Mild Cognitive Impairment (MCI) is a syndrome characterized by a decline in various cognitive domains, including prospective episodic memory (PEM) and executive functions (EF). It has been...Show moreMild Cognitive Impairment (MCI) is a syndrome characterized by a decline in various cognitive domains, including prospective episodic memory (PEM) and executive functions (EF). It has been recognized recently that vascular risk factors (VRF), such as hypertension, diabetes, and hyperlipidemia, can also have detrimental effects on these cognitive domains. Less research has been conducted on the synergistic influence of MCI and VRF on cognition, with available studies providing mixed results. Moreover, only one study has been conducted on the topic regarding the Greek population, so more research is needed to account for possible differences in ethnicity-related variables. Therefore, we sought to investigate how MCI with comorbid VRF influence PEM and EF, compared to VRF alone and healthy ageing. A sample of 111 Greek older adults participated in the study, divided into three groups: patients with MCI and concomitant VRF, patients with VRF and healthy controls. To assess cognition, tests were used to measure PEM, interference control, flexibility and semantic and phonemic verbal fluency. Data were analysed using MANCOVA, controlling for the educational level of the participants. Results showed that there were no differences between the two pathological groups for any of the measures, but the healthy controls outperformed the MCI+VRF (adjusted mean difference of total score being 8.94, 95 % confidence interval (CI) [3.67, 14.20], p < .001) and the VRF group (adjusted mean difference of total score being 8.20, 95% CI [2.94, 13.46], p < .001) in the semantic fluency task. Indeed, literature has shown that both MCI and VRF affect the integrity of frontal networks, which mainly support EF function. Methodological differences, such as the older age of the sample and the simplicity of the PEM task, ethnic differences and limitations in the statistical analysis can possibly account for the discrepancies with previous studies. All in all, this study suggests that there are no differences in cognition between VRF and MCI+VRF patients, while emphasizing the need for and more research into the cognitive consequences of comorbid MCI and VRF both in the Greek population and internationally.Show less
The DuLIP-Extended is the extension of the Dutch Linguistic Intraoperative Protocol (De Witte et al., 2015) which aims to test language function on the linguistic levels of phonology, semantics,...Show moreThe DuLIP-Extended is the extension of the Dutch Linguistic Intraoperative Protocol (De Witte et al., 2015) which aims to test language function on the linguistic levels of phonology, semantics, and syntax in cases of awake brain surgery on glioma patients with no or mild aphasia. The extension aims to make awake surgery feasible for glioma patients who have severe preoperative aphasia, by the addition of less complex tasks on all linguistic levels. This study aims to provide insight into how a healthy Flemish and Dutch sample perform on the DuLIP-Extended. Insight was gained by investigating which items should be removed depending on low accuracy rate in a healthy Dutch and a healthy Flemish sample, what the accuracy rates of the performances were on subtask level, whether the performances of the Dutch and Flemish samples significantly differed from each other, and whether the factors of sex, age, and education level affected task performances. The Dutch sample contained 71 participants and the Flemish contained 80 participants. Across the samples the age range was 18 years of age to 83 years of age. Accuracy rate was below 80% for only a few items (k = 6 in the Dutch sample, k = 3 in the Flemish sample) and these items were marked for removal in future versions of the DuLIP-Extended. Overall performances of both samples were high in accuracy (all subtask medians were above 80%). Mann-Whitney U tests revealed differences in performances on four subtasks of the DuLIP-Extended between the Flemish and Dutch sample. Lastly, sex, age, and education level had no effect on the performances of the Dutch sample.Show less
Background. The prevalence of metabolic syndrome is high in patients with depression or anxiety, which might explain the higher risk of cardiovascular mortality in this population. Symptoms of...Show moreBackground. The prevalence of metabolic syndrome is high in patients with depression or anxiety, which might explain the higher risk of cardiovascular mortality in this population. Symptoms of affective disorders can lead to changes in eating behaviors. However, poor diet quality seems implicated in underlying pathology of behavioral health disorders and could be a risk factor for developing depression and anxiety disorders. Objective. We aim to investigate the association between diet quality and metabolic syndrome in participants with and without anxiety and depressive disorders. Psychotropic medication, symptom severity, and lifestyle factors (i.e. physical activity, smoking, and alcohol use) are investigated as potential moderators. Methods. In the Netherlands Study of Depression and Anxiety (NESDA), the Mediterranean diet, the metabolic syndrome, physical activity, smoking, alcohol use, severity of symptoms, and medication were assessed among participants with depressive (n = 110), anxiety (n = 149), remitted disorders (n = 761), comorbid disorders (n = 110), and healthy controls (n = 295), in a cross-sectional design. Follow-up data from NESDA wave six is used, nine years after baseline measurement. Results. Participants (n = 1425) were on average 52.4 years old (SD = 13.13) of which 65.2% female. The association between diet quality and metabolic syndrome was the strongest for individuals with current depression (β = -.23 (CI: -.42 ; -.08); t = -2.87; p = .005), comorbid disorders (β = -.20 (CI: -.36 ; -.02); t = -2.22; p = .029), and remitted disorders (β = -.12 (CI: -.19 ; -.06); t = -3.85; p < .001). The association between diet quality and metabolic syndrome was not moderated by medication, symptom severity and lifestyle factors. Limitations. Results cannot be generalized to other cultures and the use of self-report scales could lead to a misclassification bias. Due to the cross-sectional design, it is impossible to provide evidence for temporal or causal relations. Conclusion. Low adherence to the Mediterranean diet is associated with a high score on metabolic syndrome for patients experiencing depression, comorbid depression and anxiety or remitted depression or anxiety. This association is not moderated by medication, symptom severity and lifestyle factors.Show less
Patients with prolactinoma are often initially treated with dopamine agonists (DAs). Although in many cases effective, DAs can cause severe (psychological) side effects and sometimes require...Show morePatients with prolactinoma are often initially treated with dopamine agonists (DAs). Although in many cases effective, DAs can cause severe (psychological) side effects and sometimes require lifelong intake. Neurosurgical counseling offers an alternative treatment option. The current study investigated whether neurosurgical counseling leads to better outcomes than DA treatment regarding adverse mood symptoms, health-related quality of life (HRQoL), and disease burden in patients with prolactinoma. A preliminary analysis of the Prolactinoma Clinical Trial-study was conducted. Patients were included in a randomized controlled trial or the observational arm, receiving either neurosurgical counseling or DA treatment. Adverse mood symptoms (Hospital Anxiety and Depression Scale; HADS), HRQoL (Short-Form Health Survey; SF-36), and disease burden (Leiden Bothers and Needs Questionnaire; LBNQ) were measured at baseline and 12 months follow-up. Demographic and clinical variables were derived from electronic patient files. To investigate the effects of time, group, and time*group interaction, multivariate linear mixed models were performed on outcomes of the HADS, SF-36, and LBNQ, controlling for age, sex, and prolactin levels at baseline. Data were available for 71, 61, and 69 patients in the analysis on the HADS, SF-36, and LBNQ, respectively. A larger decline in anxiety symptoms was found in the group of neurosurgical counseling (time*group; B = -3.66 (95% CI [-5.85 – -1.47]), p = .001) compared to the DA group. Prolactin levels at baseline were predictive of more adverse mood symptoms, lower mental well-being, and more perceived bothers at 12 months follow-up (all p < .004). Neurosurgical counseling showed comparable effects to DA treatment in terms of HRQoL and disease burden but was superior at relieving anxiety symptoms. Furthermore, prolactin levels emerged as a more potent predictor of these outcomes than the choice of treatment. These findings may optimize treatment for patients with prolactinoma, addressing their mood, emotional well-being, and HRQoL.Show less
Problematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a...Show moreProblematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a heavy burden on both professional and family caregivers. Especially since family caregivers are often overlooked as a factor in care. This study therefore investigates the effectiveness of the STA OP! method (SOM), a stepwise approach to address problematic behaviour and pain in individuals with dementia, as well as how the efficacy of SOM is moderated by family involvement. The study, conducted within the CARED-4 project, utilizes a quasi-experimental longitudinal design with measurements at baseline, 3 months, and 6 months after implementing SOM. It included 84 residents with dementia from 10 Dutch nursing homes units paired with their family caregivers. Problematic behaviour was examined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and family involvement was examined through a tailored questionnaire. Analysis was performed with RM Anova for problematic behaviour and family involvement and a general linear model for the moderation of SOM by family involvement. Results indicated that SOM effectively reduces problematic behaviour overall (F(2,55) = 3.81, p = 0.028), after 3 months (Mean Difference = 5.47 SE= 1.97, p = 0.007), but not after 6 months (Mean Difference = 5.70 SE = 3.36, p = 0.095). Family involvement did not change overall (F(1.62,30) = 2.12, p = 0.138). Accordingly, family involvement did not moderate the impact of SOM on problematic behaviour (F(2) = 1.43, p = 0.243). Despite methodological challenges mainly due to missing data, the study takes a first step towards understanding how the effectiveness of SOM interacts with family involvement. So, although family involvement did not moderate a significant reduction in problematic behaviour, the efficacy of SOM has further been established.Show less
Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique showing promise in stroke rehabilitation, with evidence indicating significant enhancement in motor function of...Show moreTranscranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique showing promise in stroke rehabilitation, with evidence indicating significant enhancement in motor function of the contralateral limb following treatment. While TMS appears promising for stroke rehabilitation, there is variability in the level of improvement individuals exhibit. This variability may be attributed to oscillatory neurophysiology, which refers to the rhythmic electrical activity of the brain. Therefore, this study investigated phase-dependent changes in cortical excitability after TMS among stroke patients in affected and unaffected hemispheres. We investigated motor-evoked and TMS-evoked potentials at four phases of the ongoing motor cortical mu rhythm (trough, peak, rising, falling) in both hemispheres (affected, unaffected). Participants comprised N=11 chronic subcortical stroke patients (6 female, mean ± std age: 58 y ± 11.4) with affected lateralized upper-limb impairment. Four blocks of 150 TMS pulses were applied on each hemisphere, targeting the primary motor hotspot of the first dorsal interosseus muscle of the contralateral hand. Participants watched nature videos during stimulation to maintain consistent attention levels. Cortical excitability was assessed by analyzing motor-evoked potentials (MEP) and TMS-evoked potentials (TEP). Results showed that motor responses (measured through MEP amplitudes) were significantly larger at the trough and rising phase compared to the peak phase. No significant differences were observed between the affected and unaffected hemispheres. TEP components, the brain signals in response to TMS, did not exhibit significant phase-dependent changes. While our findings showed a nonsignificant effect of stroke severity, exploratory correlation analyses presented a positive association between higher remaining movement function and enhanced phase-dependent responses to TMS. The findings build upon previous research indicating phase-dependent changes in cortical excitability for MEPs but not for TEPs. The larger MEP amplitudes during trough and rising phases suggest that TMS can be more effective at specific points of cortical activity. Further exploration is needed to assess the efficacy of phase-specific TMS interventions in clinical settings, potentially through larger-scale clinical trials with longitudinal designs and comparative effectiveness studies, aiming to evaluate functional outcomes and determine their impact on motor recovery.Show less
Attentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from...Show moreAttentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from itch; (2) whether this differs between people with chronic itch and healthy controls; (3) and if there is a possible AB/stress association. This is because understanding ABs to/from itch further elucidates the experience of patients with chronic itch and possible future clinical applications. Furthermore, an explorative analysis compared two tasks measuring AB, namely the Posner cueing and dot-probe task. The two tasks, alongside a stress-questionnaire, were administered online to the participants (N=70). A (frequentist and Bayesian) RM ANOVA was done for the main analysis, and a within- subjects t-test for the explorative task-comparison. Given that the task-comparison found the two tasks differing significantly (p = 0.01 d = -0.31), the results of the two tasks were interpreted separately. Overall, indications of AB being biased away from itch stimuli was found. When the AB was contrasted between participant group (people with and without chronic itch), the Posner cueing task found no significant difference (p = 0.68, ηp 2 = 0.003) whereas the dot-probe task found an AB away from itch-stimuli in patients with chronic itch (p = 0.02, ηp 2 = 0.077). Similar pattern unfolded with the stress-association: the Posner cueing task finding that AB did not significantly differ with stress (p = 0.23, ηp 2 = 0.021). The dot-probe task did find that they significantly differed (p = 0.01, ηp 2 = 0.091) where with higher stress, the AB switched to being an AB towards itch stimuli. The discrepancy between the two tasks aligns with expectations considering that the tasks were found inequivalent - highlighting one of the strengths of this study being that the two tasks were compared. Altogether this points towards differences in what the two tasks tap into, and that the attention of people with chronic itch is biased as a function of stress. Summarizing, AB to itch differed between the two groups and was associated with stress when using dot-probe task, which did not apply to the Posner cueing task.Show less
Hashimoto’s thyroiditis is a common autoimmune disorder. Hashimoto’s thyroiditis patients may experience cognitive impairments such as memory problems, even after receiving LT4-monotherapy. This...Show moreHashimoto’s thyroiditis is a common autoimmune disorder. Hashimoto’s thyroiditis patients may experience cognitive impairments such as memory problems, even after receiving LT4-monotherapy. This study investigates the memory performance of Hashimoto’s thyroiditis patients with residual symptoms after receiving LT4 monotherapy, utilizing participants from the T3-4 Hypo Trial. Memory performance was assessed using the Rey Auditory Verbal Learning Test (RAVLT) 15-Word Task and the data were compared to normative data from the Advanced Neuropsychological Diagnostics Infrastructure Norms (ANDI-Norms). Results indicate that Hashimoto’s thyroiditis patients do not significantly perform different to the general population. This study investigated whether age and sex are potential predictors of memory performance. These factors showed no significant results suggesting that they are not related to memory performance. However, this study does highlight limitations such as possible comorbidity, uneven distribution of sex and education levels that need consideration. Future research is advised to better understand the complex relationship between Hashimoto’s thyroiditis and cognitive function. This study contributes to the broader understanding of the relationship between cognitive function and Hashimoto’s thyroiditis and underscores the need for future research to develop effective and/or improve existing clinical management strategies.Show less
While amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s disease (AD) are primarily defined by cognitive deficits, studies have demonstrated that motor impairments can precede cognitive...Show moreWhile amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s disease (AD) are primarily defined by cognitive deficits, studies have demonstrated that motor impairments can precede cognitive symptoms by several years in these conditions. However, it is uncertain if the ability to learn sequences of movements is also impaired in this population. Therefore, this study investigated whether aMCI and AD affect motor sequence learning abilities, and how such abilities are related to AD biomarkers. The sample included 33 individuals with aMCI, 28 with AD, and 52 healthy controls (HCs). All groups completed a motor task consisting of performing a sequence of button presses, alternated with random blocks. Reaction time, coefficient of variation, and learning rates were obtained from the task. Participants also completed a series of cognitive tests to assess memory, visuospatial abilities, processing speed, language, and attention. Additionally, the following biomarkers for AD were assessed: amyloid beta via PET imaging, hippocampal volume via structural MRI, and number of e4 alleles via APOE genotyping. ANOVAs showed that AD participants had longer and more variable reaction times, followed by aMCI individuals, and with HCs having the shorter and more consistent reaction times. No significant differences in sequence learning rate were observed between groups. Exploratory analyses revealed that aMCI/AD had significantly slower initial learning rate than HCs. Linear regressions showed associations of slower reaction times with smaller hippocampal volume, and of higher coefficients with higher amyloid deposition. Poisson regressions revealed no significant correlations between motor sequence learning and APOEe4 allele count. Akaike Information Criterion (AIC) results indicated that combining cognitive test with motor measures improves the prediction of AD biomarkers. Overall, AD and aMCI individuals showed impairments in general motor performance but relatively preserved motor sequence learning abilities, with some deficits in initial rate of learning. Moreover, statistical model comparison suggested that adding motor sequence learning measures to neuropsychological assessment tools enhanced the prediction of AD biomarkers. As such, future studies should explore the value of integrating motor sequence learning measures in the assessment and tracking of AD/aMCI.Show less
Introduction: The Locus Coeruleus (LC) is a small structure residing in the midbrain and is the primary source of Noradrenaline (NA) in the brain. The LC-NA system’s roles include focusing...Show moreIntroduction: The Locus Coeruleus (LC) is a small structure residing in the midbrain and is the primary source of Noradrenaline (NA) in the brain. The LC-NA system’s roles include focusing attention towards salient stimuli. Animal studies suggest that the LC-NA system plays a role in reward related functions, an aspect primarily attributed to the Ventral Tegmental Area (VTA) Dopamine (DA) system. Animal studies suggest that habituation of the LC to salient stimuli occurs rapidly. The Dorsal and Ventral attentional networks (DAN and VAN respectively) are other regions relevant in attentional focus. Thus, we hypothesise that the reward and salient stimuli will elicit higher responses in the LC compared to the control, the LC will habituate across trials, the DAN network will respond highest to reward, and the VAN highest to salience. Methods: Forty-five healthy participants were recruited to complete a reward-oddball task during fMRI scanning. Repeated Measures (RM)-ANOVAs assessed changes in BOLD levels in our regions of interest (LC, VTA, DAN, VAN) as participants responded to the different stimuli oddballs (reward, salient, no reward). Results: A main effect for stimulus type on LC activity was not found (p=.079). Activity in the LC did not significantly habituate (p=.469). The DAN had overall higher activation than the VAN and had higher activation to the reward oddball compared to the salient (p<.001). The VAN region also had higher activation to the reward compared to the salient condition (p<.001). Conclusion: Results suggest that the LC had a similar degree of activation to each stimulus. This may suggest that the LC responds to contextual saliency and may not account for how goal relevant a stimulus is. We did not find a statistically significant habituation across trials. This may suggest that habituation in humans happens at a slower/less extensive rate than rats. The DAN region had globally higher activation than the VAN, reflecting this region’s role in sustained and goal related attention. The lack of activation within the VAN may suggest an orientation response was not required during this task. Strengths, limitations, and directions for future research are discussed.Show less
Parkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by motor symptoms due to the degeneration of dopaminergic neurons. However, non-motor symptoms such as cognitive...Show moreParkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by motor symptoms due to the degeneration of dopaminergic neurons. However, non-motor symptoms such as cognitive decline are prevelant in up to 80% of PD patients. Multi-system degeneration and neurotransmitter decifiences are likely the cause. One of the systems implicated in PD-related cognitive decline is the cholinergic system but it remains unclear to what extent the system is affected and how it links to different disease stages. This retrospective cohort study explores the integrity of the cholinergic system in PD through the measurement of alpha reactivity using electroencephalography (EEG). EEG data from 191 participants, including 46 early-stage PD patients, 17 late-stage PD patients, and 128 healthy controls was analyzed. Alpha reactivity, measured as the difference in alpha power between eyes closed and eyes open conditions, was assessed via EEG. Cognition was assessed via the Mini-Mental State Exam (MMSE). Results revealed significantly reduced alpha reactivity in PD patients compared to healthy controls. ANCOVA analyses demonstrated reductions in alpha reactivity in both early-stage and late-stage PD groups when compared to healthy controls. However, no significant reduction in alpha reactivity was found between early and late-stage PD patients. These findings provide neurophysiological evidence of a reduction in alpha reactivity in PD patients, which could indicate a cholinergic dysfunction in PD, irrespective of disease stage. This study also highlights the potential utility of alpha reactivity as a biomarker for assessing disease severity.Show less
This is the first cross-sectional, observational study concerning the experience of Central Disorders of Hypersomnolence (CDH) symptoms and Quality of Life (QoL) in the context of the menstrual...Show moreThis is the first cross-sectional, observational study concerning the experience of Central Disorders of Hypersomnolence (CDH) symptoms and Quality of Life (QoL) in the context of the menstrual cycle, pregnancy and menopause within the female human CDH population. 104 Dutch women (16-85 years) with CDH completed a self-designed hormone questionnaire, the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FSS) and the Short-Form Health Survey (SF-36) to assess the experience of CDH symptoms during the menstrual cycle, pregnancy and menopause. It was expected that per hormonal phase a majority of women would experience a difference in their CDH symptoms and that women who experienced a difference would have a worse QoL compared to the women who did not experience a difference. Results: For the menstrual cycle a minority of women experienced a difference (X2(1, N = 56) = 4.57, p = .033). For pregnancy a majority of women experienced a difference (X2 (1, N = 30) = 10.80, p = .001). For menopause no significant result was found. Exploration revealed the majority of eleven specific experienced CDH symptoms to change in intensity during the menstrual cycle and during pregnancy. This was not found for menopause. Additionally, no significant outcomes were found concerning the ESS, FSS and SF-36 between women that experienced a difference and women that did not experience a difference in their CDH symptoms during hormonal phases. Conclusion: This study is the first to suggest that not all female CDH patients share the same experience, providing a starting point for further investigation to fully understand how the experience of CDH can be altered within women as a result of hormonal influences. If it is known how and why CDH can present itself differently, CDH will be better detectable, leading female patients to receive accurate diagnosis, treatment and support more quickly. However, results of this study need to be interpreted with caution due to limitations including retrospective data, utilization of a non-validated questionnaire and a small research sample.Show less
This current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and...Show moreThis current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and avoidance behaviour influence pain experience. However, there seems to be little research into the combined influence. Seeing that research also showed that pinpointing a cause for the chronic low back pain is difficult, this study aimed to give insight into interacting factors that influence chronic low back pain. To gather data participants (N=18) filled in a questionnaire five times a day for two weeks. This provided insight into their levels of pain in the morning and the evening, if they expected to experience pain and if they were more likely to avoid movements, they expected to be painful. These statements were answered with answering scales, ranging from 0 (not at all) to 6 (extremely), given how likely that statement was for the participant. A mediation analysis inspecting possible relations between the level of pain and expectancies, the level of pain and avoidance, and the level of pain, expectancies and avoidance yielded no significant relations. Therefore, it could not be concluded that avoidance and/or expectancy are influencing the level of pain in the evening when compared to the level of pain in the morning. There were two significant findings, the impact of level of pain in the morning on expectancies and the impact of expectancies on avoidance. These findings are in line with what was found in existing literature and give incitement for further research on this topic. Another incitement for further research is the small sample used in this current study. The implication for the scientific field therefore is to perform this study on a bigger sample. Another consideration for further research would be to try and use a more diverse sample in both age and gender, this to make a more representative sample to draw conclusions for the general population. This could also lead to more substantial implications for the clinical field since this study did not have significant results.Show less
Background. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience...Show moreBackground. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience cognitive complaints, as well as physical complaints about their health. Their general wellbeing can also be an issue. Fortunately, for most patients these complaints typically improve over time. This study investigates patients’ memory, concentration, energy, as well as general wellbeing, over time. Methods. Patients received questionnaires about their health and wellbeing every three months following hospital release, with the main goal to track their health and wellbeing after TBI. That data was used for this research. Energy, concentration, and memory were all measured by one question in the questionnaire. General wellbeing was measured by taking the average ratings of all questions on the questionnaire. Analyses were done with three and six questionnaires over time, using repeated measures ANOVAs. Descriptive statistics were used from the first questionnaire. Results. This study found that while patients rated all these measures on average positively, they still did not feel the same as before the injury, and most experienced hindrances in daily life. When looking at the ANOVAs with three questionnaires, there was a significant improvement on concentration, energy, as well as general wellbeing over time. For all of these, most improvement took place between the first and the second questionnaires. Memory did not change significantly over time. None of the ANOVAs with six questionnaires had any significant changes over time. Conclusion. This study shows that patients may suffer from long-lasting effects of TBI. It questions whether more should be done for these patients following hospital release, to alleviate symptoms. This study has limitations concerning selection bias and drop out.Show less
Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
