Functional Disabilities and Psychiatric Symptoms in Primary Progressive Aphasia.

OBJECTIVE: The aims of this study are to describe the chronology of functional disabilities in primary progressive aphasia (PPA), and to examine associations between psychiatric comorbidities and functional disabilities. METHODS: We conducted a retrospective data analysis using subjects enrolled at Alzheimer's Disease Research Centers between 2005 and 2019. Data were obtained from the National Alzheimer's Coordinating Center database. We included subjects whose primary diagnosis was PPA. Functional status was coded as a binary variable for the following functions: ambulation, transaction skills, verbal communication, meal preparation, and self-care. Behavioral data derived from the Neuropsychiatric Inventory Questionnaire. Descriptive statistics and cox proportional hazard analyses were used to characterize the emergence of disabilities and their association with psychiatric comorbidities. RESULTS: Data included 91 subjects with a clinical dementia rating scale of zero at baseline. At the initial visit, no individuals had impairments in self-care, while 7% had impairments in transactions, 3% in ambulation, and 2% in meal preparation. Ninety-three percent had language impairments at the onset of the study, and all by visit 4. By visit 5, 41% of patients had impairments in ambulation and in self-care, 49% were impaired in meal preparation and 70% had impairment in transactions. The presence of anxiety, depression, sleep disturbance and psychosis were all significantly associated with an increased risk for multiple functional disabilities. CONCLUSION: These findings provide clinicians with guidance for forecasting disabilities and targeting interventions in PPA.

Loss of Consciousness and Altered Mental State as Predictors of Functional Recovery Within 6 Months Following Mild Traumatic Brain Injury.

OBJECTIVE: The authors tested the hypothesis that a combination of loss of consciousness (LOC) and altered mental state (AMS) predicts the highest risk of incomplete functional recovery within 6 months after mild traumatic brain injury (mTBI), compared with either condition alone, and that LOC alone is more strongly associated with incomplete recovery, compared with AMS alone. METHODS: Data were analyzed from 407 patients with mTBI from Head injury Serum Markers for Assessing Response to Trauma (HeadSMART), a prospective cohort study of TBI patients presenting to two urban emergency departments. Four patient subgroups were constructed based on information documented at the time of injury: neither LOC nor AMS, LOC only, AMS only, and both. Logistic regression models assessed LOC and AMS as predictors of functional recovery at 1, 3, and 6 months. RESULTS: A gradient of risk of incomplete functional recovery at 1, 3, and 6 months postinjury was noted, moving from neither LOC nor AMS, to LOC or AMS alone, to both. LOC was associated with incomplete functional recovery at 1 and 3 months (odds ratio=2.17, SE=0.46, p<0.001; and odds ratio=1.80, SE=0.40, p=0.008, respectively). AMS was associated with incomplete functional recovery at 1 month only (odds ratio=1.77, SE=0.37 p=0.007). No association was found between AMS and functional recovery in patients with no LOC. Neither LOC nor AMS was predictive of functional recovery at later times. CONCLUSIONS: These findings highlight the need to include symptom-focused clinical variables that pertain to the injury itself when assessing who might be at highest risk of incomplete functional recovery post-mTBI.

Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.

OBJECTIVE: To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer's Disease (AD). METHODS: Twenty-seven home-dwelling patients with AD were randomized to either an exercise intervention program delivered by their caregivers or a home safety assessment control. Measures of functional performance (primary), cognition, neuropsychiatric symptoms, quality of life and caregiver burden (secondary) were obtained at baseline and at 6 and 12 weeks following randomization. For each outcome measure, intent-to-treat analyses using linear random effects models were performed. Feasibility and adverse events were also assessed. RESULTS: Adherence to the exercise program was good. On the primary outcomes (functional performance) patients in the exercise group demonstrated a trend for improved performance on measures of hand function and lower extremity strength. On secondary outcome measures, trends toward worse depression and lower quality of life ratings were noted. CONCLUSIONS: The physical exercise intervention developed for the study, delivered by caregivers to home-dwelling patients with AD, was feasible and was associated with a trend for improved functional performance in this group of frail patients. Given the limited efficacy to date of pharmacotherapies for AD, further study of exercise intervention, in a variety of care setting, is warranted.