Predicting Patient Reported Outcomes of Cognitive Function Using Connectome-Based Predictive Modeling in Breast Cancer.

Being able to predict who will likely experience cancer related cognitive impairment (CRCI) could enhance patient care and potentially reduce economic and human costs associated with this adverse event. We aimed to determine if post-treatment patient reported CRCI could also be predicted from baseline resting state fMRI in patients with breast cancer. 76 newly diagnosed patients (n = 42 planned for chemotherapy; n = 34 not planned for chemotherapy) and 50 healthy female controls were assessed at 3 times points [T1 (prior to treatment); T2 (1 month post chemotherapy); T3 (1 year after T2)], and at yoked intervals for controls. Data collection included self-reported executive dysfunction, memory function, and psychological distress and resting state fMRI data converted to connectome matrices for each participant. Statistical analyses included linear mixed modeling, independent t tests, and connectome-based predictive modeling (CPM). Executive dysfunction increased over time in the chemotherapy group and was stable in the other two groups (p < 0.001). Memory function decreased over time in both patient groups compared to controls (p < 0.001). CPM models successfully predicted executive dysfunction and memory function scores (r > 0.31, p < 0.002). Support vector regression with a radial basis function (SVR RBF) showed the highest performance for executive dysfunction and memory function (r = 0.68; r = 0.44, p's < 0.001). Baseline neuroimaging may be useful for predicting patient reported cognitive outcomes which could assist in identifying patients in need of surveillance and/or early intervention for treatment-related cognitive effects.

Levels of α-2 Macroglobulin in cognitively normal Mexican- Americans with Subjective Cognitive Decline: A HABLE Study.

BACKGROUND: The presence of Subjective Cognitive Decline (SCD) in the absence of objective change and the inflammatory biomarker Alpha 2 Macroglobulin (A2M) have both been implicated in preclinical Alzheimer's disease. Mexican Americans are population with high rates of cardiovascular and inflammatory disorders. OBJECTIVES: The current study investigated the levels of A2M in cognitively normal Mexican Americans with and without complaints of cognitive decline. METHOD: 293 (243 females, 50 males) community-based cognitively normal older Mexican Americans from the ongoing Health and Aging Brain among Latino Elders (HABLE) study were grouped based on subjective cognitive decline and blood samples were assayed by electrochemiluminescence to determine levels of A2M. RESULTS: Participants with SCD had significantly higher levels of A2M than those without SCD. Females with SCD had a significantly higher level of A2M. CONCLUSIONS: Results suggest that higher levels of A2M, a marker of neuronal injury, may be involved in subtle changes in cognitive functioning recognizable to persons reporting SCD but too subtle to be objectively measured. Longitudinal research is needed to assess the impact of SDC and A2M in progression to MCI and dementia in Mexican Americans.

Texas Mexican American adult normative studies: Normative data for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is an assessment of neuropsychological functioning commonly used in clinical and research settings. To our knowledge, normative data for the RBANS is not available for Hispanic, Mexican Americans, which the current study sought to establish. Data from 136 Hispanic, Mexican Americans from Project FRONTIER were analyzed. Approximately half of the sample was administered testing in Spanish. Normative tables were created for English and Spanish speaking Mexican Americans. Generated RBANS normative references are provided for unadjusted raw scores as well as output adjusted by education level.

Association Between Cognitive Impairment and Chronic Kidney Disease in Mexican Americans.

OBJECTIVES: To analyze the association between chronic kidney disease (CKD) and mild cognitive impairment (MCI) in Mexican Americans and to determine whether there is a blood-based proteomic profile linking CKD to MCI. DESIGN: Retrospective analysis of cohort study. SETTING: Health and Aging Brain among Latino Elders study. PARTICIPANTS: Mexican Americans (N = 437, 105 men, 332 women). MEASUREMENTS: Data were analyzed to examine the link between estimated glomerular filtration rate (eGFR) and detailed neuropsychological functioning. Serum proteomic markers were also examined. RESULTS: Lower eGFR levels were associated with significantly poorer neuropsychological functioning across multiple domains. After adjusting for age, sex, education, and diabetes mellitus, participants with an eGFR less than 45 mL/min per 1.73 m(2) performed significantly worse than those with an eGFR from 45 to 59 mL/min per 1.73 m(2) or 60 mL/min per 1.73 m(2) and higher in processing speed (F = 14.1, P < .001), executive functioning (F = 4.5, P = .01), visuospatial skills (F = 4.8, P = .009), and global cognitive functioning (F = 6.2, P = .002). Participants with an eGFR less than 45 mL/min per 1.73 m(2) also performed significantly worse than those with an eGFR of 60 mL/min per 1.73 m(2) or greater on delayed memory (F = 3.8, P = .02). There was a trend toward lower eGFR levels being associated with greater risk of MCI (odds ratio (OR) = 2.4, 95% confidence interval (CI) = 0.91-6.1, P = .07), which was stronger for men (OR = 9.6, 95% CI = 1.3-74.3, P = .03). A serum proteomic profile consisting of Factor VII, interleukin-10, C-reactive protein, and fatty acid binding protein was 93% accurate in detecting CKD-related MCI. CONCLUSION: Lower eGFR was associated with significantly poorer neuropsychological functioning in Mexican Americans. A blood-based profile was generated that was highly accurate in detecting CKD-related MCI. A blood profile capable of predicting CKD-related cognitive impairment would be of benefit for the design of clinical interventions.

A brief Spanish-English equivalent version of the Boston Naming Test: a Project FRONTIER study.

The Boston Naming Test is a neuropsychological measure of confrontation naming, short forms of which can be advantageous with various populations. The purpose of this study was to establish a Spanish-English equivalent version of the BNT using item response theory. Data were analyzed from 380 Project FRONTIER participants; 27 items differed between groups and were removed from the measure. Additionally, 18 items did not differ between groups but were poor items. The current 15-item Spanish-English equivalent version of the BNT offers significant advantages. Future work is required to validate the diagnostic utility of the instrument in various settings and populations.

Hyperbaric oxygen therapy. Part 1: history and principles.

OBJECTIVE: Review the historical development and physiologic principles of hyperbaric oxygen therapy (HBOT) based on human and veterinary experimental literature and current equipment in use. DATA SOURCES: Review of basic physiologic concepts. Data from human and veterinary journals were reviewed through Pubmed and Veterinary Information Network database searches as well as reference searches on several articles covering hyperbaric therapy in clinically applicable situations. HUMAN DATA SYNTHESIS: HBOT has been gaining acceptance as an adjunctive treatment in human medicine. The understanding of the physiology and application of hyperbaric therapy is increasing through ongoing research and greater access to hyperbaric equipment. VETERINARY DATA SYNTHESIS: Several animal models have been utilized to examine the effects of HBOT. Most models utilize dogs and rats but pigs, cats, and other species have been studied. CONCLUSIONS: Hyperbaric therapy utilizes several physiologic principles of how gases respond under pressure and more specifically of how oxygen responds under pressure. The increase in concentration of oxygen in solution, based on its solubility under pressure, increases the diffusion gradient for its delivery deeper into tissues, which is the premise of HBOT. Ultimately the increases in dissolved oxygen generated by hyperbaric therapy have several physiologic effects that can alter tissue responses to disease and injury. As this technology becomes more available to clinical practice, HBOT should be considered as a therapeutic option.

Hyperbaric oxygen therapy. Part 2: application in disease.

OBJECTIVE: Review the mechanisms of action and clinical application of hyperbaric oxygen therapy (HBOT) based on human and veterinary clinical and experimental literature. DATA SOURCES: Pubmed and Veterinary Information Network databases were searched for human and veterinary journal articles on hyperbaric therapy in clinically applicable situations. Historical reference searches on several articles in addition to basic physiologic concepts were also reviewed. HUMAN DATA SYNTHESIS: HBOT has gained acceptance as an adjunctive treatment in clinical conditions other than diving-related injuries, such as select problem wounds and central nervous system diseases, in human medicine. Access to hyperbaric therapy has increased and ongoing research has furthered understanding of the mechanisms and potential therapeutic uses of HBOT. VETERINARY DATA SYNTHESIS: Several animal models have been utilized to examine the effects of HBOT; primarily rodents (mice, rats) and rabbits but also dogs, cats, and pigs. Data related to animal model research as it pertains to clinical application of HBOT is reviewed. CONCLUSIONS: There is a substantial body of literature that has examined the adverse and beneficial effects of HBOT in animal models. As technology becomes more readily available to clinical practice and more clinical trials are performed to define its effectiveness, HBOT may be considered as an additional therapeutic option in many conditions including select problem wounds, spinal cord injury, and cerebral ischemic injury. Understanding the mechanisms by which HBOT exerts its effects will help guide research and use of the modality in clinical patients.

Potential uses of recombinant human factor VIIa in veterinary medicine.

In human beings, rFVIIa has been used successfully to promote hemostasis in patients with various bleeding disorders. Patients with hemophilia, thrombocytopenia, and thrombocytopathy have been effectively and safely treated as well as patients with severe trauma or surgery resulting in profuse bleeding and patients with impaired liver function. Given these successes, the possibility of using rFVIIa in veterinary medicine is appealing. The clinical indications and uses in veterinary medicine would be similar, but there are currently two major obstacles: immunogenicity and cost. If these problems can be addressed, rFVIIa may become a valuable and indispensable therapy, especially in the emergency and critical care settings. The use of rFVIIa could allow for successful treatment of otherwise intractable bleeding as well as decrease the number of blood transfusions needed.