Addenbrooke's Cognitive Examination-Third Edition Predicts Neuropsychological Test Performance.

OBJECTIVE: Effective screening tools can help providers with treatment decisions, including when to refer patients for neuropsychological evaluations, which are the gold standard for cognitive assessment of neurodegenerative disease. The authors examined whether performance on the Addenbrooke's Cognitive Examination-Third Edition (ACE-III), a readily available cognitive screening tool for older adults, predicted performance on subsequent neuropsychological evaluations. METHODS: In total, 217 patients referred for neurocognitive concerns completed a neuropsychological evaluation, including the ACE-III. Patients were diagnosed as having normal cognition (NC, N=67), mild neurocognitive disorder (mild NCD, N=105), or major NCD (N=45). Regression analyses were used to determine whether ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. Logistic regression was used to assess whether ACE-III total score and overall neuropsychological test performance predicted diagnosis. Separate analyses compared those with higher and lower educational attainments. ACE-III subscales and total scores were compared by diagnostic group. RESULTS: Across all groups, ACE-III subscale scores predicted within-construct neuropsychological performances with moderate to strong effects (p<0.001) but were less predictive for those with lower educational attainment. ACE-III total score was less sensitive than overall neuropsychological test performance in predicting neurocognitive disorders. ACE-III subscale and total scores distinguished diagnostic groups (NC>mild NCD>major NCD, p<0.001). CONCLUSIONS: ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. However, overall performance on neuropsychological testing was more sensitive than ACE-III total score in predicting neurocognitive disorder diagnosis. Total ACE-III score differed by level of cognitive impairment. Comprehensive neuropsychological testing is recommended for patients who have lower educational status or complex symptom presentations or are younger.

Feasibility and Acceptance of Direct-to-Home Tele-neuropsychology Services during the COVID-19 Pandemic.

OBJECTIVE: Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients' homes (DTH-TNP). METHODS: We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP. RESULTS: Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters. CONCLUSIONS: These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.

Surveys about attended births appear to be deceptive in CAR: are the population saying what they think NGO's want to hear?

BACKGROUND: Non-governmental organizations (NGOs) and donors often promote certain practices to a community, such as in-facility births and then evaluate the efficacy of those interventions, in part, by surveying those populations. METHODS: A project to assess the accuracy of birth and death monitoring by local community-based monitors was undertaken with a partner health agency in areas (pop. 94,000) where they supported medical facilities. Thirty clusters of 30 households each were selected at random, probability proportional to size. Half of those households were enrolled for a monthly visitation surveillance process. To gain insights into the effects of the agency's services, an additional 240 households were selected at random and interviewed from 8 nearby "matched villages" not serviced by any NGO as a comparison sample. RESULTS: The 896 households with 4243 living residents within the NGO service area were interviewed about household births and deaths within the past 8 months. They reported an annualized birth rate of 5.6% (95% CI: 4.5-6.7) with only 3% of those births occurring at home. The reported death rate was 4.2/1000/month (95% CI: 3.3-5.0). In the "matched villages," the population reported a similar birth and death rate, but they reported 29% of births occurring within the home. The monthly surveillance data found over the year that followed that 32% of births occurred at the home. Clinic and hospital birth attendance data suggested an attended annual birth rate of only 2.8%, consistent with the surveillance data implication that a huge fraction of births occur at home. CONCLUSION: It is believed that because the baseline interviews occurred with a stranger, this induced interviewees to say what they thought the interviewers wanted to hear. This calls into question the validity of household surveys when agencies have a known agenda or position, and highlights the need for external validation or triangulation of survey findings.

Accountability strategies for sexual and reproductive health and reproductive rights in humanitarian settings: a scoping review.

BACKGROUND: Many of the 35 million women and girls aged 15-49 requiring humanitarian assistance have inadequate access to the sexual and reproductive health (SRH) services to which they are entitled. Ensuring accountability is critical to realizing their SRH and reproductive rights (RR). OBJECTIVES: This scoping review examines the extent and nature of existing evidence on accountability strategies for SRH in humanitarian settings in different geographical scopes/contexts, and contextualizes these findings in the larger thematic literature. This review seeks to answer the following questions: What accountability strategies are employed to address the availability, accessibility, acceptability, and quality of SRH in humanitarian settings? What do we know about the successes and challenges of the given strategies? What are the implications for practice? METHODS: We consulted public health, social science, and legal databases including SCOPUS, PubMed, ProQuest, and LexisNexis for peer-reviewed articles, as well as Google Advanced search for grey literature; the search was conducted in March 2019. We searched for relevant articles and documents relating to accountability, humanitarian, and SRH and/or RR. To identify key challenges not reflected in the literature and additional grey literature, 18 key informants from international NGOs, local government bodies, academia, and donor agencies were interviewed from March-June 2019. RESULTS: A total of 209 papers and documents were identified via our literature searches and interviews for review. We identified three categories of approaches to accountability in our background reading, and we then applied these to the papers reviewed a priori. We created a fourth category based on our findings. The categories include: (1) humanitarian principles, codes of conduct, and legal instruments; (2) technical, performance, and impact standards; (3) efforts to solicit and address the rights and needs of the affected populations, or "listening and responding," and, (4) accountability demands made by affected populations themselves. Almost all papers identified referred to challenges to realizing accountability in humanitarian contexts. There are promising accountability approaches - some specific to SRH and some not - such as open-ended feedback from affected populations, quality improvement, and practical application of standards. Reflecting a largely top down orientation, papers concentrate on accountability mechanisms within humanitarian work, with much less focus on supporting affected populations to deepen their understanding of structural causes of their position, understand their entitlements, or access justice. CONCLUSION: In the last 20 years, there has been increasing standard and guideline development and program experiences related to accountability in humanitarian settings. Yet, the emphasis is on tools or mechanisms for accountability with less attention to changing norms regarding SRH and RR within affected communities, and to a lesser extent, among implementers of humanitarian programs or to institutionalizing community participation.

CME-HSS Interaction and Characteristics Tracked from Sun to Earth.

In a thorough study, we investigate the origin of a remarkable plasma and magnetic field configuration observed in situ on June 22, 2011, near L1, which appears to be a magnetic ejecta (ME) and a shock signature engulfed by a solar wind high-speed stream (HSS). We identify the signatures as an Earth-directed coronal mass ejection (CME), associated with a C7.7 flare on June 21, 2011, and its interaction with a HSS, which emanates from a coronal hole (CH) close to the launch site of the CME. The results indicate that the major interaction between the CME and the HSS starts at a height of 1.3 R ⊙ up to 3 R ⊙ . Over that distance range, the CME undergoes a strong north-eastward deflection of at least 30 ∘ due to the open magnetic field configuration of the CH. We perform a comprehensive analysis for the CME-HSS event using multi-viewpoint data (from the Solar TErrestrial RElations Observatories, the Solar and Heliospheric Observatory and the Solar Dynamics Observatory), and combined modeling efforts (nonlinear force-free field modeling, Graduated Cylindrical Shell CME modeling, and the Forecasting a CME's Altered Trajectory - ForeCAT model). We aim at better understanding its early evolution and interaction process as well as its interplanetary propagation and related in situ signatures, and finally the resulting impact on the Earth's magnetosphere.

Motor timing intraindividual variability in amnestic mild cognitive impairment and cognitively intact elders at genetic risk for Alzheimer's disease.

INTRODUCTION: Intraindividual variability (IIV) in motor performance has been shown to predict future cognitive decline. The apolipoprotein E-epsilon 4 (APOE-ε4) allele is also a well-established risk factor for memory decline. Here, we present novel findings examining the influence of the APOE-ε4 allele on the performance of asymptomatic healthy elders in comparison to individuals with amnestic MCI (aMCI) on a fine motor synchronization, paced finger-tapping task (PFTT). METHOD: Two Alzheimer's disease (AD) risk groups, individuals with aMCI (n = 24) and cognitively intact APOE-ε4 carriers (n = 41), and a control group consisting of cognitively intact APOE-ε4 noncarriers (n = 65) completed the Rey Auditory Verbal Learning Test and the PFTT, which requires index finger tapping in synchrony with a visual stimulus (interstimulus interval = 333 ms). RESULTS: Motor timing IIV, as reflected by the standard deviation of the intertap interval (ITI), was greater in the aMCI group than in the two groups of cognitively intact elders; in contrast, all three groups had statistically equivalent mean ITI. No significant IIV differences were observed between the asymptomatic APOE-ε4 carriers and noncarriers. Poorer episodic memory performance was associated with greater IIV, particularly in the aMCI group. CONCLUSIONS: Results suggest that increased IIV on a fine motor synchronization task is apparent in aMCI. This IIV measure was not sensitive in discriminating older asymptomatic individuals at genetic risk for AD from those without such a genetic risk. In contrast, episodic memory performance, a well-established predictor of cognitive decline in preclinical AD, was able to distinguish between the two cognitively intact groups based on genetic risk.

Deflection and Rotation of CMEs from Active Region 11158.

Between 13 and 16 February 2011, a series of coronal mass ejections (CMEs) erupted from multiple polarity inversion lines within active region 11158. For seven of these CMEs we employ the graduated cylindrical shell (GCS) flux rope model to determine the CME trajectory using both Solar Terrestrial Relations Observatory (STEREO) extreme ultraviolet (EUV) and coronagraph images. We then use the model called Forecasting a CME's Altered Trajectory (ForeCAT) for nonradial CME dynamics driven by magnetic forces to simulate the deflection and rotation of the seven CMEs. We find good agreement between ForeCAT results and reconstructed CME positions and orientations. The CME deflections range in magnitude between 10° and 30°. All CMEs are deflected to the north, but we find variations in the direction of the longitudinal deflection. The rotations range between 5° and 50° with both clockwise and counterclockwise rotations. Three of the CMEs begin with initial positions within 2° from one another. These three CMEs are all deflected primarily northward, with some minor eastward deflection, and rotate counterclockwise. Their final positions and orientations, however, differ by 20° and 30°, respectively. This variation in deflection and rotation results from differences in the CME expansion and radial propagation close to the Sun, as well as from the CME mass. Ultimately, only one of these seven CMEs yielded discernible in situ signatures near Earth, although the active region faced toward Earth throughout the eruptions. We suggest that the differences in the deflection and rotation of the CMEs can explain whether each CME impacted or missed Earth.

Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer's disease.

We examined the impact of physical activity (PA) on longitudinal change in hippocampal volume in cognitively intact older adults at varying genetic risk for the sporadic form of Alzheimer's disease (AD). Hippocampal volume was measured from structural magnetic resonance imaging (MRI) scans administered at baseline and at an 18-month follow-up in 97 healthy, cognitively intact older adults. Participants were classified as High or Low PA based on a self-report questionnaire of frequency and intensity of exercise. Risk status was defined by the presence or absence of the apolipoprotein E-epsilon 4 (APOE-ε4) allele. Four subgroups were studied: Low Risk/High PA (n = 24), Low Risk/Low PA (n = 34), High Risk/High PA (n = 22), and High Risk/Low PA (n = 17). Over the 18 month follow-up interval, hippocampal volume decreased by 3% in the High Risk/Low PA group, but remained stable in the three remaining groups. No main effects or interactions between genetic risk and PA were observed in control brain regions, including the caudate, amygdala, thalamus, pre-central gyrus, caudal middle frontal gyrus, cortical white matter (WM), and total gray matter (GM). These findings suggest that PA may help to preserve hippocampal volume in individuals at increased genetic risk for AD. The protective effects of PA on hippocampal atrophy were not observed in individuals at low risk for AD. These data suggest that individuals at genetic risk for AD should be targeted for increased levels of PA as a means of reducing atrophy in a brain region critical for the formation of episodic memories.

Recognition of famous names predicts cognitive decline in healthy elders.

OBJECTIVE: The ability to recognize familiar people is impaired in both Mild Cognitive Impairment (MCI) and Alzheimer's Dementia (AD). In addition, both groups often demonstrate a time-limited temporal gradient (TG) in which well known people from decades earlier are better recalled than those learned recently. In this study, we examined the TG in cognitively intact elders for remote famous names (1950-1965) compared to more recent famous names (1995-2005). We hypothesized that the TG pattern on a famous name recognition task (FNRT) would predict future cognitive decline, and also show a significant correlation with hippocampal volume. METHOD: Seventy-eight healthy elders (ages 65-90) with age-appropriate cognitive functioning at baseline were administered a FNRT. Follow-up testing 18 months later produced two groups: Declining (≥ 1 SD reduction on at least one of three measures) and Stable (< 1 SD). RESULTS: The Declining group (N = 27) recognized fewer recent famous names than the Stable group (N = 51), although recognition for remote names was comparable. Baseline MRI volumes for both the left and right hippocampi were significantly smaller in the Declining group than the Stable group. Smaller baseline hippocampal volume was also significantly correlated with poorer performance for recent, but not remote famous names. Logistic regression analyses indicated that baseline TG performance was a significant predictor of group status (Declining vs. Stable) independent of chronological age and APOE ε4 inheritance. CONCLUSIONS: The TG for famous name recognition may serve as an early preclinical cognitive marker of cognitive decline in healthy older individuals.