Slowing: A Vascular Geriatric Syndrome?

OBJECTIVES: This study aimed to investigate the interrelation between slowing in walking, thinking and mood, and their relationship with cerebral small vessel disease (CSVD) in a geriatric population. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: 566 geriatric outpatients from the Amsterdam Aging Cohort (49% female; age 79 ±6 years), who visited the Amsterdam UMC geriatric outpatient memory clinic. METHODS: Patients underwent a comprehensive geriatric assessment, brain imaging, and a neuropsychological assessment as part of medical care. Three slowing aspects were investigated: gait speed, processing speed, and apathy symptoms (higher scores indicating more advanced slowing). We visually rated CSVD [white matter hyperintensities (WMHs), strategic lacunes, and microbleeds] on brain imaging. RESULTS: Regression analyses showed that slowing in walking (gait speed) was associated with slowing in thinking [processing speed; ß = 0.35, 95% confidence interval (CI) 0.22, 0.48] and slowing in mood (apathy symptoms; ß = 0.21, 95% CI 0.13, 0.30), independent of important confounders. Large confluent areas of WMH (Fazekas 3) were associated with all slowing aspects: gait speed (ß = 0.49, 95% CI 0.28, 0.71), processing speed (ß = 0.36, 95% CI 0.19, 0.52) and apathy symptoms (ß = 0.30, 95% CI 0.09, 0.51). In addition, in patients with more slowing aspects below predefined cutoffs, severe WMH was more common. Presence of ≥3 microbleeds was associated with apathy symptoms (ß = 0.39, 95% CI 0.12, 0.66), whereas lacunes were not associated with slowing. CONCLUSIONS AND IMPLICATIONS: This study provides evidence that slowing in walking, thinking, and mood are closely related and associated with CSVD. This phenotype or geriatric syndrome could be helpful to identify and characterize patients with CSVD.

Memory complaints in chronic stroke patients are predicted by memory self-efficacy rather than memory capacity.

BACKGROUND: Memory self-efficacy (MSE) is the belief about one's mastery of memory functioning. In healthy elderly, memory complaints are related to MSE rather than to objectively measured memory capacity. MSE has scarcely been studied in patients that suffered a stroke. The aim of this study was twofold: (1) to examine whether memory capacity and MSE can predict the presence of memory complaints in stroke patients, and (2) to study which variables are the best predictors of MSE. METHODS: In a cross-sectional study, 136 stroke patients (>18 months after onset) were recruited from April 2008 to November 2009. MSE was measured using the Metamemory in Adulthood questionnaire. Depression, coping and personality were measured using validated questionnaires, and memory performance was measured using the Rivermead Behavioural Memory Test (RBMT) and the Auditory Verbal Learning Test (AVLT). Patients were divided into a 'complaints' and a 'no complaints' group. RESULTS: A lower MSE score was an independent predictor of having memory complaints (adjusted odds ratio: 0.422; p = 0.000), adjusted for age and depression. The RBMT and AVLT scores did not predict the presence of memory complaints (p > 0.263). Presence of memory complaints and depression were the strongest predictors of MSE (B = -1.748, p = 0.000; B = -0.054, p = 0.000), followed by word fluency, not having a partner and side of stroke (B = 0.038, p = 0.012; B = -0.517, p = 0.082; B = -0.479, p = 0.088). CONCLUSIONS: Memory complaints are predicted by MSE rather than memory capacity. MSE memory training might be an effective training strategy for reducing memory complaints in selected chronic stroke patients.

The relative effect of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke.

OBJECTIVE: To investigate the relative associations of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke. DESIGN: Cross-sectional study. SUBJECTS: A total of 213 patients after stroke (> 18 months post-onset), mean age 59 years (standard deviation (SD) 9.86 years), 56% men, mean time post-stroke 53 months (SD 37.8 months). METHODS: Coping strategy was measured using the assimilative-accommodative coping scale, depression using the Center for Epidemiologic Studies Depression Scale, and quality of life using the World Health Organization Quality of Life-BREF. Multivariable regression analyses were performed, adjusted for patient characteristics. RESULTS: Depression score was independently related to all domains of quality of life (Psychological Health (B = -0.924; p = 0.000), Physical Health (B = -0.832; p = 0.000), Social Relationships (B = -0.917; p = 0.000), Environment (B = -0.662, p = 0.000)). Accommodative coping (B = 0.305; p = 0.024) and assimilative coping (B = 0.235; p = 0.070) were independently related to the domain Psychological Health, adjusted for depression and education level. CONCLUSION: Coping strategies and depression score were independently associated with Psychological Health in patients in the chronic phase after stroke. Patients who prefer an accommodative coping strategy may show less symptoms of depression. Preferable coping strategies may be trained in order to improve both depression score and health-related quality of life in future research.

Long-lasting effects of a new memory self-efficacy training for stroke patients: a randomized controlled trial.

BACKGROUND AND PURPOSE: This study aims to determine the long-term effects of a new Memory Self-efficacy (MSE) training program for stroke patients on MSE, depression, and quality of life. METHODS: In a randomized controlled trial, patients were allocated to a MSE training or a peer support group. Outcome measures were MSE, depression, and quality of life, measured with the Metamemory-In-Adulthood questionnaire, Center for Epidemiological Studies-Depression Scale (CES-D), and the Who-Qol Bref questionnaire, respectively. We used linear mixed models to compare the outcomes of both groups immediately after training, after 6 months, and after 12 months, adjusted for baseline. RESULTS: In total, 153 former inpatients from 2 rehabilitation centers were randomized-77 to the experimental and 76 to the control group. MSE increased significantly more in the experimental group and remained significantly higher than in the control group after 6 and 12 months (B = 0.42; P = .010). Psychological quality of life also increased more in the experimental group but not significantly (B = 0.09; P = .077). However, in the younger subgroup of patients (<65 years old), psychological quality of life significantly improved in the experimental group compared to the control group and remained significantly higher over time (B = 0.14; P = .030). Other outcome measures were not significantly different between both groups. CONCLUSIONS: An MSE training program improved MSE and psychological quality of life in stroke patients aged <65 years. These effects persisted during 12 months of follow-up.

Training memory self-efficacy in the chronic stage after stroke: a randomized controlled trial.

BACKGROUND: Stroke patients with a low memory self-efficacy (MSE) report more memory complaints than patients with a high MSE. OBJECTIVE: The aim of this study was to examine the effect of a memory-training program on MSE in the chronic phase after stroke and to identify which patients benefit most from the MSE training program. METHODS: In a randomized controlled trial, the effectiveness of the MSE training program (experimental group) was compared with a peer support program (control group) in chronic stroke patients. The primary outcome was MSE, measured using the Metamemory-In-Adulthood Questionnaire. Secondary outcomes included depression, quality of life, and objective verbal memory capacity. Changes in outcomes over the intervention period were compared between both groups. Demographic and clinical variables were studied as potential predictors of MSE outcome in the experimental group. RESULTS: In total, 153 patients were included: mean age = 58 years (standard deviation [SD] = 9.7), 54.9% male, and mean of 54 months (SD = 37) after stroke. Of these, 77 were assigned to the training and 76 to the control group. Improvement of MSE (B = 0.40; P = .019) was significantly greater in the training than in the control group. No significant differences were found for the secondary outcomes. An increase in MSE after training was predicted by a younger age (B = -0.033; P = .006) and a better memory capacity (B = 0.043; P = .009), adjusted for baseline MSE. CONCLUSIONS: MSE can be improved by the MSE training program for stroke patients. Younger patients and patients with a better memory capacity benefit most from the MSE training program (Dutch Trial Register: NTR-TC 1656).

Memory self-efficacy and psychosocial factors in stroke.

OBJECTIVE: To explore whether Memory Self-efficacy is related to depression, neuroticism and coping in patients after stroke, as it is in healthy elderly subjects. DESIGN: A cross-sectional design. The relation between Memory Self-efficacy and psychosocial factors was analysed using a Mann-Whitney U test and non-parametric Spearman correlations. PATIENTS: Seventeen male and 6 female patients after stroke from an inpatient rehabilitation setting were included. METHODS: Memory Self-efficacy, depression, neuroticism and coping were assessed with validated questionnaires. Patients with severe aphasia, subarachnoidal haemorrhage or subdural haematomas were excluded. RESULTS: As in healthy elderly subjects, higher depression ratings are significantly related to lower Memory Self-efficacy ratings (Z = -2.13; p = 0.033). Lower Memory Self-efficacy seems related to higher neuroticism ratings and a more passive coping style score (Z = -1.54; p = 0.123; Z = -1.42; p = 0.155, respectively). The Spearman correlations confirm these finding (p < 0.10). CONCLUSION: This study replicated the relationships between Memory Self-efficacy and depression and neuroticism found in a healthy population, in an inpatient stroke population. Future research on Memory Self-efficacy in patients after stroke should focus on other potential determinants such as awareness and, ultimately, on the effectiveness and efficacy of interventions aimed at Memory Self-efficacy to improve participation and quality of life.