Dual tasking in individuals with post-stroke aphasia: a scoping review protocol.

OBJECTIVE: The purpose of this scoping review is to identify the main theoretical frameworks being used to explain dual-task performance deficits in people with post-stroke aphasia, to identify the domains of function being measured and the assessments being used, to highlight current interventions to improve dual-task performance, and to identify the gaps in the current body of literature on dual tasking and aphasia. INTRODUCTION: Post-stroke aphasia can lead to challenges across all activities of daily living. However, little is known about how a stroke and co-occurring language impairment may affect the allocation of cognitive resources, particularly in dual-task conditions. This vital information will allow researchers and clinicians to develop more effective interventions to combat the effects of the infarct. INCLUSION CRITERIA: To be considered in the review, articles must be written in English, include individuals at least 6 months post stroke, include adults with aphasia (with data presented separately from other populations), and include measures of dual-task performance. METHODS: This review will be conducted in line with the JBI methodology for scoping reviews. A search of Linguistics and Language Behavior Abstracts, PsycINFO, Communication Mass Media Complete, PubMed, CINAHL Plus, ScienceDirect, and the Cochrane Library will be undertaken to identify publications on the topic. Results will be restricted to sources that meet the inclusion/exclusion criteria. Data will be extracted from included papers by up to 3 independent reviewers using a data extraction tool developed by the reviewers. The results will be presented as a narrative summary, accompanied by charted results, as appropriate. REVIEW REGISTRATION: Open Science Framework https://osf.io/2yx76.

Validity and reliability of the NIH Toolbox® Standing Balance Test As compared to the Biodex Balance System SD.

BACKGROUND/ PURPOSE: The NIH Toolbox® was developed to assess functions among motor, sensory, emotional, and cognitive domains. The motor domain of the NIH Toolbox® includes an assessment for standing balance. Studies have validated early versions of the balance assessment for ages 3 through 85; however, no studies have examined the reliability and validity in its current version (using iPod Touch) against established balance measurements such as the Biodex SD modified clinical test of sensory integration of balance (m-CTSIB). SUBJECTS: Ninety-three community dwelling older adults (38 males 55 females) ≥60 years old (SD 74 ± 6). METHODS: One-day assessment using the NIH Toolbox® and the Biodex SD m-CTSIB. Intraclass correlation coefficients (ICC3,1) were used to measure the test-retest reliability, and Pearson's product correlation examined criterion validity. RESULTS: The overall composite of the Biodex SD m-CTSIB and NIH Toolbox® showed moderate test-retest reliability (ICC3,1 = 0.71, MDC = 1.21) (ICC3,1 = 0.84, MDC = 0.65,) respectively. The NIH Toolbox® Theta Score and Biodex overall Sway Index (SI) shows acceptable reliability criterion validity (r = 0.52) indicating moderate overlap in constructs. CONCLUSIONS: The NIH Toolbox®balance assessment demonstrates acceptable criterion validity compared to the Biodex SD m-CTSIB. The NIH Toolbox® is a valid, reliable, and accessible device; therefore, the NIH Toolbox® should be considered for use in clinical evaluations.

Physical Therapists' and Physical Therapist Students' Experiences and Views on the Provision of Physical Therapy Services to People With Dementia: A Scoping Review.

BACKGROUND AND PURPOSE: Physical therapists (PTs) require specialized education and training to increase the capacity and competence of the dementia care workforce. Four areas of critical dementia workforce education and training gaps that apply to the physical therapy profession have been identified, including recruitment/retention, financing and cost of training, interprofessional education, and translation/implementation of effective dementia care. A critical step in developing effective training programs and educational curricula is to understand PTs' and PT students' experiences and views on working with people with dementia (PwD). Therefore, the purpose of this scoping review was to examine the extent and types of evidence that explore the experiences and views of PTs and PT students on the provision of physical therapy services to PwD. METHODS: The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, ERIC, PEDro, Web of Science, and Medline databases and sources of gray literature were searched for sources of evidence that met the inclusion criteria of the review protocol. The literature was mapped according to author, participant role, setting, publication type, study design, study aim, key findings, and dementia workforce training gaps addressed. RESULTS AND DISCUSSION: A total of 552 sources of evidence were screened for eligibility, and 16 studies were selected for inclusion. Twelve studies included PTs as participants, and 5 included PT students. Included sources explored PTs' experiences, behaviors, knowledge, attitudes, and confidence in working with PwD and the influence of educational, organizational, and other factors on these domains. Challenges to and strategies for delivering effective care to PwD were examined in multiple sources. The 4 areas of critical dementia workforce education and training gaps were each addressed by at least 1 of the included studies. CONCLUSIONS: The current body of literature identifies several gaps in both research and education that need to be addressed before our profession is truly prepared to effectively manage this challenging population of patients with specialized needs.

Efficacy of Traditional Physical Therapy Versus Otago-Based Exercise in Fall Prevention for ALF-Residing Older Adults.

BACKGROUND AND PURPOSE: Falls are a leading cause of morbidity, mortality, loss of independence, and significant functional decline in aging populations. Effective interventions aimed at reducing the risk of falls, and preventing associated disability and functional decline, are needed to promote the health and wellness of older adults. Recent literature has found that an Otago-based exercise program (OBEP), which incorporates strengthening, balance, and walking, may not only decrease falls and fall risk among community-dwelling older adults but may also be effective among older adults residing in assisted living facilities (ALFs). The purpose of this study is to expand upon current research by comparing the outcomes of an OBEP and traditional physical therapy (TPT) in decreasing falls and the risk of falls among older adults living in an ALF. The authors hypothesized that traditional physical therapy would reduce fall risk and the number of falls in older adults residing in ALFs more than an OBEP. METHODS: This study conducted a 2-group retrospective chart review of 59 older adults living in an ALF from January 2013 to October 2018 who received either TPT (n = 29) or the OBEP (n = 30). Participants were a mean of 87 years old and were classified at risk for falls by the Tinetti Performance-Oriented Mobility Assessment (POMA). Primary variables included the number of falls prior to intervention, during intervention, and 1 year following intervention, as well as pre- and posttreatment Tinetti POMA scores. Efficacy was examined using multiple linear regression analysis. RESULTS AND DISCUSSION: Both groups achieved reduced falls and increased POMA scores. Group assignment did not significantly predict performance in key outcome measures, namely the number of falls (P = .199) and Tinetti POMA scores (P = .063) following treatment. CONCLUSIONS: These findings indicated that both an OBEP and tpt may be effective interventions for reducing falls and fall risk in the ALF setting.

Knowledge gains and intent to change practice patterns after the Leveraging Existing Abilities in Dementia (LEAD)™ Training Program.

Few investigations have examined dementia training programs for rehabilitation professionals. To address this, the Leveraging Existing Abilities in Dementia (LEAD) program was developed and examined with a pilot study. LEAD addressed dementia knowledge; the Strength-Based Approach; strategies for communication, recognizing behaviors, and learning techniques; and documentation. Participants completed pre-program, post-program, and three-month follow-up questionnaires assessing confidence, practice patterns, and dementia knowledge. Confidence and use of treatment strategies increased through the three-month follow-up and dementia knowledge significantly increased following training. LEAD positively impacted rehabilitation professionals' knowledge, confidence, and use of evidence-based treatment strategies. Implications of LEAD and future research are discussed.

Does skeletal muscle morphology or functional performance better explain variance in fast gait speed in older adults?

BACKGROUND: Fast gait speed is being increasingly recognized as an important clinical tool in older adults. However, the underlying muscular and functional contributors to fast gait speed performance remain poorly understood. AIM: We sought to determine predictors of fast gait speed in older adults. We hypothesized that lower-extremity skeletal muscle size and quality would be strong predictors. METHODS: Ninety community-dwelling older adults (33 men, 57 women; mean ± SD age = 74 ± 6 years) participated. B-mode ultrasonography was used to capture images of the vastus lateralis, rectus femoris, and gastrocnemius in the transverse plane. Each participant performed 30-second chair stand, heel-rise, functional reach, and grip strength tests. Fast gait speed was measured using the NIH Toolbox 4-Meter Walk Test. ImageJ software was used to quantify cross-sectional area (CSA), subcutaneous tissue thickness, and echo intensity. Two separate stepwise regression analyses were performed, one using muscle morphology variables as independent variables, and another including the functional outcomes. RESULTS: The ultrasound variables exhibited weak-to-moderate correlations with fast gait speed (|r| range = 0.168-0.416). The initial regression analysis indicated that the combination of medial gastrocnemius CSA and subcutaneous tissue thickness explained 22.8% of the variance in fast gait speed. The secondary analysis indicated that 30-second chair stand, heel-rise, and grip strength performance explained 45.5% of the variance. CONCLUSION: While medial gastrocnemius morphology is important, measures of upper and lower-extremity muscle function are better predictors of fast gait speed. These results highlight a dissociation between skeletal muscle morphology and fast gait speed.

Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery.

BACKGROUND: Omission of axillary lymph node dissection (ALND) is accepted for patients with one or two positive sentinel nodes, and studies are focusing on clinically node-positive patients who have been downstaged with neoadjuvant chemotherapy (NAC). Evidence is lacking for patients with positive nodes who undergo surgery upfront. These patients are assumed to have a higher burden of nodal disease such that ALND remains the standard of care. METHODS: Patients who underwent ALND for breast cancer between 2010 and 2019 at the authors' institution were retrospectively identified. Those with clinical N1 disease were included in the study. Patients who received NAC and those who had surgery for sentinel node positive disease or axillary recurrence were excluded. Clinical and pathologic factors associated with nodal stage were evaluated. RESULTS: Of 111 patients who met the inclusion criteria, 61.3% had a palpable node on exam, and 41.4% ultimately had pN1 disease. Most of the tumors were estrogen receptor (ER)-positive (91.5%), and 21.7% of the tumors were invasive lobular cancers. Lobular histology, tumor size, and metastasis size were associated with higher nodal stage. In the multivariable analysis, the patients with nodal metastasis larger than 10 mm had significantly lower odds of having pN1 disease (odds ratio 0.12; 95% confidence interval 0.02-0.69; p = 0.02). In a subset analysis of patients with palpable nodes, tumor size and histology remained significantly associated with nodal stage. CONCLUSION: More than 40% of breast cancer patients with clinically positive nodes had minimal nodal disease (pN1) at surgery. Additionally, palpable nodes on exam did not predict higher nodal stage. A subset of patients with clinically positive nodes may be identified who can potentially be spared the morbidity of ALND.

Can the Wii Fit Balance Board be Used as a Fall Risk Assessment Tool among Poststroke Patients?

BACKGROUND: The prevalence of falls can be as high as 73% in the stroke population. Falls occur as a result of multiple factors. Factors such as balance impairments can be improved through physical therapy intervention. However, insurance payers limit the number of visits per patient. It is crucial to find other ways to assess balance after discharge from rehabilitation. PURPOSE: The purpose of this study is to determine if the Nintendo Wii Fit can be used as a fall risk assessment tool among the poststroke population. METHODOLOGY: A sample of 11 stroke survivors were recruited (mean age 63.36 years). Each participant completed a balance and fall risk assessment using the Berg Balance Scale, Timed Up & Go, Four Square Step Test, Five Times Sit-to-Stand and 8-Foot Walk Test. Bivariate correlation will examine the validity of the Nintendo Wii Fit as a fall risk assessment tool in this population. RESULTS: The Nintendo Wii Fit Balance Test was found to be correlated with gait speed measured by the 8-Foot Walk Test. There is no correlation between the Wii Fit Balance Tests and most common standardized fall risk measures. Standardized fall risk outcome measures also significantly correlate with each other. CONCLUSIONS: The study suggests that while there is a potential utility of the game system to be used at home by patient and caregivers, the Wii Fit Balance Test may not be an appropriate substitute to the standardized fall risk assessment tool for stroke patients in the clinical setting.

Examining the Effects of an Otago-Based Home Exercise Program on Falls and Fall Risks in an Assisted Living Facility.

BACKGROUND AND PURPOSE: The Otago exercise program is a strengthening, balance, and walking program designed to decrease falls among community-dwelling older adults. Few studies have examined the effects of the Otago program in an assisted living environment. The purpose of the current study was to assess the effects of an Otago-based home exercise program in decreasing falls and the risk of falls among older adults living in an assisted living facility. METHODS: A retrospective chart review of 30 individuals residing at either of 2 assisted living facilities in central Florida was undertaken. Participants had a mean age of 87 years, were at risk for falls as determined by the Tinetti Performance-Oriented Mobility Assessment (POMA), and were provided with an Otago-based intervention by home health physical therapy. The outcome measures were the number of falls in the previous year, the number of falls in the year following the intervention, and Tinetti POMA scores pre- and post-intervention. RESULTS AND DISCUSSION: The mean (SD) number of falls significantly decreased from 1.4 (0.9) to 0.5 (0.7) fall per person per year after home health physical therapy with the tailored Otago based-exercise intervention. The intervention resulted in a statistically significant improvement in Tinetti POMA scores from 11.8 (2.5) to 17.6 (3.8). CONCLUSIONS: An Otago-based strengthening, balance, and walking home exercise program can potentially be used to decrease the number of falls and the risk of falling among older adults residing in an assisted living facility.

Improved Functional Performance in Individuals With Dementia After a Moderate-Intensity Home-Based Exercise Program: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Individuals with dementia (IWDs) experience difficulties across cognitive and functional domains. Nonpharmacological interventions aimed at reducing disability are greatly needed. Exercise is a low-cost and easily implemented approach, but investigation has yielded mixed evidence to date. The purpose of the current study was to evaluate a novel and innovative moderate-intensity functional exercise intervention for IWDs, which was developed using principles from exercise science along with a Strength-Based Approach, consisting of 24 home-based sessions. METHODS: A randomized, controlled intervention trial with a 2-group pretest and posttest design was used with a sample of 23 community-dwelling IWDs (intervention group: n = 13; comparison group: n = 10). Average age of participants was 73.9 years (standard deviation, 9.1) with mild to moderate cognitive impairment (Mini-Mental State Examination, Mean = 20.8; standard deviation, 5.0). RESULTS AND DISCUSSION: A 99.0% attendance rate indicated high adherence to the moderate-intensity exercise program. Efficacy was examined using multiple linear regression. Group assignment significantly predicted performance in key outcome measures, with IWDs from the intervention group improving in lower extremity strength (B = 5.92, t = 3.26, P = .004), balance (B = 4.04, t = 4.13, P = .001), and fast gait speed (B = .32, t = 2.61, P = .02). These findings indicated IWDs are able to participate in and benefit from a moderate-intensity functional exercise program, consisting of strength and balance activities. CONCLUSIONS: The current intervention used a Strength-Based Approach to facilitate implementation of exercise activities that could be completed by the sample. Therefore, integration of these techniques into mainstream clinical practice and research should be feasible with this patient population. Future research directions and implications of these findings also are discussed.

Accepting the Challenge-Moderate-Intensity Exercise with Individuals with Dementia: A Case Series.

BACKGROUND AND PURPOSE: The global impact of dementia demands a response from researchers and clinicians to not only assist with prevention and a cure, but also to assist in the management of symptoms related to this progressive disease. The purpose of this case series is to highlight the participation of 3 individuals with varying levels of dementia in a moderate-intensity functional exercise program. INTERVENTION: The intervention, developed using principles from exercise science and a Strength-Based Approach, consisted of 24 sessions of moderate-intensity exercises delivered in participant's home. OUTCOMES: Each participant completed a pre- and post-assessment including gait speed, strength, balance, depressive symptoms, cognition, and perceived difficulty with activities of daily living. Despite various clinical presentations, each participant successfully completed all 24 sessions with noted improvements in at least two measures. DISCUSSION: These findings highlight the flexibility of using the Strength-Based Approach to enhance participation in a standardized exercise program.

An Investigation of the Predictors of Comfortable and Fast Gait Speed in Community-Dwelling Older Adults.

BACKGROUND/PURPOSE: To identify the unique predictors of comfortable and fast gait speed in community-dwelling older adults using measures of physical performance (eg, lower extremity strength and balance), self-reported balance confidence, and global cognitive function. METHODS: Demographic information was collected from 60 healthy, community-dwelling older adults older than 60 years. Participants completed the following assessments: Mini-Mental State Examination; Activities-Specific Balance Confidence Scale; 30-second Chair Stand (30-SCS); Functional Reach (FR); and gait speed (comfortable and fast) using the GAITRite system. Hierarchical linear regression was used to examine the relationship of both fast and comfortable gait speeds with functional performance (CST and FR), cognition (Mini-Mental State Examination), Activities-Specific Balance Confidence Scale, and demographic information (age, gender, and body mass index). RESULTS AND DISCUSSION: Functional performance measures (30-SCS and FR) explained 55.4% and 64.7%, respectively, of the variance in comfortable and fast gait speed. Unique predictors for comfortable gait speed included 30-SCS, FR, and body mass index. Unique predictors of fast gait speed included 30-SCS, FR, gender, body mass index, and Activities-Specific Balance Confidence Scale score. These predictors explained 68.5% and 80.4% of the total variance in comfortable and fast gait speed, respectively. Global cognition was not a unique predictor of gait speed when performance measures were statistically controlled. However, the current study measured global cognitive status rather than the specific cognitive constructs, such as processing speed or executive function. Further research is needed to determine the role of cognition in the composition of gait speed. CONCLUSIONS: Gait speed is an important indicator for many outcomes such as fall risk, mortality, and functional status. Understanding that key variables of strength and balance comprise a large portion of gait speed allows clinicians to better direct their care and optimize rehabilitation outcomes. This study specifically used functional measures of strength and balance that can be easily implemented in the clinical setting.

Echo Intensity Versus Muscle Function Correlations in Older Adults are Influenced by Subcutaneous Fat Thickness.

Recently, an equation that allows investigators to correct echo intensity for subcutaneous fat was developed. We evaluated correlations between uncorrected and corrected echo intensity versus measures of lower-extremity function. Twenty-three older adults (11 men, 12 women; mean age = 72 y) participated. B-Mode ultrasonography was used to quantify rectus femoris echo intensity and subcutaneous fat thickness. Knee extensor isometric peak torque and rate of torque development at 200 ms (RTD200) were determined (joint angle = 90°). Fast gait speed was evaluated at 10- and 400-m distances. Partial correlations between normalized peak torque, RTD200 and 10- and 400-m gait speed versus uncorrected echo intensity were weak and insignificant. Correction for subcutaneous fat strengthened the correlations (peak torque r = -0.500, RTD200 r= -0.425, 10-m r = -0.409, 400-m r = -0.410). Correcting echo intensity values for subcutaneous fat strengthened the associations with lower-extremity muscle function in older adults.

Examining the reliability, correlation, and validity of commonly used assessment tools to measure balance.

OBJECTIVES: The Biodex SD Stability System has been shown to be a reliable assessment tool for postural stability. However, its ability to provide an accurate representation of balance has not been compared with functional performance measures such as the four-square step test (FSST) and timed-up-and-go test (TUG). The purpose of this study was to investigate reliability, internal consistency, and construct validity of FSST, TUG, and Biodex SD (limits of stability [LOS] and modified Clinical Test of Sensory Organization and Balance [m-CTSIB]). METHODS: An observational reliability and validity study was conducted. A convenience sample of 105 healthy adults, 77 females and 28 males, mean age 24.5 years old (± 4.66 SD) performed balance assessments including the FSST, TUG, Biodex SD LOS, and m-CTSIB. For LOS, the overall percentage and test duration were recorded. For m-CTSIB, the overall Sway Index was recorded. Condition 1 of the m-CTSIB represented simple postural stability. RESULTS: The Biodex SD LOS overall percentage, TUG, and FSST showed strong to excellent test-retest reliability (ICC [3, 1] = .83 [mean 1: 58.14, mean 2: 60.54], .88 [mean 1: 6.98 seconds, mean 2: 6.91 seconds], .92 [mean 1: 6.29 seconds, mean 2: 6.14 seconds], respectively), while the Biodex SD m-CTSIB overall percentage demonstrated strong test-retest reliability (ICC [3, 1] = .75 [mean 1: 1.18, mean 2: 1.18]). The LOS test duration showed moderate test-retest reliability (ICC [3, 1] = .58 [mean 1: 38.55 seconds, mean 2: 37.10 seconds]), while the m-CTSIB condition 1 showed poor test-retest reliability (ICC [3, 1] = .24 [mean 1: 0.63, mean 2: 0.66]). Weak construct validity was found between TUG, FSST, and Biodex SD measures of LOS and m-CTSIB (r values = -0.15-0.22). CONCLUSION: It is suggested that clinicians use more than one measure to assess different aspects of a patient's balance deficits to better guide treatment and intervention.

Turnover among Community Mental Health Workers in Ohio.

This study examined turnover of community mental health workers in 42 randomly selected mental health agencies in Ohio. The turnover rate in 2011 was 26 %. A regression analysis indicated that agencies with lower turnover offered higher maximum pay and were smaller in size, while those offering career advancement opportunities, such as career ladder programs, had higher turnover. The findings suggest that improving wages for workers is likely to reduce turnover. It is also possible that smaller agencies have lower turnover due to stronger relationships with workers and/or more successful hiring practices. Furthermore, turnover that occurs as a result of career advancement could have positive effects and should be examined separate from other types of turnover in the future.

Can Interpreting Nonsignificant Findings Inform the Lessons Learned From an Intervention?

Reducing Disability in Alzheimer's Disease (RDAD) is an evidenced-based intervention for individuals with dementia and their caregivers aimed at reducing the psychosocial strain of the caregiver and improving functional ability of the individual with dementia. Overall efficacy, acceptability, and feasibility outcomes have been published regarding RDAD; however, no specific outcome information has been published on the objective physical performance measures (PPM) of gait speed, functional reach, and balance. Data from the Replication of RDAD (n = 508) was utilized to test the hypothesis that each PPM would show change for participants who completed the program. No significant changes were identified in 3 PPM: gait speed (t = .24, P =.81), balance (t = .23, P = .82), and functional reach (t = -.55, P = .58). To strengthen the research about exercise interventions for individuals with dementia, discussion and interpretation of nonfindings is important for improving intervention designs and methodologies. In the case of RDAD, the intervention protocol may require a sufficient dosage of exercise with respect to fundamental exercise science principles, or there may be misalignment between the intervention and outcome measures.

Increasing Appropriate BRCA1/2 Mutation Testing: The Role of Family History Documentation and Genetic Counseling in a Multidisciplinary Clinic.

BACKGROUND: Findings show that 5-10 % of women with a diagnosis of breast cancer (BCa) have actionable genetic mutations. The National Comprehensive Cancer Network guidelines for testing to detect BRCA1/2 mutations include personal history (PH) variables such as age of 45 years or younger and a family history (FH) variables. Rates of FH documentation and overall rates of appropriate referral for genetic testing are low, ranging from about 30 to 60 %. The authors hypothesized that an upfront FH documentation and inclusion of a genetics counselor in a multidisciplinary clinic (MDC) setting would increase rates of appropriate referral for genetic testing. METHODS: The study enrolled 609 consecutive women with non-metastatic BCa seen in consultation between June 2012 and December 2015 at a multidisciplinary clinic. Rates of FH documentation and referral for genetic testing to detect BRCA1/2 mutations were assessed before and after inclusion of a genetic counselor in the MDC. RESULTS: The rates of FH documentation and appropriate referral were 100 and 89 %, respectively. Half (50 %) of the patients had only FH-based indications for testing. All the patients with PH-based indications were referred. The inclusion of a genetic counselor significantly increased appropriate referral rates among those with only FH-based indications (62 vs. 92 %) and overall (80 vs. 96 %) (p < 0.0001 for both). Among the 12 % of the patients with actionable mutations, 60 % were 45 years of age or younger, whereas 30 % had only FH-based testing indications. CONCLUSIONS: This report shows substantially higher FH documentation and appropriate genetic testing rates than prior reports. Many patients with indications for genetic testing may have only FH-based indications for testing, and this subset may account for the sizable proportion of patients with newly diagnosed BCa who have actionable mutations.

'I wish they would remember that I forget:' The effects of memory loss on the lives of individuals with mild-to-moderate dementia.

PURPOSE OF STUDY: Due to changing cognitive and functional capabilities, individuals with dementia face challenging care-related issues such as feelings of embarrassment, relationship strain, and symptoms of depression and anxiety. Limited research exists examining individuals with dementia's perceptions and concerns about these issues and how their perspectives can impact the quality and process of their illness experience. DESIGN AND METHODS: As part of a larger study, individuals with dementia (n = 114) answered five open-ended questions about their illness experience including: (1) daily routine, (2) concerns about memory loss, (3) relationships with others, (4) fears, and (5) what they wish others understood/knew. For each question, individuals with dementia's responses were analyzed for common themes within and across questions. RESULTS: Individuals with dementia commented on a wide range of issues involving their memory loss, including negative emotional impacts, future concerns and illness progression, forgetting, loss of independence, and the negative and positive influences on interpersonal relationships. Across questions, many individuals also stated that their memory loss did not significantly impact their lives. IMPLICATIONS: Discussion highlights how these findings can be used to expand our understanding of individuals with dementia's illness experience and to develop efficacious interventions for addressing negative aspects of living with memory loss while supporting positive aspects.

SERUM THYROTROPIN CONCENTRATIONS ARE NOT PREDICTIVE OF AGGRESSIVE BREAST CANCER BIOLOGY IN EUTHYROID INDIVIDUALS.

OBJECTIVE: The potential influence of hypothyroidism on breast cancer remains incompletely understood. The objective of this study was to investigate the relationship between serum thyrotropin (thyroid-stimulating hormone, TSH) concentration and markers of aggressive breast cancer biology as defined by receptor expression profile, tumor grade, and American Joint Committee on Cancer (AJCC) stage characteristics. METHODS: This was a retrospective cohort study of patients from 2002 to 2014. All breast cancer patients who had complete receptor (estrogen receptor, ER; progesterone receptor, PR; and human epidermal growth factor receptor 2, Her2/neu) and prediagnosis serum TSH data (n = 437) were included. All patients had 1 of 6 receptor profiles: ER+ PR+ Her2/neu-, ER+ PR- Her2/neu-, ER+ PR+ Her2/neu+, ER+ PR- Her2/neu+, ER- PR- Her2/neu+, or ER- PR- Her2/neu-. Log-transformed serum TSH concentrations were analyzed using multinomial and logistic regressions to identify potential relationships with markers of breast cancer aggressiveness. RESULTS: Increasing serum TSH concentration was associated with a lower probability of having the receptor expression profile ER+ PR+ Her2/neu+ compared to patients with the ER+ PR+ Her2/neu- profile (odds ratio [OR] = 0.52, P = .0045). No significant associations between other receptor expression profiles and serum TSH concentration were found. All time-weighted and unweighted median serum TSH concentrations were within normal limits. No significant associations between serum TSH concentration and tumor grade, overall AJCC stage, tumor size (T), lymph node positivity (N), or presence of metastasis (M) were observed. CONCLUSIONS: Serum TSH was not associated with markers of breast cancer aggressiveness in our cohort.