3; E. Carrow-Woolfolk, 1999) in 38 participants: 19 with Down syndrome (DS), age 12 to 21 years, and 19 typically developing (TD) children, age 3 to 5 years, matched on syntax comprehension, as measured by TACL-3 Subtests II and III. Of the 5 dependent measures of comprehension, auditory-verbal short-term memory accounted for significant amounts of variance in 4; group membership, 1 (semantic role assignment); and visual short-term memory, 0. In the group with DS, hearing status predicted variation in Grammatical Morphemes (TACL-3 Subtest II). Using the SCT, the authors also investigated the effects of varying sentence voice and supporting visual context on sentence comprehension. SCT performance was significantly poorer in terms of (a) referent selection and semantic role assignment, for passive (vs. active) sentences in both groups, and (b) semantic role assignment in all sentences for the group with DS (vs. the TD group). Vocabulary strengths in the group with DS were found with the Peabody Picture Vocabulary Test—Third Edition (L. M. Dunn & L. M. Dunn, 1997) but not the TACL-3 Vocabulary subtest.
Journal Article
Spatial Working Memory Impairment in Subclinical Hypothyroidism: An fMRI Study
Objective: Using a block-designed BOLD-fMRI to explore the neural basis of spatial working memory impairment in patients with subclinical hypothyroidism (SCH) performing an n-back task. Methods: Sixteen patients with SCH before and after being treated with levothyroxine (LT 4 ) for 6 months and 16 matched euthyroid subjects were scanned by fMRI under the n-back task. Results: The fMRI scan found that a neural network consisting of bilateral dorsolateral prefrontal cortex (DLPFC), bilateral premotor area (PreMA), supplementary motor area/anterior cingulate cortex, bilateral parietal lobe (PA) and right caudate nucleus/thalamus was activated, with right hemisphere dominance. In euthyroid subjects, all these regions of interest (ROIs) showed load effect; however, only left DLPFC, left PA, bilateral PreMA and right caudate nucleus/thalamus showed the same effect in Pre-SCH patients. Furthermore, activation intensities of most ROIs (especially DLPFC and right PA) for Pre-SCH patients were lower than those in the euthyroid subjects (F <3.046, p > 0.062). Importantly, after a 6-month treatment with LT 4 , the load effect in SCH patients appeared the same as in the euthyroid subjects in all the ROIs (F >13.176, p < 0.0001). Conclusion: Our previous study shows that verbal working memory of SCH patients is impaired with abnormal activity in bilateral frontal areas. In this study, the results indicated that SCH patients may also have spatial working memory impairments, and the altered activities of right DLPFC and right posterior parietal lobe may be one of the underlying neural mechanisms. Most importantly, this study shows that LT 4 replacement therapy can improve the memory impairment and reverse the altered neural activity network.
Journal Article
A Programmable Prompting Device Improves Adherence to Highly Active Antiretroviral Therapy in HIV-Infected Subjects with Memory Impairment
Background. Patients cite “forgetting” as a reason for nonadherence to highly active antiretroviral therapy (HAART). We measured the effect of a memory-prompting device on adherence to HAART in memory-intact and memory-impaired human immunodeficiency virus (HIV)—infected subjects. Methods. The study was a prospective, randomized, controlled trial involving 64 HIV-infected adults. The intervention was the Disease Management Assistance System (DMAS) device, combined with monthly adherence counseling. Control subjects received only adherence counseling. The DMAS was programmed with HAART regimen data to provide verbal reminders at dosing times. Adherence was measured for 24 weeks using electronic drug exposure monitor (eDEM) caps. Results. A total of 58 subjects completed the 24-week study period; 28 were HAART naive (12 DMAS users and 16 control subjects). Mean adherence scores did not differ significantly between DMAS users (80%) and control subjects (65%). Post hoc analysis of 31 memory-impaired subjects (14 DMAS users and 17 control subjects) revealed significantly higher adherence rates among DMAS users (77%), compared with control subjects (57%) (P = .001). However, analysis of memory-intact subjects showed that adherence was not significantly improved for DMAS users (83%), compared with control subjects (77%) (P = .25). At week twelve, 38% of the DMAS users and 14% of the control subjects had an undetectable plasma HIV RNA load (P = .014), and at week 24, the plasma HIV RNA load was undetectable for 34% of the DMAS users and 38% of the control subjects (P = .49). CD4+ cell counts did not differ between the study arms. Virological and immunological responses were not related to DMAS use in memory-impaired subjects. Conclusion. The DMAS prompting device improved adherence for memory-impaired subjects but not for memory-intact subjects.
Journal Article
Dietary fat intake in relation to cognitive change in high-risk women with cardiovascular disease or vascular factors
Background/Objectives: Dietary fat intake may influence the rate of cognitive change among those at high risk due to vascular disease or risk factors. Subjects/Methods: Women's Antioxidant Cardiovascular Study began in 1995–1996 as a randomized trial of antioxidants and B vitamin supplementation for secondary prevention in women with cardiovascular disease or >or=3 coronary risk factors. From 1998–1999, eligible participants aged >or=65 years were administered a telephone cognitive battery including five tests of general cognition, memory and category fluency (n=2551). Tests were administered four times over 5.4 years. The primary outcome was a global composite score averaging z-scores of all tests. Multivariable generalized linear models for repeated measures were used to evaluate the difference in cognitive decline rates across tertiles of total fat and various types of fat. Results: Total fat intake or different types of fat were not related to cognitive decline. However, older age significantly modified the association: among the oldest participants, higher intakes of mono- and polyunsaturated fat were inversely related to cognitive decline (P-interaction: 0.06 and 0.04, respectively), and the rate differences between the highest and lowest tertiles were cognitively equivalent to the rate differences observed with being 4–6 years younger. Conclusions: In women at high risk of cognitive decline due to vascular disease or risk factors, dietary fat intake was not associated with 5-year cognitive change. However, a possible protective relation of unsaturated fats with cognitive decline in the oldest women warrants further study.
Journal Article
Vestibular vertigo and comorbid cognitive and psychiatric impairment: the 2008 National Health Interview Survey
Background/aimsPatients with vestibular disease have been observed to have concomitant cognitive and psychiatric dysfunction. We evaluated the association between vestibular vertigo, cognitive impairment and psychiatric conditions in a nationally representative sample of US adults.MethodsWe performed a cross-sectional analysis using the 2008 National Health Interview Survey (NHIS), which included a Balance and Dizziness Supplement, and questions about cognitive function and psychiatric comorbidity. We evaluated the association between vestibular vertigo, cognitive impairment (memory loss, difficulty concentrating, confusion) and psychiatric diagnoses (depression, anxiety and panic disorder).ResultsWe observed an 8.4% 1-year prevalence of vestibular vertigo among US adults. In adjusted analyses, individuals with vestibular vertigo had an eightfold increased odds of ‘serious difficulty concentrating or remembering’ (OR 8.3, 95% CI 4.8 to 14.6) and a fourfold increased odds of activity limitation due to difficulty remembering or confusion (OR 3.9, 95% CI 3.1 to 5.0) relative to the rest of the US adults. Individuals with vestibular vertigo also had a threefold increased odds of depression (OR 3.4, 95% CI 2.9 to 3.9), anxiety (OR 3.2, 95% CI 2.8 to 3.6) and panic disorder (OR 3.4, 95% CI 2.9 to 4.0).ConclusionsOur findings indicate that vestibular impairment is associated with increased risk of cognitive and psychiatric comorbidity. The vestibular system is anatomically connected with widespread regions of the cerebral cortex, hippocampus and amygdala. Loss of vestibular inputs may lead to impairment of these cognitive and affective circuits. Further longitudinal research is required to determine if these associations are causal.
Journal Article