EPC Review of Cognitive Training Findings: Reactions, Current Evidence, Future Directions. Sherry L. Willis, PhD
|
|
- Quentin McBride
- 5 years ago
- Views:
Transcription
1 EPC Review of Cognitive Training Findings: Reactions, Current Evidence, Future Directions Sherry L. Willis, PhD University of Washington Preventing Dementia & Cognitive Impairment Workshop National Academies of Science, Engineering, Medicine October 25, 2016 Washington, DC
2 Outline of Talk To summarize key points from EPC Review on Cognitive Training To review briefly major findings from ACTIVE trial To discuss key concerns in EPC Review on Cognitive Training, with focus on ACTIVE Limitations in publications reviewed, with focus on ACTIVE Concerns related to Transfer ( diffusion, spillover ) Concerns related to Attrition & implications for ratings of Strength of Evidence Concerns on limitations in findings on slowing or reducing dementia incidence Summary & Future Directions
3 EPC Review: Results, Discussion, Conclusions Of the 13 classes of interventions we examined we found no high-strength evidence for the effectiveness of interventions to delay or prevent age-related cognitive decline Cognitive Training: Moderate-strength evidence indicates that cognitive training produces sustained benefit over 2 year for cognitive performance that was target of training. little evidence of diffusion of benefits in other cognitive areas e.g., transfer Strength of evidence..low in longer follow-up..high attrition
4 Major Findings from ACTIVE Trial
5 Does intervening on basic abilities transfer to real-world tasks? Baseline Characteristics: Mean age: 73.6 Range: Gender: 75.9% female Race: 26% African American Education: HS diploma 88.6% Marital Status: 35.6% married Cognitive Status: MMSE 27.3 Multi-site Trial: N = 2802 Source: Jobe et al., 2001
6 Design of ACTIVE Trial pre-specified in RFA-AG INTERVETIONS focus on cognitive abilities PRIMARY OUTCOME: Everyday independence; functional competence
7 % Participants above Baseline Memory Reason Speed Control Memory 35.9% 31% Reason 73%** 61% Speed 70%** 48% 10-yr Post Training Memory Reason Speed Control After initial Training Memory 26%* 15% Reason 74%** 39% Speed 87%** 31%
8 Effect Sizes at 5 Years (JAMA 2006) Standardized Training Effect Size (Control Group as Reference) Memory composite Reasoning composite Speed composite 0 Memory trained Reasoning trained Speed trained -0.1 Training Group
9 Primary Outcome as Mandated by RFA Everyday Functioning (IADL)
10 10-Year Trajectory of Self-Reported IADL Difficulty, by Training Group (JAGS 2014)
11 Secondary Outcomes related to Everyday Functioning: Findings at 5-,10-yr Follow-up Mobility and Driving Reduction in Auto Crashes: Speed & Reason Training Internal Control Increase in Control Beliefs: Speed & Reason Training Depression Less depressive symptoms in Speed training Subjects in Memory & Reasoning Training with depressive symptoms profit from training
12 Reduction in Auto Crashes: Comparison of Speed & Reasoning Training & Control Group: 5- and 10-yr Findings Reduced Crashes for participants in Speed & Reasoning Training at high risk for crash For training groups, % high risk participants who crashed was reduced to level of low risk participants
13 Booster Training: Increased Reasoning & Speed Training Effects S Reasoning Training Speed Training
14 Key Concerns with EPC Review on Cognitive Training, Limitations in publications reviewed, with focus on ACTIVE Concerns related to Transfer ( diffusion, spillover ) Concerns related to Attrition & implications for ratings of Strength of Evidence Concerns on limitations in findings on slowing or reducing dementia incidence
15 Limitation in Number and Scope of Publications cited in EPC Review (1) Only 38 cognitive training studies met EPC inclusion criteria (e.g., attrition, 6 mo follow up) Only 11 training studies rated as medium or low risk of bias EPC review found NO high-strength evidence/studies 10 of 11 training studies rated with medium or low risk bias had less than 2 yr follow-up, except ACTIVE (2 yr). Strength of evidence is low in longer follow-up high attrition
16 Limitation in Number and Scope of Publications cited in EPC Review (2) Only 7 publications were included in EPC Review of ACTIVE out of approximately 40 training publications Many key publications reporting Primary and Secondary outcome effects were not included Driving: Ball et al., 2010; Edwards et al., 2009 Depression: Gallo et al., 2003; Wolinsky et al., 2009 Generalizability of ACTIVE findings: Prindle & McArdle, 2013 MCI: Cook et al., 2013; Unverzagt et al., of 7 publications reviewed were rated as high risk of bias due to attrition.
17 Key Concerns with EPC Review: TRANSFER (1) The ACTIVE trial showed most clearly that cognitive training could improve performance on domains trained.. but there was little spillover to other domains. There may be an IADL effects at 10 yrs, but high attrition. EPC reviewers appear to have taken a traditional interpretation of transfer (spillover) E.g., Does training on memory show spillover (transfer) to reasoning ability. Implicit assumption that transfer (spillover effects) should occur immediately after training at immediate posttest. Current views of transfer are broader and extend beyond this traditional view.
18 Key Concerns with EPC Review: TRANSFER (2) The ACTIVE RFA mandated a different view of transfer. The PRIMARY outcome was everyday functioning, not performance on abilities trained. Key Question: Does training on cognitive abilities transfer to maintenance or enhancement of everyday functioning? Everyday functioning is a criteria in both MCI and dementia diagnoses and thus is of importance in study of training effects on dementia incidence. Our ACTIVE findings on transfer to everyday functioning suggest that transfer does not occur immediately after training. Analogous to medical treatments: rapid change in risk factors; delay in outcomes such as stroke
19 Key Concerns with EPC Review: TRANSFER (3) In ACTIVE, everyday functioning was assessed in multiple ways: Self Report of IADL difficulty significant differences in all training groups compared to control at 10-yr follow-up Secondary outcomes related to everyday functioning: State motor vehicle records of auto crash Speed and Reasoning training showed reduced crash at 5- and 10-yr follow-up Locus of Control Beliefs Speed and Reasoning training showed increased control beliefs Depression Speed training showed lowered depressive symptoms compared to control. Reason and Memory training showed those with depressive symptoms profited from training.
20 Key Concerns with EPC Review: Attrition (1) The 5- and 10 year outcomes had a high risk of bias due to attrition. Key findings regarding PRIMARY OUTCOME (everyday functioning) were found at 5- and 10-yr follow up and thus were given little attention in review. Incorrect statement: much of the sample loss was unexplained A consort table was included in 10-year report (Rebok et al, 2014) providing a detailed accounting of sources of attrition (next slide)
21 Pattern of attrition was similar for each training group compared to control at each follow-up occasion. No group differences. Total Attrition: 1582/2832 (Approximate 5% attrition/yr) Deaths: 31% Subject withdraw: 35% Lost to follow-up: 4.1% Site decision: 17% Family refusal: 3.3% Much of attrition is involuntary (death, illness/frailty) Minority sample (26%) contribute to higher attrition
22 Key Concerns with EPC Review: Attrition (3) The rate of attrition in ACTIVE given a communitydwelling sample (baseline mean 73 yrs) is not surprisingly high. Over 10 years, annual attrition of 5% Attrition in longitudinal studies of aging was discussed in Rebok et al, Attrition in ACTIVE was comparable to other longitudinal studies. ACTIVE dealt with attrition in statistically appropriate ways (e.g. linear mixed methods; multiple imputation, propensity weighting; Hedeker missing data approach; sensitivity analyses). Statistical approaches indicate attrition tends to affect LEVEL, not RATE of CHANGE
23 Key Concerns with EPC Review: Study of Dementia Incidence The ACTIVE trial was not designed to study the incidence of dementia. The MMSE was the only clinically valid measure of dementia included. At 5- and 10-yr follow, there have been reports on group differences in incidence of dementia based primarily on a psychometric score approach to impairment (see following slides). The 10-year report has not been published and is thus preliminary. We report on some promising findings regarding the potential for cognitively impaired to profit from training.
24 Memory Impaired at Baseline Profited from Reasoning and Speed Training Memory impaired at baseline did not benefit from memory training. Memory impaired at baseline did benefit, to same degree as cognitively normal, on Reasoning and Speed training.
25 Dementia Findings: 5-year Follow-up
26 Definitions of Dementia 1. Memory -1.5 SD below mean; and Reasoning, Speed, or Vocabulary -1.5 SD below mean; and functional impairment (MDS IADL <=10%tile); or, 2. First visit in which MMSE < 22 and all subsequent visits are MMSE < 22 or are missing; or, 3. Self- or proxy-report of diagnosis of dementia or AD during the follow-up; or, 4. Self- or proxy-report of institutionalization during the follow-up; or, 5. Deactivation: family refuses access to subject
27 Incident dementia by Tx groups Memory Reasoning Speed All Tx grps Control Total N Event Event rate Incidence rate/ 1000 person yrs (95% CI) 17.1 (12.2,22.1) 18.9 (13.6,24.2) 16.1 (11.4,20.9) 17.4 (14.5,20.2) 19.2 (13.9,24.6)
28 Time to dementia by training: 5 yr
29 Dementia Findings: 10-yr Follow-up N=2785 participants in analyses, n=296 met dementia criteria (10.6%)
30 Speed Training Delays Dementia Onset 33% risk reduction HR=0.67, 95%CI , p=.012
31 Effects of Speed Training are Dose Dependent 48% risk reduction HR=0.52, 95%CI , p=.005
32 Conclusions on Dementia Findings Dementia incidence and risk factors comparable to large epi studies supports our dementia definition 5- and 10-Yr Findings: 5 Yr: Brief exposure to cognitive training in late life did not reduce the likelihood of developing dementia. Hazard ratio went in the protective direction but was nonsignificant (Unverzagt et al. 2012) 10 Yr: Preliminary, unpublished Findings. Speed training delayed dementia onset; and delay of dementia was dose dependent. (Edwards et al. IAAG presentation, 2016)
33 Summary (1) Numerous studies indicate immediate benefits of cognitive training Long term follow-up studies are critical to examine whether cognitive training in normal adults can prevent or slow incidence of dementia Attrition is inevitable in long-term studies of cognitive interventions with older adults Rather than dismiss or reduce ratings of long-term studies due to attrition, the more appropriate approach should focus on understanding nature of attrition effects and appropriate strategies for correcting for attrition effects. A broader approach to conceptualization and assessment of transfer effects is needed, including transfer to everyday function, as well as across cognitive abilities, and the possibility of lagged transfer effects.
34 Summary (2) Cognitive interventions need to be embedded in the everyday lives of older adults, not a separate, short-term activity. Given that the cognitive decline is related to multiple risk factors, multimodal interventions need further study. The recent inclusion of brain scans in assessment of cognitive training effects needs further study. Brain plasticity, a network approach to brain functioning, and brain stimulation needs further exploration
35 Thank you
36 Acknowledgements We acknowledge the funding for the ACTIVE trial from the National Institutes of Aging and Nursing Research Comments and contributions of ACTIVE PIs to this presentation are gratefully acknowledged (Rebok, Marsiske, Ball) We thank the 2802 ACTIVE participants and the staff at each of the 6 ACTIVE sites for their contribution.
Cognitive Training Interventions for Delaying Cognitive Decline
Cognitive Training Interventions for Delaying Cognitive Decline Jessica B. Langbaum, Ph.D. Principal Scientist, Banner Alzheimer s Institute Associate Director, Alzheimer s Prevention Initiative Disclosures
More informationInterventions to Prevent Age- Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer s-type Dementia
Interventions to Prevent Age- Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer s-type Dementia Minnesota Evidence-based Practice Center for the Health and Medicine Division,
More informationF. D. Wolinsky. H. Mahncke. M. W. Vander Weg. College of Nursing Publications
College of Nursing Publications 5-1-2010 Speed of processing training protects self-rated health in older adults: enduring effects observed in the multi-site ACTIVE randomized controlled trial F. D. Wolinsky
More informationMental Disorders in Older Adults, by George W. Rebok, is available under a Creative Commons Attribution-NonCommercial-ShareAlike 2.5 Generic license.
Mental Disorders in Older Adults, by George W. Rebok, is available under a Creative Commons Attribution-NonCommercial-ShareAlike 2.5 Generic license. 2007, The Johns Hopkins University and George W. Rebok.
More informationSchool of Aging Studies, University of South Florida, Tampa. 3. Department of Psychology, 5. Department of Medicine, and 6
Ross, L.A., Edwards, J.D., O Connor, M.L., Ball, K.K., Wadley, V.G., & Vance, D.E. (2015). The Transfer of Cognitive Speed of Processing Training to Older Adults Driving Mobility Across 5 Years. Journals
More informationUseful Use of View Test UFOV - Reference List
Useful Use of View Test UFOV - Reference List Sekuler, R. & Ball, K. Measuring older persons' functional visual fields. (1985). Investigative Ophthalmology and Visual Science Suppl., 1985, 26, 307. Ball,
More informationEveryday Problem Solving and Instrumental Activities of Daily Living: Support for Domain Specificity
Behav. Sci. 2013, 3, 170 191; doi:10.3390/bs3010170 Article OPEN ACCESS behavioral sciences ISSN 2076-328X www.mdpi.com/journal/behavsci Everyday Problem Solving and Instrumental Activities of Daily Living:
More informationLambros Messinis PhD. Neuropsychology Section, Department of Neurology, University of Patras Medical School
Lambros Messinis PhD Neuropsychology Section, Department of Neurology, University of Patras Medical School Type 2 Diabetes Mellitus is a modern day epidemic Age is a significant predictor of diabetes Males
More informationBrain Fitness for Positive Aging
Brain Fitness for Positive Aging Ray Ownby, MD, PhD Interprofessional Geriatrics Training Institute July 7, 2017 Overview Cognitive aging and what we can do about it. Positive Aging Optimal Cognitive Function
More informationDATA CORE MEETING. Observational studies in dementia and the MELODEM initiative. V. Shane Pankratz, Ph.D.
DATA CORE MEETING Observational studies in dementia and the MELODEM initiative V. Shane Pankratz, Ph.D. Outline Theme: Overcoming Challenges in Longitudinal Research Challenges in observational studies
More informationThe Council on Aging of Ottawa Annual Spring Luncheon Wednesday, May 8, 2013
The Council on Aging of Ottawa Annual Spring Luncheon Wednesday, May 8, 2013 Successful Aging: A Shared Responsibility What can you (Senior or Junior ) do? What can our Health & Social Professionals do?
More informationSpeed of processing training results in lower risk of dementia
1 2 3 4 5 6 7 Featured Article Speed of processing training results in lower risk of dementia Q8 Jerri D. Edwards a, *, Huiping Xu b, Daniel O. Clark c, Lin T. Guey d, Lesley A. Ross e, Frederick W. Unverzagt
More informationP E R S P E C T I V E S
PHOENIX CENTER FOR ADVANCED LEGAL & ECONOMIC PUBLIC POLICY STUDIES Revisiting Internet Use and Depression Among the Elderly George S. Ford, PhD June 7, 2013 Introduction Four years ago in a paper entitled
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Professor Stephen Lord Coffs Harbour Falls Prevention Network Rural Forum 28 th February 2014 Acknowledgments: Dr Jasmine Menant, Mr. Daniel Schoene Recent falls risk
More informationNine Months of Memory Training Increases Cognistat Measured Memory in Year-Old Mild Cognitively Impaired Individuals
Advances in Aging Research, 2015, 4, 79-88 Published Online May 2015 in SciRes. http://www.scirp.org/journal/aar http://dx.doi.org/10.4236/aar.2015.43010 Nine Months of Memory Training Increases Cognistat
More informationFrailty in Older Adults
Frailty in Older Adults John Puxty puxtyj@providencecare Geriatrics 20/20: Bringing Current Issues into Perspective Session Overview Definition of Frailty Strategies for identifying frail older adults
More informationCommittee on Accessible and Affordable Hearing Health Care for Adults
Committee on Accessible and Affordable Hearing Health Care for Adults IOM April 27, 2015 Molly V. Wagster, PhD Chief, Behavioral & Systems Neuroscience Branch Division of Neuroscience National Institute
More informationThe role of memory on patients with mild cognitive impairment. Sophia Vardaki, PhD National Technical University of Athens
The role of memory on patients with mild cognitive impairment Sophia Vardaki, PhD National Technical University of Athens Athens, 26 June 2015 Objective-Presentation Structure Objective To explore the
More informationIMPORTANCE OF AND CRITERIA FOR EVALUATING EXTERNAL VALIDITY. Russell E. Glasgow, PhD Lawrence W. Green, DrPH
IMPORTANCE OF AND CRITERIA FOR EVALUATING EXTERNAL VALIDITY Russell E. Glasgow, PhD Lawrence W. Green, DrPH 1 OVERVIEW Rationale for and Importance of External Validity (EV) for Translation Proposed EV
More informationDiversity and Dementia
Diversity and Dementia Kala M. Mehta, DSc, MPH January 17, 2012 Overview Background Incidence and Prevalence of Dementia Why are these differences found? What s important for diverse dementia patients
More informationExploration of a weighed cognitive composite score for measuring decline in amnestic MCI
Exploration of a weighed cognitive composite score for measuring decline in amnestic MCI Sarah Monsell NACC biostatistician smonsell@uw.edu October 6, 2012 Background Neuropsychological batteries used
More informationGeneralizing the right question, which is?
Generalizing RCT results to broader populations IOM Workshop Washington, DC, April 25, 2013 Generalizing the right question, which is? Miguel A. Hernán Harvard School of Public Health Observational studies
More informationEvidence Based Practice
Evidence Based Practice RCS 6740 7/26/04 Evidence Based Practice: Definitions Evidence based practice is the integration of the best available external clinical evidence from systematic research with individual
More informationDriveWise Driving Evaluation. Ann M. Hollis OTR/L
DriveWise Driving Evaluation Ann M. Hollis OTR/L DriveWise Objective assessment of driving safety with support for patient/family Hospital based, Multidisciplinary team approach ClinicalEvaluation, Research
More information10/19/2017. Cognitive changes of normal aging What is normal, what is not? Dementia, Alzheimer s what s the difference?
Cognitive changes of normal aging What is normal, what is not? Dementia, Alzheimer s what s the difference? Mild Cognitive Impairment and Pre Alzheimer s disease OK, so what can I do? Cognitive Aging:
More informationCRITICALLY APPRAISED PAPER (CAP)
CRITICALLY APPRAISED PAPER (CAP) Pitkälä, K. H., Pöysti, M. M., Laakkonen, M.-L., Tilvis, R. S., Savikko, N., Kautiainen H., & Strandberg, T. E. (2013). Effects of the Finnish Alzheimer Disease Exercise
More informationFrailty. Nicholas Butler MD, MBA Department of Family Medicine University of Iowa
Frailty Nicholas Butler MD, MBA Department of Family Medicine University of Iowa Doris 84 yo female who comes into your clinic with her daughter. She complains of feeling increasingly fatigued and just
More informationCognitive ageing and dementia: The Whitehall II Study
Cognitive ageing and dementia: The Whitehall II Study Archana SINGH-MANOUX NIH: R01AG013196; R01AG034454; R01AG056477 MRC: K013351, MR/R024227 BHF: RG/13/2/30098 H2020: #643576 #633666 Outline Lifecourse
More informationFood Labels and Weight Loss:
Food Labels and Weight Loss: Evidence from the National Longitudinal Survey of Youth Bidisha Mandal Washington State University AAEA 08, Orlando Motivation Who reads nutrition labels? Any link with body
More informationDelirium in Older Persons: An Investigative Journey
Delirium in Older Persons: An Investigative Journey Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair
More informationPreventing Cognitive Decline and Dementia A Way Forward
Preventing Cognitive Decline and Dementia A Way Forward Ronald C. Petersen, PhD, MD Mayo Clinic Rochester, MN USA for Committee on Preventing Cognitive Decline National Academies of Science, Engineering
More informationRadhika Patil¹, Kirsti Uusi-Rasi 1,2, Kari Tokola¹, Pekka Kannus 1,3,4, Saija Karinkanta 1, Harri Sievänen 1 IFA
Effects of a multi-component exercise program on physical function and falls among older women: a two-year community-based, randomized controlled trial Radhika Patil¹, Kirsti Uusi-Rasi 1,2, Kari Tokola¹,
More informationThe Long-term Prognosis of Delirium
The Long-term Prognosis of Jane McCusker, MD, DrPH, Professor, Epidemiology and Biostatistics, McGill University; Head, Clinical Epidemiology and Community Studies, St. Mary s Hospital, Montreal, QC. Nine
More informationSupplementary Online Content
Supplementary Online Content Sun LS, Li G, Miller TLK, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. doi:10.1001/jama.2016.6967
More informationEvaluation of Risk Factors for Repeat DUI Offenses
Evaluation of Risk Factors for Repeat DUI Offenses PRELIMINARY DRAFT REPORT Prepared for Alaska Department of Transportation & Public Facilities Steven Hamilton C & S Management Associates Anchorage, Alaska
More informationNeurocognitive Functional Assessment After TAVR: Methodologies and Clinical Importance
AORTIC VALVE THERAPIES Today and Tomorrow II September 14, 2014 Neurocognitive Functional Assessment After TAVR: Methodologies and Clinical Importance Ronald M Lazar, PhD, FAHA, FAAN Division of Stroke
More informationAOTA S EVIDENCE EXCHANGE GUIDELINES TO CRITICALLY APPRAISED PAPER (CAP) WORKSHEET
AOTA S EVIDENCE EXCHANGE GUIDELINES TO CRITICALLY APPRAISED PAPER (CAP) WORKSHEET Sign in the OASIS Submission Site to view the CAP Worksheet. Critically Appraised Papers (CAPs) are at-a-glance summaries
More informationMeasurement and Classification of Neurocognitive Disability in HIV/AIDS Robert K. Heaton Ph.D University of California San Diego Ancient History
Measurement and Classification of Neurocognitive Disability in HIV/AIDS Robert K. Heaton Ph.D University of California San Diego Ancient History Group Means for NP and MMPI Variables N=381 Consecutive
More informationBehavioral Intervention Rating Rubric. Group Design
Behavioral Intervention Rating Rubric Group Design Participants Do the students in the study exhibit intensive social, emotional, or behavioral challenges? % of participants currently exhibiting intensive
More informationPUBLIC HEALTH, PUBLIC PERSPECTIVE, PUBLIC POLICY: THE INFLUENCE OF SOCIAL PROOF
PUBLIC HEALTH, PUBLIC PERSPECTIVE, PUBLIC POLICY: THE INFLUENCE OF SOCIAL PROOF University of California, San Francisco Dental Public Health Seminar, April 12, 2016 Brittany Seymour, DDS, MPH Assistant
More informationScholarly Project Award Cover Page
Allaire 1 Scholarly Project Award Cover Page THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE PROPOAL Name: Jason C. Allaire Department: Psychology Campus Box #: 7650 Project Title: Examining the Efficacy
More informationThe Industry s Views on Older Old Patients
The Industry s Views on Older Old Patients Susanna Del Signore and Philippe Guillet Global Regulatory Policy and Ageing Therapeutic Strategic Unit SANOFI R&D 1 Outline Introduction EFPIA Survey: Overview
More informationAchieving the Promise of Prevention for Older Adults
Achieving the Promise of Prevention for Older Adults George W. Rebok, Ph.D. Department of Mental Health Bloomberg School of Public Health July 2, 2008 Summer Institute in Mental Health Research Different
More informationFrailty Assessment: Simplifying the Complex
Frailty Assessment: Simplifying the Complex Natalie Sanders, DO Internal Medicine, Geriatrics Rocky Mountain Geriatrics Conference 2017 U N I V E R S I T Y O F U T A H H E A L T H, 2 0 1 7 OBJECTIVES Define
More informationEffective Health Care Program
Comparative Effectiveness Review Number 188 Effective Health Care Program To Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer s-type Dementia Executive Summary Background
More informationUSDA Nutrition Evidence Library: Systematic Review Methodology
USDA Nutrition Evidence Library: Systematic Review Methodology Julie E. Obbagy, PhD, RD USDA Center for Nutrition Policy & Promotion Meeting #2 October 17, 2016 The National Academies of Sciences, Engineering,
More informationThe American Cancer Society National Quality of Life Survey for Caregivers
The American Cancer Society National Quality of Life Survey for Caregivers Rachel S. Cannady Strategic Director, Cancer Caregiver Support Atlanta, GA Agenda Definition and prevalence of cancer survivorship
More informationMeasure #282: Dementia: Functional Status Assessment National Quality Strategy Domain: Effective Clinical Care
Measure #282: Dementia: Functional Status Assessment National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process DESCRIPTION: Percentage
More informationTherapeutic Benefits of Caregiver Interventions
Therapeutic Benefits of Caregiver Interventions Laura N. Gitlin, Ph.D. Professor, Department Community Public Health, School of Nursing Director, Center for Innovative Care in Aging Johns Hopkins University
More informationAPPENDIX: Supplementary Materials for Advance Directives And Nursing. Home Stays Associated With Less Aggressive End-Of-Life Care For
Nicholas LH, Bynum JPW, Iwashnya TJ, Weir DR, Langa KM. Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. Health Aff (MIllwood).
More informationMultnomah County: Leading Causes of Death
Leading causes of death are presented in this report by gender and race/ethnicity. Mortality data is based on the Death Certificate statistical file provided by the Center for Health Statistics, Oregon
More informationChange in Self-Rated Health and Mortality Among Community-Dwelling Disabled Older Women
The Gerontologist Vol. 45, No. 2, 216 221 In the Public Domain Change in Self-Rated Health and Mortality Among Community-Dwelling Disabled Older Women Beth Han, PhD, MD, MPH, 1 Caroline Phillips, MS, 2
More informationDoes it Matter How You Ask? Question Wording and Males' Reporting of Contraceptive Use at Last Sex
Does it Matter How You Ask? Question Wording and Males' Reporting of Contraceptive Use at Last Sex Jennifer Yarger University of Michigan Sarah Brauner-Otto Mississippi State University Joyce Abma National
More informationAOTA S EVIDENCE EXCHANGE CRITICALLY APPRAISED PAPER (CAP) GUIDELINES Annual AOTA Conference Poster Submissions Critically Appraised Papers (CAPs) are
AOTA S EVIDENCE EXCHANGE CRITICALLY APPRAISED PAPER (CAP) GUIDELINES Annual AOTA Conference Poster Submissions Critically Appraised Papers (CAPs) are at-a-glance summaries of the methods, findings and
More informationSexual Health screening: Experiences of STI and HIV testing
Royal College of Surgeons in Ireland e-publications@rcsi Psychology Conference Proceedings and Posters Department of Psychology 10-1-2013 Sexual Health screening: Experiences of STI and HIV testing Caroline
More informationDriver Distraction: Towards A Working Definition
Driver Distraction: Towards A Working Definition International Conference on Distracted Driving Toronto, Ontario October 2-5, 2005 Leo Tasca, Ph.D. Road Safety Program Office Road User Safety Division
More informationCrash Risk of Alcohol Impaired Driving
Crash Risk of Alcohol Impaired Driving 1 R. P. Compton, 2 R. D. Blomberg, 3 H. Moskowitz, 3 M. Burns, 4 R. C. Peck, and 3 D. Fiorentino 1 National Highway Traffic Safety Administration, 2 Dunlap and Associates,
More informationMeasuring health related quality of life in persons with dementia
University of Wollongong Research Online Australian Health Services Research Institute Faculty of Business 2008 Measuring health related quality of life in persons with dementia Madeleine King University
More informationPrevention of Geriatric Syndrome
National Center for Geriatrics and Gerontology 1 Healthy Ageing -A Life without Comobidity- Prevention of Geriatric Syndrome Takao Suzuki, Research Institute, National Center for Geriatrics and Gerontology
More informationQuality ID #282: Dementia: Functional Status Assessment National Quality Strategy Domain: Effective Clinical Care
Quality ID #282: Dementia: Functional Status Assessment National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process DESCRIPTION:
More informationImproving the Methodology for Assessing Mild Cognitive Impairment Across the Lifespan
Improving the Methodology for Assessing Mild Cognitive Impairment Across the Lifespan Grant L. Iverson, Ph.D, Professor Department of Physical Medicine and Rehabilitation Harvard Medical School & Red Sox
More informationImplementation of estimands in Novo Nordisk
Implementation of estimands in Novo Nordisk Søren Andersen Helle Lynggaard Biostatistics, Novo Nordisk A/S DSBS meeting 26 October 2017 2 Agenda Overview of implementation process Cross-functional working
More informationOlder people are living longer than before, but are they living healthier?
Older people are living longer than before, but are they living healthier? Trajectories of Frailty among Chinese Older People in Hong Kong between 2001 and 2012: An Age-period-cohort Analysis Ruby Yu,
More informationSUPPLEMENTARY DATA. Supplementary Figure S1. Cohort definition flow chart.
Supplementary Figure S1. Cohort definition flow chart. Supplementary Table S1. Baseline characteristics of study population grouped according to having developed incident CKD during the follow-up or not
More informationAssessing cognition in ELDERLY drivers
Assessing cognition in ELDERLY s Alexandra Economou Assistant Professor Department of Psychology University of Athens 18 October 2013 Athens Overview ability in the older ability in the older The older
More informationKorean-VCI Harmonization Standardization- Neuropsychology Protocol (K-VCIHS-NP)
Korean-VCI Harmonization Standardization- Neuropsychology Protocol (K-VCIHS-NP) Yeonwook Kang, Ph.D. Department of Psychology, Hallym University Department of Neurology, Hallym University Sacred Heart
More informationOverview. Case #1 4/20/2012. Neuropsychological assessment of older adults: what, when and why?
Neuropsychological assessment of older adults: what, when and why? Benjamin Mast, Ph.D. Associate Professor & Vice Chair, Psychological & Brain Sciences Associate Clinical Professor, Family & Geriatric
More informationHOW TO PREVENT COGNITIVE DECLINE.AT MCI STAGE?
EAMA CORE CURRICULUM HOW TO PREVENT COGNITIVE DECLINE.AT MCI STAGE? Sofia Duque Orthogeriatric Unit São Francisco Xavier Hospital Occidental Lisbon Hospital Center University Geriatric Unit, Faculty of
More informationMeasuring health-related quality of life in persons with dementia DOMS results & recommendations
Measuring health-related quality of life in persons with dementia DOMS results & recommendations Madeleine King, Siggi Zapart, Jan Sansoni, Nick Marosszeky On behalf of the Dementia Outcomes Measurement
More informationONE of the most robust findings in the cognitive aging
Payne, B.R., Jackson, J.J., Hill, P.L., Gao, X., Roberts, B.W., & Stine-Morrow, E.A.L. (2012). Memory self-efficacy predicts responsiveness to inductive reasoning training in older adults. The Journals
More informationAppropriate Use of Antipsychotics. Acknowledgements. Objectives. Seniors Health SCN and Addiction and Mental Health SCN.
Appropriate Use of Antipsychotics Seniors Health SCN and Addiction and Mental Health SCN October 9, 2013 Acknowledgements I would like to acknowledge that some of the slides used today were developed by:
More informationApplication of Item Response Theory to ADAS-cog Scores Modeling in Alzheimer s Disease
Application of Item Response Theory to ADAS-cog Scores Modeling in Alzheimer s Disease Sebastian Ueckert 1, Elodie L. Plan 2, Kaori Ito 3, Mats O. Karlsson 1, Brian W. Corrigan 3, Andrew C. Hooker 1 1.
More informationSupplementary Online Content
Supplementary Online Content Rollman BL, Herbeck Belnap B, Abebe KZ, et al. Effectiveness of online collaborative care for treating mood and anxiety disorders in primary care: a randomized clinical trial.
More informationObjectives. The Problem. The Problem. The Problem. Assessing the Older Driver
Assessing the Older Driver Objectives Practical office evaluation. Testing and reporting Dementia and driving Strategies for counseling On-line resources Amelia Gennari, MD Director of Ambulatory Care
More informationDementia in Parkinson s disease:
Dementia in Parkinson s disease: A 20 year Prospective Neuropsychological Study Sydney Multicentre Study Associate Professor Wayne GJ Reid PhD FAPS 149 newly diagnosed community living Parkinson s Disease
More informationMaintenance of weight loss and behaviour. dietary intervention: 1 year follow up
Institute of Psychological Sciences FACULTY OF MEDICINE AND HEALTH Maintenance of weight loss and behaviour change Dropouts following and a 12 Missing week healthy Data eating dietary intervention: 1 year
More informationNational Sleep Foundation. State of the States Report on Drowsy Driving: Summary of Findings. November 2008
National Sleep Foundation State of the States Report on Drowsy Driving: Summary of Findings vember 2008 1 Executive Summary Drowsy is an under-ed and under-recognized public safety issue plaguing America
More informationEFFECTIVE MEDICAL WRITING Michelle Biros, MS, MD Editor-in -Chief Academic Emergency Medicine
EFFECTIVE MEDICAL WRITING Michelle Biros, MS, MD Editor-in -Chief Academic Emergency Medicine Why We Write To disseminate information To share ideas, discoveries, and perspectives to a broader audience
More informationAnalysis methods for improved external validity
Analysis methods for improved external validity Elizabeth Stuart Johns Hopkins Bloomberg School of Public Health Department of Mental Health Department of Biostatistics www.biostat.jhsph.edu/ estuart estuart@jhsph.edu
More informationSociety for Prevention Research 2018 Call for Papers Author Abstract Submission Questions. Research Foci
Society for Prevention Research 2018 Call for Papers Author Abstract Submission Questions Research Foci Please select your Research Foci. (Select all that apply) Academic Achievement ADHD Addiction Aging
More informationCOGNITIVE CHANGE IN OLDER ADULTS: PRACTICE EFFECTS, SHORT- TERM VARIABILITY, AND THEIR ASSOCIATION WITH SLEEP
COGNITIVE CHANGE IN OLDER ADULTS: PRACTICE EFFECTS, SHORT- TERM VARIABILITY, AND THEIR ASSOCIATION WITH SLEEP By JOSEPH MICHAEL DZIERZEWSKI A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY
More informationThe Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing
The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing. (AUSTRALIAN ADNI) July 2012 UPDATE Imaging Christopher Rowe MD Neuroimaging stream leader October 2011 The Australian Imaging Biomarkers
More informationAge of Drinking Onset, Driving After Drinking, and Involvement in Alcohol Related Motor Vehicle Crashes
Title: Age of Drinking Onset, Driving After Drinking, and Involvement in Alcohol Related Motor Vehicle Crashes Author(s): Affiliation: Hingson, R., Heeren, T., Levenson, S., Jamanka, A., Voas, R. Boston
More informationPharmaceutical Statistics Journal Club 15 th October Missing data sensitivity analysis for recurrent event data using controlled imputation
Pharmaceutical Statistics Journal Club 15 th October 2015 Missing data sensitivity analysis for recurrent event data using controlled imputation Authors: Oliver Keene, James Roger, Ben Hartley and Mike
More informationFalls: Cognitive Motor Perspectives
Falls: Cognitive Motor Perspectives Joe Verghese, MBBS, MS. Integrated Divisions of Cognitive & Motor Aging (Neurology) & Geriatrics (Medicine) Albert Einstein College of Medicine, Bronx, NY joe.verghese@einstein.yu.edu
More informationMethodological Issues in Measuring the Development of Character
Methodological Issues in Measuring the Development of Character Noel A. Card Department of Human Development and Family Studies College of Liberal Arts and Sciences Supported by a grant from the John Templeton
More informationAndrea Ungar, MD, PhD, FESC
Ipertensione e ipotensione: un connubio deleterio per l anziano Andrea Ungar, MD, PhD, FESC Dept. of Geriatrics and Intensive Care University of Florence, Italy Ipertensione e ipotensione: un connubio
More informationNONRESPONSE ADJUSTMENT IN A LONGITUDINAL SURVEY OF AFRICAN AMERICANS
NONRESPONSE ADJUSTMENT IN A LONGITUDINAL SURVEY OF AFRICAN AMERICANS Monica L. Wolford, Senior Research Fellow, Program on International Policy Attitudes, Center on Policy Attitudes and the Center for
More informationObjective: To describe a new approach to neighborhood effects studies based on residential mobility and demonstrate this approach in the context of
Objective: To describe a new approach to neighborhood effects studies based on residential mobility and demonstrate this approach in the context of neighborhood deprivation and preterm birth. Key Points:
More informationRace Original cohort Clean cohort HR 95%CI P HR 95%CI P. <8.5 White Black
Appendix Table 1: Hazard Ratios of the association between CSCs and all-cause mortality from original cohort and the clean cohort excluding CHD/strokes. CSC categories Race Original cohort Clean cohort
More informationDESCRIPTION: Percentage of patients with dementia for whom an assessment of functional status was performed at least once in the last 12 months
Quality ID #282: Dementia: Functional Status Assessment National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Prevention, Treatment, and Management of Mental Health 2019 COLLECTION
More informationTable e-1. MCI diagnosis criteria used by articles included in AAN MCI guideline. MCI diagnosis criteria used by included articles
Memory complaint Cognitive complaint Memory impairment Cognitively impaired Relatively preserved general cognition Intact ADL No dementia CDR 0.5 Table e-1. MCI diagnosis criteria used by articles included
More informationW E D N E S D A Y, M A R C H 1, T H U R S D A Y, M A R C H 2,
American Geriatrics Society Support provided by: National Institutes of Health "Does Mental and Physical Activity Promote Cognitive Vitality in Late Life?" Third in the Annual R13 Conference Series, "From
More informationDiscussions with Older Family Members about Safe Driving: Findings from the AAA LongROAD study
RESEARCH BRIEF This research brief used baseline data from the Longitudinal Research on Aging Drivers (LongROAD) study to examine the frequency of, and reasons for, older drivers having discussions with
More informationMethodological Issues for Longitudinal Studies. Graham Kalton
Methodological Issues for Longitudinal Studies Graham Kalton grahamkalton@westat.com Varieties of Longitudinal Studies 2 A. Cohort studies of individuals NLSY, ECLS-B and K, PATH, HRS (financial units),
More informationTable of Contents. Preface to the third edition xiii. Preface to the second edition xv. Preface to the fi rst edition xvii. List of abbreviations xix
Table of Contents Preface to the third edition xiii Preface to the second edition xv Preface to the fi rst edition xvii List of abbreviations xix PART 1 Developing and Validating Instruments for Assessing
More informationBehavioral Intervention Rating Rubric. Group Design
Behavioral Intervention Rating Rubric Group Design Participants Do the students in the study exhibit intensive social, emotional, or behavioral challenges? Evidence is convincing that all participants
More informationDonna Fick, RN, PhD, FGSA, FAAN¹, 2
Designing Interventions For Delirium Superimposed on Dementia: U13 Delirium Conference, February 11, 2014 Donna Fick, RN, PhD, FGSA, FAAN¹, 2 Distinguished Professor Co-Director Hartford Center of Geriatric
More informationFormat of Conditions in Prior Study
PARENT-ONLY INTERVENTION REDUCES SYMPTOMS AND DISABILITY IN ABDOMINAL PAIN PATIENTS Rona L. Levy Professor and Director Behavioral Medicine Research Group University of Washington Seattle WA Acknowledgements
More informationYou must answer question 1.
Research Methods and Statistics Specialty Area Exam October 28, 2015 Part I: Statistics Committee: Richard Williams (Chair), Elizabeth McClintock, Sarah Mustillo You must answer question 1. 1. Suppose
More information