Abstract: This article is based on observation of a cross-disciplinary, cross-institutional team that worked on an intervention called ‘Memory Mate’ for use in a UK Cancer Centre. This aimed to improve treatment outcomes for patients who had comorbid dementia or other memory impairment. Comorbid patients present ambiguous, spoiled identities, problematising the boundaries of health specialisms and frames of understanding. Memory Mate is theorised as a boundary object facilitating service transformation by changing relations between oncology and mental health care practice. It crosses the boundaries between oncology and mental health. Its introduction signifies an important step in reconfiguring relations between the specialisms. As a boundary object, it contains parallel, even contesting worlds, with potential to enable an eventual synthesis of the double stigma of cancer and dementia. Memory Mate comprises physical things, such as an animation, but its principal value is in the interaction it initiates across disciplines and services. It supports evolution of practices to address a newly emergent challenge for health service provision, namely the cancer patient with comorbid dementia/cognitive impairment. Getting clinicians from different disciplines working together on a practical solution generates a dialogue that can shift professional identity and change the culture of practice.
Abstract: Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. This work evaluates the association between the average risk score and measures of socioeconomic status (index of multiple deprivation) and health (index of health and disability). The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, suggesting that females are more at risk from this kind of multiple medication. The risk may be monitored and controlled in a healthcare management system that is well-equipped with tools implementing appropriate techniques of artificial intelligence.
Abstract: A major challenge in medical studies, especially those that are longitudinal, is the problem of missing measurements which hinders the effective application of many machine learning algorithms. Furthermore, recent Alzheimer's Disease studies have focused on the delineation of Early Mild Cognitive Impairment (EMCI) and Late Mild Cognitive Impairment (LMCI) from cognitively normal controls (CN) which is essential for developing effective and early treatment methods. To address the aforementioned challenges, this paper explores the potential of using the eXtreme Gradient Boosting (XGBoost) algorithm in handling missing values in multiclass classification. We seek a generalized classification scheme where all prodromal stages of the disease are considered simultaneously in the classification and decision-making processes. Given the large number of subjects (1631) included in this study and in the presence of almost 28% missing values, we investigated the performance of XGBoost on the classification of the four classes of AD, NC, EMCI, and LMCI. Using 10-fold cross validation technique, XGBoost is shown to outperform other state-of-the-art classification algorithms by 3% in terms of accuracy and F-score. Our model achieved an accuracy of 80.52%, a precision of 80.62% and recall of 80.51%, supporting the more natural and promising multiclass classification.
Abstract: This study explores the relationship between the level of functionality and cognitive impairment in older adult women from the south-east of Mexico. It is a descriptive, cross-sectional study; performed with 172 participants in total who attended a health institute and live in Merida, Yucatan Mexico. After a non-probabilistic sampling, Barthel and Pfeiffer scales were applied. The results show statistically significant correlation between the cognitive impairment (Pfeiffer) and the levels of independence and function (Barthel) (r =0.489; p =0.001). Both determine a dependence level so they need either a little or a lot of help. Society needs that the older woman be healthy and that the professionals of mental health develop activities to prevent and rehabilitate because cognitive impairment and function are directly related with the quality of life.
Abstract: Neurological disorders are the most debilitating of manifestations seen in patients infected with HIV. The clinical profile of neurological manifestations in HIV patients has undergone a shift in recent years with opportunistic infections being controlled with combination anti-retroviral therapy and the advent of drugs which have higher central nervous system penetrability. The aim of this paper is to study the clinical, investigation profile and various neurological disorders in HIV patients on anti‐retroviral therapy. Fifty HIV patients with neurological manifestations were studied. A complete neurological examination including neurocognitive functioning using Montreal Cognitive Assessment and HIV Dementia scale were assessed. Apart from relevant investigations, CD4 count, cerebrovascular fluid analysis, computed tomography (CT) and magnetic resonance imaging (MRI) of brain were done whenever required. Neurocognitive disorders formed the largest group with 42% suffering from HIV associated Neurocognitive Disorders. Among them, asymptomatic neurocognitive impairment was seen in 28%; mild neurocognitive disorder in 12%, and 2% had HIV‐associated dementia. Opportunistic infections of the nervous system accounted for 32%, with meningitis being the most common. Four patients had space occupying lesions of central nervous system; four tuberculomas, and one toxoplasmosis. With the advent of highly active retroviral therapy, HIV patients have longer life spans with suppression of viral load leading to decrease in opportunistic infections of the nervous system. Neurocognitive disorders are now the most common neurological dysfunction seen and thus neurocognitive assessment must be done in all patients with HIV.
Abstract: The goal of this paper is to present the diagnostic
contribution that the screening instrument, Mini-Mental State
Examination-2: Expanded Version (MMSE-2:EV), brings in
detecting the cognitive impairment or in monitoring the progress of
degenerative disorders. The diagnostic signification is underlined by
the interpretation of the MMSE-2:EV scores, resulted from the test
application to patients with mild and major neurocognitive disorders.
The cases were selected from current practice, in order to cover vast
and significant neurocognitive pathology: mild cognitive impairment,
Alzheimer’s disease, vascular dementia, mixed dementia, Parkinson’s
disease, conversion of the mild cognitive impairment into
Alzheimer’s disease. The MMSE-2:EV version was used: it was
applied one month after the initial assessment, three months after the
first reevaluation and then every six months, alternating the blue and
red forms. Correlated with age and educational level, the raw scores
were converted in T scores and then, with the mean and the standard
deviation, the z scores were calculated. The differences of raw scores
between the evaluations were analyzed from the point of view of
statistic signification, in order to establish the progression in time of
the disease. The results indicated that the psycho-diagnostic approach
for the evaluation of the cognitive impairment with MMSE-2:EV is
safe and the application interval is optimal. In clinical settings with a
large flux of patients, the application of the MMSE-2:EV is a safe
and fast psychodiagnostic solution. The clinicians can draw objective
decisions and for the patients: it does not take too much time and
energy, it does not bother them and it doesn’t force them to travel
frequently.
Abstract: This study aimed at investigating whether the
functional brain networks constructed using the initial EEG (obtained
when patients first visited hospital) can be correlated with the
progression of cognitive decline calculated as the changes of
mini-mental state examination (MMSE) scores between the latest and
initial examinations. We integrated the time–frequency cross mutual
information (TFCMI) method to estimate the EEG functional
connectivity between cortical regions, and the network analysis based
on graph theory to investigate the organization of functional networks
in aMCI. Our finding suggested that higher integrated functional
network with sufficient connection strengths, dense connection
between local regions, and high network efficiency in processing
information at the initial stage may result in a better prognosis of the
subsequent cognitive functions for aMCI. In conclusion, the functional
connectivity can be a useful biomarker to assist in prediction of
cognitive declines in aMCI.
Abstract: Brain functional networks based on resting-state EEG
data were compared between patients with mild Alzheimer’s disease
(mAD) and matched patients with amnestic subtype of mild cognitive
impairment (aMCI). We integrated the time–frequency cross mutual
information (TFCMI) method to estimate the EEG functional
connectivity between cortical regions and the network analysis based
on graph theory to further investigate the alterations of functional
networks in mAD compared with aMCI group. We aimed at
investigating the changes of network integrity, local clustering,
information processing efficiency, and fault tolerance in mAD brain
networks for different frequency bands based on several topological
properties, including degree, strength, clustering coefficient, shortest
path length, and efficiency. Results showed that the disruptions of
network integrity and reductions of network efficiency in mAD
characterized by lower degree, decreased clustering coefficient, higher
shortest path length, and reduced global and local efficiencies in the
delta, theta, beta2, and gamma bands were evident. The significant
changes in network organization can be used in assisting
discrimination of mAD from aMCI in clinical.
Abstract: An early and accurate detection of Alzheimer's disease (AD) is an important stage in the treatment of individuals suffering from AD. We present an approach based on the use of structural magnetic resonance imaging (sMRI) phase images to distinguish between normal controls (NC), mild cognitive impairment (MCI) and AD patients with clinical dementia rating (CDR) of 1. Independent component analysis (ICA) technique is used for extracting useful features which form the inputs to the support vector machines (SVM), K nearest neighbour (kNN) and multilayer artificial neural network (ANN) classifiers to discriminate between the three classes. The obtained results are encouraging in terms of classification accuracy and effectively ascertain the usefulness of phase images for the classification of different stages of Alzheimer-s disease.
Abstract: The purpose of this study was to investigate the effectiveness of a recreational workout program for adults with disabilities over two semesters. This investigation was an action study conducted in a naturalistic setting. Participants included equal numbers of adults with severe cognitive impairments (n = 35) and adults without disabilities (n = 35). Adults with disabilities severe cognitive impairments were trained 6 self-initiated workout activities over two semesters by adults without disabilities. The numbers of task-analyzed steps of each activity performed correctly by each participant at the first and last weeks of each semester were used for data analysis. Results of the paired t-tests indicate that across two semesters, significant differences between the first and last weeks were found on 4 out of the 6 task-analyzed workout activities at a statistical level of significance p < .05. The recreational workout program developed in this study was effective.