The Impact of Chemotherapy-Related Cognitive Impairment on Social Roles and Well-Being in Breast Cancer Survivors.

PURPOSE: To explore the impact of disruptions in information processing (DIPs) on social roles, well-being, and quality of life (QOL) in breast cancer survivors after chemotherapy. PARTICIPANTS & SETTING: Experiences of DIPs were explored in eight breast cancer survivors aged 53-70 years, 12-60 months post-treatment, referred from a National Cancer Institute-designated cancer center and a nonprofit breast cancer support organization from January 6 to August 31, 2020. METHODOLOGIC APPROACH: This study used a mixed-methods approach. Participants journaled and answered questionnaires sent via mail that asked them about changes in their cognition, QOL, and social roles. Qualitative data were thematically analyzed using constant comparative analysis, and questionnaire scores were compared with qualitative data. FINDINGS: Journals revealed problems with functioning in occupational roles and increased stress, anxiety, and frustration. Women with more DIPs tended to have lower role satisfaction and QOL. Greater role satisfaction was associated with higher QOL and social role participation. IMPLICATIONS FOR NURSING: Mitigating the effects of DIPs on social function may allow women to continue in important roles, which has the potential to affect QOL.

Electrophysiological resting state brain network and episodic memory in healthy aging adults.

Recent studies have emphasized the changes in large-scale brain networks related to healthy aging, with the ultimate purpose to aid in differentiating normal neurocognitive aging from neurodegenerative disorders that also arise with age. Emerging evidence from functional Magnetic Resonance Imaging (fMRI) indicates that connectivity patterns within specific brain networks, especially the Default Mode Network (DMN), distinguish those with Alzheimer's disease from healthy individuals. In addition, disruptive alterations in the large-scale brain systems that support high-level cognition are shown to accompany cognitive decline at the behavioral level, which is commonly observed in the aging populations, even in the absence of disease. Although fMRI is useful for assessing functional changes in brain networks, its high costs and limited accessibility discourage studies that need large populations. In this study, we investigated the aging-effect on large-scale networks of the human brain using high-density electroencephalography and electrophysiological source imaging, which is a less costly and more accessible alternative to fMRI. In particular, our study examined a group of healthy subjects in the age range from middle- to older-aged adults, which is an under-studied range in the literature. Employing a high-resolution computation model, our results revealed age associations in the connectivity pattern of DMN in a consistent manner with previous fMRI findings. Particularly, in combination with a standard battery of cognitive tests, our data showed that in the posterior cingulate / precuneus area of DMN higher brain connectivity was associated with lower performance on an episodic memory task. The findings demonstrate the feasibility of using electrophysiological imaging to characterize large-scale brain networks and suggest that changes in network connectivity are associated with normal aging.

Amplitude of fNIRS Resting-State Global Signal Is Related to EEG Vigilance Measures: A Simultaneous fNIRS and EEG Study.

Recently, functional near-infrared spectroscopy (fNIRS) has been utilized to image the hemodynamic activities and connectivity in the human brain. With the advantage of economic efficiency, portability, and fewer physical constraints, fNIRS enables studying of the human brain at versatile environment and various body positions, including at bed side and during exercise, which complements the use of functional magnetic resonance imaging (fMRI). However, like fMRI, fNIRS imaging can be influenced by the presence of a strong global component. Yet, the nature of the global signal in fNIRS has not been established. In this study, we investigated the relationship between fNIRS global signal and electroencephalogram (EEG) vigilance using simultaneous recordings in resting healthy subjects in high-density and whole-head montage. In Experiment 1, data were acquired at supine, sitting, and standing positions. Results found that the factor of body positions significantly affected the amplitude of the resting-state fNIRS global signal, prominently in the frequency range of 0.05-0.1 Hz but not in the very low frequency range of less than 0.05 Hz. As a control, the task-induced fNIRS or EEG responses to auditory stimuli did not differ across body positions. However, EEG vigilance plays a modulatory role in the fNIRS signals in the frequency range of less than 0.05 Hz: resting-state sessions of low EEG vigilance measures are associated with high amplitudes of fNIRS global signals. Moreover, in Experiment 2, we further examined the epoch-to-epoch fluctuations in concurrent fNIRS and EEG data acquired from a separate group of subjects and found a negative temporal correlation between EEG vigilance measures and fNIRS global signal amplitudes. Our study for the first time revealed that vigilance as a neurophysiological factor modulates the resting-state dynamics of fNIRS, which have important implications for understanding and processing the noises in fNIRS signals.

Assessing Discrepancies in Neurocognitive and Patient-Reported Measures of Brain Tumor Survivors.

OBJECTIVES: To examine the association between performance-based neurocognitive and patient-reported cognitive function tests and identify characteristics that may explain observed discrepancies as a means to advance intervention development. SAMPLE & SETTING: 40 adults diagnosed with a primary brain tumor (PBT) (high-grade, n = 35) were recruited from two academic neuro-oncology clinics in North Carolina. METHODS & VARIABLES: Eligibility included a Mini-Mental State Examination score of 24 or greater, having completed cancer treatment, and having tumor stability. Participants completed performance-based neurocognitive and patient-reported cognitive function, demographic, and symptom assessment tests at one time point. RESULTS: Neurocognitive impairments included executive control, memory, and attention. Age, time since diagnosis, and tumor- or treatment-specific variables were not associated with neurocognitive or patient-reported cognitive function. Those reporting worse cognitive impairment tended also to report greater severity of PBT-specific and depressive symptoms. IMPLICATIONS FOR NURSING: Patient-reported cognitive concerns warrant additional assessment for potential interventions to maintain function.

Sleep-Disordered Breathing and Cerebral Oxygenation During Sleep in Adults With Mild Cognitive Impairment.

The current study examined relationships between laterality in cerebral oxygenation (L-COX), sleep-disordered breathing (SDB), and daytime function in 16 adults with mild cognitive impairment (MCI). All participants underwent two nights of diagnostic polysomnography. Using dual-cerebral oximetry, L-COX was defined by differences ≥4% in right- versus left-sided percent cerebral oxyhemoglobin saturation. Eight patients had SDB. L-COX was found in five patients, but only on nights with SDB. Greater L-COX was associated more severe SDB: higher frequency of apneas + hypopneas per hour (r = 0.66, p < 0.01), desaturations per hour (r = 0.73, p < 0.01), and percent time with oxygen saturation <88% (r = 0.65, p < 0.01). Greater laterality, but not severity of SDB, was associated with poorer functional ability (Lawton Instrumental Activities of Daily Living Scale: r = -0.83, p = 0.02), lower cognitive function (Mini-Mental State Examination: r = -0.76, p = 0.03), and greater daytime sleepiness (Epworth Sleepiness Scale: r = 0.85, p < 0.001). L-COX associated with SDB suggests disruptions in cerebral autoregulation and need for aggressive treatment of SDB in individuals with MCI. [Res Gerontol Nurs. 2018; 11(6):282-292.].

Accelerated vascular aging and persistent cognitive impairment in older female breast cancer survivors.

Advances in breast cancer treatment have markedly increased survivorship over the past three decades, with over 3.1 million survivors expected to live into their 70s and 80s. Without symptom relief interventions, nearly 35% of these survivors will have life-altering and distressing cognitive symptoms. This pilot study explored associations between serum markers of vascular aging, laterality in cerebral oxygenation, and severity of cognitive impairment in women, 12-18 months after chemotherapy for stage 2/3 invasive ductal breast cancer. Fifteen women (52-84 years) underwent a brief cognitive assessment (Montreal Cognitive Assessment [MOCA]) and blood draws to assess markers of vascular aging (interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α], C-reactive protein [CRP], and insulin growth factor-1 [IGF-1]). All underwent a computer-based test protocol that is known to increase blood flow within the frontal lobes. Percent cerebral oxyhemoglobin saturation (rcSO2) was recorded during and after testing. Laterality in rcSO2 was defined by ≥ 3% difference between left and right rcSO2 (|rcSO2 meanRIGHT - meanLEFT|). Eight participants had MOCA scores between 21 and 25 points, suggestive of mild cognitive impairment. Neither CRP (r = -.24) nor IL-6 (r = .34) nor TNF-α (r = .002) were associated with MOCA scores. Higher IL-6 was associated with greater laterality (r = .41). MOCA scores were significantly lower in subjects with laterality in rcSO2 than in those without laterality (F(1,14) = 13.5, p = 003). Lower IGF-1 was significantly associated with greater laterality (r = - .66, p = .007) and lower cognitive function (r = .58). These findings suggest that persistent cognitive impairment is associated with phenotypical changes consistent with accelerated vascular aging.

Hydrate for health: listening to older adults' need for information.

An interdisciplinary team of faculty and students developed the Hydrate for Health project to provide relevant and evidence-based information to community-dwelling older adults. Evidence-based factsheets on bladder health, nighttime urination, medication safety, and physical activity/exercise, as well as a fluid intake self-monitoring tool, were developed. Four focus groups were conducted and included older adults (N = 21) who participated in activities at two local senior centers to obtain their feedback about the relevance of the factsheets. Extensive revisions were required based on the feedback received. Older adults expressed a desire for pragmatic information (i.e., how to determine fluid sources from food, how to measure water, how to determine their own fluid needs). They also wanted information that could be easily incorporated into daily life. Nurses play a central role in listening to and incorporating older adults' voices into consumer education materials.

Nocturia in older adults: implications for nursing practice and aging in place.

Nocturia is a bothersome symptom that increases with age, resulting in sleep disruption, an increased risk of falls, and a greater likelihood of rating one's health as poor. It is often a symptom of conditions that cause low volume voiding, overproduction of urine across the day or only at night and a symptom of a sleep disorder. Nocturia affects quality of life and has an impact on aging in place, thus assessment and treatment are essential. Behavioral treatments should be explored first, keeping in mind what the affected older adult defines as the desired outcomes of treatment.

Psychological stress and arterial stiffness in Korean Americans.

OBJECTIVE: Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans. METHODS: A convenience sample of 102 Korean Americans (aged 21-60 years, 60% women) was recruited from North Carolina. Psychological stress was measured by the Perceived Stress Scale, the Social, Attitudinal, Familiar, and Environmental (SAFE) Acculturative Stress Scale, and the Spielberger's State-Trait Anxiety Inventory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (AtCor Medical, Australia). RESULTS: This study shows that the emotional stress response, measured by anxiety, significantly predicted arterial stiffness (ß=.25, p=.008), independently of such confounding factors as age, mean arterial pressure (MAP), gender, body mass index, smoking, education, and income. Anxiety was neither related to age (r=.12, p=.212) nor MAP (r=.14, p=.151). Additionally, this sample of Korean Americans had higher levels of psychological stress when compared to previous findings from studies of other racial/ethnic groups in the U.S. CONCLUSION: Findings demonstrate that anxiety is a significant and independent determinant of arterial stiffness. Given that anxiety was not related to MAP, these findings suggest that arterial stiffness may be a pathway to explain the connection between anxiety and hypertension risk. Studies that scrutinize the relationship between anxiety and arterial stiffness are an important next step for future research. Further studies are also recommended to explore cultural factors and individual characteristics that may affect anxiety in Korean Americans.

Cerebral oxygenation in wake and during sleep and its relationship to cognitive function in community-dwelling older adults without sleep disordered breathing.

BACKGROUND: This descriptive cross-sectional study investigated the relationships between cerebral oxygen reserve and cognitive function in community-dwelling older adults. METHODS: Participants (72 women and 40 men) underwent standard polysomnography, including regional measures of percent oxyhemoglobin saturation (rcSO(2)) determined by cerebral oximetry. Two variables were used to calculate cerebral oxygen reserve: (a) awake rcSO(2) (mean presleep rcSO(2)) and (b) the change in rcSO(2) from before sleep to the end of the first non-rapid-eye movement cycle. General linear models, adjusted for the effects of education and occupation, tested differences in performance on standard tests of memory, attention, and speed of mental processing. RESULTS: Awake rcSO(2) values were normal (60%-79.9%) in 64 participants, marginal (50%-59.9%) in 41, and low (43%-49.9%) in 7. Participants with normal awake levels had higher cognitive function than those with low levels (p < .05). Changes in rcSO(2) were greatest in participants with marginal awake rcSO(2) values; among whom, those who increased rcSO(2) during sleep (n = 17) had better memory function than the 24 who did not (p < .05). CONCLUSIONS: Low awake rcSO(2) values mark individuals with low cerebral oxygen reserves and generally lower cognitive function; marginal awake rcSO(2) values that fall during sleep may indicate loss of cerebral oxygen reserve and an increased risk for cognitive decline. Further studies may clarify the significance of and mechanisms underlying individual differences in awake rcSO(2) and the changes that occur in rcSO(2) while asleep.

Exploratory analysis of cerebral oxygen reserves during sleep onset in older and younger adults.

OBJECTIVES: To explore differences in cerebral oxygen reserves during sleep in old and young adults. DESIGN: Descriptive cross-sectional study. SETTING: General clinical research center. PARTICIPANTS: Nine old (aged 65-84) and 10 young (aged 21-39) adults. MEASUREMENTS: Subjects were monitored during the first nightly sleep cycle using standard polysomnography, including measures of arterial oxyhemoglobin saturation (SaO(2)). Changes in regional cerebral oxyhemoglobin saturation (rcSO(2)) were used to estimate cerebral oxygen reserves. General linear models were used to test group differences in the change in SaO(2) and rcSO(2) during sleep. RESULTS: Older subjects had lower SaO(2) than young subjects before sleep (baseline) (F((1,18))=5.1, P=.04) and during sleep (F((1,18))=10.7, P=.01). During sleep, half of the older subjects and none of the younger ones had SaO(2) values below 95%. In addition, the older subjects had more periods of oxygen desaturation (drops in SaO(2) > or = 4%) (chi-square=24.3, P=.01) and lower SaO(2) levels during desaturation (F((1,18))=11.1, P<.01). Although baseline values were similar, rcSO(2) decreased during sleep 2.1% in older subjects (F((1,8))=3.8, P=.05) but increased 2.1% during sleep in younger subjects (F((1,9))=4.6, P=.04). When the older subjects awakened from sleep, rcSO(2), but not SaO(2), returned to baseline; both returned to baseline in younger subjects. CONCLUSION: This exploratory analysis generated the hypothesis that lower SaO(2), combined with declines in regional blood flow, contributes to decline in cerebral oxygen reserves during sleep in older subjects. Further study will assess the effects of factors (e.g., medical conditions, subclinical disorders, and sleep architecture) that might account for these differences.

Evaluation of heart rate variability indices using a real-time handheld remote ECG monitor.

Studies on retrospective electrocardiogram (ECG) recordings of patients during cardiac arrest have shown significant changes in heart rate variability (HRV) indices prior to the onset of cardiac arrhythmia. The early detection of these changes in HRV indices increases the chances for a successful medical intervention by increasing the response time window. A portable, handheld remote ECG monitor designed in this research detects the QRS complex and calculates short-term HRV indices in real-time. The QRS detection of the ECG recordings of subjects from the MIT-Arrhythmia database yielded a mean sensitivity of 99.34% and a specificity of 99.31%. ECG recordings from normal subjects and subjects with congestive heart failure were used to identify the differences in HRV indices. An increase in heart rate, high-frequency spectral power (HFP), total spectral power, the ratio of HFP to low-frequency spectral power (LFP), and a decrease in root mean square sum of RR differences were observed. No difference was found on comparison of the standard deviation of normal to normal interval between adjacent R-waves, LFP, and very-low-frequency spectral power. Based on these, additional analytical calculations could be made to provide early warnings of impending cardiac conditions.

Accuracy of three dry-chemistry methods for lipid profiling and risk factor classification.

The purpose of this project was to determine the accuracy in lipids measurement and risk factor classification using Reflotron, Cholestech, and Ektachem DT-60 dry-chemistry analyzers. Plasma and capillary venous blood from fasting subjects (n = 47) were analyzed for total cholesterol (TC), high density lipoprotein (HDL-C), and triglycerides (TG) using these analyzers and a CDC certified laboratory. Accuracy was evaluated by comparing the results of each portable analyzer against the CDC reference method. One-way ANOVAs were performed for TC, HDL-C, and TG between all portable analyzers and the reference method. Chi-square was used for risk classification (2001 NIH Guidelines). Compared to the reference method, the Ektachem and Reflotron provided significantly lower values for TC (p < .05). In addition, the Cholestech and Ektachem values for HDL-C were higher than the CDC (p < .05). The Reflotron and Cholestech provided higher values of TG than the CDC (p < .05). Chi-squares analyses for risk classification were not significant (p > .45) between analyzers. According to these results, the Ektachem and Cholestech analyzers met the current NCEP III guidelines for accuracy in measurement of TC, while only Ektachem met guidelines for TG. All 3 analyzers provided a good overall risk classification; however, values of HDL-C should be only used for screening purposes.