Can cerebrospinal fluid biomarkers tell us something about financial capacity in Alzheimer's disease patients? A preliminary study.

BACKGROUND: Although diagnostic markers in cerebrospinal fluid (CSF) have become a rapidly growing research field, they have not as yet been investigated in relation to capacities that are of interest to geriatric psychiatry and neuropsychology, such as financial capacity. The aim of this study was to assess whether CSF biomarkers can predict financial capacity in patients with a diagnosis of major neurocognitive disorder due to Alzheimer's disease (AD). METHODS: Participants were examined with a number of neuropsychological tests, with an emphasis on the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) and CSF tests. RESULTS: Amyloid ß peptide 1-42 (Aß42), total tau, and phosphorylated tau were not found to predict financial capacity performance in AD, but MMSE shows a strong positive correlation with LCPLTAS. CONCLUSIONS: These preliminary findings indicate that complex cognitive functions, such as financial capacity, may not be directly linked to CSF concentrations of the abovementioned biomarkers. Further studies with larger numbers of patients will be required to assess the reproducibility of these findings and to determine whether this approach can assist not only in diagnosis but also in neuropsychological assessment.

Spatial Orientation Assessment in the Elderly: A Comprehensive Review of Current Tests.

Spatial orientation and navigation are complex cognitive functions that integrate sensory information, attention, and memory, enabling individuals to locate themselves in their environment. These abilities decline with age, signaling cognitive impairment in neurological patients, and significantly limit the autonomy of the elderly. Current neuropsychological assessments fall short in accurately measuring everyday wayfinding abilities, particularly in borderline cases of cognitive decline. This paper reviews various neuropsychological assessments, including Benton's Judgment of Line Orientation Test, the Almeria Spatial Memory Recognition Test, the Spatial Span subtest from the Wechsler Memory Scale, and the Spatial Orientation in Immersive Virtual Environment Maze Test, evaluating their effectiveness in delineating spatial orientation and navigation skills. The review identifies significant gaps in the validity and reliability of these tests, particularly in their shortened versions, and highlights the potential of virtual reality environments as promising tools for improving diagnostic precision. The findings underscore the need for further research to refine these tools, ensuring they accurately capture cognitive decline and improve the differential diagnosis of neurodegenerative conditions like Alzheimer's disease. Such advancements hold promise for enhancing the quality of care and autonomy for the elderly.

Burnout and Coping Strategies in Integrative Psychotherapists: Findings from Qualitative Interviews.

Burnout among psychotherapists is a pervasive challenge affecting both professional well-being and client care. This study aims to explore the experience of burnout among integrative psychotherapists and examine the strategies they employ to cope with this phenomenon. Interviews were conducted with 17 integrative psychotherapists, and the data were analyzed using Braun and Clarke's six-step thematic analysis. Through this analysis, two themes were identified: (1) work-related pressures and burnout manifestations and (2) strategies for maintaining optimal functioning. Fatigue, headaches, challenges in decision-making or session planning, numbness in the form of paralysis, and disconnection from clients emerged as primary symptoms, impacting therapeutic efficacy. Participants' intense sense of responsibility toward clients and their self-worth validation through client progress intensified burnout risks, particularly among novices. Personal therapy and clinical supervision emerged as pivotal in mitigating burnout, offering support, and enhancing therapist resilience. Additionally, peer support and organizational interventions were deemed crucial during crises, emphasizing the need for structured support systems within professional bodies. These findings contribute to a deeper understanding of burnout in psychotherapy and highlight the need for targeted interventions to enhance professionals' resilience and sustain effective client outcomes.

Do sex and handedness influence general cognition and financial capacity in patients with aMCI and healthy older adults? Emphasis on women's performance.

Objectives: The effects of sex and handedness on financial capacity performance remain unexplored both in healthy older adults and in patients with amnestic mild cognitive impairment (aMCI). Methods: The aim of this study was to study the effect of the above factors (sex, handedness, and health condition), following a factorial experimental design; hence, eight groups (each with ten individuals) with similar demographic characteristics (age and education level) were formed consisting of right/left-handed, women/men and healthy/not healthy (with a diagnosis of aMCI) older adults. Mini-Mental State Examination (MMSE) was administered as a measure of general cognitive ability, and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) was used as an indicator of financial capacity; moreover, GDS-15 was used to assess depressive symptomatology. Self-reports of hand preference were also included. Results: Although as expected healthy men and women regardless of their handedness outperformed aMCI patients on MMSE and LCPLTAS, performance on cash transactions, bank statement management, bill payment, financial decision making, and knowledge of personal assets from LCPLTAS is significantly higher for right-handed aMCI women compared with left-handed aMCI women. Conclusions: Future research should further elucidate the reasons for this left-handed female patient with aMCI profile in larger groups of patients. This is an exploratory study, and the small sample size limits the strength of conclusions; further studies on this topic are needed.

Age-related effects in magnitude and place-value processing.

While general cognitive skills decline during aging, numerical skills seem to be mainly preserved. Such skills are essential for an independent life up to old age, e.g., when dealing with money or time. Operating with numbers usually requires number magnitude and place-value processing. The question is whether these processes are negatively affected by aging due to the general cognitive decline or positively affected due to lifelong experience with numbers. Therefore, we investigated age-related changes in the distance and compatibility effects in single-digit, two-digit, and four-digit number comparison. On the one hand, older adults took longer for number processing and showed a smaller distance effect, indicating altered number magnitude representations. On the other hand, older adults were better in place-value processing as indicated by a smaller compatibility effect than in younger adults. We conclude that aging differentially affects basic numerical skills.

Can Brief Listening to Mozart's Music Improve Visual Working Memory? An Update on the Role of Cognitive and Emotional Factors.

The aim of this research was to enhance understanding of the relationship between brief music listening and working memory (WM) functions. The study extends a previous large-scale experiment in which the effects of brief exposure to music on verbal WM were explored. In the present second phase of the experiment, these effects were assessed for the visuospatial subcomponent of WM. For that aim, visuospatial WM was measured using the Corsi blocks task-backwards and Visual Patterns Test in a large sample of 311 young and older adults after being exposed to musical excerpts coming from different music composers (Mozart, Vivaldi, Glass). To account for possible effects of arousal, a silence condition was used. Individual preference for music excerpts and emotional reactions to each condition were also subjectively rated using the Positive and Negative Affect Schedule (PANAS) to account for the role of emotional reactions in shaping subsequent cognitive performance. Results showed that music affected the visuospatial sketchpad of WM. In line with the previously described Mozart effect, only Mozart's music had a significant positive impact on visuospatial WM in the two age groups, regardless of preferences, and on overall age-related WM decline in older adults. The Mozart effect was more prominent for the VPT than the Corsi task and was also expressed for the prevailing positive effect. These observations are in contrast to the selective influence of Vivaldi's music on verbal WM that was detected in our first study. Together, the results demonstrate a differential music influence on the phonological loop and on the visuospatial sketchpad. They thus contribute to the debate of whether music has the potential to affect distinct processes within working memory in an excerpt- or composer-specific manner. Also, they suggest that emotional activation and central executive attention are essentially involved in modulating the influence of music on subsequent cognition. These findings can assist in the selection of music excerpts used in cognitive rehabilitation programs that focus on visuospatial skills.

Understanding the Neuropsychological Implications of Klinefelter Syndrome in Pediatric Populations: Current Perspectives.

Klinefelter syndrome (KS), also known as 47,XXY, is a genetic disorder characterized by the presence of an extra X chromosome. Despite the prevalence of verbal learning disabilities, memory impairments, and executive function deficits in individuals with KS, comprehensive research on the neuropsychological profiles of affected children and adolescents remains limited. Additionally, KS has been associated with comorbid conditions such as depression, anxiety, schizophrenia, attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorders (ASDs). However, systematic investigations into the neuropsychological manifestations of KS in pediatric populations are scarce. Therefore, the primary objectives of this review are to provide an overview of key studies examining the neuropsychological profiles of children and adolescents with KS and to delineate the limitations and implications of existing research findings. By synthesizing available literature, this review aims to bridge the gap in understanding the cognitive and behavioral characteristics of children and adolescents with KS, shedding light on potential avenues for future research and clinical interventions. Ultimately, this review serves as a valuable resource for clinicians, researchers, policymakers, parents, and educators involved in the assessment and management of the neuropsychological aspects of Klinefelter syndrome in pediatric populations.

Unveiling Anxiety Factors in Orthorexia Nervosa: A Qualitative Exploration of Fears and Coping Strategies.

Orthorexia nervosa represents a controversial phenomenon in the realm of eating practices, characterized by an obsessive fixation on consuming only foods deemed 'healthy', and a preoccupation with food purity. While the existing literature has identified the presence of stressful behaviors among individuals with orthorexia, the precise factors and circumstances eliciting these stress-inducing emotions remain the subject of ongoing inquiry. This study aims to explore the triggers and situations that precipitate stressful beliefs and emotions among individuals who self-identify as preoccupied with healthy eating, as well as the coping mechanisms developed to manage these feelings. Through conducting one-to-one interviews with thirteen individuals, thematic analysis was employed to elucidate the nuances of their experiences. Participants articulated concerns regarding the contamination of foods available in supermarkets and restaurants, thereby prompting the meticulous selection of food sources and aversion to dining out. The prospect of trying new foods and engaging in social gatherings involving food emerged as anxiety-inducing scenarios, prompting individuals to adhere to monotonous dietary patterns and impose self-isolation. Additionally, medical appointments were perceived as stressful, driven by health concerns underpinning the adoption of stringent dietary practices. These findings underscore the spectrum of fears and coping mechanisms exhibited by individuals with orthorexia nervosa, which hold profound implications for their overall well-being.

Echoes of Support: A Qualitative Meta-Synthesis of Caregiver Narratives in Lung Cancer Care.

Lung cancer stands as one of the prevalent cancers, impacting both men and women globally. Family caregivers, deeply involved in the care of individuals affected by this disease, often endure heightened distress and struggle to navigate the manifold challenges associated with caregiving. Understanding the intricate experiences and challenges of caregivers in the realm of lung cancer care is critical, given its profound impact on their well-being and the quality of patient care. This study aimed to comprehensively examine and synthesize qualitative data concerning caregiver experiences within the context of lung cancer. Six databases were systematically searched for studies with qualitative findings relevant to caregivers and lung cancer. Seventeen studies were included, and findings were reviewed and synthesized. The main challenges identified were: 'Information accessibility', 'Dual roles and family dynamics', 'Coping with emotional challenges and uncertainty', and 'Need for support networks'. These findings underscore the profound challenges faced by caregivers, shedding light on the substantial impact of cancer on their well-being and functionality. Moreover, the study accentuates the pressing need for tailored support systems that can address the emotional toll and information needs of caregivers. This emphasis on supportive interventions is vital to enhance the quality of care and overall well-being for both patients and caregivers within the lung cancer care continuum.

What do health care professionals, students, and laypeople in Greece believe about informed consent for research on medical practices? Unleashing Pandora's box.

Background: Attitudes toward informed consent for research on medical practices has been little investigated in Greece in the general population as well as in health care students and professionals, and at the same time, undergraduate and postgraduate curricula with focus on informed consent issues are entirely missing. Methods: To explore attitudes toward informed consent for research on medical practices among students, doctors, and laypeople in Greece across several demographic variables. A total of 380 participants (180 first-year healthcare university students from various faculties including medicine, pharmacy, biology, nursing, physiotherapy, midwifery, health care engineers, 100 medical doctors of various specialties working in hospitals and private practice, and 100 laypeople) completed a survey questionnaire along with a detailed demographics questionnaire. Results: The results revealed that between the three groups, there were statistically significant differences in the responses for all aspects of attitudes toward informed consent. Overall, Greek participants reported more negative attitudes when compared with findings from the United States. In addition, most of the participants reported lack of educational experience regarding informed consent. Conclusion: The findings showed that the efforts and relevant initiatives by the Greek State, private institutions, and the Greek Medical Societies should refocus and emphasize on educational programs concerning the dissemination of relevant scientific information on informed consent processes, either as a provider or as a consumer. Future research should further investigate in more depth the complex influence of additional social and/or psychological factors for the reported differences.

What goes wrong with the perceptions of elder financial abuse? Data from older adults, healthcare professionals and students from Greece.

This study examines what healthcare professionals, students and older adults believe about elder financial abuse in Greece. Participants responded to two vignettes by choosing which characteristics indicate elder financial abuse. Greeks are less likely to perceive financial exploitation when the perpetrator is a close family member, but are more likely to recognize it when perpetrated by paid caregivers or more distant (male) relatives. Signing over the victim's property to another is less likely to be perceived as elder abuse than is the taking of money from bank accounts, even though the property is often worth more than what is taken from the account. Although there are some differences in perception between healthcare professionals and others in Greek society, these (and other anomalies) make it difficult to accurately report and prevent elder financial abuse in Greece.

Better Understand to Better Predict Subjective Well-Being Among Older Greeks in COVID-19 Era: Depression, Anxiety, Attitudes Towards eHealth, Religiousness, Spiritual Experience, and Cognition.

Despite similarities with previous pandemics, the potential physical and psychosocial impact of COVID-19 on older adults is still little investigated in Greece. This study examines the intercorrelations between subjective well-being/life satisfaction, depression, state anxiety, global cognitive function, attitudes towards eHealth, religiousness and spiritual experience in older adults during COVID-19. Results revealed that statistically significant negative correlations exist between subjective life satisfaction and depressive symptomatology as well as with religiousness, a finding that can be explained by the COVID-19 externally imposed religious practice restrictions. Subjective life satisfaction was positively correlated with overall cognition as measured by Mini-Mental State Examination (MMSE). MMSE was also negatively correlated with state anxiety, depression, and attitudes towards eHealth use. The best predictors of subjective well-being is global cognition (as measured by MMSE) and depressive symptomatology (measured by GDS). The conclusions of this study underscore the need to examine in more detail psychological variables during COVID-19 and quality of life in older adults.

In the Hands of Hypnos: Associations between Sleep, Cognitive Performance and Financial Capacity in aMCI and Mild AD.

Objective The aim of this monocentric observational study is to assess whether sleep disorders can predict financial capacity in single-and multiple-domain aMCI (amnestic Mild Cognitive Impairment), mild Alzheimer's Disease (AD), and healthy controls. Methods Older participants from Northern Greece were examined with several neuropsychological tests, including Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Sleep duration and quality were based on caregiver/family members' reports in the Sleep Disorders Inventory (SDI). Results These preliminary findings coming from 147 participants indicate for the first time that apart from MMSE, complex cognitive functions, such as financial capacity may be also directly linked to the frequency of sleep-disturbed behaviours as indicated by SDI frequency questions, both in aMCI and mild AD. Discussion An urgency for further investigation of the neglected sleep factor should be added in financial capacity assessment protocols.

eHEALTH BEFORE AND DURING COVID-19: DOES DEPRESSIVE SYMPTOMATOLOGY INFLUENCE ATTITUDES OF CAD PATIENTS, HEALTHCARE STUDENTS AND PROFESSIONALS?

BACKGROUND: This study aims to clarify CAD patients' attitudes towards telemedicine-and-telecare before and after the pandemic and to compare views with those of healthcare students and professionals (doctors), while taking into consideration the influence of depressive symptomatology. METHODS: All participants completed a modified version of the Information Technology Attitude Scales for Health (ITASH), the Center for Epidemiologic Studies Depression Scale-CES-D and a demographics questionnaire. RESULTS: All three groups showed statistically significant more positive views towards eHealth in the retest condition on all questions. CAD patients held the least positive views compared to healthcare students and professionals in both time points. The majority of the participants from all three groups reported that since their initial examination they still lacked educational experience regarding eHealth. Depressive symptomatology was found not to have an influence on eHealth reports. CONCLUSIONS: eHealth plays an important role both in prevention, treatment and care, but attitudes may act as an obstacle in using them. Future research should further investigate in more depth the complex influence of additional sociocultural and/or psychological factors for the reported differences.

What Do Arithmetic Errors in the Financial Context Reveal? A Preliminary Study of Individuals with Neurocognitive Disorders.

OBJECTIVES: Arithmetic errors in the financial context have been investigated mainly in cognitively normal Parkinson's disease (PD) patients and mildly impaired PD (PD-MCI) individuals. The aim of this study was to examine arithmetic errors in the financial context across neurocognitive disorders. METHODS: Four hundred and twenty older adults from Greece were divided into four groups (110 patients with a diagnosis of Alzheimer's disease (AD), 107 patients with a diagnosis of mild cognitive impairment (MCI), 109 healthy controls and 94 Parkinson's disease dementia (PDD) patients). Their ages ranged from 65 to 98 years (M = 73.96, SD = 6.68), and the sample had a mean of 8.67 (SD = 4.08) years of education. For each of the AD patients, a counterpart matched by age, educational attainment and gender was selected from a larger group of participants. RESULTS: Overall, the results reveal that healthy older adults did not commit arithmetic errors, but AD patients reported procedural errors in their responses to both questions. A high frequency of procedural errors was found in MCI patients' responses to the first question, while the errors in their responses to the second question cannot be categorized. Finally, in PDD patients, place value errors were reported for the first question, while more magnitude errors were made when responding to the second question. CONCLUSIONS: These findings support that arithmetic errors within financial contexts are not the same across neurocognitive disorders, and numerical representations are not impaired not only in PDD, but also in AD and MCI. This information could be useful in cognitive assessments performed by neurologists and neuropsychologists as these types of errors may be indicators of specific brain pathologies.

Workplace mobbing, group cohesion and intraindividual variables in nurses from a rural hospital in Northern Greece: A correlation study.

BACKGROUND: High levels of mobbing are reported in Greek nurses, but the intraindividual and perceived group emotional correlates are little investigated. OBJECTIVE: To determine the relationship between workplace mobbing (specifically in the nursing sector of a public rural hospital in Greece) and emotional correlates. METHODS: Questionnaires measuring emotional aspects such as Negative Act Questionnaire - Revised (NAQ-R) for measuring perceived exposure to bullying and victimization at work, Maslach Burnout Inventory (MBI), Overall Job Satisfaction Scale (OJS), Job Affect Scale (JAS: positive and negative subscales), Perceived Cohesion Scale (PCS), Ethical Climate Questionnaire (ECQ), and Short General Health Questionnaire (GHQ-12) were administered. For the analysis of the data, descriptive and parametric tests were performed through the Pearson correlations and regression for the relationship between variables. RESULTS: High mobbing levels were reported (M = 45.93) compared to already established cutoff scores. Statistically significant positive correlations were found for NAQ-R and MBI (Exhaustion subscale) (r = .569, p < .001), NAQ-R and JAS-negative affect (r = .610, p < .001), NAQ-R and GHQ-12 (r = .280, p = .002), and NAQ-R andeducational level (r = .196, p = .033). Statistically significant negative correlations were found for NAQ-R and ECQ (r = -.323, p < .001), NAQ-R and JAS-positive affect (r = -.556, p < .001), and NAQ-R and PCS (r = -.586, p < .001). Only burnout,negative affect, and perceived group cohesion predicted mobbing measured by NAQ- R. CONCLUSION: As mobbing and its consequences are related to specific emotional variables, these perceived individual and group indices, could be targeted in future prevention initiatives.

Brain Volumes and Metacognitive Deficits in Knowledge of Self, Task and Strategies in Mathematics: A Preliminary Pilot One-Year Longitudinal Study in aMCI Patients Compared to Healthy Controls.

Metacognitive knowledge has been little investigated in aMCI patients. The aim of this study is to examine whether there are specific deficits in knowledge of self, task and strategies in mathematical cognition, due its importance for everyday functioning, mainly due to its importance for financial capacity in old age. A total of 24 patients with a diagnosis of aMCI and one-to-one 24 matched individuals (similar age, education and gender) were examined at three time points in a year with a number of neuropsychological tests and a slightly modified version of the Metacognitive Knowledge in Mathematics Questionnaire (MKMQ). We analyzed longitudinal MRI data regarding various brain areas for the aMCI patients. Results indicated that the aMCI group differed in all MKMQ subscale scores at the three time points compared to healthy controls. Correlations were found only for metacognitive avoidance strategies and left and right amygdala volumes at baseline, while after twelve months correlations were found for avoidance and right and left parahippocampal volumes. These preliminary results highlight the role of specific brain regions that could be used as indices in clinical practice for the detection of metacognitive knowledge deficits that are found in aMCI.

Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression.

Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer's disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation.