Effects of preexisting stroke on acute hospital outcomes for older adults admitted with neurotrauma and orthopedic injury.

OBJECTIVE: We aimed to examine acute trauma outcomes, specifically among those with neurotrauma (NT), in patients with preexisting cerebrovascular accident (CVA). METHODS: We identified patients treated for neurotrauma or orthopedic trauma at hospitals in Pennsylvania with and without an identified history of stroke with residual deficits, aged 50-99 across four groups of N = 11,648 each. We assessed mortality, craniotomy, and total hospital, ICU, step-down, and ventilator days, functional status at discharge (FSD), and discharge destination. RESULTS: Stroke history did not influence mortality but was predictive of patients undergoing craniotomy (OR = 1.25, p = 0.008). There was a moderate group effect on total ICU days, with the CVA+NT group in the ICU the longest (η2 = 0.10, p < 0.001). Patients with stroke history were less likely to be discharged to home (OR = 0.65, p < 0.001) and had poorer FSD scores across the various domains assessed. CONCLUSIONS: Trauma patients with preexisting CVA were found to have poorer outcomes on a number of different metrics when compared to those without stroke history. While it is possible that functional differences pre-injury influenced FSD and discharge destination, given these results, clinicians should assess for possible comorbidities that may influence treatment.

Avoidant Coping Is Associated with Quality of Life in Persons with Multiple Sclerosis with High Cognitive Reserve.

OBJECTIVE: The goal of this study was to determine the impact of the relationship between cognitive reserve and coping strategy on quality of life (QoL) outcomes in persons with MS (PwMS) across multiple domains. METHODS: We examined the effect of the interactions between coping style and cognitive reserve on QoL and disease burden in 97 persons with MS (PwMS). Coping strategy, either active or avoidant, was measured using the COPE inventory. We defined cognitive reserve as a composite measure of years of education and scores on the Shipley-2 Vocabulary subtest. QoL and disease burden were assessed using the Functional Assessment of MS (FAMS) scale and the Expanded Disability Status Scale, respectively. We examined both the FAMS individual subscales and the overall QoL score. RESULTS: For those with higher cognitive reserve, greater avoidant coping was associated with lower QoL for the thinking and fatigue subscale (p < 0.001) and poorer overall QoL (p = 0.03); greater active coping was associated with poorer QoL for mobility (p = 0.001). However, these associations did not hold for those with lower cognitive reserve. Furthermore, there were no associations between coping strategy and cognitive reserve with disease burden. CONCLUSIONS: This study extends previous findings by demonstrating that avoidant coping, rather than active coping, is associated with poorer thinking and fatigue and overall QoL only for PwMS with greater cognitive reserve. Counseling PwMS on the impact of coping strategies on QoL outcomes, especially for those with greater cognitive reserve, may improve quality of life outcomes in this population.

Depression associated with APOE status and hippocampal volume but not cognitive decline in older adults aging with traumatic brain injury.

OBJECTIVE: To examine the relationship between depression and cognition, genetic risk, and hippocampal differences in a sample of older adults with a history of traumatic brain injury (TBI). METHOD: Participants were 85 males and 35 females (91 Caucasian, 29 African-American) with a mean age of 65.04 (±8.27) years and a history of moderate, severe, or complicated mild TBI. Participants were an average of 9.33 (±7.27) years post injury (range: 0.78-45.63). Participants underwent genetic testing, a comprehensive neuropsychological battery, surveys, and a subset underwent MRI scanning. RESULTS: Apolipoprotein E (APOE) e4 carrier status predicted clinically significant depressive symptomatology on the Geriatric Depression Scale (GDS) with an odds ratio of 3.63, 95% CI [1.33, 9.29]. GDS was not associated with scores on measures of executive function, list learning recall, or retention. Although GDS score was initially associated with poorer confrontation naming scores and story memory recall, these effect sizes were small, and this variance was better accounted for by age and cognitive reserve. Higher GDS scores were also associated with decreased hippocampal volume. CONCLUSIONS: APOE carrier status was predictive of depression in a sample of older adults with a history of TBI. Depressive symptoms were also associated with decreased hippocampal volume but did not predict cognitive deficits in the examined domains beyond the effects of cognitive reserve. Despite the relationship between GDS and biological risks for decline, depressive symptoms in this population showed no direct relationship with cognitive decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cortical processing of configurally perceived odor mixtures.

Most odors are not composed of a single volatile chemical species, but rather are mixtures of many different volatile molecules, the perception of which is dependent on the identity and relative concentrations of the components. Changing either the identity or ratio of components can lead to shifts between configural and elemental perception of the mixture. For example, a 30/70 ratio of ethyl isobutyrate (odorant A, a strawberry scent) and ethyl maltol (odorant B, a caramel scent) is perceived as pineapple by humans - a configural percept distinct from the components. In contrast, a 68/32 ratio of the same odorants is perceived elementally, and is identified as the component odors. Here, we examined single-unit responses in the anterior and posterior piriform cortex (aPCX and pPCX) of mice to these A and B mixtures. We first demonstrate that mouse behavior is consistent with a configural/elemental perceptual shift as concentration ratio varies. We then compared responses to the configural mixture to those evoked by the elemental mixture, as well as to the individual components. Hierarchical cluster analyses suggest that in the mouse aPCX, the configural mixture was coded as distinct from both components, while the elemental mixture was coded as similar to the components. In contrast, mixture perception did not predict pPCX ensemble coding. Similar electrophysiological results were also observed in rats. The results suggest similar perceptual characteristics of the AB mixture across species, and a division in the roles of aPCX and pPCX in the coding of configural and elemental odor mixtures.