Addenbrooke's Cognitive Examination-Third Edition Predicts Neuropsychological Test Performance.

OBJECTIVE: Effective screening tools can help providers with treatment decisions, including when to refer patients for neuropsychological evaluations, which are the gold standard for cognitive assessment of neurodegenerative disease. The authors examined whether performance on the Addenbrooke's Cognitive Examination-Third Edition (ACE-III), a readily available cognitive screening tool for older adults, predicted performance on subsequent neuropsychological evaluations. METHODS: In total, 217 patients referred for neurocognitive concerns completed a neuropsychological evaluation, including the ACE-III. Patients were diagnosed as having normal cognition (NC, N=67), mild neurocognitive disorder (mild NCD, N=105), or major NCD (N=45). Regression analyses were used to determine whether ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. Logistic regression was used to assess whether ACE-III total score and overall neuropsychological test performance predicted diagnosis. Separate analyses compared those with higher and lower educational attainments. ACE-III subscales and total scores were compared by diagnostic group. RESULTS: Across all groups, ACE-III subscale scores predicted within-construct neuropsychological performances with moderate to strong effects (p<0.001) but were less predictive for those with lower educational attainment. ACE-III total score was less sensitive than overall neuropsychological test performance in predicting neurocognitive disorders. ACE-III subscale and total scores distinguished diagnostic groups (NC>mild NCD>major NCD, p<0.001). CONCLUSIONS: ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. However, overall performance on neuropsychological testing was more sensitive than ACE-III total score in predicting neurocognitive disorder diagnosis. Total ACE-III score differed by level of cognitive impairment. Comprehensive neuropsychological testing is recommended for patients who have lower educational status or complex symptom presentations or are younger.

Evidence of the Associations between Individual and Partner Autonomy Support and Physiological Stress in the Context of Conversations about Weight among Couples Who are Overweight or Obese during a 6-Month Intervention.

The aim of the study was to examine the impact of supportive communication on acute physiological stress responses during weight-related conversations taking place throughout a couples' weight loss program. Participants were 47 married or cohabitating couples where each partner had a BMI of 25-40 kg/m2. Couples were randomized as a dyad into a traditional weight loss program or a program that also included training in providing support to one's partner throughout the weight loss process. Structured conversations between partners about weight management were videotaped at baseline and 6 months. Participants provided saliva samples before and after the conversations, which were assayed for cortisol and salivary alpha-amylase (sAA) to determine physiological stress and anxiety responses to conversations about weight. The results indicated that receiving support from one's partner when discussing weight-related issues was associated with greater physiological stress, as indicated by higher cortisol and sAA levels, whereas providing support to one's partner was associated with lower cortisol levels and higher sAA levels. The findings suggest that receiving support is not a universally positive experience, especially for populations facing health issues. The mixed findings for support provision align with previous studies identifying a negative association between affectionate communication and cortisol levels, as well as a positive association between sAA and anxiety and emotional arousal. The findings and their implications for understanding the physiological correlates of couples' conversations about weight are discussed.

A randomized controlled trial of a theory-based weight-loss program for couples.

OBJECTIVE: Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. METHOD: Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. RESULTS: Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). CONCLUSIONS: Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The role of partner autonomy support in motivation, well-being, and weight loss among women with higher baseline BMI.

INTRODUCTION: The association of partner autonomy support with women's motivation for healthy eating, weight-related health behavior change, and psychological well-being has been largely overlooked. Results of 2 studies showed that the positive association between autonomy support and a variety of motivational and psychological outcomes was especially pronounced for women with high body mass index (BMI) (+1 SD) compared to low BMI (-1 SD). METHOD: In Study 1, autonomy support was measured as male partners' report of their behavior in a cross-sectional design. In Study 2, autonomy support was measured as female participants' perceptions of their partners' behavior in a longitudinal home environment-based behavioral weight loss intervention. RESULTS: Study 1 showed that autonomy support from partners was associated with greater self-determined motivation for healthy eating and self-reported well-being among women with higher BMI. Study 2 showed that changes in partner autonomy support over 18 months of a home-based weight loss intervention were associated with increases in motivation for treatment and greater weight loss, especially for women who had higher baseline BMI. DISCUSSION: Both studies demonstrated that autonomy support was associated with adaptive functioning across weight status but that it was especially potent for women with higher BMI. This pattern of findings is explained in terms of the pressures women with higher BMI may feel about their weight-related behaviors. (PsycINFO Database Record

How prescriptive support affects weight loss in weight-loss intervention participants and their untreated spouses.

OBJECTIVE: Controlling or prescriptive support styles (e.g., pressure) often hinder weight loss, but can sometimes be beneficial. This secondary analysis of data from a randomized controlled trial examined persuasion, pressure, and indirect social control among cohabiting couples and the effect of these supports on weight loss. METHODS: Couples (NCouples = 130) were randomized to either Weight Watchers (WW) or a self-guided control condition (SG). Only one member of each couple received the intervention; the other member of the couple was untreated. Couples were weighed and completed study measures at baseline, 3, and 6 months. RESULTS: Dyadic multilevel models examined BMI change and differences across role (treated participant/untreated spouse) and condition (WW/SG). Prescriptive support predicted BMI change for treated participants in the WW condition only. For treated WW participants, there was no significant decrease in BMI when pressure was high (+1SD), B = -.25, p = .22, but a significant decrease when pressure was low (0), B = -.96, p < .001. Additionally, high levels of indirect social control (+1SD) predicted greater decreases in BMI compared to low (-1SD) indirect social control, B = -.91, p < .001, and, B = -.41, p < .01. CONCLUSIONS: Considering both the type and context of support for weight management is worthwhile. Intervention participants had access to treatment resources that may have engendered more effective responses to spouses' concerns or a sense of obligation to their spouse (indirect social control), whereas pressures to lose weight-while engaged in treatment-may have undermined behavior-change efforts. (PsycINFO Database Record

A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Good to Go' cluster randomized trial.

BACKGROUND: Fruit and vegetable (F&V) consumption is an important contributor to chronic disease prevention. However, most Americans do not eat adequate amounts. The worksite is an advantageous setting to reach large, diverse segments of the population with interventions to increase F&V intake, but research gaps exist. No studies have evaluated the implementation of mobile F&V markets at worksites nor compared the effectiveness of such markets with or without nutrition education. METHODS: This paper describes the protocol for Good to Go (GTG), a cluster randomized trial to evaluate F&V intake change in employees from worksites randomized into three experimental arms: discount, fresh F&V markets (Access Only arm); markets plus educational components including campaigns, cooking demonstrations, videos, newsletters, and a web site (Access Plus arm); and an attention placebo comparison intervention on physical activity and stress reduction (Comparison). Secondary aims include: 1) Process evaluation to determine costs, reach, fidelity, and dose as well as the relationship of these variables with changes in F&V intake; 2) Applying a mediating variable framework to examine relationships of psychosocial factors/determinants with changes in F&V consumption; and 3) Cost effectiveness analysis of the different intervention arms. DISCUSSION: The GTG study will fill important research gaps in the field by implementing a rigorous cluster randomized trial to evaluate the efficacy of an innovative environmental intervention providing access and availability to F&V at the worksite and whether this access intervention is further enhanced by accompanying educational interventions. GTG will provide an important contribution to public health research and practice. Trial registration number NCT02729675, ClinicalTrials.gov.

Project TEAMS (Talking about Eating, Activity, and Mutual Support): a randomized controlled trial of a theory-based weight loss program for couples.

BACKGROUND: Obesity risk is shared between spouses, yet existing weight loss programs focus on individuals and not the marital dyad. Given the interdependence of weight in couples, weight management outcomes might be improved by targeting joint weight loss and the creation of an interpersonal milieu that supports long-term behavior change. According to Self-Determination Theory (SDT), greater autonomous self-regulation of behaviors, and subsequently better treatment outcomes, are observed in needs supportive environments in which personally meaningful choice is supported and criticism and control are minimized. Correlational analyses confirm these pathways in weight management, with needs support from one's spouse or partner emerging as a distinct predictor of weight loss success. Research is now needed to establish causal links and to develop and test weight loss interventions designed to facilitate the needs supportive behavior of spouses. METHODS: Project TEAMS (Talking about Eating, Activity, and Mutual Support) is a randomized controlled trial testing a couples-based intervention, grounded in SDT, designed to change the social context of weight loss by training spouses to provide needs support for each other's eating and physical activity behavior. Sixty-four couples will be randomized to either 6 months of behavioral weight loss treatment informed by SDT (SDT-WL) or to 6 months of standard behavioral weight loss treatment (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 3, 6, and 12 months. By bolstering needs support, SDT-WL is predicted to increase autonomous self-regulation and perceived competence and produce greater weight loss and maintenance than standard behavioral treatment. Exploratory analyses will examine the SDT process model prediction that the influence of needs support on treatment outcomes will be mediated by autonomous self-regulation and perceived competence. DISCUSSION: This study addresses the fundamental importance of interpersonal support in weight management by focusing on couples rather than individuals and using a rich theoretical framework to train spouses in supportive behaviors. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT02570009 .

Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control.

Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.

Dyadic Dynamics in a Randomized Weight Loss Intervention.

BACKGROUND: Despite health and economic burdens associated with overweight and obesity, long-term weight loss intervention efforts have been largely unsuccessful. Observations that weight status tends to cluster in social groups, and findings showing "ripple" effects of weight change within social clusters, raise questions about the impact of social relationships on weight loss. PURPOSE: Through a reanalysis of data from a randomized weight loss intervention, this study compared dyadic dynamics in intervention participants and in-home partners. METHODS: Over the course of 18 months, data was collected from 201 pairs enrolled in either behavioral weight loss treatment (BWL) or treatment including partners and providing items to facilitate healthy choices at home (BWL + H). Using a dyadic growth curve model, covariance between baseline BMI, BMI change trajectories, and starting BMI and BMI trajectory for both the self and the other were examined. RESULTS: There were strong indicators of dependence in the data. Baseline BMI was positively correlated for both treatment groups. In the BWL + H condition, BMI change trajectories were positively correlated. In the BWL condition, this reversed: Change trajectories were negatively correlated. Additionally, partner BMI and primary participant BMI change were positively correlated, indicating that a heavier partner at baseline related to less weight loss. CONCLUSIONS: Social relationships exert a significant influence on weight loss outcomes. Depending on the intervention group, these influences may help (BWL + H) or hinder (BWL). It may be that home intervention changed social support and interaction in important ways and that these effects could be effectively harnessed to implement more effective interventions (NCT00200330).