Validity of remote live stream video evaluation of the North Star Ambulatory Assessment in patients with Duchenne muscular dystrophy.

Conducting functional assessments remotely can help alleviate the burden of in-person assessment on patients with Duchenne muscular dystrophy and their caregivers. The objective of this study was to evaluate whether scores from remote functional assessment of patients with Duchenne muscular dystrophy correspond to in-person scores on the same functional assessments. Remote live stream versus in-person scores on the North Star Ambulatory Assessment (including time [seconds] to complete the 10-meter walk/run and time to rise from the floor [supine to stand]) were assessed using statistical analyses, including intraclass correlation coefficient, and Pearson, Spearman, and Bland-Altman analyses. The remote and in-clinic assessments had to occur within 2 weeks of one another to be considered for this analysis. This analysis included patients with Duchenne muscular dystrophy, aged 4 to 7 years. Participants in this analysis received delandistrogene moxeparvovec (as part of SRP-9001-101 [Study 101; NCT03375164] or SRP-9001-102 [Study 102; NCT03769116]) or were randomized to receive placebo (in Part 1 of Study 102). This study evaluates score reproducibility between live stream remote scoring versus in-person functional assessments as determined by intraclass correlation coefficient, and Pearson, Spearman, and Bland-Altman analyses. The results showed that scores from remote functional assessment of patients with Duchenne muscular dystrophy strongly correlated with those obtained in person. These findings demonstrate congruence between live stream remote and in-person functional assessment and suggest that remote assessment has the potential to reduce the burden on a family by supplementing in-clinic visits.

The oral health status of residents with different cognitive and dental-related functions in three North Carolina assisted living facilities.

INTRODUCTION: The aim of the study was to describe the oral health status of persons with different cognition and dental-related functions (DRFs). METHODS: The present study was a secondary analysis of data collected for a cross-sectional study of residents in three assisted living facilities in North Carolina. The participants were aged 50 years or older, had normal to severely impaired cognition and spoke English. Upon obtaining informed consent, an oral assessment was completed by a trained geriatric dentist. A research team member who was blind to the oral examination outcomes then used the Minimum Data Set Cognition Scale to assess participants' cognition and the dental activities test to evaluate oral self-care and other DRFs. Descriptive statistics were used to describe the demographic, cognitive, functional and oral health status of the study participants. The impacts of cognitive and functional status on oral health measures were examined using simple linear regression models, negative binomial and zero-inflated negative binomial models. RESULTS: A total of 91 long-term residents from three long-term care facilities participated in the study. Oral hygiene and gingival health were significantly associated with cognition (P = 0.056 and P = 0.017, respectively) and DRFs (P = 0.013 and P = 0.008, respectively). Residents with poor cognitive and dental-related function also presented with poor oral hygiene and gingival health. CONCLUSION: The study results suggest that oral hygiene and gingival health were significantly associated with cognition and DRFs.

The pathway from cognitive impairment to caries in older adults: A conceptual model.

BACKGROUND: Caries significantly increases in people with cognitive impairment (PWCI). However, the interrelationships among cognitive impairment, dentally related function (DRF), oral hygiene, and caries remain unclear, increasing difficulties to care appropriately for PWCI. In this study, the researchers tested a conceptual model in which impaired DRF acts as a mediator between cognitive impairment and poor oral hygiene, which then leads to caries. METHODS: The researchers recruited 68 older adult dentate participants with normal to severely impaired cognition from 3 assisted-living communities in North Carolina. Within 1 week of a calibrated oral examination performed by a geriatric dentist, a trained examiner blinded to the oral examination results conducted cognitive and functional assessments. The researchers conducted statistical analyses to examine the mediating effect of DRF on the relationship between cognitive impairment and oral hygiene or caries. RESULTS: Cognitive impairment (ß = 0.05; standard error [SE], 0.02; P = .017) and DRF (ß = -0.07; SE, 0.02; P = .005) were significantly associated with oral hygiene. However, the association between cognitive impairment and oral hygiene was greatly reduced and became nonsignificant after controlling for DRF (ß = 0.01; SE, 0.03; P = .430), suggesting that the effect of cognitive impairment on oral hygiene was mediated by DRF. DRF accounted for 80% of the total effect of cognitive impairment on oral hygiene. The ratio of the indirect effect to the total effect was .8. Associations between either cognitive impairment or DRF and caries were not significant, but oral hygiene was significantly associated with caries (ß = 0.87; SE, 0.28; P < .001). CONCLUSIONS: DRF mediated the association between cognitive impairment and oral hygiene. It accounted for 80% of the total impact of cognitive impairment on oral hygiene, which was associated with increased caries in PWCI. PRACTICAL IMPLICATIONS: As a result of cognitive impairment, impaired DRF plays a critical role in the pathway from cognitive impairment to oral health decline. Therefore, DRF assessment should be a standard component of geriatric dental assessment. A functionally-tailored oral hygiene intervention is essential to improve oral health for persons with cognitive impairment.

LINKING GPS DATA TO GIS DATABASES IN NATURALISTIC STUDIES: EXAMPLES FROM DRIVERS WITH OBSTRUCTIVE SLEEP APNEA.

In naturalistic studies, it is vital to give appropriate context when analyzing driving behaviors. Such contextualization can help address the hypotheses that explore a) how drivers perform within specific types of environment (e.g., road types, speed limits, etc.), and b) how often drivers are exposed to such specific environments. In order to perform this contextualization in an automated fashion, we are using Global Positioning System (GPS) data obtained at 1 Hz and merging this with Geographic Information Systems (GIS) databases maintained by the Iowa Department of Transportation (DOT). In this paper, we demonstrate our methods of doing this based on data from 43 drivers with obstructive sleep apnea (OSA). We also use maps from GIS software to illustrate how information can be displayed at the individual drive or day level, and we provide examples of some of the challenges that still need to be addressed.

FEEDBACK FROM NATURALISTIC DRIVING IMPROVES TREATMENT COMPLIANCE IN DRIVERS WITH OBSTRUCTIVE SLEEP APNEA.

As part of a study in drivers with obstructive sleep apnea (OSA), we conducted a randomized clinical trial to assess whether individualized feedback can increase compliance with continuous positive airway pressure (CPAP) therapy. After completing 3.5 months of naturalistic driving monitoring, OSA drivers were randomized either to receive an intervention, which was feedback regarding their own naturalistic driving record and CPAP compliance, or to receive no such intervention. In the week immediately after the intervention date, drivers receiving feedback (n=30) improved their CPAP usage by an average of 35.8 minutes per night (p=0.008; 95% CI=9.6, 62.0) to a mean level of 296 minutes. By contrast, CPAP usage in the non-feedback group (n=36) decreased an average of 27.5 minutes per night (p=0.022; 95% CI=4.0, 51.0) to a mean level of 236 minutes. The mean group-specific changes were higher (better) in the feedback group than in the non-feedback group during the first, second, and third weeks of follow-up (p<0.001, p=0.001, and p=0.027, respectively). By weeks 4 through 10, the effect of the feedback had lost its significance (p>0.25 in all cases). Our study suggests that CPAP compliance can be increased using individualized feedback, but that follow-up feedback sessions or reminders may be necessary for sustained improvement.

Naturalistic distraction and driving safety in older drivers.

OBJECTIVE: In this study, we aimed to quantify and compare performance of middle-aged and older drivers during a naturalistic distraction paradigm (visual search for roadside targets) and to predict older drivers performance given functioning in visual, motor, and cognitive domains. BACKGROUND: Distracted driving can imperil healthy adults and may disproportionally affect the safety of older drivers with visual, motor, and cognitive decline. METHOD: A total of 203 drivers, 120 healthy older (61 men and 59 women, ages 65 years and older) and 83 middle-aged drivers (38 men and 45 women, ages 40 to 64 years), participated in an on-road test in an instrumented vehicle. Outcome measures included performance in roadside target identification (traffic signs and restaurants) and concurrent driver safety. Differences in visual, motor, and cognitive functioning served as predictors. RESULTS: Older drivers identified fewer landmarks and drove slower but committed more safety errors than did middle-aged drivers. Greater familiarity with local roads benefited performance of middle-aged but not older drivers.Visual cognition predicted both traffic sign identification and safety errors, and executive function predicted traffic sign identification over and above vision. CONCLUSION: Older adults are susceptible to driving safety errors while distracted by common secondary visual search tasks that are inherent to driving. The findings underscore that age-related cognitive decline affects older drivers' management of driving tasks at multiple levels and can help inform the design of on-road tests and interventions for older drivers.

NEUROPSYCHOLOGICAL PREDICTORS OF SAFETY IN URBAN LEFT-TURN SCENARIOS.

Left turns at urban intersections can be dangerous, especially when views are obstructed or pedestrians are present. Impairments in driver vision, motor, and cognition functions may further increase left-turn risk. We examined this problem in a simulated environment that included left-turn scenarios to study the driving behaviors of 28 drivers, ages 37 to 88 years, six of whom had "Useful Field of View" (UFOV) impairments. Subjects also completed a battery of neuropsychological tests. The simulated drive included an urban section with six left turns in three types of scenarios: 1) a semi truck blocking the view of oncoming traffic, 2) a lead vehicle obstruction, and 3) a pedestrian crossing ahead of the turning driver. Results showed a mean (SD) of 1.46 (1.60) collisions per driver (range 0 to 7), 83% of which occurred at intersections with semi trucks. Far visual acuity, contrast sensitivity, UFOV, Mini Mental State Examination, Trail-Making Test Part B, the Wisconsin Card Sort task, and age were all associated with the total number of collisions (Pearson correlation magnitudes between 0.37 to 0.77; p-values<0.05). Spearman correlations were less significant. Findings indicate that visual obstruction by on oncoming semi-truck is a particularly dangerous left-turn situation.

EFFECTS OF ENVIRONMENTAL FACTORS ON NATURALISTIC DRIVING IN OBSTRUCTIVE SLEEP APNEA.

Reduced visibility and other environmental factors can impair driver ability to respond to roadway hazards. We examined the effects of reduced visibility on naturalistic driving in 66 drivers, including 45 at-risk drivers with obstructive sleep apnea (OSA) and 21 controls. We analyzed three months of electronic data using "black box" recorder technology and assessed the extent to which driver speed, longitudinal acceleration, and lateral acceleration metrics depend on ambient visibility from web-based environmental data archives. We calculated summary driving metrics within 10-second intervals, and reduced these to within-subject means and tested for associations of interest. OSA drivers did not differ from controls with respect to electronic measures or visibility conditions in which they drove. On average, drivers drove slower when visibility was reduced. After controlling for speed, variations in lateral and longitudinal acceleration were positively associated with high-visibility conditions. These findings suggest that drivers exert greater vehicular control when visibility is limited, and that this association is not just due to slower speeds. Weaker relationships between visibility and driving measures in OSA suggest reduced adaptive strategies. Our methods provide a framework for analyzing the effects of other environmental factors on driving, and we provide an additional example using wind speed.

EFFECTS OF FAMILIARITY AND AGE ON DRIVER SAFETY ERRORS DURING WAYFINDING.

Wayfinding is a critical skill that enables drivers to navigate from one location to another. Wayfinding abilities decline as individuals age, which may increase older driver reliance on directional cues (e.g. signs) and divert cognitive resources at the expense of vehicle control and safety. Familiarity with an environment can facilitate wayfinding due to previous knowledge of the route. This study examines the role of familiarity in driving safety errors committed during a wayfinding task. Results suggest that age-related driving difficulties can be lessened by familiarity with the environment. The results underscore the need to consider geographical license restrictions in administrative policies aimed at improving older driver safety.