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  • 1
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2023
    In:  Archives of Clinical Neuropsychology ( 2023-10-08)
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), ( 2023-10-08)
    Abstract: Overall, 256,000 bariatric surgeries were completed in the United States in 2019 (ASMBS, 2023). Bariatric surgeries are effective in reducing morbidity, prolonging life, and improving cognition, particularly among patients with BMI & gt;40 and those with BMI & gt;35 and obesity-related complications (Handley et al., 2016; Cornejo-Pareja et al., 2021). Nevertheless, up to 16% of patients undergoing bariatric procedures experience neurological sequelae (Thaisetthawatku et al., 2004) that is likely secondary to surgery-related nutritional deficiencies (Gasmi et al., 2022). Although neuropsychological assessments may help to identify postsurgical cognitive changes, cultural and linguistic differences may preclude reliable and valid assessment of non-native English-speaking persons. Method A Spanish-dominant 38-year-old, right-handed, female reported diminished attention, reduced thinking speed, and memory difficulties that were interfering with her daily functioning. She completed a thorough Clinical Interview (both individually and with collaterals), Record Review, and a comprehensive neuropsychological workup. Results She demonstrated multi-domain impairment ( & gt;1.5 S.D. below the normative mean), suggesting a possible dementia or encephalopathy. When her cognitive profile was interpreted in the context of her medical history, further testing was recommended to rule out reversible etiologies. Interdisciplinary collaborations with primary care and gastroenterology revealed nutritional deficiencies that had persisted for over 18 months after bariatric surgery and that were not fully resolved with regular oral vitamin consumption. Conclusions Cultural and linguistic differences were relevant when assessing cognitive changes in non-native English-speaking persons, and in helping to determine whether pharmacological and behavioral interventions are ameliorating these complications. Practical considerations of these high-stakes assessments will be discussed from neuropsychological, psychosocial, and ethical perspectives.
    Type of Medium: Online Resource
    ISSN: 1873-5843
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2003528-7
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  • 2
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2020
    In:  Innovation in Aging Vol. 4, No. Supplement_1 ( 2020-12-16), p. 254-255
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 4, No. Supplement_1 ( 2020-12-16), p. 254-255
    Abstract: Delirium — an acute disorder of attention and cognition — is a common, life-threatening and costly syndrome occurring frequently in older hospitalized persons. The unexpected, rapid, and volatile nature of delirium can be difficult for family caregivers to experience and may contribute to subjective feelings of distress (i.e. “delirium burden”). The aim of this study was to examine whether pre-admission patient characteristics or patient-caregiver relationship and living arrangements were associated with caregiver burden as measured by the delirium burden scale for caregivers (DEL-B-C; score 0-40, higher score is more burden). Our sample consisted of 208 older adults and their caregivers from the Better Assessment of Illness (BASIL) study, an ongoing prospective, observational study of surgical and medical patients ≥70 years old; 22% of patients experienced delirium by the Confusion Assessment Method (CAM) and the average DEL-B-C score was 7.9, 95% CI(6.95-8.88). Results indicated that neither patient-caregiver relationship and living arrangement or patient factors including pre-admission pain, sleep disturbance, or new onset incontinence were significantly correlated with delirium-related caregiver burden. However, DEL-B-C scores were significantly higher in caregivers of patients with any ADL impairment (mean 8.5 vs. 5.2, p = .016) during hospitalization although none of the individual functional deficits alone were statistically significant. This finding suggests that the association of ADL impairment and DEL-B-C scores is not driven by a single functional domain. Future studies are needed to further understand how caregiver characteristics and patient factors occurring before and during hospitalization contribute to caregiver burden after the occurrence of delirium.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2905697-4
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  • 3
    In: Medical Decision Making, SAGE Publications, Vol. 43, No. 6 ( 2023-08), p. 656-666
    Abstract: Older adults are prone to cognitive impairment, which may affect their ability to engage in aspects of shared decision making (SDM) and their ability to complete surveys about the SDM process. This study examined the surgical decision-making processes of older adults with and without cognitive insufficiencies and evaluated the psychometric properties of the SDM Process scale. Methods Eligible patients were 65 y or older and scheduled for a preoperative appointment before elective surgery (e.g., arthroplasty). One week before the visit, staff contacted patients via phone to administer the baseline survey, including the SDM Process scale (range 0–4), SURE scale (top scored), and the Montreal Cognitive Assessment Test version 8.1 BLIND English (MoCA-blind; score range 0–22; scores  〈  19 indicate cognitive insufficiency). Patients completed a follow-up survey 3 mo after their visit to assess decision regret (top scored) and retest reliability for the SDM Process scale. Results Twenty-six percent (127/488) of eligible patients completed the survey; 121 were included in the analytic data set, and 85 provided sufficient follow-up data. Forty percent of patients ( n = 49/121) had MoCA-blind scores indicating cognitive insufficiencies. Overall SDM Process scores did not differ by cognitive status (intact cognition [Formula: see text] = 2.5, s = 1.0 v. cognitive insufficiencies [Formula: see text]  = 2.5, s = 1.0; P = 0.80). SURE top scores were similar across groups (83% intact cognition v. 90% cognitive insufficiencies; P = 0.43). While patients with intact cognition had less regret, the difference was not statistically significant (92% intact cognition v. 79% cognitive insufficiencies; P = 0.10). SDM Process scores had low missing data and good retest reliability (intraclass correlation coefficient = 0.7). Conclusions Reported SDM, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The SDM Process scale was an acceptable, reliable, and valid measure of SDM in patients with and without cognitive insufficiencies. Highlights Forty percent of patients 65 y or older who were scheduled for elective surgery had scores indicative of cognitive insufficiencies. Patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The Shared Decision Making Process scale was an acceptable, reliable, and valid measure of shared decision making in patients with and without cognitive insufficiencies.
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2040405-0
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  • 4
    In: JAMA Psychiatry, American Medical Association (AMA), Vol. 72, No. 6 ( 2015-06-01), p. 531-
    Type of Medium: Online Resource
    ISSN: 2168-622X
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2015
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  • 5
    Online Resource
    Online Resource
    International Scientific Information, Inc. ; 2018
    In:  American Journal of Case Reports Vol. 19 ( 2018-11-06), p. 1324-1328
    In: American Journal of Case Reports, International Scientific Information, Inc., Vol. 19 ( 2018-11-06), p. 1324-1328
    Type of Medium: Online Resource
    ISSN: 1941-5923
    Language: English
    Publisher: International Scientific Information, Inc.
    Publication Date: 2018
    detail.hit.zdb_id: 2517183-5
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  • 6
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2017-04-21)
    Abstract: We aimed to investigate functional connectivity and variability across multiple frequency bands in brain networks underlying cognitive deficits in primary-progressive multiple sclerosis (PP-MS) and to explore how they are affected by the presence of cortical lesions (CLs). We analyzed functional connectivity and variability (measured as the standard deviation of BOLD signal amplitude) in resting state networks (RSNs) associated with cognitive deficits in different frequency bands in 25 PP-MS patients (12 M, mean age 50.9 ± 10.5 years) and 20 healthy subjects (9 M, mean age 51.0 ± 9.8 years). We confirmed the presence of a widespread cognitive deterioration in PP-MS patients, with main involvement of visuo-spatial and executive domains. Cognitively impaired patients showed increased variability, reduced synchronicity between networks involved in the control of cognitive macro-domains and hyper-synchronicity limited to the connections between networks functionally more segregated. CL volume was higher in patients with cognitive impairment and was correlated with functional connectivity and variability. We demonstrate, for the first time, that a functional reorganization characterized by hypo-synchronicity of functionally-related/hyper-synchronicity of functionally-segregated large scale networks and an abnormal pattern of neural activity underlie cognitive dysfunction in PP-MS, and that CLs possibly play a role in variability and functional connectivity abnormalities.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2615211-3
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  • 7
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), ( 2023-10-08)
    Abstract: Los objetivos del estudio fueron describir los niveles de aflicción y bienestar psicológico en cuidadores informales (CI) de personas diagnosticadas con demencia en Puerto Rico, así como determinar la relación entre estos, durante el periodo de pandemia por COVID-19. Método En este estudio descriptivo y correlacional participaron 84 adultos puertorriqueños entre las edades de 21 y 65 años. El 92.9% se identificó con el género femenino. Se administró un cuestionario sociodemográfico, la Escala de Bienestar Psicológico de Ryff (EBPR) y el Inventario de Aflicción del Cuidador Marwit y Meuser (IACMM), formulario corto, a través de Psychdata. Resultados Un 70.0% de la muestra (n = 59) reportó presentar niveles de aflicción promedio, un 19.0% (n = 16) bajos, y 11.0% (n = 9) altos. El promedio de aflicción reportada en la IACMM fue de 63.89 (DE = 13.31). Un 61.0% (n = 51) de los participantes reportó niveles bajos de bienestar psicológico. La EBPR reflejó un promedio de 70.39 (DE = 13.09). Se llevó a cabo un análisis de correlación Pearson para evaluar la relación entre puntuaciones en la IACMM y la EBPR. Los resultados reflejaron una correlación negativa, moderada baja y estadísticamente significativa, r = −0.374 (p  & lt; 0.01). Conclusión La muestra reportó niveles de aflicción comparables con los reportados por muestras de CI en tiempos pre-pandemia. También reportaron niveles de bienestar psicológico por debajo de lo esperado para la población puertorriqueña en general. Los resultados apoyaron la correlación inversa entre aflicción y bienestar psicológico documentada previamente en la literatura. Se discutirán implicaciones de estos hallazgos para la población puertorriqueña de CI.
    Type of Medium: Online Resource
    ISSN: 1873-5843
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2003528-7
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  • 8
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2023
    In:  Archives of Clinical Neuropsychology ( 2023-10-08)
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), ( 2023-10-08)
    Abstract: This review aimed to examine and compare norm stratification of available normative data of neuropsychological tests for Spanish-speakers in the United States, Latin America, the Caribbean, and Spain. Data Selection English and Spanish studies focused on acquiring normative data for Latinx/Hispanics in Latin America, the Caribbean, the United States, and Spain, were searched from Embase, PubMed, PsycINFO APA, ClinicalTrials.gov, Science Direct, and ProQuest with the date before August 31st, 2022. We used the terms “Neuropsychological testing”, “Cognitive assessment”, “Hispanic”, “Latinx” and “Latinos”. Studies were imported to COVIDENCE, and reviewed by two Spanish-English bilingual reviewers, and one proficient English-only reviewer. Out of 345 records identified, 55 met inclusion and exclusion criteria and were not two standard deviations below the quality criteria index. Data Synthesis Age, education, and sex were the most common variables included in the stratification of normative data. Age was a predictor of lower performance in adults, and higher education was a predictor of better performance. With children and adolescents, increased age was related to better cognitive performance. Most of the studies were written in English and included a cognitively intact sample that was assessed either with the Mini-Mental State Examination, health history, or other clinical interviews or exams. Conclusion There is an evident improvement in the availability of measures for Spanish speakers. However, there is a need for better-developed tests for this population. Future studies in this area should consider adding variables such as acculturation and bilingualism into research, as well as developing novel measures for Spanish speakers.
    Type of Medium: Online Resource
    ISSN: 1873-5843
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2003528-7
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  • 9
    In: The American Journal of Geriatric Psychiatry, Elsevier BV, ( 2023-8)
    Type of Medium: Online Resource
    ISSN: 1064-7481
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 1474415-6
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  • 10
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 6, No. 5 ( 2022-07-01)
    Abstract: Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk. Research Design and Methods A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay. Results Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units. Discussion and Implications Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2905697-4
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