Notes

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Older adults with bipolar disorder (BD) commonly present with cognitive deficits (e.g., attention, memory, verbal fluency). MYCi361 mouse Concomitantly, older adults with BD commonly report subjective or perceived cognitive failures. For this study, we confirmed a 3-factor model of cognitive failures first validated with older adults free of mental illness (i.e., forgetfulness, distractibility, false triggering). We then computed a structural equation model (SEM) demonstrating the construct validity of perceived cognitive errors in relation to quality of life with BD. Use of SEM enabled us to measure quality of life broadly and germane to BD (i.e., well-being, life satisfaction, alcohol misuse, sleep quality).

We obtained responses from an international sample of 350 older adults with BD (M=61.26 years of age, range 50-87), recruited via micro-targeted social media advertising. Most lived in Canada, the U.S., U.K., Ireland, Australia and South Africa.

As hypothesized, perceived cognitive failures were predicted by BD symptoms (depression and hypo/mania). And cognitive failures directly and indirectly predicted quality of life.

Future research is needed to replicate this QoL model over time with younger patients and those recruited using more traditional methods.

Perceived cognitive failures may not be strongly correlated with objective indices of cognitive deficits; nonetheless perceived cognitive failures are significantly associated with quality of life for older adults with BD. For both cognitive errors and BD symptoms, their indirect effect on quality of life (via suicide ideation) is greater than the direct effect.
Perceived cognitive failures may not be strongly correlated with objective indices of cognitive deficits; nonetheless perceived cognitive failures are significantly associated with quality of life for older adults with BD. For both cognitive errors and BD symptoms, their indirect effect on quality of life (via suicide ideation) is greater than the direct effect.Stroke width is an important factor affecting letter legibility. Although there seems to be a critical or optimal value for stroke width, it has been difficult to estimate quantitatively because shape deterioration and the increase of stroke width are covariates. This study attempted to predict the optimal value of stroke width considering it as a duty ratio. The duty ratio is related to the amplitude of the fundamental frequency, with the maximum amplitude of the fundamental frequency occurring at a duty ratio of 0.5. The fundamental frequency decreases when the duty ratio is set either lower or higher than 0.5. Based on previous research indicating that letters also have a critical band (CB), or the frequency band which contributes most to letter recognition, which corresponds to their fundamental frequency, we hypothesized that the amplitude of CB is related to the legibility of letters. We measured the contrast thresholds using square-wave gratings and letters of differing duty ratios. In both the grating and letter stimuli, the amplitude of CB reached its maximum when the duty ratio was around 0.5. Contrast thresholds for stimuli with various duty ratios were accurately predicted by the amplitudes of CB and the contrast thresholds in the individual's sine-wave grating. Our results suggest that the amplitude of a single critical component contributes significantly to the legibility of letters, even though they contain diverse frequency components.
Rett syndrome (RTT) is a severe genetic neurodevelopmental disorder. Emotional, Behavioural and Autonomic Dysregulation (EBAD), is frequent in RTT and is associated with multiple impairments. There are major challenges in the clinical assessment of emotions, behaviours, and autonomic function in RTT patients that limit the management of symptoms.

Web-based technology (HealthTracker™) to measure the phenotype, and non-invasive, wearable sensor technology to evaluate autonomic function through Electrodermal Activity (EDA) and Heart Rate Variability (HRV) in 10 RTT patients was used, and treatment response of EBAD symptoms was monitored after different pharmacological treatments.

and discussion 4 patients received buspirone, 2 sertraline, 1 gabapentin and 3 were not started on medications. Buspirone normalized the EDA in 3 patients with associated improvement in EBAD, whilst another patient only improved marginally. Both patients treated with sertraline (including one with normal EDA) significantly improvely. Both patients treated with sertraline (including one with normal EDA) significantly improved symptomatically. The patients on unchanged regimens showed no change in symptoms and autonomic function. Within 24 h of our assessment, one patient required intensive inpatient care due to septicaemia - this patient had been on gabapentin and showed a sharp and sustained EDA increase without obvious worsening of emotional and behavioural symptoms. Unlike the EDA, the analyses of HRV metrics did not reveal patterns that were associated with clinical outcomes. Our findings suggest a reasonable association of EDA normalization and symptomatic improvement in RTT subjects with EBAD treated with buspirone and point out its potential application as a measure of dysautonomia in RTT. Very high and sustained EDA levels may be a biomarker for concurrent serious physical illness in RTT.Assessing the impact of the COVID-19 pandemic on perceived stress in older adults is critical to understanding how to best support elderly individuals navigating stressful situations, with the aim to lessen the impact of stressors on their brain health. Here, we collected measures on perceived stress, resilience, and behavioral coping strategies, in the context of the COVID-19 pandemic, in a cross-sectional sample of 141 community dwelling older adults (mean age = 74.4 ± 8.4, 59% females) who were part of two longitudinal observational studies in Massachusetts, U.S. Our results indicate that participants demonstrated moderate levels of stress related to COVID-19 and showed relatively high levels of resilience. Higher resilience was associated with greater use of adaptive coping behaviors and less use of maladaptive coping behaviors. The use of maladaptive coping strategies was associated with more stress. Moreover, hierarchical regression analyses revealed that resilience was the strongest unique predictor of stress, thus, largely accounting for the observed coping-outcome associations. Individual differences in resilience levels moderated the effects of two coping strategies (planning and self-blame) on stress. Specifically, planning was associated with increased levels of stress for people with low resilience. In contrast, high personal resilience attenuated the negative effect of self-blame on their stress levels. Taken together, our findings suggest that resilience is critical for coping with stress during the COVID-19 pandemic. Future approaches for augmenting resilience could prove to be important potential interventions to help support older adults navigating stressful situations as well as lessen adverse effects on neurocognitive and mental health in the future.
The literature is scarce for studies evaluating the anatomy of cervical vessels in patients with stroke. We sought to investigate the effect of vessel tortuosity in procedural, angiographic, and functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy (MT).

Patients with an emergent large vessel occlusion of the anterior circulation treated with MT between 2015 and 2020 were included. The tortuosity of the internal carotid artery was recorded as the tortuosity index (TI) using the following formula [(actual/straight length-1)× 100). A multivariable regression was performed to assess procedural, angiographic, and functional outcomes based on the TI.

A total of 212 patients were included. Median age was 72 years (interquartile range, 62-82 years); admission National Institutes of Health Stroke Scale score was 17 ± 6. Median TI was 7.9 (interquartile range, 3.7-19.7). A total of 127 patients (60%) had a TI <10. Early reperfusion (procedure time <60 minutes) was accomplished in 144 patients (67.9%). A multivariable analysis showed that patients with a TI <10 were more likely to achieve an early reperfusion (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.11-4.78; P= 0.025). A TI <10 was a predictor of successful reperfusion (OR, 2.0; CI, 1.05-3.93; P= 0.035) and an early reperfusion was the sole predictor of functional independence (most recent modified Rankin Scale score 0-2) (OR, 4.1; 95% CI, 1.62-10.53; adjusted P= 0.003).

Patients with a TI <10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of acute ischemic stroke.
Patients with a TI less then 10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of acute ischemic stroke.
The 2017 World Health Organization classification of pituitary adenomas identified the plurihormonal PIT-1-positive (PP1) adenoma as a distinct subtype. The reported data suggest that PP1 adenomas encompass the former class of silent subtype 3 (SS3) adenomas and might have an aggressive phenotype. In the present study, we summarized the current clinical data on PP1 and SS3 adenomas and compared the reported data with the data from a single institutional cohort.

Medline and Google Scholar were searched from 1990 to 2020 for clinical series of PP1 and SS3 adenomas in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Studies were included if they had reported pituitary pathology as PP1 or SS3 adenomas and had reported the clinical outcomes after surgical intervention. To better define the PP1 phenotype compared with non-PP1 adenomas, we also reviewed the adenomas treated surgically at our institution from 2012 to2019.

Of all the tumors reported in tdentify the pathologic subtypes of pituitary adenomas that are consistently more clinically aggressive.
For idiopathic normal pressure hydrocephalus (iNPH), risk stratifying patients and identifying those who are likely to fare well after ventriculoperitoneal shunt (VP) surgery may help improve quality of care and reduce unplanned readmissions. The aim of this study was to investigate the drivers of 30- and 90-day readmissions after VP shunt surgery for iNPH in elderly patients.

The Nationwide Readmission Database, years 2013 to 2015, was queried. Elderly patients (≥65 years old) undergoing VP shunt surgery were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Unique patient linkage numbers were used to follow patients and identify 30- and 31- to 90-day readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R).

We identified 7199 elderly patients undergoing VP shunt surgery for iNPH. A total of 1413 (19.6%) patients were readmitted (30-R n= 812 [11.3%] vs. 90-R n= 601 [8.3%] vs. Non-R n= 5786). The most prevalent 30- and 90-day complications seen among the readmitted cohort were mechanical complication of nervous system device implant (30-R 16.1%, 90-R 12.4%), extracranial postoperative infection (30-R 10.4%, 90-R 7.0%), and subdural hemorrhage (30-R 6.0%, 90-R 16.4%). On multivariate regression analysis, age, diabetes, and renal failure were independently associated with 30-day readmission; female sex, and 26th to 50th household income percentile were independently associated with reduced likelihood of 90-day readmission. Having any complication during the index admission independently associated with both 30- and 90-day readmission.

In this study, we identify the most common drivers for readmission for elderly patients with iNPH undergoing VP shunt surgery.
In this study, we identify the most common drivers for readmission for elderly patients with iNPH undergoing VP shunt surgery.
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