Evaluation of a non-auditory neurocognitive test battery in hearing-impaired according to age.

PURPOSE: Due to the demographic shift, the number of older people suffering from hearing loss and from cognitive impairment increases. Both are closely related and hard to differentiate as most standard cognitive test batteries are auditory-based and hearing-impaired individuals perform worse also in non-auditory test batteries. Therefore, reference data for hearing-impaired are mandatory. METHODS: The computer-based battery ALAcog assesses multiple cognitive domains, such as attention, (delayed) memory, working memory, inhibition, processing speed, mental flexibility and verbal fluency. A data set of 201 bilaterally hearing-impaired subjects aged ≥ 50 (mean 66.6 (SD 9.07)) was analysed. The LMS method, estimated curves for the 10th, 25th, 50th, 75th and 90th percentile were calculated, and classified according to age, starting from the age of 50. RESULTS: Cognitive function shows a decline in all subtests as people age, except for verbal fluency, which remains almost stable over age. The greatest declines were seen in recall and delayed recall and in mental flexibility. Age and hearing ability did not correlate (p = 0.68). However, as people age, inter-subject variability of cognitive test results increases. This was especially the case for inhibition. Cognitive function was not correlated with hearing ability (each p ≥ 0.13). CONCLUSION: The present results make an approach to establish reference data for a comprehensive non-auditory test battery in a large sample of elderly hearing-impaired people which can be used as a simple tool to better contextualise cognitive performance beyond mean and median scores.

[Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]. / Hören und Kognition: neurokognitive Testbatterien in der HNO-Heilkunde.

BACKGROUND: Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology. MATERIALS AND METHODS: The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus. RESULTS: A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing. CONCLUSION: With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.

Structure evolution of h.c.p./c.c.p. metal oxide interfaces in solid-state reactions.

The structure of crystalline interfaces plays an important role in solid-state reactions. The Al2O3/MgAl2O4/MgO system provides an ideal model system for investigating the mechanisms underlying the migration of interfaces during interface reaction. MgAl2O4 layers have been grown between Al2O3 and MgO, and the atomic structure of Al2O3/MgAl2O4 interfaces at different growth stages was characterized using aberration-corrected scanning transmission electron microscopy. The oxygen sublattice transforms from hexagonal close-packed (h.c.p.) stacking in Al2O3 to cubic close-packed (c.c.p.) stacking in MgAl2O4. Partial dislocations associated with steps are observed at the interface. At the reaction-controlled early growth stages, such partial dislocations coexist with the edge dislocations. However, at the diffusion-controlled late growth stages, such partial dislocations are dominant. The observed structures indicate that progression of the Al2O3/MgAl2O4 interface into Al2O3 is accomplished by the glide of partial dislocations accompanied by the exchange of Al3+ and Mg2+ cations. The interface migration may be envisaged as a plane-by-plane zipper-like motion, which repeats along the interface facilitating its propagation. MgAl2O4 grains can adopt two crystallographic orientations with a twinning orientation relationship, and grow by dislocations gliding in opposite directions. Where the oppositely propagating partial dislocations and interface steps meet, interlinked twin boundaries and incoherent Σ3 grain boundaries form. The newly grown MgAl2O4 grains compete with each other, leading to a growth selection and successive coarsening of the MgAl2O4 grains. This understanding could help to interpret the interface reaction or phase transformation of a wide range of materials that exhibit a similar h.c.p./c.c.p. transition.

[Metastasized renal cell carcinoma. Measurement of plasma levels of the tyrosine kinase inhibitors sunitinib, sorafenib and pazopanib]. / Metastasiertes Nierenzellkarzinom. Bestimmung der Plasmaspiegel der Tyrosinkinaseinhibitoren Sunitinib, Sorafenib und Pazopanib.

BACKGROUND: Several tyrosine kinase inhibitors (TKI) are used in the treatment of metastasized renal cell carcinoma (mRCC). This article presents a feasibility study for the measurement of plasma levels of sunitinib, sorafenib and pazopanib using liquid chromatography tandem mass spectrometry (LC-MS/MS). METHODS: A total of 23 patients suffering from mRCC under treatment with sunitinib (n=16), sorafenib (n=3) and pazopanib (n=4) were included. Plasma samples (100 µl) were separated by liquid chromatographic analysis and the plasma levels of the TKIs determined by tandem mass spectrometry. RESULTS: The plasma levels of sunitinib, sorafenib and pazopanib were measurable and the results reproducible. During storage of the plasma samples for 1 week at 4°C no significant decrease of the initial concentration was found. The highest plasma levels detected were 99 ng/ml for sunitinib, 9.8 µg/ml for sorafenib and 63 µg/ml for pazopanib. We could show variability in plasma levels according to changes in dosage of TKIs or during treatment-free intervals. CONCLUSION: Measurement of TKI plasma levels using LC-MS/MS is feasible. Further clinical studies have to be conducted to examine if there are any threshold levels for the incidence of adverse events or response to treatment.