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Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods: This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results: Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion: Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice. IMPLICATIONS FOR REHABILITATION: The assessment of functional cognition in stroke rehabilitation is integral to occupational therapy practice. Occupational therapists described the assessment of functional cognition as a multi-component assessment drawing from three main modalities: standardised cognitive assessments; non-standardised observations; and performance-based assessments. Professional education in, and practice guidelines, for the assessment and reporting of functional cognition could be beneficial for occupational therapists in stroke care to streamline their assessment and reporting of functional cognition. [ABSTRACT FROM AUTHOR]

Introduction Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers. Methods The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed. Results The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models and care coordination; (iii) pharmacological interventions for cognitive symptoms; (iv) non-pharmacological interventions for cognitive symptoms; (v) non-cognitive symptoms, intercurrent illnesses and palliative care. The multidisciplinary panel discussed and approved 167 clinical practice recommendations and 39 research recommendations. Commentary Italy's first National Guideline on dementia and MCI addresses diagnosis, treatment and care within the National Healthcare System. It includes recommendations on pharmacological and non-pharmacological approaches, and emphasises tailored interventions, comprehensive cognitive assessment, staff training and palliative care. The guideline also underlines the need to involve PwD in decision-making and supporting caregivers throughout the entire course of the disease. Conclusions Structured strategies for the dissemination and implementation of the guideline will be defined within the Italian Fund for Alzheimer and other Dementias 2024–2026. An interactive care pathway and a leaflet dedicated to PwD and their carers are already available. The guideline will be updated starting January 2027, but early updates may be planned in case of breakthrough advancements. [ABSTRACT FROM AUTHOR]

Purpose: The Functional External Memory Aid Tool (FEMAT) is an 11-item performance-based measure that simulates everyday tasks (e.g., medication management) to measure one’s use of compensation (e.g., pill organizer). The FEMAT is not a norm-referenced diagnostic tool; rather, it is designed to provide clinicians with information about a patient’s function and compensation in a standardized format. To provide further evidence for validity of the FEMAT, the purpose of this study was to conduct a mixed-methods analysis of FEMAT responses to operationalize the types of behaviors elicited during test administration. Method: We adopted an embedded single-case study design to analyze the FEMAT administrations of 12 community-dwelling female participants, ages 73– 90 years, who met criteria for mild cognitive impairment. These participants were part of the original validation sample during which they completed the FEMAT (Version 1.0) in a single session with an assessor. Sessions were videorecorded and transcribed. We analyzed the data qualitatively in two phases using theme and subtheme codes and then quantitatively analyzed the data for response trends. Results: Our thematic analysis revealed four themes to operationalize participants’ verbal and behavioral FEMAT responses: (a) used an external memory aid (EMA), (b) described using a strategy, (c) discussed memory and comprehension, and (d) discussed functional information. While completing the FEMAT, most participants described using a strategy (85%) and discussed their selfperceived memory and comprehension (33%). Several subthemes also emerged within each theme (e.g., self-perceived memory strengths and barrier). Conclusions: Our analysis suggests that beyond a 4-point item score, the FEMAT elicits behavioral (e.g., used an EMA) and verbal (e.g., discussion of health information) content that may be useful for person-centered treatment planning. This study is part of a comprehensive research agenda establishing the evidence for the validity of the FEMAT to support its use to inform personcentered treatment approaches. [ABSTRACT FROM AUTHOR]

This study identified evidence and considerations for allied health clinicians in providing group interventions for people with cognitive impairment. A scoping review was conducted by searching the MEDLINE (Ovid), CINHAL (EBSCOhost), Scopus (Elsevier), Embase (Ovid) and TROVE databases from 2016. Articles of any study design in which group interventions were performed by an allied health professional with participants with cognitive impairment were included. Data on physical, cognitive, psychological, and quality of life measures were extracted from the selected articles. Standardised mean changes (SMC) were calculated. Ten articles were included in the study. No article directly compared group interventions versus one‐to‐one interventions. The results of the meta‐analysis showed significant improvements after the intervention in the physical (SMC = 0.42, P = 0.013), cognitive (SMC = 0.43, P = 0.005), psychological (SMC = 0.14, P = 0.005), and quality of life domains (SMC = 0.28, P = 0.002). This review identified considerations for clinicians when developing group interventions for people with cognitive impairments, including specific participant criteria, increasing support, modifications to intervention difficulty, and environmental considerations. Group intervention for people with cognitive impairments demonstrated moderate effectiveness in improving physical and cognitive domains and a small effect in improving psychological and quality of life domains. Specific considerations are recommended when clinicians provide group interventions for people with cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline is a debilitating symptom in Parkinson's disease (PD). Cognitive impairment in PD has a significant impact on many aspects of an individual's life, social interactions, and overall quality of life (QOL). It is also associated with a faster disease progression and an increased risk of developing dementia. A biopsychosocial approach is likely to address not only the underlying biological mechanisms of cognitive impairment in PD but also the psychological and social factors that can contribute to cognitive decline and influence treatment outcomes. Method: This experimental study was conducted on 60 older adults with PD at Saveetha medical college and hospital. Participants who met the inclusion criteria were randomly allocated into two groups of Biopsychosocial (n = 30) and conventional (n = 30). Participants in the intervention group received the multiple interventions based on the biopsychosocial approach with a duration of 60 min per session. Pre and post‐test evaluation conducted using Scales for Outcomes in PD‐cognition (SCOPA‐cog) and Parkinson disease QOL Questionnaire (PDQ‐8). Result: The results of the study showed that there is a statistically significant difference in the median scores within the Groups for the outcome measures SCOPA‐cog and PDQ‐8 (p < 0.001). For SCOPA‐cog, the BPS group median score increased from 30 to 36, while the Conventional group median score increased from 31 to 33. For PDQ‐8, the BPS group median reduced from 27 to 14, compared to the Conventional group's reduced from 30 to 24. On comparison between the post‐test values, the biopsychosocial approach group showed more improvement in cognition and QOL with (p < 0.001). Conclusion: The findings of this study concluded that the biopsychosocial approach is effective in improving cognition and QOL among the Parkinson population. [ABSTRACT FROM AUTHOR]

Background: serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI. Design: Pragmatic, prospective single‐arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina. Participants: Community‐dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision‐making capacity) and their care partners (if available). Intervention: SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR. Main Outcomes: Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes. Results: Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high‐quality SIC documentation. No significant differences were observed between telephone and video visits. Conclusion: These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community‐dwelling PLCI. Further investigation of the sustainability of the intervention and its long‐term impact on patient and caregiver outcomes is needed. [ABSTRACT FROM AUTHOR]

Introduction: The therapeutic potential of phytoncide fragrances may be optimal for patients with mild cognitive impairment (MCI) that display complex symptomatology. This study aimed to explore the clinical value of phytoncide by evaluating its electrophysiological effects in patients with MCI. Materials and Methods: This was a double-blind, randomized controlled trial. A total of 24 community-dwelling patients were randomly assigned to either a phytoncide or no-odor group. Participants wore a dental mask, for 30 min at rest that had either the fragrance stimulus or water added to it. The quantitative electroencephalography (EEG) during the resting state was recorded before and after a single intervention. Results: There were significant interaction effects in absolute EEG-power values in the occipital (F = 6.52, p = 0.018) and parietal (F = 5.41, p = 0.030) left hemisphere at β frequency. Phytoncide odor significantly decreased low and high β activity in the occipital (corrected p = 0.009) and parietal (corrected p = 0.047) left hemisphere, respectively. In source localization, phytoncide odor significantly decreased deep source activation in the left inferior and middle frontal gyri at β 2 frequency band compared with the no-odor group (threshold = 4.25, p < 0.05). Conclusions: Reductions in β, indicative of anxiety, depression, and stress, suggest relief from emotion-related symptoms that are common in patients with MCI. Trial Registration: Clinical Trials Registry Korea (registration: KCT0007317). [ABSTRACT FROM AUTHOR]

In celebration of the National Institute on Aging's (NIA) 50th anniversary, this paper highlights the significant advances in cognitive aging research and the promotion of cognitive health among older adults. Since its inception in 1974, the NIA has played a pivotal role in understanding cognitive aging, including cognitive epidemiology, interventions, and methods, for measuring cognitive change. Key milestones include the shift toward understanding cognitive impairment and Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), the development of large-scale longitudinal studies, and the incorporation of AD/ADRD-related biomarkers in cognitive aging cohorts. Additionally, NIA has championed diversifying the scientific workforce through initiatives, such as the Resource Centers for Minority Aging Research and the Butler-Williams Scholars Program. The next 50 years will continue to emphasize the importance of inclusion, innovation, and impactful research to enhance the cognitive health and well-being of older adults. [ABSTRACT FROM AUTHOR]

Objective: The aim of this network meta-analysis was to compare the improvement effects of various exercise interventions and mindfulness-based interventions to determine the best interventions for the improvement of cognitive impairment. Design: Seven databases were searched to screen randomized controlled trials of exercise interventions and mindfulness-based interventions to improve cognitive impairment. The network meta-analysis was performed using Revman 5.3, R 4.2.1 and ADDIS 1.16.8 software. Results: Thirty-four randomized controlled trials involving 14 interventions were included in the study. In terms of cognitive function, except for mindfulness-based stress reduction, all interventions showed significantly greater improvement in cognitive function compared with conventional therapy. Physical activity and Qigong showed better effect in improving executive function. In terms of improving verbal memory, compensatory cognitive training, neurofeedback training, Qigong, and sham Qigong were more effective than other interventions.On performing surface under the cumulative ranking curve analysis, acceptance and commitment therapy, neurofeedback training, Qigong, and mediation had the best effects on cognitive function, quality of life, executive function, and processing speed, respectively. Conclusions:Mindfulness-based interventions were found to bemore effective than exercise interventions for alleviating cognitive impairment. More robust randomized controlled trials focusing on acceptance and commitment therapy for cognitive impairment are required to support the current evidence. [ABSTRACT FROM AUTHOR]

Objectives: Problem adaptation therapy (PATH) is a relatively new psychotherapy that recognises the importance of simultaneously targeting cognitive impairment and functional disability in the treatment of late‐life depression. This is the first systematic review to examine the effectiveness of PATH. Methods: Ageline, Embase, Medline, PsycINFO, Scopus and ProQuest databases were searched from 2010 until 5 April 2024, for studies that evaluated PATH for older people. Where possible, effect sizes (Hedges' g) with 95% confidence intervals and p values were calculated and pooled using a random effects model. The reporting quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tools and certainty of the evidence behind each result assessed with The Grading of Recommendations Assessment, Development and Evaluation method. Results: Twelve papers, from seven independent studies and a pooled sample of 579 older adults with multiple comorbidities, were included in this review. PATH participants experienced immediate reductions in depression symptom ratings (gw = 0.72, p < 0.01, Nstudies = 5), alongside small improvements in disability (gw = 0.61, p = 0.04, Nstudies = 4) compared to peers that received supportive therapy, brief psychoeducation, or usual care. The overall evidence quality was, however, characterised by bias, inconsistency, and imprecision in effect estimates. Positive participant feedback and low dropout rates (15%–31%) suggested treatment satisfaction, although these data were not routinely provided. Conclusions: PATH may be a viable treatment for older people living with mental and cognitive disorders, however there is a need for more rigorous research incorporating follow‐up assessments to consolidate the effectiveness of PATH relative to other treatments. Incorporating measures of treatment fidelity are also critical to interpreting and generalising these data. The protocol for this study was prospectively published on the Open Science Framework (https://osf.io/gx57a). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the effects of enhanced external counterpulsation (EECP) in patients with long COVID and objectively assessed cognitive impairment. Design: A retrospective evaluation of long COVID patients referred for EECP, with cognitive sequela, and having completed an objective digital assessment before and after therapy. Patients had either cognitive impairment or no cognitive impairment at baseline. We assessed changes in composite score using multifactor analysis of variance. Multiple linear and logistic regression analyses were conducted to evaluate several independent variables. Results: Eighty long COVID patients (38 cognitive impairment vs. 42 no cognitive impairment) were included for analyses. All baseline characteristics werewell matched. Therewas significant improvement in composite score post EECP in those with objective cognitive impairment at baseline. There were no notable documented safety concerns. Conclusions: This is the first study showing that EECP led to significant improvement in cognitive functioning of long COVID patients with objectively defined cognitive impairment. Although a lack of a negative control group is a limitation of this study, EECP seems to be highly safe and effective with the potential for widespread application. [ABSTRACT FROM AUTHOR]

Background: The need for cognitive testing is increasing with the aging population and the advent of new Alzheimer disease therapies. To respond to the increased demand, the XpressO was developed as a self‐administered digital cognitive prescreening tool that will help distinguish between populations of subjective and objective cognitive impairment according to the Montreal Cognitive Assessment (MoCA). Methods: This is a prospective validation study. XpressO is composed of tasks that assess memory and executive functions. It is validated compared to the digital MoCA as a gold standard. Out of 118 participants screened from the MoCA Clinic and a family practice clinic, 88 met inclusion criteria, two participants had missing data due to incomplete tasks, 86 participants were included in the analysis; the mean age was 70.34 years. A logistic regression model was built, and its accuracy was evaluated by the sensitivity, specificity, and Area Under the Curve (AUC) of the Receiver Operating Characteristic. Results: Analysis showed strong correlation between (1) XpressO memory tasks scores and the MoCA Memory Index Score (p‐values < 0.001), and between (2) XpressO sub‐test scores and MoCA total score (p‐values < 0.005). The AUC for predicting MoCA performance is 0.845. To classify individuals with normal and abnormal MoCA scores, two threshold values were introduced for the total XpressO scores: sensitivity of 91% at a cutoff of 72, specificity of 90% at a cutoff of 42, and an undetermined range in between. Conclusion: XpressO demonstrated high AUC, high sensitivity and specificity to predict cognitive performance compared to the digital MoCA. It may provide efficient cognitive prescreening by identifying individuals who would benefit from further clinical assessments, potentially reducing waiting times and high burden on healthcare clinics. [ABSTRACT FROM AUTHOR]

Purpose. This study is aimed at evaluating the effectiveness of multisensory stimulation intervention (MSS) on mood, behaviour, quality of life, and physiological parameters in people with major neurocognitive disorder who live in a nursing home. Methods. We conducted a pilot study with a quasiexperimental design. A total of 17 individuals diagnosed with moderate to severe major neurocognitive disorder received eight 30‐minute sessions of MSS. Sessions were adapted based on individuals' cognitive level (GDS 6‐7) and sensory preferences. Outcomes regarding mood, behaviour, and physiological parameters were collected before and after each session. Outcomes related to quality of life and neuropsychiatric symptoms were assessed pre and postintervention. Results. Participants presented significant improvements in mood and behaviour. They were happier, more attentive to their environment, active/alert, and relaxed/content after sessions. In addition, immediately after their sessions, they were less tearful/sad, fearful/anxious, confused, and wandering/aggressive, as well as less bored/inactive. In terms of physiological parameters, a significant increase in the median heart rate of participants was detected after the sessions, but no differences were found in oxygen saturation. Moreover, a substantial improvement in the participants' quality of life, measured with the quality of life in Alzheimer's disease (p =.03) and in neuropsychiatric symptoms (neuropsychiatric inventory‐questionnaire, p =.04), was observed postintervention. Conclusion. MSS appears to be effective on mood and behaviour immediately after sessions and also appears to improve quality of life and reduce neuropsychiatric symptoms postintervention, when these are person‐centred through one‐to‐one interventions that have been adapted to the participants' sensory preferences. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that cognitive dysfunction significantly impacts patients' quality of life. Intermittent theta burst stimulation (iTBS) has emerged as a potential intervention for cognitive dysfunction. However, consensus on the iTBS protocol for cognitive impairment is lacking. We conducted searches in the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, Chinese National Knowledge Infrastructure, Wanfang Database and the Chongqing VIP Chinese Science and Technology Periodical Database from their inception to January 2024. Random-effects meta-analyzes were used to calculate standardized mean differences and 95% confidence intervals. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Twelve studies involving 506 participants were included in the meta-analysis. The analysis showed a trend toward improvement of total cognitive function, activities of daily living and P300 latency compared to sham stimulation in patients with cognitive dysfunction. Subgroup analysis demonstrated that these effects were restricted to patients with post-stroke cognitive impairment but not Alzheimer's disease or Parkinson's disease. Furthermore, subthreshold stimulation also exhibited a significant improvement. The results suggest that iTBS may improve cognitive function in patients with cognitive dysfunction, although the quality of evidence remains low. Further studies with better methodological quality should explore the effects of iTBS on cognitive function. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the efficacy of different repetitive transcranial magnetic stimulation (rTMS) modes in stroke patients with cognitive impairment, and to rank the best option according to the outcome measures. Methods: Literature was searched in PubMed, Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to September 2023. We included randomized controlled trials (RCTs) investigating the efficacy of all rTMS modes for post‐stroke cognitive impairment. The selected studies assessed at least one of the following outcome measures: Montreal Cognitive Assessment (MoCA), Mini‐Mental State Examination (MMSE), P300 latency and amplitude, and modified Barthel Index (MBI) or BI. Two researchers independently conducted data extraction. Quality assessment was performed using RevMan 5.3 software based on the Cochrane Collaboration's tool, and statistical analysis was conducted by GeMTC 0.14.3 software and Stata 17.0 software. Results: The network meta‐analysis included 74 RCTs with a total of 5478 patients. The best probability ranking indicated that intermittent theta burst stimulation (iTBS) was the most effective in enhancing MoCA, MMSE and MBI scores (85%, 54%, 42%, respectively), followed by 10 Hz rTMS (79%, 50%, 39%, respectively), for P300 amplitude, ≤1 Hz rTMS was ranked first (52%). Conclusions: The current limited evidence suggests that iTBS may be the optimal approach for improving cognitive and daily life abilities of stroke patients, followed by 10 Hz rTMS, ≤1 Hz rTMS may be the preferred option for enhancing P300 amplitude. Trail registration: PROSPERO 2023 CRD42023424771 available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771. Key points: iTBS is the optimal approach for improving cognitive and daily life abilities in stroke patients.Following iTBS, 10 Hz repetitive transcranial magnetic stimulation (rTMS) is also beneficial for enhancing cognitive and daily life abilities.Low‐frequency rTMS (≤1 Hz) is preferred for enhancing P300 amplitude. [ABSTRACT FROM AUTHOR]

This study explores Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) factors facilitating adolescents' improvement. At each of eight therapy sessions, 41 adolescents with executive function deficits and their parents wrote the primary concept they "took away." Experts categorized their answers by the FITTED model's main factors—goals, strengths, and strategies—adding child's difficulties for the parents' answers. Results describe answer frequencies by factor in each session. Across time, strengths and strategies dominated among adolescents, and strategies and difficulties among parents. Cognitive strategies are integral to the FITTED process for improving the daily functioning of adolescents with executive function deficits. [ABSTRACT FROM AUTHOR]

Background: The mental and emotional health of persons diagnosed with cancer is frequently affected. The acceptance and commitment therapy (ACT) is one of the psychological interventions that has proven successful in easing these psychological symptoms and enhancing cancer patients' psychological well‐being. Methods: A two‐arm randomized controlled trial study was utilized, 30 eligible clients with colorectal cancer were chosen randomly and were given ACT therapy at a 1:1 ratio. ACT was delivered in six sessions for 3 weeks, followed by 3 months follow‐up. Results: The table shows a statistically significant increase in the mean scores of the mental health and its flourishing level among the study group than those of the control group. Cognitive impairment was significantly decreased among the study group than for those in the control group. Conclusion: The ACT‐based interventions may be a promising approach for improving mental health and cognitive function in cancer patients, particularly those with advanced disease. [ABSTRACT FROM AUTHOR]

Introduction: Among older adults undergoing surgery, postoperative delirium is the most common complication. Cognitive impairment and dementia are major risk factors for postoperative delirium, yet they are frequently under‐recognized. It is well established that applying delirium preventive interventions to at‐risk individuals can reduce the likelihood of delirium by up to 40%. The aim of this study was to evaluate how often delirium preventive interventions are missing in patients at risk for delirium due to baseline cognitive impairment. Methods: We conducted a retrospective study using data from the observational study Perioperative Anesthesia Neurocognitive Disorder Assessment‐Geriatric (PANDA‐G) and clinical data from the University of California San Francisco delirium prevention bundle. Patients age 65+ received preoperative multidomain cognitive assessment as part of a research protocol prior to undergoing inpatient spine surgery at a single major academic institution. Results of the cognitive testing were not available to clinical teams. Using electronic medical records, we evaluated if patients who were cognitively impaired at baseline received delirium prevention orders, sleep orders, and avoidance of AGS Beers Criteria® potentially inappropriate medications. Results: Of the 245 patients included in the study, 42% were women. The mean [SD] age was 72 [5.2] years. Preoperative cognitive impairment was identified in 40% of participants (N = 98), and of these, 34% had postoperative delirium. Of patients with preoperative cognitive impairment, 45% did not receive delirium preventive orders, 43% received PIMs, and 49% were missing sleep orders. At least one of the three delirium preventive interventions was missing in 70% of the patients. Discussion: Undiagnosed preoperative cognitive impairment among older adults undergoing spine surgery is common. When cognitive test results were not available to clinicians, patients with baseline cognitive impairment frequently did not receive evidence‐based delirium preventive interventions. These findings highlight an opportunity to improve perioperative brain health care via preoperative cognitive assessment and clinical communication. [ABSTRACT FROM AUTHOR]

Background and Aim: Previous studies have shown promising findings on effectiveness of noisy Galvanic Vestibular Stimulation (nGVS) in various cognitive disorders. The connections of the vestibular system with the hippocampus has been proven. Here we investigated the effect of vestibular galvanic stimulation on the improvement of spatial learning and memory of rats. Methods: Twelve Wistar rats were randomly divided into control and nGVS groups. The nGVS group underwent 30-minute sessions of stimulation at sub-threshold levels for a duration of fourteen days. Following the intervention, both groups underwent assessments of cognitive indices through the Morris water maze task, hippocampal neuronal spike rate by Single-Unit Recording (SUR) and the concentrations of c-fos protein in the hippocampus were measured using ELISA device. Results: The nGVS group exhibited a significant difference compared to the control group in both the time taken to reach the target platform and the percentage of time spent in the goal quarter during the Morris water maze test. The nGVS treatment significantly enhanced spike rate of hippocampal dentate gyrus (p<0.01) compared to the control group. Additionally, c-fos protein concentrations were increased in the nGVS (5.833) than the control group (4.126), (p<0.001). Conclusion: According to the obtained results, nGVS plays a role in improving spatial memory, and a longer duration of intervention is suggested to achieve more obvious improvement results. [ABSTRACT FROM AUTHOR]

Purpose: Despite common clinical complaints about memory for conversation after traumatic brain injury (TBI), the nature and severity of this deficit are unknown. In this research note, we report feasibility and preliminary data from a new conversation memory study protocol. Method: Participants in this feasibility study were 10 pairs, each including an adult with chronic, moderate-to-severe TBI and their chosen familiar conversation partner. The experiment began with a naturalistic conversation between participants with TBI and their conversation partners. After a filled delay, participants next completed verbal recall for the conversation, which we transcribed and coded for their accuracy relative to the original conversation. Participants also read chosen statements from their original conversation and predicted what each partner would remember in a week. One week later, participants completed a posttest about who said each of the chosen statements, allowing direct comparison to their predictions. Results: We successfully collected conversation memory data from all 10 pairs, suggesting that this protocol is feasible for future study. In this preliminary sample, people with TBI and their conversation partners did not differ in the accuracy of their recall for the conversation about 20 min after it occurred. When asked to predict their partner’s delayed memory, conversation partners were less accurate than participants with TBI because they underestimated how much their partners with TBI would remember. Conclusion: Measuring memory for conversation in TBI is feasible and may advance the characterization of cognitive-communication impairment in TBI, and its heterogeneity, in everyday contexts. [ABSTRACT FROM AUTHOR]

Objective: To summarize the best evidence‐based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice. Design: Review. Methods: The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta‐analyses. Two researchers trained in evidence‐based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion. Results: A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management. Conclusions: This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice. Implications for the profession and/or patient care: Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence‐based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients. Reporting method: This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis. Trial and protocol registration: This study has been registered with the Fudan University Centre for Evidence‐based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs). Method: Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis. Results: Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis. Conclusions: The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions. [ABSTRACT FROM AUTHOR]

Objectives Cognitive training (CT) has been investigated as a means of delaying age-related cognitive decline in older adults. However, its impact on biomarkers of age-related structural brain atrophy has rarely been investigated, leading to a gap in our understanding of the linkage between improvements in cognition and brain plasticity. This study aimed to explore the impact of CT on cognitive performance and brain structure in older adults. Methods One hundred twenty-four cognitively normal older adults recruited from 2 study sites were randomly assigned to either an adaptive CT (n  = 60) or a casual game training (active control, AC, n  = 64). Results After 10 weeks of training, CT participants showed greater improvements in the overall cognitive composite score (Cohen's d  = 0.66, p  < .01) with nonsignificant benefits after 6 months from the completion of training (Cohen's d  = 0.36, p  = .094). The CT group showed significant maintenance of the caudate volume as well as significant maintained fractional anisotropy in the left internal capsule and in left superior longitudinal fasciculus compared to the AC group. The AC group displayed an age-related decrease in these metrics of brain structure. Discussion Results from this multisite clinical trial demonstrate that the CT intervention improves cognitive performance and helps maintain caudate volume and integrity of white matter regions that are associated with cognitive control, adding to our understanding of the changes in brain structure contributing to changes in cognitive performance from adaptive CT. Clinical Trial Registration NCT03197454 [ABSTRACT FROM AUTHOR]

The article presents letter to the editor focuses on the limitations and insights regarding virtual reality-based cognitive interventions for stroke rehabilitation. Topics include concerns about methodological heterogeneity affecting study outcomes, the need to differentiate the effectiveness of specific virtual reality technologies, and the importance of considering stroke type and using prediction intervals for reliable meta-analysis conclusions.

The design of a narrative video game for cognitive training of memory and executive functions in older adults with subjective and objective cognitive impairment is reported along with preliminary results on preferences (Study 1), user interaction experience (Study 2), and efficacy of the game (Study 3). A study of aesthetic preferences in backgrounds and avatars was implemented in 13 older adults, who were asked for their opinion on the acceptability of the plot. After completion of the design, a user interaction study was conducted in a sample of 19 older adults. In addition, a Matched Paired Experimental Design (MPED) was implemented as a preliminary test of the efficacy of the narrative video game in a sample of 22 participants with Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI). Preferences for free violence content in videogames was supported in our sample of low-frequency adult gamers and acceptability of the plot was high. The video game was rated favourably by the older adults in terms of user preferences and acceptability. The results of the preliminary MPED study suggest that the video game could be a useful tool for cognitive training in SCD and MCI older adults. [ABSTRACT FROM AUTHOR]

Dysfunctional beliefs influence the pathogenesis and maintenance of eating disorders. Cognitive-behavioral therapy (CBT) aims to modify these specific beliefs and mediate functional patterns of appraisal and thinking. The present pilot study aims to experimentally validate a computer-assisted avatar-based treatment (CAT-DB) to reduce dysfunctional body-related cognitions and symptom severity in a sample with subclinical eating disorder symptomatology. In a randomized controlled trial, 48 participants were assigned to either the control group or CAT-DB. The conviction of individual body-related cognitions and eating disorder-specific symptom expression was measured shortly before the beginning of the intervention (pre-measurement), directly after the intervention (post-measurement), and 14 days later (follow-up). There was a significant interaction effect for symptom severity, as reductions in eating disorder-specific symptomatology were significantly greater in the CAT-DB group compared to the control group at follow-up. Compared to the control group, CAT-DB resulted in non-significant but expected improvements in individual body-related automatic thoughts. The present study offers preliminary evidence suggesting that CAT-DB could be efficacious in addressing certain symptoms associated with eating disorders. Further studies with representative clinical samples diagnosed with eating disorders are needed to provide more evidence of the efficacy of CAT-DB as a support for classical CBT in a variety of therapeutic and research contexts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intermittent theta burst stimulation (iTBS) has demonstrated efficacy in patients with cognitive impairment. However, activation patterns and mechanisms of iTBS for post-stroke cognitive impairment (PSCI) remain insufficiently understood. OBJECTIVE: To investigate the activation patterns and potential benefits of using iTBS in patients with PSCI. METHODS: A total of forty-four patients with PSCI were enrolled and divided into an iTBS group (iTBS and cognitive training) or a control group (cognitive training alone). Outcomes were assessed based on the activation in functional near-infrared spectroscopy (fNIRS), as well as Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the modified Barthel Index (MBI). RESULTS: Thirty-eight patients completed the interventions and assessments. Increased cortical activation was observed in the iTBS group after the interventions, including the right superior temporal gyrus (STG), left frontopolar cortex (FPC) and left orbitofrontal cortex (OFC). Both groups showed significant improvements in LOTCA and MBI after the interventions (p < 0.05). Furthermore, the iTBS group augmented superior improvement in the total score of MBI and LOTCA compared to the control group, especially in visuomotor organization and thinking operations (p < 0.05). CONCLUSION: iTBS altered activation patterns and improved cognitive function in patients with PSCI. The activation induced by iTBS may contribute to the improvement of cognitive function. [ABSTRACT FROM AUTHOR]

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist. Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted. One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257–0.643; vs. active controls, g = 0.192–0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI). MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy. [ABSTRACT FROM AUTHOR]

Objectives. Cognitive functions in almost all domains are lower in patients with schizophrenia than those in healthy controls, with the severity of impairment differing between domains. Treatments are being developed to improve cognitive impairment in patients with schizophrenia. However, the pattern of cognitive impairment must be clarified to facilitate treatment. Therefore, this study aimed to classify the patterns of cognitive impairment in individuals and provide treatment suggestions. Methods. Patients with schizophrenia were recruited from two psychiatric hospitals in Japan. Demographic and psychopathological symptoms were assessed using the Positive and Negative Symptoms Scale for Schizophrenia and neurocognitive functions, using the CogHealth battery. The following domains were assessed: processing speed, visual attention, working memory, visual learning, and spatial attention. The scores were standardised and assigned as the same-aged average score. Hierarchical cluster analysis using Ward's method was performed based on CogHealth scores. Subsequently, one-way analysis of variance (ANOVA) and Tukey's multiple comparisons were performed to compare the variables in each cluster. Results. In total, 133 participants were classified into four clusters: Cluster 1 (n = 16), with severe cognitive impairment and psychiatric symptoms and the longest stay; Cluster 2 (n = 44), with moderate cognitive impairment and psychiatric symptoms; Cluster 3 (n = 42), with preserved cognitive function, except for spatial perception, and mild psychiatric symptoms; and Cluster 4 (n = 31), with only memory and spatial perception impairment and mild psychiatric symptoms. Implications. The clusters indicate that impairment may occur in all or selective domains. Selective domain impairments may be in spatial perception or in spatial perception and memory. Therefore, it is recommended that treatments for cognitive dysfunction are developed into four subsets considering an individual's cognitive features. [ABSTRACT FROM AUTHOR]

PROBLEM IDENTIFICATION: Patients with colorectal cancer (CRC) encounter varying degrees of objective and subjective cognitive impairment. The prevalence of objective and subjective cognitive impairment, factors affecting cognitive impairment, and interventions are presented in this review. LITERATURE SEARCH: The CINAHL Plus®, Cochrane Library, Embase®, PsycINFO®, PubMed®, and CNKI databases were systematically searched from the time of the database's establishment to May 2023. Manual searches for the relevant articles in the literature's references were also conducted. DATA EVALUATION: The results were independently assessed by two reviewers. SYNTHESIS: 25 studies were included. The prevalence of cognitive impairment in individuals with CRC was measured differently according to study designs. A model of factors contributing to cognitive impairment guided the integration of factors, including cancer treatments, psychosocial factors, and physical and emotional health conditions. Incorporated intervention programs could be integrated between objective and subjective aspects. Interventions relieved cognitive impairment in individuals with CRC. IMPLICATIONS FOR NURSING: The results of this review supported enhanced assessment and monitoring of cognitive impairment, particularly subjective cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: Poststroke cognitive impairment substantially affects patients' quality of life. This study explored the therapeutic efficacy of intermittent theta burst stimulation combined with cognitive training for poststroke cognitive impairment. Design: The experimental group received intermittent theta burst stimulation and cognitive training, whereas the control group only received cognitive training, both for 6 wks. The outcome measures were the Loewenstein Occupational Therapy Cognitive Assessment, modified Barthel Index, transcranial Doppler ultrasonography, and functional near-infrared spectroscopy. Results: After therapy, between-group comparisons revealed a substantial difference in the Loewenstein Occupational Therapy Cognitive Assessment scores (P = 0.024). Improvements in visuomotor organization and thinking operationswere more noticeable in the experimental group than in the other groups (P = 0.017 and P = 0.044, respectively). After treatment, the resistance index of the experimental group differed from that of the control group; channels 29, 37, and 41 were activated (P < 0.05). The active locations were the left dorsolateral prefrontal cortex, prefrontal polar cortex, and left Broca's region. Conclusions: Intermittent theta burst stimulation combinedwith cognitive training had a superior effect on improving cognitive function and everyday activities comparedwith cognitive training alone, notably in visuomotor organization and thinking operations. Intermittent theta burst stimulation may enhance cognitive performance by improving network connectivity. [ABSTRACT FROM AUTHOR]

Causes of behaviour that challenge in dementia are often thought to be due to reversible factors, such as a urine infection or disrupted sleep‐wake cycle. In this review, the authors consider a definition of behaviour that challenges commonly cited causes and management models. Finally, recommendations for an alternative view and subsequent approach to managing behaviour that challenges are suggested. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of Baduanjin exercise on executive function in community-dwelling older adults with cognitive frailty. Design: Randomized controlled trial. Setting: Community residential centers. Subjects: 120 eligible older adults. Interventions: Baduanjin training group received supervised Baduanjin training, 60 min sessions three times per week for 24 weeks. The control group did not receive any exercise intervention. Main measures: Primary outcome was executive function, assessed using Clock Drawing Test. Secondary outcomes included the subcomponents of executive function (working memory, inhibitory control and cognitive flexibility), attention and cognitive frailty (global cognitive function, physical frailty) assessed using Verbal Fluency Test, Trail Making Test-A/B, Stroop Test, Montreal Cognitive Assessment and Edmonton Frailty Scale, respectively, at baseline and 24 weeks after intervention. Results: After the 24-week intervention, the scores of Clock Drawing Test and Verbal Fluency Test, the Trail Making Test-B time and the Card correct numbers of Stroop Test in Baduanjin training group showed significant improvement compared with control group (all P < 0.05) with small to moderate effect sizes and the significant interaction effect of group by time in the Clock Drawing Test and Trail Making Test-B test (P = 0.003 and P = 0.043); cognitive frailty variables, including Montreal Cognitive Assessment and Edmonton Frail Scale scores, also showed significant improvement (P = 0.002 and P = 0.004) with a moderate effect sizes and a significant interaction effect (P < 0.001, P = 0.013). No adverse events were reported. Conclusion: Regular Baduanjin training may be an effective and safe intervention to improve cognitive frailty and executive function in community-dwelling older adults with cognitive frailty. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100050857. Data of registration: 8/5/2020, https://www.chictr.org.cn/showproj.html?proj = 133037. [ABSTRACT FROM AUTHOR]

The article discusses the feasible reduction of low-value care to older Americans to improve their access to affordable high-value care in 2024. Topics covered include the clinical and financial reasons to stop low-value care, and the reasons why high-value care can instead be delivered. Also noted are the latter's reduction of patient burden, improvement of clinician productivity and resource stewardship, and increase of spending efficiency.

Background: The purpose of this study was to investigate the longitudinal relationship between different levels of cognitively stimulating leisure activity (CSLA) participation and different levels of positive and negative affect among older adults with mild cognitive impairment (MCI). Methods: Using a repeated‐measured multivariate analysis of covariance (RM‐MANCOVA), this study analyzed the Health and Retirement Study (HRS) data from 2012 to 2020 (N = 5932). Results: The results presented the following. (a) The high CSLA group showed higher positive affect and lower negative affect than the mid and low groups. Also, the mid‐CSLA group presented higher positive affect and lower negative affect than the low CSLA group. (b) Both positive and negative affect showed significant differences between years and indicated a continuously declining slope year by year without exceptions. (c) The high CSLA group not only presented higher positive affect and lower negative affect during the period but also solely showed a rebounding feature in the declining slope on both emotions. Conclusions: The findings of this study provide valuable support for the design and implementation of CSLA participation programs and clinical guidelines for older adults with MCI. The results highlight the importance of determining the optimal level of CSLA engagement that is required to promote emotional health and cognitive function in this population. Healthcare professionals and clinical practitioners can leverage the insights gained from this study to develop and deliver effective CSLA interventions tailored to the specific needs and capacities of older adults with MCI. [ABSTRACT FROM AUTHOR]

Backgrounds: Cognitive frailty, a clinical syndrome with physical frailty and cognitive impairment, leads to mortality and other adverse health outcomes in older adults. This study aimed to investigate the prevalence of cognitive frailty, and its influencing factors, and follow its impact on short‐term mortality in elderly chronic obstructive pulmonary disease patients, to provide a theoretical scientific reference basis for clinical intervention and management of cognitive frailty. Methods: A sample of 243 elderly chronic obstructive pulmonary disease patients in the respiratory department of a tertiary care hospital was conveniently sampled from November 2021 to February 2023, and the prevalence of cognitive frailty was investigated using the General Information Survey Scale, the Fried Phenotype Scale, the Mini‐Mental State Examination, the Anxiety Self‐Rating Scale, the Brief Geriatric Depression Scale, and the Mortality Record. The mortality was recorded by telephone follow‐up after 6 months. A database was created and statistical analysis such as one‐way analysis of variance, logistic regression analysis, Kaplan–Meier, and Cox survival analysis were used to analyze the data. Results: A total of 47 patients (19.3%) had cognitive frailty; there were statistical differences in the prevalence of cognitive frailty by medical payment type, physical exercise, and sleeping time (P < 0.05). During a 6‐month follow‐up, 38 patients (15.6%) died. Cox survival analysis showed that the risk of death in elderly chronic obstructive pulmonary disease patients in the cognitive frailty group was 3.212 times higher than that in the normal cognitive function and non‐frailty group (95% CI 1.646–6.270, P = 0.001), and 5.266 times higher than that in the normal cognitive function and frailty group (95% CI 3.159–8.778, P < 0.001). Conclusions: The prevalence of cognitive frailty in elderly chronic obstructive pulmonary disease patients is high, and clinical staff should pay attention to patients' medical burden and financial ability, and reduce the incidence of cognitive frailty by instructing patients to perform physical exercise and arrange sleep time. Cognitive frailty is an important risk factor for mortality within 6 months in elderly chronic obstructive pulmonary disease patients, and early intervention should be emphasised to reduce or delay cognitive frailty and mortality. [ABSTRACT FROM AUTHOR]

Aims: To examine the effects of virtual reality‐based cognitive interventions on cognitive function and activities of daily living among stroke patients, and to identify the optimal design for such intervention. Design: Systematic review and meta‐analysis. Data Sources: Medline, EMBASE, Cochrane, CINANL, JBI‐EBP and Web of Science from inception to October 2023. Methods: Methodological quality was assessed by Risk of Bias Tool. Meta‐analyses were assessed by Review Manager 5.4. Subgroup analyses were conducted to explore the influence of study design. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to assess the certainty of evidence. Results: Twenty‐five randomized controlled trials (1178 participants) were included. Virtual reality‐based cognitive interventions demonstrated moderate‐to‐large effects in improving global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85]), executive function (SMD = 0.84; 95% CI [0.25, 1.43]) and memory (SMD = 0.65; 95% CI [0.15, 1.16]) compared to control treatments. No significant effects were found on language, visuospatial ability and activities of daily living. Subgroup analyses indicated one‐on‐one coaching, individualized design and dynamic difficulty adjustment, and interventions lasting ≥ 6 weeks had particularly enhanced effects, especially for executive function. Conclusions: Virtual reality‐based cognitive interventions improve global cognitive function, executive function and memory among stroke patients. Implications for the Patient Care: This review underscores the broad cognitive advantages offered by virtual technology, suggesting its potential integration into standard stroke rehabilitation protocols for enhanced cognitive recovery. Impact: The study identifies key factors in virtual technology interventions that effectively improve cognitive function among stroke patients, offering healthcare providers a framework for leveraging such technology to optimize cognitive outcomes in stroke rehabilitation. Reporting Method: PRISMA 2020 statement. PROSPERO Registration Number: CRD42022342668. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) share a collective goal of ensuring that adults with cognitive–communication disorders (CCD) due to acquired brain injuries (ABI) attain their highest possible level of participation and satisfaction in family, community, social, work and academic communications through evidence‐based interventions. While there is a considerable evidence base to support SLT cognitive–communication interventions, there are also numerous barriers to its implementation. Aims: The first aim is to describe the development of a comprehensive knowledge translation tool that synthesizes evidence‐based practice recommendations for SLT cognitive–communication interventions across the care continuum. The second aim is to critically analyse the barriers to implementation of these interventions and to explore how this knowledge translation tool might assist in overcoming these challenges. Methods & Procedures: We developed a map of 148 clinical practice recommendations extracted from 129 reviews and guidelines called the Cognitive–Communication Evidence Application for SLTs (CCEAS‐Map). The process of developing the CCEAS‐Map included: (1) examination of implementation science frameworks to inform knowledge tool creation; (2) search and synthesis of the evidence provided in reviews and guidelines that met specific criteria; (3) development of a framework to critically analyse and categorize the barriers and facilitators affecting the implementation of these clinical recommendations; (4) consultation with potential end users of the CCEAS‐Map, including 16 expert SLTs and eight persons with lived experience (PWLE), regarding the tool's construction, barriers and facilitators to implementation, and the potential of the CCEAS‐Map to address evidence–practice gaps; and (5) refining the CCEAS‐Map based on expert input. Main Contribution: To our knowledge this is the first synthesis of all available clinical recommendations for SLT cognitive–communication interventions for ABI, across all severities of injury, stages along the continuum of care, and areas of CCD practice. The paper presents a novel approach to analysing knowledge–practice gaps: drawing on implementation science tools, analysing barriers and facilitators, and collaborating with end users in designing a knowledge translation tool. Conclusions & Implications: The CCEAS‐Map provides a comprehensive synthesis of the available evidence in a format that can facilitate clinical application of the evidence, provide education for all stakeholders, serve as a basis for CCD pathway development, support researcher–clinician collaboration and encourage advocacy at the system level. As a knowledge translation tool, the CCEAS‐Map can promote the availability of SLT services and has the potential to ultimately improve the lives of those with CCD. What this paper Adds: What is already known on this subject: A great deal is known about cognitive–communication deficits incurred after ABI, including their impact on daily functioning, optimal methods for sensitive and ecologically valid assessment, and the efficacy of various speech–language therapy interventions along the care continuum. However, considerable constraints remain that interfere with the application of this evidence to daily SLT practice. A need was identified to develop a knowledge translation tool to help close these evidence–practice gaps. What this paper adds to existing knowledge: This study describes the development of the CCEAS‐Map, a critical synthesis of 129 reviews and guidelines, leading to 148 evidence‐based clinical recommendations, which can be used to guide SLT cognitive–communication practice and education, as well as clinical pathway development, and advocacy for systemic changes and other healthcare policy improvements. What are the potential or actual clinical implications of this work?: The CCEAS‐Map is a clinical knowledge translation tool designed to guide cognitive–communication interventions by linking practice recommendations directly to the current evidence. This paper also offers insights into barriers to SLT intervention across the care continuum and strategies for improving implementation of cognitive–communication best practices, to improve the lives of those living with ABI related disabilities. [ABSTRACT FROM AUTHOR]

A 69-year-old woman developed non-convulsive status epilepticus during inpatient investigation for abdominal pain. Initial detailed investigations did not identify the cause of seizures, but a jejunal biopsy and PCR testing in various fluids led to the diagnosis of Whipple's disease with neurological involvement. The seizures were controlled but she subsequently had moderate cognitive impairment. Whipple's disease is an important diagnosis, being treatable with antibiotics. Testing for Whipple's disease is not part of the recommended workup in for status epilepticus, but this case highlights the importance of considering this condition. [ABSTRACT FROM AUTHOR]

Research in modifiable behaviors, like exercise, on risk for dementia is increasing. Although many studies focus on older adults, brain pathology for Alzheimer's Disease can begin in middle age, suggesting an ideal target for intervention. We conducted a systematic review from exercise intervention studies on cognitive function among healthy, middle-aged participants (45-65). We searched multiple databases (PubMed, PsycINFO, MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar) for studies using standard, validated, neuropsychological measures following either single- or multi-session interventions in cognitively-unimpaired, middle-aged adults. We identified 13 eligible studies. There was notable heterogeneity across studies, with varying design, measures, interventions, and results. Results from single-session studies showed improvement in response inhibition, while results for cognitive flexibility were mixed. No significant changes were found on measures of attention, working memory, or processing speed. Results from multi-session studies were more varied. Verbal memory was found to improve while performance on tests of attention and working memory, processing speed, and executive function were mixed. Importantly, for both single-session and multi-session studies, there was no standard set of neuropsychological tests administered, making it more difficult to synthesize the findings into a single narrative. We end with a discussion on future directions and implementation. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Blumenthal-Barby (2024) argues that bioethicists should stop using the concept of "personhood" in both well-established bioethics debate. Topics include moral philosophers who work with the concept of personhood are trying to identify some morally significant category; and scribed legal personhood based on the understanding that our legal system.

Background and Objective The prospective association between dietary zinc (Zn) intake and cognitive decline remains uncertain. We aimed to assess the relationship of dietary Zn intake with the risk of cognitive decline in the Chinese older people, and examine the possible effect modifiers on this association. Methods A total of 3,106 older Chinese adults aged 55 years or older from China Health and Nutrition Survey were included. Dietary nutrients intake information was collected by combined 24-h dietary recalls with weighing food inventory. The cognitive decline was defined as the 5-year decline rate in global and composite cognitive scores, based on a subset of items from the Telephone Interview for Cognitive Status–modified. Results The median follow-up duration was 5.9 years. There was an L-shaped association between dietary Zn intake and the 5-year decline rates in global and composite cognitive scores, with an inflection point at 8.8 mg/day of dietary Zn. For the composite cognitive scores, compared with the first quantile (<7.9 mg/day) of dietary Zn intake, quantiles 2–6 (≥7.9 mg/day) had a significantly slower cognitive decline rate (β : −0.24; 95% confidence interval: −0.40 to −0.07). Similar results were found for the global cognitive scores. Moreover, the inverse association between dietary Zn intake and cognitive decline in composite cognitive scores was significantly stronger in those with lower levels of physical activity (P -interactions = 0.041). Conclusion Dietary Zn intake was negatively associated with cognitive decline in the older people. Maintaining appropriate dietary Zn levels may prevent cognitive decline. [ABSTRACT FROM AUTHOR]

The aim of this review was to identify, assess, collate, and analyze existing research that has made a direct contribution to aiding understanding of the ethical and decision-making issues related to the use of advance care directives for people with dementia and/or other major neurocognitive disorders and/or their surrogate decision-makers on treatment. The Web of Science, Scopus, PubMed, CINAHL, Academic Search Ultimate, and MEDLINE databases were searched between August and September 2021 and July to November 2022 limited to primary studies written in English, Spanish, or Portuguese. Twenty-eight studies of varying quality that addressed related thematic areas were identified. These themes being support for autonomy in basic needs (16%), making decisions ahead/planning ahead and upholding these decisions (52%), and support in decision-making for carers (32%). Advance care directives are an important mechanism for documenting treatment preferences in patient care planning. However, the available literature on the topic is limited in both quantity and quality. Recommendations for practice include involving decision makers, promoting educational interventions, exploring how they are used and implemented, and promoting the active involvement of social workers within the healthcare team. [ABSTRACT FROM AUTHOR]

Cognitive impairment associated with schizophrenia can lead to functional disability and poor quality of life. Established cognitive remediation programs have variable results for adults with schizophrenia, with some participants receiving little or no benefit. This scoping review investigates the efficacy of music therapy as cognitive remediation for adults with schizophrenia. Literature was identified using electronic databases, reference list searching and citation tracking. A total of 13 studies met the criteria for inclusion. Results demonstrated that music therapy improved attention, executive function, language, memory, and processing speed. However, more research is required to better understand and develop cognitively beneficial music therapy programs for adults with schizophrenia. [ABSTRACT FROM AUTHOR]

The article provides updates on the pathophysiology of HIV-associated neurocognitive disorder (HAND) and provides an overview of the clinical features of, diagnostic imaging findings of, and treatment for this medical condition. Topics discussed include distinct conditions of HAND, most crucial cell population to the pathogenesis of HAND, and stages of HAND pathophysiology.

Background: Despite the growing importance of home health care (HHC) in the care of older adults with cognitive impairment, limited evidence exists about factors associated with documented severe pain among older adults receiving HHC. Methods: This secondary data analysis used a 5% random national sample of the 2017 national Outcome and Assessment Information Set (OASIS) data. Multivariable Poisson regression model was used to examine the association between documented severe pain, cognitive impairment, and a range of sociodemographic, clinical, and cognitive factors. Results: HHC patients (n = 183,038) were mean age 79.7 years, 61.7% female, and 78.6% non-Hispanic White. In multivariable models, cognitive impairment was associated with lower likelihood of documented severe pain (prevalence ratio [PR] = 0.96, confidence interval [CI] = [0.94–0.98]). Other factors independently associated with less documented severe pain included Hispanic ethnicity (PR = 0.92, CI = [0.89–0.95]), the oldest (≥85 years) groups (PR = 0.65, CI = [0.63–0.66]), male patients (PR = 0.83, CI = [0.82–0.85]), those with a formal diagnosis of Alzheimer's Disease Related Dementias (PR = 0.67, CI = [0.65–0.69]), and patients with verbal- and speech-related difficulty (PR = 0.83, CI = [0.80–0.86]). Patients with history of falls (PR = 1.18, CI = [1.16–1.20]), positive screen on the Patient Health Questionnaire-2 (PR = 1.36, CI = [1.31–1.41]), shortness of breath (PR = 1.14, CI = [1.12–1.14]), anxiety daily (PR = 1.16, CI = [1.14–1.18]), and anxiety daily or more often (PR = 1.40, CI = [1.37–1.43]) were more likely to have documented severe pain. Conclusions: HHC patients with cognitive impairment were less likely to have documented severe pain even with a range of sociodemographic, clinical, functional, and cognitive characteristics were considered. These findings may reflect a link between cognitive impairment missed opportunities for clinicians to provide pain management. Tailored interventions are needed to better assess and manage pain in this vulnerable group of HHC patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current therapeutic evidence suggests limited efficacy of the cognitive and exercise training in mild cognitive impairment (MCI) on depression, anxiety, memory retention, comprehension, calculation, concentration, orientation, dual-task performance, and sleep disorders. Nevertheless, the immediate effects of multimodal cognitive therapy (MCT) have recently developed and its individual effects remains unknown in MCI. OBJECTIVE: This study aimed to compare the immediate effects of MCT on cognitive and psychological measures between young healthy and older adults with MCI. METHODS: Forty young healthy and older adults with MCI underwent immediate MCT (5 minutes each), including transcranial direct current stimulation (tDCS), light therapy, computerized cognitive therapy (CCT), robotic-assisted gait training (RAGT), core breathing exercises (CBE), and music therapy. Outcome measures included memory retention, comprehension, calculation, attention, orientation, dual-task performance, awareness, depression, anxiety, and sleep disorders. The Mann-Whitney U test and Friedman's test were used at P < 0.05. RESULTS: Significant differences in depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness were observed between the tDCS, CCT, and music therapy groups (P < 0.05). CONCLUSION: MCT was beneficial for mitigating depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness. [ABSTRACT FROM AUTHOR]

Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example. [ABSTRACT FROM AUTHOR]

Neurologic complications, associated with cardiac surgery and cardiopulmonary bypass (CPB) in adults, are common and can be devastating in some cases. This comprehensive review will not only consider the broad categories of stroke and neurocognitive dysfunction, but it also summarises other neurological complications associated with CPB, and it provides an update about risks, prevention and treatment. Where appropriate, we consider the impact of off-pump techniques upon our understanding of the contribution of CPB to adverse outcomes. [ABSTRACT FROM AUTHOR]

Idiopathic hypersomnia (IH) is a rare sleeping disorder that is difficult to diagnose, and little is known about its pathophysiology. A defining symptom of IH is excessive daytime sleepiness, which can manifest as narcolepsy-like episodes or as continuous sleepiness. Other symptoms of IH includes sleep inertia and cognitive impairment. Currently, calcium, magnesium, potassium and sodium oxybates is the only FDA approved pharmacological treatment option in the management of IH. Off-label treatment options are recommended by guidelines, with many also being used for the management of narcolepsy. [ABSTRACT FROM AUTHOR]