Handicraft art leisure activities and cognitive reserve.

ObjectiveOlder individuals face a higher likelihood of developing dementia. The rate of cognitive decline resulting from dementia is not equivalent for all, as some patients with dementia are able to function independently longer than others, despite having similar disease burden. The cognitive reserve (CR) theory provides one explanation for the differing rate of decline. CR suggests that there are factors-most notably, educational attainment and occupational attainment-that can protect against the cognitive decline. Although the beneficial effects of these notable CR factors are clear, not all are easily modifiable. Participation in leisure activities may represent a more easily modifiable factor. Some research hints at beneficial effects of leisure activities, although specific leisure activities have not been well examined. The present study examined the relations between handicraft art leisure activities (HALAs) and multiple cognitive domains. MethodArchival WAIS-IV and demographic data for 50 California retirement community residents were examined. ResultsHALA participation accounted for statistically significant variance in working memory performance (R2 = .40, ß = .24%) over and above the established CR factors of age, depression, educational attainment, and occupational attainment. In addition, HALA participation was related to a better ability to perform abstract visual information tasks (Block Design subtest, r = .28, p = .05) and non-verbal reasoning tasks (Visual Puzzles subtest, r = .38, p = .008). ConclusionsHALA participation among older adults could contribute to the retention of cognitive function, supporting the role of HALA participation as a CR factor.

Age-based stereotype threat and neuropsychological performance in older adults.

The current study investigated the effects of age-based stereotype threat on neuropsychological assessment outcomes in an older adult population. Community volunteers (n = 49) age 65 and older were screened for cognitive impairment, depression, and anticholinergic medication use. Screened individuals were randomly stratified into either an ABST or a Control group. All participants were administered a broad range of neuropsychological measures of cognition as well as a self-rating measure assessing subjective concern about cognitive ability. A main effect of ABST on subjective concern about cognitive ability was supported. Specifically, individuals in the ABST group were significantly more likely to attribute their memory errors to the onset of dementia (F(1,41) = 5.334, p = .026). However, results showed no significant difference between groups on objective neuropsychological performance measures. The current study discusses the importance of considering ABST effects in the context of neuropsychological assessment in older adult populations.

Dementia Worry and Neuropsychological Performance in Healthy Older Adults.

OBJECTIVE: Dementia is one of the most feared diseases in American society. However, limited research exists regarding how worrying about dementia may influence peoples' cognitive abilities. The current study examines how dementia worry affects performance on neuropsychological domains of executive function, memory, attention, and processing speed in a healthy older adult population. METHOD: Participants (n = 40) were screened for depression using the Patient Health Questionnaire-8 (PHQ-8, scores > 10 were excluded) and for mild cognitive impairment using the Telephone Interview for Cognitive Status (TICS, scores < 32 were excluded). All participants were administered common neuropsychological tests of executive function, memory, attention, and processing speed. Participants were also asked to complete the Dementia Worry Scale (DWS), a measure assessing the level of dementia worry individuals experience in daily life. RESULTS: A multivariate effect of dementia worry on neuropsychological measures of executive function was supported. Specifically, higher levels of dementia worry were significantly related to poorer performance on combined measures of executive function (Wilk's Lambda = 0.821, F (2, 36) = 3.934, p = .028). CONCLUSIONS: Dementia worry significantly affects scores on specific neuropsychological measures. Inasmuch, dementia worry may have both functional implications for older adults, as well as assessment implications for practicing neuropsychologists. Further research is necessary to parse apart whether dementia worry represents a psychological variable affecting cognitive performance and/or serves as an early marker of cognitive decline.

Hope as a protective factor for cognitive difficulties during the COVID-19 pandemic.

The COVID-19 pandemic has had many negative outcomes, including problems of cognition; however, the degree to which individuals have noticed cognitive difficulties has varied. Protective factors that buffer against cognitive difficulties in women should be explored as women have faced great changes in the pandemic, including unemployment, increases in unpaid care work, increases in gender-based violence, and health concerns. For this reason, the present study sought to determine if hope acts as a protective factor for perceived problems of cognition. Using an online survey measuring aspects of cognitive functioning and hopefulness, results indicate that women with low hope report greater negative impacts of the COVID-19 pandemic on school and work, greater difficulties working from home, and more problems with attention, memory, and concentration than women with higher levels of hope. The findings suggest that hope may represent a protective factor that lessens the impact of the COVID-19 pandemic on perceived cognition.

Multiple environmental stressors induce complex transcriptomic responses indicative of phenotypic outcomes in Western fence lizard.

BACKGROUND: The health and resilience of species in natural environments is increasingly challenged by complex anthropogenic stressor combinations including climate change, habitat encroachment, and chemical contamination. To better understand impacts of these stressors we examined the individual- and combined-stressor impacts of malaria infection, food limitation, and 2,4,6-trinitrotoluene (TNT) exposures on gene expression in livers of Western fence lizards (WFL, Sceloporus occidentalis) using custom WFL transcriptome-based microarrays. RESULTS: Computational analysis including annotation enrichment and correlation analysis identified putative functional mechanisms linking transcript expression and toxicological phenotypes. TNT exposure increased transcript expression for genes involved in erythropoiesis, potentially in response to TNT-induced anemia and/or methemoglobinemia and caused dose-specific effects on genes involved in lipid and overall energy metabolism consistent with a hormesis response of growth stimulation at low doses and adverse decreases in lizard growth at high doses. Functional enrichment results were indicative of inhibited potential for lipid mobilization and catabolism in TNT exposures which corresponded with increased inguinal fat weights and was suggestive of a decreased overall energy budget. Malaria infection elicited enriched expression of multiple immune-related functions likely corresponding to increased white blood cell (WBC) counts. Food limitation alone enriched functions related to cellular energy production and decreased expression of immune responses consistent with a decrease in WBC levels. CONCLUSIONS: Despite these findings, the lizards demonstrated immune resilience to malaria infection under food limitation with transcriptional results indicating a fully competent immune response to malaria, even under bio-energetic constraints. Interestingly, both TNT and malaria individually increased transcriptional expression of immune-related genes and increased overall WBC concentrations in blood; responses that were retained in the TNT x malaria combined exposure. The results demonstrate complex and sometimes unexpected responses to multiple stressors where the lizards displayed remarkable resiliency to the stressor combinations investigated.

Anesthesia for Trauma Patients.

An improved understanding of the pathophysiology of combat trauma has evolved over the past decade and has helped guide the anesthetic care of the trauma patient requiring surgical intervention. Trauma anesthesia begins before patient arrival with warming of the operating room, preparation of anesthetic medications and routine anesthetic machine checks. Induction of anesthesia must account for potential hemodynamic instability and intubation must consider airway trauma. Maintenance of anesthesia is accomplished with anesthetic gas, intravenous infusions or a combination of both. Resuscitation must precede or be ongoing with the maintenance of anesthesia. Blood product transfusion, antibiotic administration, and use of pharmacologic adjuncts (e.g., tranexamic acid, calcium) all occur simultaneously. Ventilatory strategies to mitigate lung injury can be initiated in the operating room, and resuscitation must be effectively transitioned to the intensive care setting after the case. Good communication is vital to efficient patient movement along the continuum of care. The resuscitation that is undertaken before, during and after operative management must incorporate important changes in care of the trauma patient. This Clinical Practice Guideline hopes to provide a template for care of this patient population. It outlines a method of anesthesia that incorporates the induction and maintenance of anesthesia into an ongoing resuscitation during surgery for a trauma patient in extremis.

Thrombin Generation Biomarkers Decline With Parenteral Anticoagulation-An Overlooked Means of Anticoagulation Monitoring?

Anticoagulation therapy is administered to patients to prevent or stop thrombin generation in vivo. Although plasma tests of in vivo thrombin generation have been available for more than 2 decades, they are not routinely used in clinical trials or practice to monitor anticoagulation therapy. We observed a fall in one such marker, the D-dimer antigen, in patients receiving anticoagulation therapy. We therefore conducted a systematic review of the medical literature to document the change in serum biomarkers of thrombin generation following the initiation of anticoagulation therapy. Using a defined search strategy, we screened PubMed and Embase citations and identified full-length articles published in English. Eighteen articles containing serial changes in 1 of 3 markers of thrombin generation (D-dimer antigen, thrombin-antithrombin complexes, and prothrombin fragment 1+2 antigen levels) in the 14 days following the initiation of anticoagulation were identified. Even though the assays used varied considerably, each of the 3 markers of thrombin generation declined in the initial period of anticoagulation therapy, with changes evident as early as 1 day after beginning therapy. These observations provide a rationale for further exploration of these markers as measures of the adequacy of anticoagulation using classic as well as novel anticoagulants. Particular patient groups that would benefit from additional means of monitoring anticoagulation therapy are discussed.

Prospective Memory in Depression: Review of an Emerging Field.

Depressive disorders have been linked to a variety of neuropsychological deficits, including in the areas of processing speed, memory, and executive functioning. These neurocognitive disturbances may contribute to the impairments in daily functioning often experienced by those suffering with depression. Prospective memory (PM), which refers to remembering to execute a previously formed intention at some point in the future, has been shown to play a critical role in daily functioning and may be particularly relevant in the context of depression. In this review, we synthesize the literature on PM and its relation to depression. We also put forth a new five-phase model of PM through which we frame our discussion of the existing literature on PM and depression. The results of this review reveal that PM deficits emerge in those tasks that place the greatest demands on executive functioning (e.g., monitoring for a PM cue, maintaining an intention over a delay). We conclude the review by highlighting the potential clinical relevance of these findings and proposing directions for future research.

Evaluation of a Reflex Testing Algorithm for Suspected Heparin-Induced Thrombocytopenia.

OBJECTIVES: We implemented a policy of reflex serotonin-release assay (SRA) testing for all patients with a positive heparin-induced thrombocytopenia (HIT) immunoassay. METHODS: We identified all patients who had SRA testing sent as a consequence of a positive HIT immunoassay test. We reviewed charts of patients to calculate the 4Ts clinical score, determined the effect of testing on clinical management, and documented the change in utilization of direct thrombin inhibitors (DTIs). RESULTS: The likelihood of a positive SRA varied with the optical density (OD) of the immunoassay. The performance of the immunoglobulin G (IgG)-specific and polytypic enzyme-linked immunosorbent assay was not statistically different. Both OD and 4Ts score correlated with the likelihood of a positive SRA but demonstrated poor specificity. Discontinuation of DTIs in patients with negative SRAs resulted in decreased drug utilization. CONCLUSIONS: The IgG-specific HIT immunoassay OD correlates with the likelihood of a positive SRA but does not achieve high specificity. The reflex testing algorithm allows for definitive classification of patients, and the cost of such a reflex testing program may be offset by decreased utilization of DTIs.

Enhancing memory and imagination improves problem solving among individuals with depression.

Recent work has revealed links between memory, imagination, and problem solving, and suggests that increasing access to detailed memories can lead to improved imagination and problem-solving performance. Depression is often associated with overgeneral memory and imagination, along with problem-solving deficits. In this study, we tested the hypothesis that an interview designed to elicit detailed recollections would enhance imagination and problem solving among both depressed and nondepressed participants. In a within-subjects design, participants completed a control interview or an episodic specificity induction prior to completing memory, imagination, and problem-solving tasks. Results revealed that compared to the control interview, the episodic specificity induction fostered increased detail generation in memory and imagination and more relevant steps on the problem-solving task among depressed and nondepressed participants. This study builds on previous work by demonstrating that a brief interview can enhance problem solving among individuals with depression and supports the notion that episodic memory plays a key role in problem solving. It should be noted, however, that the results of the interview are relatively short-lived.

Event-based prospective memory among veterans: The role of posttraumatic stress disorder symptom severity in executing intentions.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been linked with neuropsychological deficits in several areas, including attention, learning and memory, and cognitive inhibition. Although memory dysfunction is among the most commonly documented deficits associated with PTSD, our existing knowledge pertains only to retrospective memory. The current study investigated the relationship between PTSD symptom severity and event-based prospective memory (PM). METHOD: Forty veterans completed a computerized event-based PM task, a self-report measure of PTSD, and measures of retrospective memory. RESULTS: Hierarchical regression analysis results revealed that PTSD symptom severity accounted for 16% of the variance in PM performance, F(3, 36) = 3.47, p < .05, after controlling for age and retrospective memory. Additionally, each of the three PTSD symptom clusters was related, to varying degrees, with PM performance. CONCLUSIONS: Results suggest that elevated PTSD symptoms may be associated with more difficulties completing tasks requiring PM. Further examination of PM in PTSD is warranted, especially in regard to its impact on everyday functioning.

Decreased white matter integrity in neuropsychologically defined mild cognitive impairment is independent of cortical thinning.

Improved understanding of the pattern of white matter changes in early and prodromal Alzheimer's disease (AD) states such as mild cognitive impairment (MCI) is necessary to support earlier preclinical detection of AD, and debate remains whether white matter changes in MCI are secondary to gray matter changes. We applied neuropsychologically based MCI criteria to a sample of normally aging older adults; 32 participants met criteria for MCI and 81 participants were classified as normal control (NC) subjects. Whole-head high resolution T1 and diffusion tensor imaging scans were completed. Tract-Based Spatial Statistics was applied and a priori selected regions of interest were extracted. Hippocampal volume and cortical thickness averaged across regions with known vulnerability to AD were derived. Controlling for corticalthic kness, the MCI group showed decreased average fractional anisotropy (FA) and decreased FA in parietal white matter and in white matter underlying the entorhinal and posterior cingulate cortices relative to the NC group. Statistically controlling for cortical thickness, medial temporal FA was related to memory and parietal FA was related to executive functioning. These results provide further support for the potential role of white matter integrity as an early biomarker for individuals at risk for AD and highlight that changes in white matter may be independent of gray matter changes.

Interspecific effects of 4A-DNT (4-amino-2,6-dinitrotoluene) and RDX (1,3,5-trinitro-1,3,5-triazine) in Japanese quail, Northern bobwhite, and Zebra finch.

The purpose of this study was to assess the toxicological effects of two munition compounds, 4-amino-2,6-dinitrotoluene (4A-DNT) and 1,3,5-trinitro-1,3,5-triazine (RDX), on three different bird species: two common toxicological model species-the Northern Bobwhite (Colinus virginianus) and the Japanese Quail (Coturnix japonica), and a representative passerine-the Zebra Finch (Taeniopygia guttata). Bobwhite were exposed to 4A-DNT at 0, 8, 15, 30, 60, or 150 mg/kg body weight (bw) d by oral gavage for seven days; because the high dose of 4A-DNT was lethal to bobwhite, the maximum dose was changed to 100 mg/kg bw d for Japanese quail and finches to ensure tissue could be used for future toxicogenomic work. RDX was similarly administered at 0, 0.5, 1.5, 3, 6, or 12 mg/kg bw d. Blood was drawn prior to euthanasia for blood cellularity and chemistry analyses. Finches were clearly least affected by 4A-DNT as evidenced by a lack of observable effects. Bobwhite appeared to be the most sensitive species to 4A-DNT as observed through changes in blood cellularity and plasma chemistry effects. Bobwhite appeared to be more sensitive to RDX than Japanese Quail due to increased effects on measures of plasma chemistries. Finches exhibited the greatest sensitivity to RDX through increased mortality and seizure activity. This study suggests that sensitivity among species is chemical-specific and provides data that could be used to refine current avian sensitivity models used in ecological risk assessments.

Multiple environmental stressors elicit complex interactive effects in the western fence lizard (Sceloporus occidentalis).

Evaluation of multiple-stressor effects stemming from habitat degradation, climate change, and exposure to chemical contaminants is crucial for addressing challenges to ecological and environmental health. To assess the effects of multiple stressors in an understudied taxon, the western fence lizard (Sceloporus occidentalis) was used to characterize the individual and combined effects of food limitation, exposure to the munitions constituent 2,4,6-trinitrotoluene (TNT), and Plasmodium mexicanum (lizard malaria) infection. Three experimental assays were conducted including: Experiment I--TNT × Food Limitation, Experiment II--Food Limitation × Malaria Infection, and Experiment III--TNT × Malaria Infection. All experiments had a 30 day duration, the malaria treatment included infected and non infected control lizards, food limitation treatments included an ad libitum control and at least one reduced food ration and TNT exposures consisting of daily oral doses of corn oil control or a corn oil-TNT suspension at 5, 10, 20, 40 mg/kg/day. The individual stressors caused a variety of effects including: reduced feeding, reduced testes mass, anemia, increased white blood cell (WBC) concentrations and increased mass of liver, kidney and spleen in TNT exposures; reduced cholesterol, WBC concentrations and whole body, testes and inguinal fat weights given food limitation; and increased WBC concentrations and spleen weights as well as decreased cholesterol and testes mass in malaria infected lizards. Additive and interactive effects were found among certain stressor combinations including elimination of TNT-induced hormesis for growth under food limitation. Ultimately, our study indicates the potential for effects modulation when environmental stressors are combined.

Implementation intentions and imagery: individual and combined effects on prospective memory among young adults.

Prospective memory (PM) has been found to benefit from implementation intentions (i.e., "when I see X, I will do Y"). However, to date, it is unclear whether implementation intentions must incorporate imagery in order to produce a positive effect on PM, or whether the verbal statement alone is sufficient. It is also equivocal whether the use of visual imagery alone improves PM, absent an intentional statement. The present study investigated the individual influences of implementation intentions and imagery, as well as their combined effect, on PM. A total of 64 undergraduates were placed into one of four instructional conditions-read-only, implementation intention, imagery, or combined-and were then tested on a laboratory PM task. The results revealed that participants in the implementation intention, imagery, and combined groups completed significantly more PM tasks than did participants in the read-only group, but they did not differ from one another. Combining implementation intentions and imagery, however, did not improve PM performance over either strategy alone. Additionally, the implementation intention and imagery groups outperformed the read-only group on a secondary ongoing digit detection task. The results of this study suggest that implementation intentions do not require imagery to be effective in improving PM, and that imagery alone has positive effects on PM. Finally, the results of the ongoing digit detection task suggest that the use of implementation intentions and imagery might provide for automatic identification and processing of environmental cues.

Imagine that: self-imagination improves prospective memory in memory-impaired individuals with neurological damage.

Recent research has demonstrated that "self-imagination" - a mnemonic strategy developed by Grilli and Glisky (2010) - enhances episodic memory in memory-impaired individuals with neurological damage more than traditional cognitive strategies, including semantic elaboration and visual imagery. The present study investigated the effect of self-imagination on prospective memory in individuals with neurologically based memory deficits. In two separate sessions, 12 patients with memory impairment took part in a computerised general knowledge test that required them to answer multiple choice questions (i.e., ongoing task) and press the "1" key when a target word appeared in a question (i.e., prospective memory task). Prior to the start of the general knowledge test in each session, participants attempted to encode the prospective memory task with one of two strategies: self-imagination or rote-rehearsal. The findings revealed a "self-imagination effect (SIE)" in prospective memory as self-imagining resulted in better prospective memory performance than rote-rehearsal. These results demonstrate that the mnemonic advantage of self-imagination extends to prospective memory in memory-impaired individuals with neurological damage and suggest that self-imagination has potential in cognitive rehabilitation.

Implementation intentions and prospective memory among older adults: an investigation of the role of frontal lobe function.

Prospective memory (PM) among older adults has been shown to be influenced by frontal lobe (FL) function. An implementation intention (e.g., 'if situation X occurs, I will do Y') is a mnemonic strategy that may be particularly beneficial for individuals with low-FL function, as it has been suggested that implementation intentions produce heightened accessibility to environmental cues, and automatic triggering of previously formed intentions. The present study investigated the effectiveness of implementation intentions among 32 older adults characterized as possessing high- or low-FL function. Participants were placed into one of two conditions: Read-Only or Implementation Intentions, before being tested on a laboratory prospective memory task. Results indicated that older adults with high-FL composite scores demonstrated better PM than those with low-FL scores, and that those who made implementation intentions outperformed those who simply read task instructions. Of particular interest is the finding that high-FL participants benefited from implementation intentions, suggesting that implementation intentions may improve PM of all older adults regardless of FL function. Theoretical underpinnings of implementation intentions are discussed in the context of FL function.

Toxic effects of oral 2-amino-4,6-dinitrotoluene in the Western fence lizard (Sceloporus occidentalis).

The compound 2-amino-4,6-dinitrotoluene (2A-DNT) was evaluated under laboratory conditions in the Western fence lizard (Sceloporus occidentalis) to assess the potential for reptile toxicity. Oral LD(50) values were 1406 and 1867 mg/kg for male and female lizards, respectively. Based on responses from a 14-day subacute study, a 60-day subchronic experiment followed where lizards were orally dosed at 0, 5, 15, 20, 25, 30 mg/kg-d. At day 60, number of days and survivors, food consumption, and change in body weight were inversely related to dose. Signs of toxicity were characterized by anorexia and generalized cachexia. Significant adverse histopathology was observed in hepatic tissue at ≥ 15 mg/kg-d, consistent with hepatocellular transdifferentiation. Based on survival, loss of body weight, diminished food intake, changes in liver, kidney, and testes, and increased blood urea nitrogen, these data suggest a LOAEL of 15 mg/kg-d and a NOAEL of 5 mg/kg-d in S. occidentalis.