Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the folstein mini-mental state examination. The Alzheimer's Disease Assessment Scale: Evaluation of Psychometric Properties and Patterns of Cognitive Decline in Multicenter Clinical Trials of Mild to Moderate Alzheimer's Disease Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study. Prevalence and Causes of Blindness and Low Vision in Southern Sudan Mini Nutritional Assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors. The effects of age, glucose ingestion and gluco-regulatory control on episodic memory. A comparison of statistical approaches used to evaluate change in cognitive function following pharmacologic challenge: an example with lorazepam. A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables. The Association of Brain MRI Characteristics and Postoperative Delirium in Cardiac Surgery Patients. Cancer and the risk for taking early retirement pension: A Danish cohort study The combined effect of visual impairment and cognitive impairment on disability in older people. Current and remote blood pressure and cognitive decline. Predictors of retrograde amnesia following ECT. EORTC elderly task force position paper: approach to the older cancer patient. Current estimates of blindness in India Computer-based Cognitive Training for Mild Cognitive Impairment: Results from a Pilot Randomized, Controlled Trial The Cognitive Mechanisms of the SNARC Effect: An Individual Differences Approach Clinical and biomarker changes in dominantly inherited Alzheimer's disease. Cognitive Change in Schizophrenia and Other Psychoses in the Decade Following the First Episode. Quality of Life Determinants and Hearing Function in an Elderly Population: Osservatorio Geriatrico Campano Study Group Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial. Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy of physical therapy. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation.
PURPOSE To assess the neurocognitive effects of cranial radiotherapy on patients with low- grade gliomas , we analyzed cognitive performance data collected in a prospect i ve , intergroup clinical trial . METHODS Patients included 203 adults with supratentorial low- grade gliomas r and omly assigned to a lower dose ( 50.4 Gy in 28 fractions ) or a higher dose ( 64.8 Gy in 36 fractions ) of localized radiotherapy . Folstein Mini-Mental State Examination ( MMSE ) scores and neurologic function scores ( NFS ) at baseline and key evaluations were analyzed . Median follow-up was 7.4 years in 101 patients still alive . A change of more than three MMSE points was considered clinical ly significant . RESULTS In patients without tumor progression , significant deterioration from baseline occurred at years 1 , 2 , and 5 in 8.2 % , 4.6 % , and 5.3 % of patients , respectively . Most patients with an abnormal baseline MMSE score ( < 27 ) experienced significant increases . Baseline variables such as radiation dose , conformal versus conventional radiotherapy , number of radiation fields , age , sex , tumor size , NFS , seizures , and seizure medications did not predict cognitive function changes . CONCLUSION In this population , most low- grade glioma patients maintained a stable neurocognitive status after focal radiotherapy as measured by the MMSE . Patients with an abnormal baseline MMSE were more likely to have an improvement in cognitive abilities than deterioration after receiving radiotherapy . Only a small percentage of patients had cognitive deterioration after radiotherapy . However , more discriminating neurocognitive assessment tools may identify cognitive decline not apparent with the use of the MMSE Purpose To evaluate the psychometric properties and patterns of decline on the total score and item scores of the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-Cog ) in patients with Alzheimer Disease ( AD ) . Methods We analyzed data from 536 AD out patients r and omized to the  placebo group in two identical 26-week multicenter drug trials . Results Mean deterioration at week 26 on the ADAS-Cog total score for subjects with moderate dementia was 84 % greater than that for those with milder severity ( p < 0.001 ) . After adjusting for this effect , age ( p = 0.015 ) and educational level ( p = 0.01 ) also predicted cognitive decline . In a model , absolute change for most individual ADAS items was less than 10 % of the possible change , and it was generally smaller than one-third of the st and ard deviation of the measure . Measurement error variability was greatest for word recognition and the “ placebo ” effect was greatest for word recall . Variability increased with trial duration in a model . Conclusions There is a relationship between baseline severity and magnitude of cognitive decline . In 6-month trials , measurement error makes a substantial contribution to the variance in ADAS-Cog change scores . Sensitivity to intervention effects will therefore depend both on the variability and magnitude of change . Such data must be considered when design ing future trials to minimize measurement error variability and increase sensitivity for specific population BACKGROUND Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability . Furthermore , malnutrition among people living in special housing , i.e. in nursing homes or sheltered accommodation , appears to be more common than among those living in regular housing , i.e. in their own homes . However , it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement , i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing . OBJECTIVES The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden , with a focus on housing and living arrangement .  DESIGN Population -based cohort study . SETTING AND PARTICIPANTS The study focused on people living in regular or in special housing and comprised 1,402 r and omly selected individuals ( 60 - 96 years of age ) who lived in one municipality in south-eastern Sweden and participated in SNAC-B ( the Swedish study on Aging and Care - Blekinge ) , 2001 - 2003 . METHODS Data regarding demography , nutrition and functional and cognitive ability were collected through question naires , medical examinations and structured interviews . RESULTS The relationship was the strongest between cognitive ability and nutritional status among those living in special housing . Regardless of housing and living arrangement , older people with a moderate or severe cognitive impairment risked ( OR 2.59 - 16.00 ) being malnourished , irrespective of functional ability . CONCLUSION This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition , irrespective of living and housing arrangement . The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition Background Blindness and low vision are thought to be common in southern Sudan . However , the magnitude and geographical distribution are largely unknown . We aim ed to estimate the prevalence of blindness and low vision , identify the main causes of blindness and low vision , and estimate targets for blindness prevention programs in Mankien payam ( district ) , southern Sudan . Methods and Findings A cross-sectional survey of the population aged 5 y and above was conducted in May 2005 using a two-stage cluster r and om sampling with probability proportional to size . The Snellen E chart was used to test visual acuity , and participants also underwent basic eye examination . Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity ( VA ) . A total of 2,954 persons were enumerated and 2,499 ( 84.6 % ) examined .  Prevalence of blindness ( presenting VA of less than 3/60 in the better eye ) was 4.1 % ( 95 % confidence interval [ CI ] , 3.4–4.8 ) ; prevalence of low vision ( presenting VA of at least 3/60 but less than 18/60 in the better eye ) was 7.7 % ( 95 % CI , 6.7–8.7 ) ; whereas prevalence of monocular visual impairment ( presenting VA of at least 18/60 in better eye and VA of less than 18/60 in other eye ) was 4.4 % ( 95 % CI , 3.6–5.3 ) . The main causes of blindness were considered to be cataract ( 41.2 % ) and trachoma ( 35.3 % ) , whereas low vision was mainly caused by trachoma ( 58.1 % ) and cataract ( 29.3 % ) . It is estimated that in Mankien payam 1,154 persons aged 5 y and above ( lower and upper bounds = 782–1,799 ) are blind , and 2,291 persons ( lower and upper bounds = 1,820–2,898 ) have low vision . Conclusions Blindness is a serious public health problem in Mankien , and there is urgent need to implement comprehensive blindness prevention programs . Further surveys are essential to confirm these tragic findings and estimate prevalence of blindness and low vision in the entire region of southern Sudan in order to facilitate planning of VISION 2020 objectives OBJECTIVE In stating the Millennium Development Goals , the United Nations aims to halve malnutrition around the world by 2015 . Nutritional status of the elderly population in low-income countries is seldom focused upon . The present study aim ed to evaluate the magnitude of malnutrition among an elderly population in rural Bangladesh . DESIGN AND SETTING Data collection for a multidimensional cross-sectional study of community-based elderly people aged 60 years and over was conducted in a rural area in Bangladesh . SUBJECTS Of 850 r and omly selected elderly individuals , 625 participated in home interviews .  Complete nutritional information was available for 457 individuals ( mean age 69+/-8 years , 55 % female ) .  Nutritional status was assessed using an adapted form of the  Mini Nutritional Assessment ( MNA ) including body mass index ( BMI ) . Age , sex , education , household expenditure on food and self-reported health problems were investigated as potential predictors of nutritional status . RESULTS BMI < 18.5 kg m(-2 ) , indicating chronic energy deficiency , was found in 50 % of the population . MNA revealed a prevalence of 26 % for protein-energy malnutrition and 62 % for risk of malnutrition . Health problems rather than age had a negative impact on nutritional status . Level of education and food expenditure were directly associated with nutritional status . CONCLUSION In order to reduce world hunger by half in the coming decade , it is important to recognise that a substantial proportion of the elderly population , particularly in low-income countries , is undernourished BACKGROUND Previous research has been inconclusive regarding the impact of glucose ingestion and gluco-regulatory control on cognitive performance in healthy older adults . The aim of this research was to determine whether glucose specifically enhanced episodic memory in an older population . In addition , the link between individual differences in glucose regulation and the magnitude of the enhancement effect was examined . DESIGN AND SUBJECTS A within subjects , counterbalanced , crossover design was used with 20 participants ( 60 - 80 year olds ) , each serving as his/her control . METHODS Episodic memory was tested by presenting unrelated paired associates followed by immediate and delayed cued recall , and delayed recognition , under single and dual task conditions . In addition , a battery of cognitive tests was administered , including tests of semantic memory , working memory and speed of processing . RESULTS Glucose ingestion was found to largely facilitate performance of episodic memory . Furthermore , subsidiary analyses found that gluco-regulatory efficiency predicted episodic memory performance in both control and glucose conditions . CONCLUSIONS A boost in performance after glucose ingestion was particularly seen in the episodic memory domain . Notably , strong evidence was provided for the utility of gluco-regulatory control measures as indicators of cognitive decline in the elderly BACKGROUND Neuropsychological tests are commonly used in psychopharmacological research to underst and the nature and the magnitude of cognitive effects of licensed and novel compounds . While the science of cognitive change assessment has advanced considerably , statistical techniques used to guide inferences about differences in cognitive change have not been considered in the same detail , especially in light of recent advances in modeling repeated data . METHODS Data from a r and omized , placebo-controlled , crossover study of the effect of an acute dose of lorazepam on cognitive function in healthy adults were analyzed using five statistical approaches ( paired sample t-test , area under curve ( AUC ) , repeated measures analysis of variance ( ANOVA ) , change from baseline , and linear mixed models ( LMM ) ) . Results of significance tests and effect sizes were compared at maximum concentration ( C(max ) ) and over the ascending slopes of cognitive performance . RESULTS LMM approaches were superior to other statistical approaches with respect to results of significance testing and magnitudes of estimated effect size change . CONCLUSIONS Results of this study suggest that employment of LMM , which permit examination of specific fixed effects ( e.g. , time , treatment , treatment x time ) and that are not confounded by between-subject variability , provide a sensitive approach to detecting the cognitive effects of pharmacologic challenges , even with small sample OBJECTIVE Many biological variables , endodontic treatment factors , and restorative considerations have been suggested in the literature to affect the outcome of endodontic treatment . However , few attempts have been made recently to study these variables further . The purpose of this study was to identify the biologic and endodontic treatment-associated variables that are most predictive of treatment outcome for conventional endodontic therapy and to determine the magnitude of risk these variables pose on the outcome . STUDY DESIGN The population of this historical prospect i ve cohort study comprised a total of 200 teeth with 441 root canals . Diagnostic and treatment information was abstract ed from the original patient records . An endodontic follow-up examination was conducted 4 + /- 0.5 years after obturation . Each tooth/root was analyzed according to 3 indices of periradicular status at 2 time points . The main outcome measure was the presence of apical periodontitis . The criteria used for evaluation of the outcome were modified from Strindberg . Data were subjected to univariate and multivariate analysis . Logistic regression models were fit by using various clinical measures to determine which combination of biologic and treatment-associated factors best predicted treatment outcome . RESULTS The preoperative pulp diagnosis , the periapical diagnosis , the preoperative periapical radiolucency size , and the sex of the patients were revealed , by means of univariate analysis , to exert a significant influence on endodontic treatment outcome ( P < .05 ) . In the logistic regression model , the strongest effect on postoperative healing was the presence and magnitude of preoperative apical periodontitis . In the presence of this variable , no other factor contributed value to the prediction . The correct prediction of this model was 74.7 % ( P < .05 ) . CONCLUSION The major biologic factors influencing the outcome of endodontic treatment appear to be the extent of microbiological insult to the pulp and periapical tissue , as reflected by the periapical diagnosis and the magnitude of periapical pathosis PURPOSE Delirium is common after cardiac surgery and is associated with adverse consequences , including cognitive decline . Identification of vulnerable older adults might allow for early implementation of delirium-prevention strategies . Brain MRI findings provide insight into structural brain changes that may identify vulnerable patients . The purpose of this study was to examine the association between brain MRI characteristics potentially associated with delirium vulnerability and the development of postoperative delirium in a nested cohort of patients undergoing cardiac surgery . METHODS We identified 79 cardiac surgery patients who had brain MRI imaging after cardiac surgery , as part of an ongoing r and omized trial evaluating the efficacy of blood pressure management based on cerebral autoregulation monitoring versus st and ard management for improving neurological outcomes . Cerebral lateral ventricular size , cortical sulcal width , and white matter hyperintensities ( WMH ) on brain MRI scans were grade d on a vali date d 0 to 9 scale , and categorized into tertiles . New ischemic lesions were characterized as present or absent . Delirium was assessed using a vali date d chart- review .  Neuropsychological testing  performed before surgery was used to establish preoperative cognitive baseline . Multivariable logistic regression was used to assess the independent association between MRI characteristics and postoperative delirium . FINDINGS The average age of patients was 70.1 ± 7.8 years old , and 72 % were male . Twenty-eight of 79 ( 35.4 % ) patients developed postoperative delirium . Patients with delirium had higher unadjusted ventricular size ( median 4 vs. 3 , P = 0.003 ) , and there was a trend towards higher sulcal sizes and WMH grade s. Increasing tertiles of ventricular size ( Odds Ratio [ OR ] 3.59 ; 95 % Confidence Interval [ CI ] 1.59 - 8.12 ; P = 0.002 ) and sulcal size ( OR 2.15 ; 95%CI 1.13 - 4.12 ; P = 0.02 ) were associated with postoperative delirium , with a trend for tertiles of WMH grade ( OR 1.91 ; 95%CI 0.99 - 3.68 ; P = 0.05 ) . In multivariable models adjusted for logistic EuroSCORE , baseline cognitive status , bypass time , and any postoperative complication , each tertile of ventricular size was associated with increased odds of postoperative delirium ( OR 3.23 per tertile increase in ventricular size ; 95%CI 1.21 - 8.60 ; P = 0.02 ) . There were no differences in odds of delirium by tertiles of sulcal grade , tertiles of white matter grade , or presence of new ischemic lesions , in adjusted models . IMPLICATION S Increased brain ventricular size was independently associated with delirium after cardiac surgery . These results suggest that cerebral atrophy may contribute to increased vulnerability for postoperative delirium . Baseline brain MRIs may be useful in identifying cardiac surgery patients at high risk for postoperative delirium , who might benefit from targeted perioperative approaches to prevent delirium . Clinical Trials.gov identifier : NCT00981474 Aims : The purpose of this study was to determine the risk for taking early retirement pension ( ERP )  in cancer survivors who were working at the time of diagnosis . Methods : We conducted a nationwide and population based cohort study including 44,905 persons aged 30—60 years diagnosed with selected cancers in the period 1981—2000 and 211,562 r and omly sample d cancer-free controls . Information on socioeconomic status , demography and physical and psychiatric comorbidity was obtained from Danish administrative registries . Results : We analyzed the risk for ERP  adjusted for known risk factors and found that cancer patients has an excess risk of ERP  compared to cancer-free controls ( RR , 1.60 ; 95 % CI , 1.55—1.65 and RR , 1.55 ; 95 % CI , 1.46—1.65 for women and men , respectively ) . The observed risk factors for taking  ERP  were late age , dissimilated disease , manual job , sickness leave the year before taking ERP  , physical and psychological comorbidity , low education and low income . Three risk categories were identified ( high , medium and low ) by cancer site and we found that in the high risk category , people diagnosed with leukemia , prostate cancer or ovary cancer had a more than two-fold increased risk for ERP  and the risk remained increased with up to 8 years of follow-up . Conclusions : We observed a significantly increased risk for taking early retirement  up to 8 years after the cancer diagnosis and that the magnitude of the risk was dependent of cancer sites OBJECTIVES To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment , cognitive impairment , or the multimorbidity . DESIGN Prospect i ve cohort . SETTING North Carolina . PARTICIPANTS Three thous and eight hundred seventy-eight participants in the North Carolina Established Population s for the Epidemiologic Studies of the Elderly with nonmissing visual status , cognitive status , and disability status data at baseline MEASUREMENTS  Short Portable Mental Status Question naire  ( cognitive impairment defined as > or = 4 errors ) ,  self reported visual acuity ( visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print ) , demographic and health-related variables , disability status ( activities of daily living ( ADLs ) , instrumental activities of daily living ( IADLs ) , mobility ) , death , and time to nursing home placement . RESULTS Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability ( odds ratio (OR)=6.50 , 95 % confidence interval (CI)=4.34 - 9.75 ) , mobility disability ( OR=4.04 , 95 % CI=2.49 - 6.54 ) , ADL disability ( OR=2.84 , 95 % CI=1.87 - 4.32 ) , and incident ADL disability ( OR=3.66 , 95 % , CI=2.36 - 5.65 ) . In each case , the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone , a pattern that was not observed for other adverse outcomes assessed . No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status . CONCLUSION Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability , with each condition contributing additively to disability risk . Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity . When visual or cognitive impairment is present , efforts to maximize the other function may be beneficial CONTEXT Previous studies raise the possibility that blood pressure ( BP ) in middle age predicts later cognitive decline . OBJECTIVE To examine prospect ively the relationship of BP with level of and change in cognitive function in the elderly . DESIGN Longitudinal , population -based study comprising subjects enrolled in the East Boston component of the Established Population s for the Epidemiologic Study of the Elderly ( EPESE ) ( 1982 - 1983 ) and the Hypertension Detection and Follow-Up Program ( HDFP ) ( 1973 - 1974 ) . SETTING East Boston , Mass. PARTICIPANTS Of the 3657 participants in the EPESE with baseline BP measurements , 2068 also participated in the HDFP . Subjects were aged 65 to 102 years at baseline in the EPESE and had mental status and memory assessed at baseline and 3 and 6 years . MAIN OUTCOME MEASURES Numbers of errors on the Short Portable Mental Status Question naire and the East Boston Memory Test and rates of change in these numbers of errors . Subjects had BP measured both at baseline in the EPESE and 9 years before , as part of the HDFP . RESULTS In analyses adjusted for age , sex , and education , there was no strong linear association between BP and cognition . The associations found were fairly small in magnitude , and varied according to which test was used to measure cognition . There was little evidence for an effect of BP on change in cognitive function with either test , or for an effect on level of function on the memory test . In analyses of level of mental status question naire performance , however , elevated systolic BP ( > or = 160 mm Hg ) 9 years before baseline was associated with a 14 % ( 95 % confidence interval [ CI ] , 4%-25 % ) increase in error rate , relative to the referent ( 130 - 139 mm Hg ) . Baseline systolic BP had a U-shaped association with the number of errors ; error rates were 9 % higher compared with the referent group among those with systolic BP lower than 130 mm Hg ( 95 % CI , 1%-17 % ) and 7 % greater ( 95 % CI , 0%-15 % ) among those with elevated systolic BP . Diastolic BP 9 years before baseline also had a U-shaped association with errors on the mental status question naire . CONCLUSION The findings do not suggest a linear association of BP with cognitive decline , but they are consistent with a more complex relationship between BP and cognition than previously appreciated OBJECTIVE Substantial progress has been made in identifying how the treatment parameters used in ECT impact on cognitive side effects . However , there is limited information regarding individual differences in vulnerability to these side effects . The authors examined patients ' pretreatment global cognitive status and postictal orientation recovery time as potential predictors of the magnitude of retro grade amnesia for autobiographical memories after ECT . METHOD Seventy-one in patients with major depressive disorder were r and omly assigned to four ECT conditions that varied in electrode placement ( right unilateral versus bilateral ) and stimulus dosage ( low versus high intensity ) . Orientation recovery time was assessed at virtually every session during the course of ECT .  Global cognitive status was assessed with the modified Mini-Mental State examination before treatment , during the week after termination of treatment , and 2 months after treatment ended . Retro grade amnesia was assessed at these same time points with the Autobiographical Memory Interview . RESULTS Pre-ECT global cognitive status and the duration of postictal disorientation were strong predictors of the magnitude of retro grade amnesia in the week after the course of ECT and at 2-month follow-up . In general , these relationships were maintained regardless of technical parameters in the administration of the ECT . CONCLUSIONS Patients who manifest global cognitive impairment before treatment and patients who experience prolonged disorientation in the acute postictal period may be the most vulnerable to persistent retro grade amnesia for autobiographical information As a result of an increasing life expectancy , the incidence of cancer cases diagnosed in the older population is rising . Indeed , cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones . Despite this high incidence of cancer in older patients , solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking , mostly due to under-representation of these patients in prospect i ve clinical trials . The clinical behaviour of common malignant diseases , e.g. breast , ovarian and lung cancers , lymphomas and acute leukaemias , may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth . The decision to treat or not these patients should be based on patients ' functional age rather than the chronological age . Assessment of patients ' functional age includes the evaluation of health , functional status , nutrition , cognition and the psychosocial and economic context . The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population Background : Evidence based planning has been the hallmark of the blindness control programme in India . A nationwide survey was undertaken in 1999–2001 to document the magnitude and causes of blindness . Methods : One district each in 15 populous states was covered . 25 clusters were r and omly selected in each district and all individuals aged 50 years and above were enumerated . Presenting and best corrected vision was recorded using retroilluminated logMAR tumbling E charts and detailed eye examination was offered . Results : The response rate was 89.3 % . Presenting vision < 6/60 , in the better eye , was observed in 8.5 % ( 95 % CI : 8.1 to 8.9 ) . Age , sex , residence , literacy , and working status were associated with blindness . The highest risk was among those aged 70 + and the illiterate .  Cataract was responsible for 62.4 % of bilateral blindness . Prevalence of cataract blindness was 5.3 % ( 95 % CI : 4.97 to 5.62 ) . Reduction in blindness prevalence among people aged 50 years and above was observed compared to earlier studies . Conclusion : Blindness control efforts seem to have played a part in arresting the increasing prevalence of blindness in India and there is hope that the goals of the “ Vision 2020—right to sight ” initiative can be achieved if there is strong political will and prioritised action We performed a pilot r and omized , controlled trial of intensive , computer-based cognitive training in 47 subjects with mild cognitive impairment . The intervention group performed exercises specifically design ed to improve auditory processing speed and accuracy for 100 min/d , 5 d/wk for 6 weeks ; the control group performed more passive computer activities ( reading , listening , visuospatial game ) for similar amounts of time . Subjects had a mean age of 74 years and 60 % were men ; 77 % successfully completed training . On our primary outcome , Repeatable Battery for Assessment of Neuropsychological Status total scores improved 0.36 st and ard deviations ( SD ) in the intervention group ( P=0.097 ) compared with 0.03 SD in the control group ( P=0.88 ) for a nonsignificant difference between the groups of 0.33 SD ( P=0.26 ) . On 12 secondary outcome measures , most differences between the groups were not statistically significant . However , we observed a pattern in which effect sizes for verbal learning and memory measures tended to favor the intervention group whereas effect sizes for language and visuospatial function measures tended to favor the control group , which raises the possibility that these training programs may have domain-specific effects . We conclude that intensive , computer-based mental activity is feasible in subjects with mild cognitive impairment and that larger trials are warranted Access to mental representations of smaller vs. larger number symbols is associated with leftward vs. rightward spatial locations , as represented on a number line . The well-replicated SNARC effect ( Spatial-Numerical Association of Response Codes ) reveals that simple decisions about small numbers are facilitated when stimuli are presented on the left , and large numbers facilitated when on the right . We present novel evidence that the size of the SNARC effect is relatively stable within individuals over time . This enables us to take an individual differences approach to investigate how the SNARC effect is modulated by spatial and numerical cognition . Are number-space associations linked to spatial operations , such that those who have greater facility in spatial computations show the stronger SNARC effects , or are they linked to number semantics , such that those showing stronger influence of magnitude associations on number symbol decisions show stronger SNARC effects ? Our results indicate a significant correlation between the SNARC effect and a  2D mental rotation task  , suggesting that spatial operations are at play in the expression of this effect . We also uncover a significant correlation between the SNARC effect and the distance effect , suggesting that the SNARC is also related to access to number semantics . A multiple regression analysis reveals that the relative contributions of spatial cognition and distance effects represent significant , yet distinct , contributions in explaining variation in the size of the SNARC effect from one individual to the next . Overall , these results shed new light on how the spatial-numerical associations of response codes are influenced by both number semantics and spatial operations BACKGROUND The order and magnitude of pathologic processes in Alzheimer 's disease are not well understood , partly because the disease develops over many years . Autosomal dominant Alzheimer 's disease has a predictable age at onset and provides an opportunity to determine the sequence and magnitude of pathologic changes that culminate in symptomatic disease . METHODS In this prospect i ve , longitudinal study , we analyzed data from 128 participants who underwent baseline clinical and cognitive assessment s , brain imaging , and cerebrospinal fluid ( CSF ) and blood tests .  We used the participant 's age at baseline assessment and the parent 's age at the onset of symptoms of Alzheimer 's disease to calculate the estimated years from expected symptom onset ( age of the participant minus parent 's age at symptom onset ) . We conducted cross-sectional analyses of baseline data in relation to estimated years from expected symptom onset in order to determine the relative order and magnitude of pathophysiological changes . RESULTS Concentrations of amyloid-beta (Aβ)(42 ) in the CSF appeared to decline 25 years before expected symptom onset . Aβ deposition , as measured by positron-emission tomography with the use of Pittsburgh compound B , was detected 15 years before expected symptom onset . Increased concentrations of tau protein in the CSF and an increase in brain atrophy were detected 15 years before expected symptom onset . Cerebral hypometabolism and impaired episodic memory were observed 10 years before expected symptom onset . Global cognitive impairment , as measured by the Mini-Mental State Examination and the Clinical Dementia Rating scale , was detected 5 years before expected symptom onset , and patients met diagnostic criteria for dementia at an average of 3 years after expected symptom onset . CONCLUSIONS We found that autosomal dominant Alzheimer 's disease was associated with a series of pathophysiological changes over decades in CSF biochemical markers of Alzheimer 's disease , brain amyloid deposition , and brain metabolism as well as progressive cognitive impairment . Our results require confirmation with the use of longitudinal data and may not apply to patients with sporadic Alzheimer 's disease . ( Funded by the National Institute on Aging and others ; DIAN Clinical Trials.gov number , NCT00869817 . ) OBJECTIVE Schizophrenia is associated with a marked cognitive impairment that is widely believed to remain stable after illness onset . Yet , to date , 10-year prospect i ve studies of cognitive functioning following the first episode with good methodology are rare . The authors examined whether schizophrenia patients experience cognitive decline after the first episode , whether this decline is generalized or confined to individual neuropsychological functions , and whether decline is specific to schizophrenia . METHODS Participants were from a population -based case-control study of patients with first-episode psychosis who were followed prospect ively up to 10 years after first admission . A neuropsychological battery was administered at index presentation and at follow-up to patients with a diagnosis of schizophrenia ( N=65 ) or other psychoses ( N=41 ) as well as to healthy comparison subjects ( N=103 ) . RESULTS The schizophrenia group exhibited declines in IQ and in measures of verbal knowledge and of memory , but not processing speed or executive functions . Processing speed and executive function impairments were already present at the first episode and remained stable thereafter . The magnitude of declines ranged between 0.28 and 0.66 st and ard deviations . Decline in measures of memory was not specific to schizophrenia and was also apparent in the group of patients with other psychoses . Healthy individuals with low IQ  showed no evidence of decline , suggesting that a decline is specific to psychosis . CONCLUSIONS Patients with schizophrenia and other psychoses experience cognitive decline after illness onset , but the magnitude of decline varies across cognitive functions . Distinct mechanisms consequent to the illness and /or psychosocial factors may underlie impairments across different cognitive functions Background : Hearing impairment ( HI ) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated . Moreover , the cognitive status may be impaired in relation to hearing function . Objective : The goal of the study was to evaluate : ( a ) the prevalence of HI in a r and om sample of elderly people aged 65 and over ( n = 1,750 ) living in Campania , a region of southern Italy ; ( b ) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability , and ( c ) to assess the role of hearing aids on depressive symptomatology . Methods : Cross-sectional study on a r and om sample of elderly population . Results : The overall participation rate in the study was 74.8 % ( n = 1,332 , mean age was 74.2 ± 6.4 years ) . The prevalence rate of HI ( evaluated by question naire ) was 27.2 % , cognitive impairment prevalence ( evaluated by the Mini-Mental State Examination ( MMSE ) ) was 27.9 % , mean depressive symptomatology score ( evaluated by Geriatric Depression Scale ( GDS ) ) was 11.4 ± 6.6 , while disability assessed by Activity of Daily Living ( ADL ) was present in 7.0 % of the whole population . A strong relationship was found between both decreasing hearing function and MMSE decline , independently by the effect of age and education ( r = 0.97 ; p < 0.01 ) . A positive relationship ( r = 0.85 ; p < 0.01 ) between GDS score and hearing function was also found . Moreover , at an increased level of hearing loss , a lower ADL score was recorded ( r = 0.98 ; p < 0.01 ) . Finally , the use of hearing aids reduced GDS score . In logistic regression analysis , gender , age and educational level indicate that hearing loss risk increased with age ( odds ratio 1.60 ; 95 % confidence interval 1.53–1.71 ) , whereas education plays a protective role ( odds ratio 0.75 ; 95 % confidence interval 0.72–0.80 ) . Conclusion : HI is very prevalent among elderly people and is associated with either cognitive impairment and /or depression and reduction of functional status . This study suggests that hearing aids may protect against cognitive impairment and disability , improving quality of life of aged people PURPOSE The management of glioblastoma multiforme ( GBM ) in elderly patients with poor performance status is not well established . A trial evaluating the efficacy and safety of temozolomide alone in this population was undertaken . PATIENTS AND METHODS Patients age 70 years or older with newly diagnosed GBM and postoperative Karnofsky performance score ( KPS ) less than 70 were eligible for this nonr and omized phase II trial . Treatment consisted of 150 to 200 mg/m(2)/d temozolomide for 5 days every 4 weeks until disease progression . Radiotherapy was not administered . The primary end point was overall survival ( OS ) ; secondary end points included progression-free survival ( PFS ) , safety , quality of life , and cognition . RESULTS Seventy patients ( median age , 77 years ; median KPS , 60 ) were enrolled between July 2007 and February 2009 . Grade 3 to 4 neutropenia and thrombocytopenia occurred in 13 % and 14 % of patients , respectively . Median PFS was 16 weeks ( 95 % CI , 10 to 20 weeks ) , and median OS was 25 weeks ( 95 % CI , 19 to 28 weeks ) , comparing favorably with a 12- to 16-week OS expected from a purely supportive approach . Twenty-three patients ( 33 % ) improved their KPS by 10 or more points , and 18 ( 26 % ) became capable of self-care ( KPS ≥ 70 ) . Overall quality of life and cognition improved over time before disease progression . In the 31 tumors evaluated for O(6)-methylguanine-DNA methyltransferase ( MGMT ) promoter methylation , a methylated status indicated longer PFS ( 26 v 11 weeks ; P = .03 ) and OS ( 31 v 19 weeks ; P = .03 ) . CONCLUSION Temozolomide has an acceptable tolerance in elderly patients with GBM and KPS less than 70 . It is associated with improvement of functional status in 33 % of patients and appears to increase survival compared with supportive care alone , especially in patients with methylated MGMT promoter BACKGROUND AND PURPOSE The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers ' compensation was examined . The primary purpose of the study was to describe the level of disability , physical impairment , and rate of return to work for compensated patients . SUBJECTS One hundred thirty-eight patients ( 84 male , 54 female ) , aged 17 to 63 years ( mean = 38 , SD = 10 ) , were evaluated prospect ively . METHODS Subjects were assessed initially ( INA ) and were reevaluated 1 month later ( 1MO ) and again at the time of discharge ( DC ) . The Oswestry disability score , fingertip-to-floor distance during forward bending , maximal isometric lift , and work status were described as outcomes . Subjects were grouped based on compliance , chronicity , and leg symptoms . Each disability/impairment outcome was analyzed with paired t tests ( INA versus 1MO and INA versus DC ) . The frequency of subjects returning to work across groups was evaluated with a chi-square analysis corrected for unequal group sizes . RESULTS Overall , there was improvement in each dependent measure at 1MO and DC compared with the INA . Subjects with high compliance had a 10 % reduction in mean disability at 1MO and a 12 % reduction in mean disability at DC compared with the INA . The low-compliance group , in contrast , showed less than a 5 % reduction in mean disability at both the 1MO and DC assessment s compared with the INA . The magnitude of improvement in disability status , forward bending , and maximal lift was approximately two to three times greater for subjects with acute symptoms compared with those with chronic symptoms . The increase in mean forward bending for subjects without leg symptoms was over twice as large as the increase in forward bending for subjects with leg symptoms . Seventy-five percent of the subjects followed at DC ( 30 out of 40 ) were released to work in some capacity . There was no association between compliance or presence of leg symptoms and work status at DC . Eighty percent of the subjects with acute symptoms , however , were working at the time of DC compared with 44 % of those with chronic symptoms . CONCLUSION AND DISCUSSION Compliance , chronicity , and leg symptoms are all factors that can affect the outcome of physical therapy . The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment PURPOSE To present 5-year data on treatment efficacy , cosmetic results , and toxicities for patients enrolled on the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial . METHODS AND MATERIAL S A total of 1440 patients ( 1449 cases ) with early-stage breast cancer receiving breast-conserving therapy were treated with the MammoSite device to deliver accelerated partial-breast irradiation ( APBI ) ( 34 Gy in 3.4-Gy fractions ) . Of 1449 cases , 1255 ( 87 % ) had invasive breast cancer ( IBC ) ( median size , 10 mm ) and 194 ( 13 % ) had ductal carcinoma in situ ( DCIS ) ( median size , 8 mm ) . Median follow-up was 54 months . RESULTS Thirty-seven cases ( 2.6 % ) developed an ipsilateral breast tumor recurrence ( IBTR ) , for a 5-year actuarial rate of 3.80 % ( 3.86 % for IBC and 3.39 % for DCIS ) . Negative estrogen receptor status ( p=0.0011 ) was the only clinical , pathologic , or treatment-related variable associated with IBTR for patients with IBC and young age ( < 50 years ; p=0.0096 ) and positive margin status ( p=0.0126 ) in those with DCIS . The percentage of breasts with good/excellent cosmetic results at 60 months ( n=371 ) was 90.6 % . Symptomatic breast seromas were reported in 13.0 % of cases , and 2.3 % developed fat necrosis . A subset analysis of the first 400 consecutive cases enrolled was performed ( 352 with IBC , 48 DCIS ) . With a median follow-up of 60.5 months , the 5-year actuarial rate of IBTR was 3.04 % . CONCLUSION Treatment efficacy , cosmesis , and toxicity 5 years after treatment with APBI using the MammoSite device are good and similar to those reported with other forms of APBI with similar follow-up
The results showed that cognitive decline is strongly associated with frailty , being a probable main clinical outcome .
In this sense , any strategy aim ed at mitigating or reversing the incidence of frailty with ageing should take into account that physical and cognitive frailty seem to have similar temporal trajectories
The purpose of present study was to analyze the magnitude of the effect-size in the assessment of the cognitive status of population s over 60 years of age .