A randomized trial of cognitive rehabilitation in cancer survivors.

AIMS: The second most frequently reported post-treatment symptom in cancer survivors are concerns about impaired cognition. Despite numerous studies demonstrating significant impairments in a portion of survivors, information on effective treatments remains an emerging area of research. This study examined the effectiveness of a group-based cognitive rehabilitation intervention in cancer survivors. MAIN METHODS: This study was a randomized, controlled study of a 7-week cognitive rehabilitation intervention delivered in group format. Participants were evaluated with subjective symptom questionnaires and objective neurocognitive tests prior to and following treatment. KEY FINDINGS: Twenty-eight participants (mean age 58 years) with a median of 3 years (± 6 years) post-primary/adjuvant treatment and various cancer sites (breast, bladder, prostate, colon, uterine) completed the study. Compared to baseline, the treatment group demonstrated improvements in symptoms of perceived cognitive impairments (p<.01), cognitive abilities (p<.01) and overall quality of life with regard to cognitive symptoms (p<.01) as measured by the FACT-Cog. The treatment group also improved on objective measures of attention (p<.05) and a trend toward improvement on verbal memory. Significant improvement was not observed on all cognitive tests. SIGNIFICANCE: A group based cognitive rehabilitation intervention in cancer survivors was effective for improving attention abilities and overall quality of life related to cognition. Results suggest that group based cognitive rehabilitation may be an effective intervention for treating cognitive dysfunction in cancer patients and should be further studied in a larger trial with an active control condition.

The interface of medical devices and pharmaceuticals: Part I.

This two-part article considers the complexities of developing and commercialising combination products using examples from experience with drug-eluting stents and drug-eluting beads. Part I discusses the technical challenges of developing these products.

The interface of medical devices and pharmaceuticals: Part II.

The technical challenges of developing combination products were addressed in Part I of this two part article. Part II reviews the preclinical tests and shelf-life testing that are required using drug eluting stents and drug eluting beads as examples. Regulatory considerations and ways to simplify development are also examined.

The use of rhodamine 6G and fluorescence microscopy in the evaluation of phospholipid-based polymeric biomaterials.

A technique is described that allows the staining and subsequent visualization of polymers that contain the phosphorylcholine (PC) group. These materials are useful as bulk materials or coatings for the fabrication of medical devices. The staining method employs rhodamine 6G, which can be simply and rapidly applied to the polymer coating and imaged using fluorescence microscopy. The specificity of the staining for the PC polymers makes this technique suitable for the evaluation of a wide range of substrates and provides qualitative information on coating uniformity, coverage and morphology. It can be used to examine the durability of, and defects in, the coating. Statistical analysis of the fluorescent intensity by measuring the pixel value during imaging can allow for the method to be used as a quality control tool.

ACTIVE: a cognitive intervention trial to promote independence in older adults.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Memorability functions in verbal memory: a longitudinal approach.

Middle-aged (N = 252, M = 39.91), young-old (N = 486, M = 60.77), and old-old (N = 137, M = 74.42) participants in the Seattle Longitudinal Study were tested on two occasions on their recall of a 20-item word list. Proportions of participants in each group correctly recalling each word-unit served as the dependent measure. Word-unit scores obtained in 1991 were regressed on those from 1984, yielding linear functions that varied by age group. Each set of word-unit scores (three groups on two occasions) was then regressed on word familiarity, imageability, primacy, and recency. The relative influence of each of these variables on memorability was then compared, both between and within cohorts. Primacy and familiarity were consistently strong predictors. Imageability and recency were predictive of memorability in the middle-aged group, but less so in the young-old, and not at all in the old-old group. Results and possible implications are discussed.

Cognitive and sociodemographic risk factors for mortality in the Seattle Longitudinal Study.

The relationship between cognitive function and survivorship was examined in a community-dwelling sample. Survival analysis was used to examine how level and change in intellectual functioning, verbal memory, perceptual speed, and psychomotor speed were related to mortality in a sample of 601 individuals who subsequently died (decedents; n = 342 men; n = 259 women; M = 73.81 years of age) and a control group of 609 survivors (n = 296 men; n = 313 women; M = 71.96). The sample of survivors was selected to be of similar age and to have a similar level of education as the decedents. Individuals in the lowest 25th percentile of performance (crystallized abilities, visualization abilities, verbal memory, and perceptual and psychomotor speed) had a significant risk for subsequent mortality compared to individuals in the highest 25th percentile. However, after adjusting for demographic variables and psychomotor speed, only perceptual speed remained a significant risk factor for mortality. Significant 7-year declines (lowest 25th percentile) in measurements of Verbal Meaning, Spatial Ability, Reasoning Ability, and Psychomotor Speed were risk factors for subsequent mortality relative to those who had the least amount of decline. The relationship between mortality and cognitive function tended to be a specific rather than a pervasive phenomenon, even after adjusting for sociodemographic factors and psychomotor speed. Decrease in cognitive performance tended to be a better predictor of subsequent mortality than was the level of cognitive performance.

Everyday problem solving among individuals with Alzheimer's disease.

Loss of functioning on complex tasks of daily living is an early indicator of dementia. The performance of 65 older adults with mild to moderate levels of Alzheimer's disease was examined on the Everyday Problems Test for the Cognitively Challenged Elderly (EPCCE), self-report inventories of functional performance, and a broad battery of clinical and neuropsychological measures. The EPCCE was designed to assess older adults on a set of complex tasks of daily living that involved not only global cognitive processes, but also higher-order executive functions. Participants solved an average of 45% of EPCCE tasks with significant differences in scores by disease severity. Performance was significantly related to global cognitive functioning and disease severity, and in particular to executive functions. Significant additional variance was accounted for by these executive functions beyond the variance accounted for by global cognitive measures.

Everyday cognitive competence in elderly persons: conceptual issues and empirical findings.

This article focuses on everyday cognitive competence as a critical aspect of functional health. Everyday cognitive competence is defined as the ability to perform adequately those cognitively complex tasks considered essential for living on one's own in this society. A major challenge for those involved in assessment and judgment of competence is to define the critical domains of functional abilities associated with living independently. Prior research on the instrumental activities of daily living (IADLs) may be particularly useful. Findings from our research on a measure assessing everyday cognitive competence within each of the IADL domains are presented. Elderly persons' performance on the measure of everyday cognition relate to behavioral observations of those subjects performing similar activities in their home and to self and spousal IADL ratings. Seven-year longitudinal data indicate that there is relatively modest decline in performance on cognitively complex everyday tasks during the 60s, but that steeper patterns of normative decline are found in the late 70s and 80s.

Everyday problem solving in older adults: observational assessment and cognitive correlates.

Older adults' ability to solve practical problems in 3 domains of daily living was assessed using a new measure of everyday problem solving, the Observed Tasks of Daily Living (OTDL). Findings showed that the OTDL formed internally consistent scales representing 3 distinct factors of everyday problem solving. Moreover, the OTDL showed convergent validity with related scales of a paper-and-pencil test. Older adults' performance on the OTDL was significantly correlated with their scores on measures of basic mental abilities. Path analysis showed that age affected older adults' performance on the OTDL directly and indirectly via cognitive abilities. Participants' education and health affected their everyday competence indirectly through cognitive abilities. The effects of perceptual speed and memory span were mediated by fluid and crystallized intelligence.

Analysis of false results in a series of 835 fine needle aspirates of breast lesions.

OBJECTIVE: To analyze cases of false diagnoses from a large series to help increase the accuracy of fine needle aspiration of palpable breast lesions. STUDY DESIGN: The results of FNA of 835 palpable breast lesions were analyzed to determine the reasons for false positive, false negative and false suspicious diagnoses. RESULTS: Of the 835 aspirates, 174 were reported as positive, 549 as negative and 66 as suspicious or atypical but not diagnostic of malignancy. Forty-six cases were considered unsatisfactory. Tissue was available for comparison in 286 cases. The cytologic diagnoses in these cases were reported as follows: positive, 125 (43.7%); suspicious, 33 (11.5%); atypical, 18 (6.2%); negative, 92 (32%); and unsatisfactory, 18 (6.2%). There was one false positive diagnosis, yielding a false positive rate of 0.8%. This lesion was a case of fibrocystic change with hyperplasia, focal fat necrosis and reparative atypia. There were 14 false negative cases, resulting in a false negative rate of 13.2%. Nearly all these cases were sampling errors and included infiltrating ductal carcinomas (9), ductal carcinomas in situ (2), infiltrating lobular carcinomas (2) and tubular carcinoma (1). Most of the suspicious and atypical lesions proved to be carcinomas (35/50). The remainder were fibroadenomas (6), fibrocystic change (4), gynecomastia (2), adenosis (2) and granulomatous mastitis (1). CONCLUSION: A positive diagnosis of malignancy by FNA is reliable in establishing the diagnosis and planning the treatment of breast cancer. The false-positive rate is very low, with only a single case reported in 835 aspirates. Most false negatives are due to sampling and not to interpretive difficulties. The category "suspicious but not diagnostic of malignancy" serves a useful purpose in management of patients with breast lumps.

Similarity in married couples: a longitudinal study of mental abilities and rigidity-flexibility.

Longitudinal changes in couple similarity on the Primary Mental Abilities and the Test of Behavioral Rigidity were studied over 7-year intervals from 1956 to 1984 in 169 couples from the Seattle Longitudinal Study. Positive, initial intraclass spousal correlations were significant for verbal meaning, inductive reasoning, word fluency, educational aptitude, intellectual aptitude, attitudinal flexibility, psychomotor speed, and social responsibility, as well as age and education. After age and education had been controlled, significant increases in spousal similarity were found for verbal meaning and intellectual ability over 14 years and for attitudinal flexibility over 21 years. The higher functioning spouses' word fluency influenced the lower functioning spouses' verbal meaning and word fluency over time. Couples who became more similar over time involved husbands in higher occupations and wives with fewer changes in profession.

Dimensionality of everyday problem solving in older adults.

This study investigated individual differences in older adults' everyday problem-solving performance using 3 instruments. Past research, typically using only single measures, has yielded a multitude of findings regarding age effects in everyday problem solving. The present sample consisted of 111 older adults (44 men, 67 women) who ranged in age from 68 to 94 years. Confirmatory factor analyses revealed that, within each of the 3 instruments, subscales representing particular content domains could be reliably identified. There was, however, little relation between the different instruments, and the measures also differed in their relation with chronological age. These results support the view that everyday problem-solving competence is a multidimensional construct, of which previous investigations may only have studied particular dimensions.

Perceived intellectual performance change over seven years.

Actual and perceived change in intellectual performance over seven years was examined in a sample of 837 participants in the Seattle Longitudinal Study who took five subtests of Thurstone's Primary Mental Abilities (PMA) test in 1977 and 1984. In 1984 participants rated perceived change in intellectual performance from 1977 to 1984. Participants were categorized, based on their actual performance, into those who maintained earlier performance level, significantly increased their performance, or declined in performance. A typology linking actual and perceived change in performance was created: Realists (those who accurately estimated change in their performance); Optimists (those who oveestimated positive change); and Pessimists (those who overestimated negative change). Classification of participants varied across abilities. Women were more likely to be pessimists on Spatial Orientation than men. Older individuals were more likely to be pessimists on Verbal Meaning and Inductive Reasoning Abilities and to be realists on Number ability compared to younger participants.

Age difference patterns of psychometric intelligence in adulthood: generalizability within and across ability domains.

Cross-sectional data from the 5th (1984) wave of the Seattle Longitudinal Study are reported with regard to the generalizability of age differences in psychometric intelligence within and across ability domains. Ss were 1,628 community-dwelling individuals drawn from a Pacific Northwest health maintenance organization. Age difference patterns of 9 groups with mean ages from 29 to 88 years are examined for the ability domains of verbal ability, spatial orientation, inductive reasoning, numeric ability, verbal memory, and perceptual speed. Each ability is marked by 3 or 4 observed variables.

Influence of direct computer experience on older adults' attitudes toward computers.

This research examined whether older adults' attitudes toward computers became more positive as a function of computer experience. The sample comprised 101 community-dwelling older adults aged 57 to 87. The intervention involved a 2-week computer training program in which subjects learned to use a desktop publishing software program. A multidimensional computer attitude measure was used to assess differential attitude change and maintenance of change following training. The results indicated that older adults' computer attitudes are modifiable and that direct computer experience is an effective means of change. Attitude change as a function of training was found for the attitude dimensions targeted by the intervention program: computer comfort and efficacy. In addition, maintenance of attitude change was established for at least two weeks following training.

Adult personality and psychomotor performance: cross-sectional and longitudinal analyses.

Results are presented from cross-sectional and longitudinal analyses of data from the Test of Behavioral Rigidity for 3,442 subjects over the age range from 22 to 84 years. Data are presented on the Behavioral Flexibility, Attitudinal Flexibility, and Social Responsibility questionnaire scales, as well as on performance score measures indexing Associational Flexibility, Instructional Set Flexibility, Copying Speed, and Associational Speed. Data on these scales were obtained for 5 samples examined 7 years apart (1956, 1963, 1970, 1977, and 1984). These data permit analyses of birth cohort differences and rate of change within the same individuals, as well as successive samples drawn from the same cohort over as long as 28-year periods. Results of the analyses confirm the presence of substantial generational differences, with generally only limited change over time within cohorts.

Relationship between rigidity-flexibility and cognitive abilities in adulthood.

The interrelationship of measures of rigidity-flexibility and of psychometric intelligence is examined. The latent factors of Attitudinal Flexibility, Motor-Cognitive Flexibility, and Psychomotor Speed are derived from the Test of Behavioral Rigidity, and factors of Inductive Reasoning, Spatial Orientation, Verbal Ability, Numeric Ability, Verbal Memory, and Perceptual Speed are derived from the Thurstone Primary Mental Abilities Test and the Educational Testing Service Kit of Factor-Referenced Tests. The data base in this study comes from the fifth wave of the Seattle Longitudinal Study (N = 1,628; age range, 22-95 years). The Rigidity-Flexibility factors were found to be independent of the cognitive domain. Also, longitudinal stability of the factor structure of the rigidity-flexibility domain was confirmed for 837 participants tested in both 1977 and 1984.