Search

Amyotrophic lateral sclerosis (ALS) is a multi‐system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty‐two ALS patients and 21 demographically‐matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS. [ABSTRACT FROM AUTHOR]

Background: Delirium is costly for patients, carers, and healthcare systems. In addition, non‐pharmacological and pharmacological management of delirium is challenging. Electroconvulsive therapy (ECT) has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. Objective: To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. Methods: A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inclusion if modified ECT was used to treat delirium symptoms. ECT for delirium in people with neuroleptic malignant syndrome, catatonia, or confusional states associated with acute primary psychiatric conditions were excluded. All included records were first ranked using the hierarchy of evidence‐based medicine; quality was then assessed using the Joanna Briggs critical appraisal checklists. Pooled data across the cases identified were analysed using descriptive statistics. Results: Of 1226 records screened, 10 studies met inclusion criteria: six case reports, three case series, and one quasi‐experimental study. The literature base was of mixed quality. A single quasi‐experimental study was assessed to be of 'fair' quality, the remainder of the case series and case reports were rated as 'poor' to 'fair' quality. A total of only 40 individual people with delirium who were treated with ECT were identified. In 33/40 cases, the aetiology of delirium was substance withdrawal. The number of ECT treatments administered ranged from 1 to 13. ECT was reported to positively contribute towards treatment of delirium in all cases, although objective measures of improvement were reported in only 6/13 patient cases from case reports and case series (46%). The singular quasi‐experimental study reported a statistically significant decrease in duration of delirium, time spent in physical restraint, and in benzodiazepine requirement when ECT was used as an adjunct in benzodiazepine withdrawal delirium. When adverse events were described these included mild confusion and memory deficits; all were reported as time limited and reversible. Considerable limitations in the quality of the evidence base were identified, including the risk of selection, publication and reporting bias. Much data reporting on safety and efficacy of ECT in delirium was missing. Conclusion: There is insufficient literature to support modified ECT as a clinical treatment for delirium. The few studies identified were generally of weak evidence lacking important data on safety and objective outcome measures, and not including populations with broad delirium aetiologies. Further research using more robust methodologies and broader populations (age, aetiology) of people with delirium treated with ECT is needed. [ABSTRACT FROM AUTHOR]

Objective: To determine if there is an association between antenatal hypnotic benzodiazepine receptor agonist exposure and congenital malformations or other adverse pregnancy outcomes in the offspring. Methods: Databases were searched to January 31, 2021. Cohort studies published in English on congenital malformations or other adverse pregnancy outcomes in infants following exposure compared with those unexposed, were summarized and meta‐analyzed where possible. Results: Following screening, 25 studies were assessed for eligibility and seven included in the meta‐analyses. Five studies were pooled for congenital malformations following first trimester exposure and not statistically significant (OR 0.87, 95% CI 0.56–1.36). The five studies that assessed for preterm birth following anytime exposure did pool to a statistically significant effect (OR 1.49, 95% CI 1.19–1.86); study quality, control for other psychotropic drugs and psychiatric diagnosis did not appear to be moderators. There were two missing studies when examining for publication bias in both of the main analyses above but the revised estimates were similar to the original. Low birth weight (LBW) was significant (three studies, any time exposure, OR 1.51, 1.27–1.78) as was small for gestational age (SGA) (three studies with anytime exposure, OR 1.34, 1.22–1.48). There were too few studies to summarize birth weight, gestational age, respiratory difficulties, APGAR score at 5 min and NICU admission. Conclusions: Pregnancy exposure to hypnotics was not associated with a higher risk for congenital malformations but was associated with an increased risk for preterm birth, LBW and SGA compared with those infants who were not exposed. These findings are consistent with the antidepressant and benzodiazepine literature. [ABSTRACT FROM AUTHOR]

Background: Studies into cognitive changes typically employ detailed in person cognitive testing, which is not always feasible. Therefore, we compared the relationship between brain morphology (sulcal width) and cognitive functioning, using an online and an in‐person modality and disentangled the influence of age, sex, β‐Amyloid (Aβ) and APOE‐status. Method: 141 healthy participants (mean age 60, range 46‐71 years, 75% female) assessed with structural MRI; cognitive batteries both, face‐to‐face and online (Cambridge Brain Systems), Aβ status (Fluorine‐18 florbetaben‐PET scan) and APOE genotype (Lupton et al., 2021); Canonical Partial Least Square method to compare cognitive modalities and Sulcal width (SW; Morphologist pipeline‐BrainVISA toolbox; Borne et al., 2020). Age effects tested with two‐sided Wald Test. Analysis of covariance to test age and sex‐interactions, amyloid and APOE status, sex‐effects (controlling for age), Aβ, and APOE (controlling for age and sex). Result: The single robust mode for brain (SW) ‐ behaviour (cognition) covariation loaded most strongly onto memory and executive functions for both the onsite (1st mode, p = 0.013, cov = 3.55, z‐cov = 2.93, R2 = 0.18, z‐R2 = 0.95; 2nd mode, p>0.99), and the online battery (1st mode, p<0.001, cov = 2.76, z‐cov = 4.71, R2 = 0.14, z‐R2 = 1.15; 2nd mode, p = 0.99) (Fig. 1). Cognition‐related SW showed a regional pattern similar for online and in person cognitive appraisal. Significant effect of sex on SW projections in both the online and onsite conditions with larger sulcal width for men (p<0.001) and a similar effect on onsite cognitive projections with lower performance for men (p<0.001) (Fig. 2a). Cognitive performance ‐ both online (p = 0.03) and in‐person (p<0.01) – showed a significantly steeper decline with age for Aβ‐positive participants (Fig. 2b). Variance explained for the online cognitive assay (R2 = 0.15) was only slightly less than for the in‐person testing (R2 = 0.18). Brain‐behaviour z‐transformed covariance was likewise comparable across modalities. Conclusion: Similar sulcal width brain projections for both cognitive modalities, with memory and executive domains showing the strongest loadings. Aβ‐aggregation associated with a steeper cognitive projection slope for both batteries, suggesting that in our preclinical sample the early stages of Aβ accumulation accelerate cognitive ageing potentially before translation into structural brain changes. Adequate sensitivity of online cognitive tests for studying age‐related neurobiology of cognition is suggested. [ABSTRACT FROM AUTHOR]

Pathogenic variants in the gene encoding deleted in colorectal cancer (DCC) are the first genetic cause of isolated agenesis of the corpus callosum (ACC). Here we present the detailed neurological, brain magnetic resonance imaging (MRI), and neuropsychological characteristics of 12 individuals from three families with pathogenic variants in DCC (aged 8-50y), who showed ACC and mirror movements (n=5), mirror movements only (n=2), ACC only (n=3), or neither ACC nor mirror movements (n=2). There was heterogeneity in the neurological and neuroimaging features on brain MRI, and performance across neuropsychological domains ranged from extremely low (impaired) to within normal limits (average). Our findings show that ACC and/or mirror movements are associated with low functioning in select neuropsychological domains and a DCC pathogenic variant alone is not sufficient to explain the disability. WHAT THIS PAPER ADDS: Neuropsychological impairment severity is related to presence of mirror movements and/or agenesis of the corpus callosum. A DCC pathogenic variant in isolation is associated with the best prognosis. [ABSTRACT FROM AUTHOR]

Background: Self‐administered online cognitive testing offers a cost‐effective and flexible alternative to in‐person neuropsychological assessments. We used the Creyos platform (previously named Cambridge Brain Sciences) to assess cognitive function in a large sample (N = 1673) of middle aged and older adults participating in the PISA (Prospective Imaging Study of Aging) study. PISA aims to characterise the early symptoms and progression of Alzheimer's disease at its prodromal phase. Method: We have utilised our Australia‐wide population based sample recruitment pool of research participants with genome wide genotyping. Participants completed a comprehensive online survey and online cognitive assessments, including Creyos, consisting of 12 self‐administered tasks covering memory, executive function, language, and visuo‐spatial domains. Using genetic profile scores in a sample size of 1,673 (70% female, aged 42‐75 years, mean 60.8). We tested the association between cognitive test results and genetic risk for Alzheimer's disease and related phenotypes including structural neuroimaging measures. Results: Our findings indicate a significant association of Alzheimer's polygenic risk scores (PRS) with cognitive test results in healthy individuals within memory and executive function domains. The results of analyses with additional genetic profile scores including psychiatric traits and structural neuroimaging measures will also be presented. Conclusion: Those who are at high genetic risk for Alzheimer's disease have reduced cognitive function prior to dementia diagnosis from middle age. Our results highlight the utility of online cognitive testing as a cost‐effective alternative to in person testing for large scale studies and the potential for it's used as a pre‐screening approach to identify those at high risk of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning ( MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ2 = 23.3, d.f. =1, P < 0.001). This did not occur in the control wards. The qualitative data ( n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation. [ABSTRACT FROM AUTHOR]

Objective People with schizophrenia have difficulty engaging in specific future-directed thoughts and behaviours, such as generating phenomenological characteristics of future events (a component of episodic foresight), and executing directed preparatory behaviours (a component of prospective memory). However, it remains unclear whether they also exhibit difficulties using episodic foresight to appropriately guide future-directed behaviours. Method People with schizophrenia and non-clinical controls were administered a behavioural measure that met strict criteria for assessing episodic foresight. In keeping with our focus on the functional application of foresight, this measure required participants to identify a problem, self-generate a resolution, and execute the appropriate future-directed intention. Results Relative to controls, people with schizophrenia were less likely to spontaneously acquire items that would later allow a problem to be solved, and were also less likely to subsequently use these items to solve the problems. There was no interaction between group and task, indicating that these two components of foresight were disrupted to an equivalent degree. In the clinical (but not the control) group, item acquisition and item use were correlated with general cognitive capacity. No significant associations with clinical variables emerged. Conclusion The capacity to apply episodic foresight in a functionally adaptive way is disrupted in schizophrenia and may at least partially reflect broader cognitive dysfunction. Future work is now needed to clarify the implications of these difficulties in everyday life, as well as how these difficulties might be remediated. Practitioner points People with schizophrenia have known difficulties with episodic foresight, and it now appears that those difficulties extend to the performance of foresightful preparatory behaviours., Because preparatory behaviours are central to routine and adaptive planning, difficulties with episodic foresight may contribute to or be a result of some of the functional difficulties experienced by people with schizophrenia., Further research is needed to determine whether interventions might be developed for people with reduced episodic foresight., Interventions may include the use of remedial tools that support and encourage the performance of foresightful behaviour, or cognitive training programs that actively improve the ability and propensity to exercise foresight independently. [ABSTRACT FROM AUTHOR]

We report a case of probable Alzheimer's disease who presented with the unusual feature of disinhibited rhyming. Core language skills were largely intact but generative language was characterized by semantic-based associations, evident in tangential and associative content, and phonology-based associations, evident in rhyming, in the context of prominent executive dysfunction. We suggest this pattern is underpinned by a failure to terminate or inhibit verbal associations resulting in a 'loosening' of associations at the level of conceptual preparation for spoken language. [ABSTRACT FROM AUTHOR]

Objectives To describe the development and use of a quality improvement service self-evaluation tool within Pacific addiction services in New Zealand. Methods The study involved two phases: (i) a development phase; and (ii) a testing phase. In Phase I, a preliminary tool was developed and piloted with two Pacific addiction drugs services. It was modified to reduce the number of statements, aligning the statements with the National Sector Standards and incorporating Pacific concepts, themes and motifs that underlie the practices of Pacific providers. In Phase II the resulting tool, named Potalanoa, was then tested in four Pacific addiction treatment services. All services provided feedback on the user acceptability and feasibility of the tool, usefulness and adaptability of the tool to specific service settings. Results The participating services generally found the evaluation tool to be understandable, acceptable and useful. Each service provider demonstrated varied use or implementation strategies for Potalanoa with a general consensus that incorporating the evaluation process within existing team meetings would be ideal. The involvement of all staff within a group setting was also found to be an essential part of the process and a trained facilitator helped with the flow of discussion. Conclusions The study found that there is a need for an evaluation tool for the provision of quality services. For Pacific services it was important that the tool recognize and capture the Pacific approaches utilized in their service delivery. Overall the tool was found to be acceptable and feasible to use, assisted services to identify areas of achievement and to prioritize areas requiring improvement and was adaptable to 'real world' Pacific addiction treatment settings in New Zealand. [ABSTRACT FROM AUTHOR]

Background: The PISA study aims to characterise the natural history and symptom progression of Alzheimer's disease (AD) at its prodromal phase. Utilising genetic risk prediction we have identified middle‐aged and older Australians at high risk of dementia. In addition to onsite phenotyping, online surveys and cognitive testing have been used to economically collect information from an Australia‐wide sample. Method: We have utilised our population based sample recruitment pool (N=15,351) of previous research participants who have been genome wide genotyped. Participants are invited to complete a comprehensive online survey, then complete online cognitive assessments, including Cambridge Brain Sciences (CBS), Cogstate, and an emotion recognition task. Result: Thus far nearly 4,000 participants have taken part in our online survey, and of these 2055 participants have completed the CBS assessment consisting of twelve subtests assessing memory, reasoning, attention, and planning. Recruitment for CBS and the other platforms is ongoing and participants are being invited to complete follow‐up assessments after two years. At baseline we find significant association of both APOE genotype and polygenetic risk scores (PRS) for AD (omitting the APOE region) in healthy middle aged and elderly individuals with cognitive domains tested using the CBS platform. Conclusion: The utility of online cognitive testing for large scale testing in cohort and epidemiological studies will be discussed. The identification of cognitive changes associated with AD risk and prodromal disease gives important insights into mechanisms of AD development throughout the life span and is an opportunity to investigate prodromal markers to allow selection of individuals for early treatment strategies. [ABSTRACT FROM AUTHOR]

Beyond the classroom, adults are benefiting from learning through community involvement as a component of career or retirement activities. [ABSTRACT FROM AUTHOR]

This article examines the significant events in the history of mental health care that have contributed to the development of a specialty within the counseling profession referred to as mental health counseling. The development of credentials for the specialty and the issues currently facing mental health counseling are discussed, and a perspective on directions for the future is offered. [ABSTRACT FROM AUTHOR]

Background: Neuropathology accumulates for decades prior to the onset of cognitive decline in Alzheimer's disease (AD). Interventions to modify the course of the disease have the greatest potential to avert neuronal death and later disease burden if they are introduced during this crucial window. Our prospective cohort study, "Prospective Imaging Study of Ageing: Genes, Brain and Behaviour" (PISA) aims to characterise the natural history of AD at its prodromal phase. Using genetic risk prediction we have identified middle‐aged and older Australians at high risk of dementia to enable the discovery of biological markers of early neuropathology, identify modifiable risk factors, and establish the very earliest phenotypic and neuronal signs of disease conversion. Method: We utilized APOE genotype and polygenic risk scores (PRS) to identify individuals at high and low risk of AD. We have leveraged our extensive in‐house cohorts, comprising ∼15,000 individuals aged 40‐70 years with available genome wide genotyping data to generate a genetically enriched cohort for investigating prodromal markers for AD. Online surveys and cognitive testing are used to collect information from a national sample currently totally nearly 3,000 participants. Subjects (N = 400) from a defined at‐risk cohort and positive controls (clinical cohort of patients with mild cognitive impairment and/or early AD) have taken part in onsite visits for lifestyle monitoring, cognitive testing, blood sample donation, MRI and PET imaging. Result: A high prediction accuracy for AD with an AUC of 78.2% can be achieved by a prediction model including APOE genotype, and PRS (containing GWAS association SNPs with P value <0.5) with the PRS adding significant predictive value over APOE alone. The association of genetic factors with baseline imaging and neuropsychological phenotypes will be presented as well as multivariate analysis investigating the influence of genetic risk on inter‐individual phenotypic relationships. Conclusion: The PISA study is an at risk AD cohort enriched by genome‐wide risk prediction, aiming to validate early markers of prodromal Alzheimer's disease that can be utilized in middle age. This study will help elucidate changes in early prodromal AD risk variants observed in middle age, and evaluate which measures show the earliest changes. [ABSTRACT FROM AUTHOR]

The article reviews the book, "Psychological Management of Stroke," by N.B. Lincoln, I.I. Kneebone, J.A.B. Macniven and R.C. Morris.