Exergaming and cognitive functions in people with mild cognitive impairment and dementia: a meta-analysis.

Exergaming is a combination of exercise and gaming. Evidence shows an association between exercise and cognition in older people. However, previous studies showed inconsistent results on the cognitive benefits of exergaming in people with cognitive impairment. Therefore, this study aims to examine the effect of exergaming intervention on cognitive functions in people with MCI or dementia. A systematic literature search was conducted via OVID databases. Randomized controlled trials (RCTs) examined the effect of an exergaming intervention on cognitive functions in people with MCI or dementia were included. Subgroup analyses were conducted according to the type of intervention and training duration. Twenty RCTs with 1152 participants were identified, including 14 trials for MCI and 6 trials for dementia. In people with MCI, 13 studies used virtual-reality (VR)-based exergaming. Those who received VR-based exergaming showed significantly better global cognitive function [SMD (95%CI) = 0.67 (0.23-1.11)], learning and memory [immediate recall test: 0.79 (0.31-1.27); delayed recall test: 0.75 (0.20-1.31)], working memory [5.83 (2.27-9.39)], verbal fluency [0.58 (0.12-1.03)], and faster in executive function than the controls. For people with dementia, all studies used video-based exergaming intervention. Participants with exergaming intervention showed significantly better global cognitive function than the controls [0.38 (0.10-0.67)]. Subgroup analyses showed that longer training duration generated larger effects. The findings suggest that exergaming impacts cognitive functions in people with MCI and dementia. Cognitive benefits are demonstrated for those with a longer training duration. With technological advancement, VR-based exergaming attracts the attention of people with MCI and performs well in improving cognitive functions.

Computerized cognitive training for memory functions in mild cognitive impairment or dementia: a systematic review and meta-analysis.

Dementia is a common medical condition in the ageing population, and cognitive intervention is a non-pharmacologic strategy to improve cognitive functions. This meta-analysis evaluated the benefits of computerized cognitive training (CCT) on memory functions in individuals with MCI or dementia. The study was registered prospectively with PROSPERO under CRD42022363715 and received no funding. The search was conducted on MEDLINE, Embase, and PsycINFO on Sept 19, 2022, and Google Scholar on May 9, 2023, to identify randomized controlled trials that examined the effects of CCT on memory outcomes in individuals with MCI or dementia. Mean differences and standard deviations of neuropsychological assessment scores were extracted to derive standardized mean differences. Our search identified 10,678 studies, of which 35 studies were included. Among 1489 participants with MCI, CCT showed improvements in verbal memory (SMD (95%CI) = 0.55 (0.35-0.74)), visual memory (0.36 (0.12-0.60)), and working memory (0.37 (0.10-0.64)). Supervised CCT showed improvements in verbal memory (0.72 (0.45-0.98)), visual memory (0.51 (0.22-0.79)), and working memory (0.33 (0.01-0.66)). Unsupervised CCT showed improvement in verbal memory (0.21 (0.04-0.38)) only. Among 371 participants with dementia, CCT showed improvement in verbal memory (0.64 (0.02-1.27)) only. Inconsistency due to heterogeneity (as indicated by I2 values) is observed, which reduces our confidence in MCI outcomes to a moderate level and dementia outcomes to a low level. The results suggest that CCT is efficacious on various memory domains in individuals with MCI. Although the supervised approach showed greater effects, the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.

Comparison of pre-formalin fixation and postfixation temporal artery biopsy lengths.

OBJECTIVE: To evaluate the difference in temporal artery biopsy length before and after formalin fixation and identify any correlations with pathologic diagnosis. DESIGN: Prospective case series. PARTICIPANTS: Patients undergoing temporal artery biopsy between June 2020 and October 2021. METHODS: The pre- and postfixation biopsy lengths were compared. The primary outcome was the difference in temporal artery length as measured before fixation by the surgeon versus the postfixation measurement by the pathologist. RESULTS: Forty-seven consecutive biopsies in 46 patients were included. One patient had a repeat biopsy. Mean age was 75.3 ± 8.4 years (range, 49-94 years); 74% of patients (34 of 46 patients) were female. Mean prefixation biopsy length was 2.36 ± 0.58 cm (range, 1.1-4.5 cm). Mean postfixation biopsy length was 2.09 ± 0.59 cm (range, 0.6-3.8 cm). Mean difference (postfixation shrinkage) was 0.27 ± 0.24 cm (p = 0.0298), and 36% of biopsies (17 of 47 biopsies) were positive. There was no significant difference in prefixation temporal artery biopsy length (p = 0.38) or postfixation shrinkage (p = 0.24) between positive and negative biopsies. In a univariate analysis, elevated erythrocyte sedimentation rate was 31.3 mm/h (range, 4-88 mm/h) in negative biopsies versus 54.5 mm/h (range, 29-98 mm/h) in positive biopsies (p = 0.01), C-reactive protein was 17.4 mg/L (range, 0.2-145 mg/L) in negative biopsies versus 78.56 mg/L (range, 5-244.4 mg/L) in positive biopsies (p = 0.003), and platelets were 254.9 × 109/L (range, 134-570 × 109/L) in negative biopsies versus 393.8 × 109/L (range, 210-593 × 109/L) in positive biopsies (p < 0.001), all associated with a positive pathologic diagnosis. CONCLUSIONS: The average temporal artery biopsy was approximately 0.27 cm shorter on pathologic reports compared with before fixation measurements. Surgeons should account for this shrinkage with a buffer of at least 0.3 cm, aiming for excision of at least 2.3 cm, if they desire a postfixation size of 2 cm.

Complete unilateral vision loss and optic nerve cupping from metastatic prostate cancer to the optic canal.

A 71-year-old man, living with metastatic castrate-resistant prostate cancer to the lymph nodes, spine and skull, presented with acute on chronic left eye vision loss. Examination revealed no-light-perception vision, a relative afferent pupillary defect and optic disc cupping. MRI brain revealed optic canal narrowing from metastatic sphenoid bone expansion and extraosseous tumour compressing the intracanalicular optic nerve. The optic disc cupping and excavation without significant pallor of the remaining neuroretinal rim was likely secondary to chronic compression of the optic nerve. The patient was treated with radiation therapy, but did not regain vision and was referred to palliative care as his condition continued to worsen. As patients live longer with advanced cancer, there is a greater risk of metastasis to atypical areas of the body including the optic nerve. This case demonstrates the unique combination of optic disc cupping from optic canal metastasis due to prostate cancer.

Outcomes after implantable collamer lens surgery in a Canadian cohort.

OBJECTIVE: To describe refractive outcomes and complications after implantable collamer lens (ICL) implantation. DESIGN: Retrospective, interventional case series. METHODS: A database search of ICL surgeries over a 5-year period (2009-2013) was conducted, and 83 eyes of 44 patients were included. The Visian ICL (STAAR Surgical, Monrovia, Calif.) was used in all eyes. The primary outcome measure was postoperative uncorrected distance acuity (UCDA). Secondary outcomes include predictability, safety, and adverse events. RESULTS: Mean age was 31 years, and 59% of patients were female. Mean observation time was 14.9 months. Mean manifest refractive spherical equivalent (MRSE) was -11.1 ± 3.24 D preoperatively and -0.18 D ± 0.57 D postoperatively. Mean astigmatism was -1.90 ± 1.34 D, and 82% of eyes received toric ICLs, 93.4% of eyes achieved 20/40 UCDA, and 50.8% achieved 20/20 at last observation; 67.1% and 89.5% of eyes had MRSE within 0.5 and 1.00 D of target refraction, respectively. Safety index was 1.16 and overall improvement of 0.060 logMAR was observed. Eight (10.5%) eyes had residual astigmatism with 5 (6.5%) requiring laser enhancement. Glare and haloes were reported in 6 eyes (7.9%). Three eyes developed cataract. One eye had a retinal detachment. CONCLUSIONS: Toric and nontoric ICL implantations show promising refractive outcomes and acceptable safety in moderate to high myopes and can be considered for patients who are noncandidates for refractive laser surgery.

Terrien Marginal Degeneration: Clinical Characteristics and Outcomes.

PURPOSE: To describe outcomes of patients with Terrien marginal degeneration. DESIGN: Retrospective case series. METHODS: Database review of 25 patients (43 eyes) seen over 10 years (2004-2013) at Toronto Western Hospital cornea clinic. Outcome measures included demographics, location of disease, topographic astigmatism, visual acuity, coexisting ocular disease, and surgical management. RESULTS: Mean age at presentation was 44 years (range, 20-82 years) and 54% were male. Eighteen patients (72%) had bilateral disease. Mean follow-up was 30.3 months. Mean topographic astigmatism was 4.02 diopters (D) at 5 degrees. Mean change in astigmatism 1 year from baseline was 0.75 D; at 2 years was 1.22 D; and at 3 years was 1.68 D. Mean best spectacle-corrected visual acuity (BSCVA) at presentation was 20/46 and 20/48 at last follow-up. Eyes requiring surgery (23.3%) had mean BSCVA of 20/81 at presentation and 20/106 after surgery. Five eyes perforated: 4 spontaneously, and 1 from trauma. Three eyes (6.9%) presented with pseudopterygium. Two eyes (4.7%) had intracorneal cysts. Fourteen patients (56%) presented with ocular surface inflammation. CONCLUSIONS: Terrien marginal degeneration is a slow-progressing, bilateral but asymmetric degeneration of the peripheral cornea. Men over 40 are more commonly affected. Stromal thinning, vascularization, lipid deposition, and against-the-rule astigmatism are classic signs. Though typically noninflammatory, a variant form characterized by prominent inflammation exists. Surgery (lamellar graft) can preserve corneal integrity and is indicated when conventional options fail to maintain vision or if perforation is imminent. Perforations are rare but can result in significant vision loss.